Improving the health of Aboriginal people is a national priority and improving coordination of services for Aboriginal families is critical to achieving this goal. A care coordination framework has been developed from a limited range of clinical settings. We reflect on the utility of this framework for assessing service coordination for Aboriginal families in Australia. We conducted stakeholder consultation, service mapping and in-depth interviews with service providers and an Aboriginal mother, using a tool based on the framework domains. A fragmented range of services support Aboriginal families with complex and changing needs, highlighting the importance of care coordination. Relationships underpinned care coordination; however, we identified few opportunities for developing relationships and several factors that undermined relationships, including unclear accountability mechanisms, resource constraints, anxiety about follow-up and transfer of information to child protection. The Care Coordination Framework enabled a 'systems-perspective' of the main care coordination domains for Aboriginal families from individual experiences. However, there were some limitations in capturing subtle historical and cultural dimensions affecting care coordination in this context where health care practice in large institutions is framed by the dominant culture. An additional 'equity' domain would capture these dimensions, address a growing international policy challenge and strengthen the framework.
There are an estimated 370 million Indigenous peoples living in more than 70 countries. Indigenous populations are defined as the First Peoples occupying countries or regions at times of colonization, with distinct cultural, religious, and social practices that distinguish them from other populations. Indigenous peoples across the globe have deep, intimate, holistic, localized, and reciprocal relationships and connections to their “Country” (as it is known in Australia), which includes elements of the land, sea, waterways, sky, stars, and living and nonliving entities. This relationship is largely unacknowledged through Western biomedical models of health, which tend to focus on individual risk behaviors and disease outcomes, thereby situating Indigenous health inequities in terms of deficiency and ignoring the ongoing impacts and trauma of colonization. Indigenous concepts of health are holistic, encompassing emotional, physical, cultural, and spiritual health. Country is central to health and is steeped in the harmonized interrelationships that constitute cultural well-being. Models for measuring and understanding health outcomes for Indigenous peoples need to respectfully incorporate the full range of determinants that are relevant to their health that understand the importance of connection to Country.
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