⌚ Penelopes Early Recognition Analysis

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Although this appears to be a rapid, cost effective part of the solution, there are no clear or enforceable standards for classroom acoustics in Australia [ 44 ]. Although not delineating specific disabilities, three articles were identified that centred on developing and maintaining relationships between allied health professionals, young Indigenous children and families, and teachers. Facilitators to successful occupational therapy access included investing and committing time to establish and maintain therapeutic relationships and using appropriate communications strategies such as gaining and giving knowledge with a respectful tone, using understandable language, and demonstrating unfamiliar tasks [ 47 ]. Additional facilitators include setting the program in culturally safe and accessible locations, such as an Indigenous health or educational setting, and involving Indigenous health workers [ 47 — 49 ].

Overall, the voices and needs of Indigenous families of children with disabilities were minimally represented in the literature identified. One report specifically targeting Indigenous families of children with disabilities indicated that families wanted practical support such as transport to multiple appointments and completing forms. With one of the highest rates of OM in the world, it is not surprising that a preponderance of literature on Australian Indigenous child health depicts the implications of this preventable and treatable disease.

Despite disability manifesting in low rates of school participation and recidivism, there are minimal data on Indigenous childhood and disability [ 50 ], as has been reported in other Indigenous populations [ 16 ]. This was apparent in the current review as well as in a recent analysis of descriptive studies describing the health, development, wellbeing of Indigenous children which found that research predominantly addressed physical health The resurgence in the literature is evident in adolescence where drug, alcohol, and incarceration manifest as evidence of marginalisation, racism, and a failure to address early childhood disabilities, many of which are treatable with early intervention [ 51 ].

Likewise omitted from the extant knowledge, particularly in peer-reviewed forums, are the experiences of the Indigenous family, carers, and children and their unmet needs. This is an important focus for future research. The higher rate of disability in Indigenous compared to non-Indigenous Australians is a pattern of disparity seen in many Indigenous populations throughout the world[ 16 ]. Socioeconomic disadvantage has been linked to intellectual and developmental disability, both as cause and effect, given inequitable resource allocation within social systems and subsequent contextual issues [ 53 ].

Socioeconomic disadvantage, racism, and oppression influence learning and health outcomes [ 16 ]. The absence of Indigenous Australian child disability statistics until reflects this history of dispossession, distrust, and enduring disparity. The legacy of stolen generations and a recent resurgence of government control [ 54 ] has resulted in a strong scepticism and mistrust of government organisations. Considerations for addressing disability in Indigenous children are depicted in Figure 2. As noted in the Australian literature, systematic screening for delay or impairment, particularly where English is not the first language, is vital [ 16 ].

Considerations in dealing with disability in Aboriginal children. The significant and enduring consequences of unaddressed disability were discussed and suggestions for improving awareness of cultural differences in education settings and tailoring programs to address the needs of Indigenous children provided. Johnston [ 55 ] has described education as positively associated with health through mediating pathways that exist at individual, family and community level. Johnston [ 55 ] urges clinicians to consider early childhood and school education as an important focus that requires rigorous research into interventions that address the barriers to effectiveness in implementing quality educational experiences and opportunities for Indigenous children.

There are a number of strategic initiatives to address the data shortcomings, to date, and to address factors that will maximise Indigenous participation in society. Among these is the Study of Environment on Indigenous Resilience and Child Health SEARCH project, a prospective longitudinal cohort study which will be a long-term resource to investigate the causes and trajectories of health and illness in Indigenous children aged 0—17 from urban and large regional centres in New South Wales, Australia, to identify potential targets for interventions to improve health.

Data is being collected on OM, hearing impairment, and developmental delay [ 56 ]. Another example is the Gudaga study, a prospective descriptive longitudinal cohort study assessing the health, development, and service use of Indigenous infants and their mothers in Southwest Sydney [ 15 ]. The work of the Telethon Institute for Child Health Research is also providing a stimulus for addressing the health and well-being of Indigenous children [ 57 ].

This review was limited by the available published literature and therefore does not reflect the scope of the problem. Although government reports and other sources of the grey literature were reviewed for this project, sparse data reflects that many issues of childhood disability hover below the radar and only manifest when the consequences are dire and catastrophic [ 58 ]. Although a feature of disability [ 58 ], this is likely aggravated among Indigenous children where a disclosure of a problem may cast an unwanted focus on family circumstances and social situation.

Given that the needs of these populations are very unique, the outcomes of the retrieved studies may not be generalisable to the entire Australian Indigenous nor other Indigenous populations, necessarily. This review was undertaken using rigorous methods and has identified potential solutions for addressing childhood disability. This review has elucidated important contextual determinants of child health and disparities among Indigenous Australians. It also underscores the importance of shifting from a purely biomedical lens to a holistic approach to address the needs of vulnerable Indigenous children.

This will require ongoing partnership and collaboration between health, education, and social service agencies. Given the diverse study designs and inconsistent reporting, the ability of this review to decipher strength of evidence was limited. Instead, this review has provided a snapshot of the current foci of literature and approaches to describing disability in Australian Indigenous children. The solutions for addressing health disparities and maximising societal participation among Indigenous Australians have been clearly identified by Indigenous people. Recognising and addressing entrenched and institutional racism is an important first step in ensuring the needs of Indigenous children are addressed [ 59 ]. This review has indicated that a great deal is still unknown about Indigenous childhood disability, yet important foci should include prevention of problems that improve health and living situations, particularly effective antenatal care.

Importantly, factors that promote prevention, recognition, access, and viable solutions, as summarised in Figure 2 , are warranted. Further research must be conducted in order to provide evidence for effective and sustainable practice and policy. This is particularly the case for developing culturally appropriate interventions. Ensuring such research is led by Indigenous people using appropriate methods is a critical step in developing tailored and targeted solutions.

It is critical that health and social services are accessible and acceptable to Indigenous people. Indigenous-led and controlled services are an important form of engagement. Increasing the workforce participation of Indigenous people in health, education, and social services [ 60 ] is an important step and strongly linked to addressing childhood disability and maximising participation in the education system [ 38 ]. Achieving these goals requires addressing entrenched power relationships and dismantling barriers between mainstream and Indigenous controlled services. It also will require challenging traditional professional boundaries and decreasing silos between health, education, and social services. Given the links between childhood disability and education, teachers have an essential role to play in monitoring developmental stages, thus necessitating teacher training that ensures appropriate recognition of potential disability.

Greater congruency between health and education systems needs to occur, as well as other strategies to ensure children with hearing disabilities are not left behind, such as amplification systems with classrooms [ 61 ]. Despite higher rates of disability than in non-Indigenous children, this review has identified the scant focus on disability in Indigenous children in the face of the burden and ramifications of not achieving educational and social milestones. Given the lack of research in this area, further investigation must be conducted.

The emphasis on OM in this review reflects the hard work of a committed group of researchers, but currently, the literature fails to encapsulate the breadth and complexity of Indigenous childhood disability. Although extensive investment is apparent in downstream health problems, ensuring the foundations of health and wellbeing through early intervention is critical in decreasing health inequity. Google Scholar. Commission on Social Determinants of Health: Closing the gap in a generation: health equity through action on the social determinants of health: Final Report of the Commission on Social Determinants of Health. J Intellect Dev Disabil. Article Google Scholar. Acuin J: Chronic suppurative otitis media: burden of illness and management options.

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Medical J of Aust. J of Aust Indigenous Issues. Download references. MD is a postdoctoral fellow supported by this grant. You can also search for this author in PubMed Google Scholar. MD contributed to conception and design, acquisition and analysis of data, and manuscript drafting and revision. PMD contributed to conception and design, acquisition and analysis of data, and manuscript drafting. TD acquired and analysed data and revised the manuscript. SJM contributed to data analysis and manuscript drafting. PD contributed to study conception, design, and review. PA contributed to conception, design, and manuscript revision. JD contributed to study conception and review. FV contributed to study conception and review.

All authors read and approved the manuscript. This article is published under license to BioMed Central Ltd. Reprints and Permissions. DiGiacomo, M. Childhood disability in Aboriginal and Torres Strait Islander peoples: a literature review. Int J Equity Health 12, 7 Download citation. Received : 13 April Federal judges are following suit. Richard W.

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