Ngala Nanga Mai pARenT Program
Knowledge Circle Practice Profiles

Overview

Practice focus

Community art, arts in health, early childhood and parenting skills, improving access to health care services.

Delivered by

The Ngala Nanga Mai pARenT Group Program (NNM) is auspiced by the Department of Community Child Health at the Sydney Children's Hospital's Network (Randwick) and is housed and delivered in the La Perouse Aboriginal Community Health Centre. This practice profile was developed with the assistance of the program's Project Officer, who also received input from some of the NNMs participants.

Location(s)

The program is housed and delivered at the La Perouse Aboriginal Community Health Centre located in La Perouse in South Eastern Sydney.

Issue being addressed

In collaboration with the local La Perouse community, the NNM program was developed in response to community concerns that parents of Aboriginal children were not engaging with health and educational services.

The program also aims to strengthen parenting skills and educational opportunities. The difficulty that some Aboriginal people living in urban areas have in accessing health services has been explored by Ware (2013), who quotes the 2008 National Aboriginal and Torres Strait Islander Social Survey that found about 26% of Aboriginal people aged 15 and over living in non-remote areas had difficulty accessing health services.

Service type

Community art, arts in health, early childhood and parenting skills, improving access to health care services.

Target population

The primary target population is parents and families with Aboriginal children under 5 years living in the La Perouse area. However, the program is also available to the broader Aboriginal community.

Aims and objectives

Started in 2009, the NNM program aims to improve the social connectedness of parents and families with Aboriginal children and improve their access to health services and education. It consists of 3 components: art, education and health services. It also aims to empower its clients with practical parenting skills, educational opportunities, improved health knowledge and access to primary and community health care. Through regular gatherings and group work, the program aims to improve the sense of community among young families.

Program basis

The art program is a 3-hour art workshop run weekly at the La Perouse Aboriginal Community Health Centre that uses artistic activities to facilitate social connectedness among young parents but also encourages them to access the health services while they are in the same facility. The program provides transport for clients from home to the art workshops. It is staffed by a Project Officer, who is supported by an Aboriginal Health Education Officer, an Early Childhood Nurse, a Paediatric Doctor and childcare providers. These Health Care workers provide drop-in services for clients, health information and referrals and parenting skills workshop and health clinics.
The program also aims to provide clients with access to educational courses or further study. The program provides a tutor who acts as a mentor to clients and supports them with enrolling and completing their studies with external education providers.

The program works from a strengths-based and participatory-action research approach to guide its activities. A strengths-based approach looks at a person’s resources and strengths to help address their challenges. Participatory action research is a self reflexive research approach where service users are active participants in evaluating, understanding and improving the practices in which they participate.

Cultural relevance

Local community context

A relatively high proportion of people living in the La Perouse area identify as Aboriginal: approximately eight percent compared to the NSW state average of two percent. The Aboriginal community is also relatively young (30 percent of the 2006 population aged 0-14 years) and teenage pregnancies are relatively high (Jersky, et al. 2013). Prior to the program's commencement, early childhood health workers observed that many mothers were socially isolated and lacked support. In particular, service providers were concerned about the lack of aspirations and the barriers and emotional challenges facing young parents. Local parents had access to an informal playgroup, paediatric clinics and a midwifery service, but access among younger mothers to these services was noted to be poor.

Involvement of Aboriginal and Torres Strait Islanders

The idea for the NNM program came from an Aboriginal Health Education Officer from the Sydney Children's Hospital's Network (Randwick) who was conducting early childhood home visits in the La Perouse area and noticed the needs of the parents. Following discussion with the community and service providers seed funding was obtained to run a program for Aboriginal mothers and their children. The Aboriginal Health Education Officer continues to play a large role in the program and has provided significant cultural guidance and supervision to the Program Officer (who is non-Aboriginal). Aboriginal participants decided the name of the program, which means "We Dream" in the local traditional language. The participants and the local community also have ongoing input in deciding the activities of the art program. Previous group decisions have included a photographic project, the publication of a poetry collection and a collaborative exhibition. The La Perouse Advisory Health-Link Committee also plays a key role in deciding the direction of the program and in the evaluations that have been conducted to date.

Cultural practices and materials

The NNM program provides a culturally safe space where activities take place and art is created. Participants explore, express and/or raise issues that are important to them as parents or carers of Aboriginal children. In particular, issues around the themes of identity, loss, social inclusion/exclusion, racism, conflict and healing have been explored in art works, art exhibitions and discussions.

Evaluation

Evaluation status

Two external evaluations of the program have been conducted and were completed in 2011 and 2012. This section of the report is based on information contained in both of these reports. Summary documents about the program and its evaluations are available (listed below).

Evaluation details

The aim of the 2011 evaluation was to evaluate the NNM program's process and its impact on clients. It sought to ascertain whether the program was reaching the target group, meeting their needs and being implemented as planned. The 2012 evaluation had similar objectives but also sought to compare results with the outcomes of the first evaluation and identify new ideas for overcoming any program challenges.

Both evaluations used quantitative and qualitative methods for data collection. To gather baseline data, the quantitative methods included culturally appropriate surveys (2011 evaluation) and the collection of routine data from the health service relating to the use of health services by the program's participants (2012 evaluation). The qualitative methods used by both evaluations included semi-structured interviews and focus groups conducted with participants and service providers.

Aboriginal people were involved in the evaluations of the program in the following ways:

  • prior to the commencement of the evaluations, the community were consulted on the evaluation aims and methodology. The La Perouse Advisory Health-Link Committee also provided comments on the proposed evaluation design.
  • an Aboriginal researcher advised the evaluators (both medical students) on the design and conduct of the evaluations
  • the style of the focus groups was adapted in response to participants' suggestions. For example, the make-up of focus groups was adjusted to allow different personalities to have maximum opportunity to voice their opinion.
  • the evaluations used surveys that had been validated as appropriate for use in Aboriginal communities.
  • the evaluators spent time with the program participants prior to the commencement of the evaluations to help build relationships.

Effectiveness

Most effective aspect

The most effective aspect of the program was not specifically assessed by the two evaluations of the program. However, for participants the most effective aspect of the program is that it provides opportunities for social connectedness within the group, and is a point of contact and a link back into the broader community. In addition, program staff believe what has been critical to the success of the program is that it is conducted in a culturally safe place for its participants.

Demonstrated outcomes

The key findings from both of the evaluations are:

Quantitative findings:

  • The 2012 evaluation summarised the participants' routine health and baseline data (e.g.demographics, service usage, and presenting problems) for the period from the commencement of the program until the end of the evaluation period (September 2012). It found the health data suggested that the program had made significant impact to child health through their exposure to health services and promotion of health seeking behaviour.

Qualitative findings:
The qualitative findings and anecdotal evidence from both evaluations indicated that the program had:

  • improved social connectedness: many participants said the program made them feel part of a social network and helped them develop relationships with people from similar backgrounds.
  • improved health education and access: parents and service providers placed high value on the ease of accessing services and participants said their health literacy had increased.
  • improved wellbeing of children: parents believed the program improved children's opportunity for socialising, their sense of Aboriginality and creativity. However, some participants thought the program could focus more on children's activities.
  • improved education opportunities: the 2012 evaluation found most participants are actively learning through the program either through improved health knowledge or the completion of TAFE courses with support from the program.
  • improved sense of empowerment: the 2012 evaluation suggested that participants have achieved or are achieving personal empowerment characterised by improved sense of self-worth and ability to help others.
Resourcing

The program is funded by the Sydney Children's Hospital Network's (Randwick) Department of Community Child Health.

Evidence base and opportunities

Other sources of information about the program:
https://sphcm.med.unsw.edu.au/sites/default/files/sphcm/Centres_and_Units/IYSEWB_ResearchReport_MM.pdf
http://education.unimelb.edu.au/__data/assets/pdf_file/0007/1067434/011_JERSKY_PAPER.pdf

Jersky M, Titmuss A, Haswell-Elkins M, Freeman N, Osborne P, Callaghan L, Winters J, Fitzpatrick S, Zwi K (2014). Improving health service access and the well-being of young Aboriginal parents in an urban setting: the efficacy of an art-based program. Submitted Australian Health Review.

Evidence about the use of arts programs in Aboriginal communities:
http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Our_publications/2014/ctgc-rs28.pdf
http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2013/ctgc-rs27.pdf

 

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