Preventing alcohol-related harm in Aboriginal and Torres Strait Islander communities: The experience of an Aboriginal Community Controlled Health Service in Central Australia

Boffa, John; Tilton, Edward; Chee, Donna Ah

doi:10.31128/ajgp-08-18-4661

Cited by 9 publications

(9 citation statements)

References 6 publications

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“…This highlights the importance of multilevel interventions that address the economic/social disparities among marginalised populations to reduce the negative effects of alcohol/substance misuse. Additionally, given past research [ 36 , 37 ] shows that child maltreatment and domestic violence are commonly associated with alcohol/substance misuse, this again emphasises the need for multidimensional interventions to support families and children living with FASD.…”

Section: Discussionmentioning

confidence: 99%

Adverse childhood experiences, associated stressors and comorbidities in children and youth with fetal alcohol spectrum disorder across the justice and child protection settings in Western Australia

et al. 2022

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Background Individuals with Fetal Alcohol Spectrum Disorder (FASD) are at risk of having adverse childhood experiences (ACEs), especially those with child protection and/or justice system involvement. The complex relationship between FASD and psychosocial vulnerabilities in the affected individual is an important clinical risk factor for comorbidity. This study (1) explored the ACEs and associated stressors in individuals with FASD; (2) investigated the association between ACEs and negative outcomes, i.e., justice/child protection system involvement; and (3) examined the relationship between ACEs and comorbid conditions such as mood and neurodevelopmental disorders. Methods Data were collected retrospectively via file review from diagnostic clinics in Western Australia. Life adversity was coded using a standardised ACEs questionnaire. A total of 211 participants (72% males) with FASD with a mean age of 11 years (range = 2–21) were included in the final sample. 70% of the total sample had been involved with the child protection system and 40% had trouble with the law. Results Exposure to drinking/substance misuse at home (70%) and domestic violence (52%) were the two most common ACEs across the total sample. In the entire cohort, 39% had four or more ACEs, indicating higher risks of poor health outcomes. Additional stressors recorded were disengagement from school (43%), transiency (19%), victims of bullying (12%), traumatic brain injury (9%) and homelessness (5%). ACEs such as drinking/substance misuse at home, emotional neglect and physical neglect were positively associated with child protection system involvement. Additionally, exposure to domestic violence was positively correlated with justice system involvement. Higher rates of life adversity in this clinical population were associated with an increased number of comorbidities. Specifically, those with FASD who had comorbidities such as attachment disorder, substance use disorder, and PTSD also reported higher ACEs scores. Conclusion ACEs were common in this clinical population. Increased ACEs in this sample were associated with increased comorbidities and involvement with the child protection and/or justice system. This highlights that prevention, intervention and early diagnosis of FASD are important for at risk children to reduce the negative effects of ACEs.

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Section: Discussionmentioning

confidence: 99%

Adverse childhood experiences, associated stressors and comorbidities in children and youth with fetal alcohol spectrum disorder across the justice and child protection settings in Western Australia

et al. 2022

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“…Thus, highlighting the importance of multilevel interventions that address the economic/social disparities among marginalised populations to reduce the negative effects of alcohol/substance misuse. Additionally, given past research (33,34) shows that child maltreatment and domestic violence are commonly associated with alcohol/substance misuse, this again emphasises the need for multidimensional interventions to support families and children living with FASD. Domestic violence was present in half of this sample.…”

Section: Aces In the Overall Fasd Samplementioning

confidence: 99%

Adverse Childhood Experiences, Associated Stressors and Comorbidities in Children and Youth with Fetal Alcohol Spectrum Disorder across the Child Protection and Justice Settings in Western Australia

Tan

Symons

Fitzpatrick³

et al. 2021

Preprint

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Background: Individuals with Fetal Alcohol Spectrum Disorder (FASD) are at risk of having adverse childhood experiences (ACEs), especially those with child protection or justice system involvement. The complex relationship between FASD and psychosocial vulnerabilities in the affected individual is an important clinical risk factor for comorbidity. This study (1) explored the ACEs and associated stressors in individuals with FASD; (2) compared the ACEs profiles of those who had been involved with the child protection system only, justice system only, both or neither; (3) examined the relationship between ACEs and comorbid conditions such as mood and neurodevelopmental disorders. Methods: Data were collected retrospectively via file review from diagnostic clinics in Western Australia. Life adversity was coded using a standardised ACEs questionnaire. 211 participants (71.6% males) with FASD with a mean age of 11.12 (range = 2-21) were included in the total sample.Results: Exposure to drinking/substance misuse at home (70.1%) and domestic violence (51.7%) were the two most common ACEs across the total sample. In the entire cohort, 39.3% had four or more ACEs. Additional stressors reported were involvement with child protection system (69.7%), disengagement from school (43.1%), trouble with the law (40.3%), transiency (19.0%), documented victims of bullying (12.3%), traumatic brain injury (9.0%) and homelessness (5.2%). Further, individuals who had been involved with both the child protection and justice system were four to eleven times more likely than those without any involvement to report parental drinking/substance misuse at home, parental incarceration, exposure to domestic violence and emotional/physical neglect. Higher rates of life adversity in this clinical population were associated with an increased number of comorbidities, p <.001. Specifically, those with FASD who had comorbidities such as attachment disorder (p =.001), substance use disorder (p =.006), and PTSD (p <.001) also reported higher ACEs score.Conclusion: ACEs were common in this clinical population, particularly those who had been involved with both the child protection and justice system. Increased ACEs in this clinical population were associated with increased comorbidities. This highlights that prevention, intervention and early diagnosis of FASD are important for at risk children to reduce the negative effects of ACEs.

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“… 10 The establishment of Aboriginal and Torres Strait Islander community controlled, culturally responsive and comprehensive primary healthcare services in over 150 locations in Australia has been a life-changing achievement for the Aboriginal and Torres Strait Islander community. 11 The research project, WOmen’s action for Mums and Bubs (WoMB), was designed to explore the involvement of community women in identifying and implementing strategies to improve MCH outcomes in Aboriginal and Torres Strait Islander communities. A non-randomised step wedge implementation trial was designed using WGs as an initiative.…”

Section: Introductionmentioning

confidence: 99%

“…In Australia, the setting for this review, Aboriginal and Torres Strait Islander peoples has been working for decades to address the health disparities they experience 10. The establishment of Aboriginal and Torres Strait Islander community controlled, culturally responsive and comprehensive primary healthcare services in over 150 locations in Australia has been a life-changing achievement for the Aboriginal and Torres Strait Islander community 11. The research project, WOmen’s action for Mums and Bubs (WoMB), was designed to explore the involvement of community women in identifying and implementing strategies to improve MCH outcomes in Aboriginal and Torres Strait Islander communities.…”

Section: Introductionmentioning

confidence: 99%

How and why do women’s groups (WGs) improve the quality of maternal and child health (MCH) care? A systematic review of the literature

et al. 2022

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BackgroundThis systematic review was undertaken to assist the implementation of the WOmen’s action for Mums and Bubs (WOMB) project which explores Aboriginal and Torres Strait Islander community women’s group (WG) action to improve maternal and child health (MCH) outcomes. There is now considerable international evidence that WGs improve MCH outcomes, and we were interested in understanding how and why this occurs. The following questions guided the review: (1) What are the characteristics, contextual influences and group processes associated with the MCH outcomes of WGs? (2) What are the theoretical and conceptual approaches to WGs? (3) What are the implications likely to inform Aboriginal and Torres Strait Islander WGs?MethodsWe systematically searched electronic databases (MEDLINE (Ovid); CINAHL (Ebsco); Informit health suite, Scopus, Emcare (Ovid) and the Cochrane Library and Informit), online search registers and grey literature using the terms mother, child, group, participatory and community and their variations during all time periods to January 2021. The inclusion criteria were: (1) Population: studies involving community WGs in any country. (2) Intervention: a program/intervention involving any aspect of community WGs planning, acting, learning and reviewing MCH improvements. (3) Outcome: studies with WGs reported a component of: (i) MCH outcomes; or (ii) improvements in the quality of MCH care or (iii) improvements in socioemotional well-being of mothers and/or children. (4) Context: the primary focus of initiatives must be in community-based or primary health care settings. (5) Process: includes some description of the process of WGs or any factors influencing the process. (6) Language: English. (7) Study design: all types of quantitative and qualitative study designs involving primary research and data collection.Data were extracted under 14 headings and a narrative synthesis identified group characteristics and analysed the conceptual approach to community participation, the use of theory and group processes. An Australian typology of community participation, concepts from Aboriginal and Torres Strait Islander group work and an adapted framework of Cohen and Uphoff were used to synthesise results. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Tools.ResultsThirty-five (35) documents were included with studies conducted in 19 countries. Fifteen WGs used participatory learning and action cycles and the remainder used cultural learning, community development or group health education. Group activities, structure and who facilitated groups was usually identified. Intergroup relationships and decision-making were less often described as were important concepts from an Aboriginal or Torres Strait Islander perspective (the primacy of culture, relationships and respect). All but two documents used an explicit theoretical approach. Using the typology of community participation, WGs were identified as predominantly developmental (22), instrumental (10), empowerment (2) and one was unclear.DiscussionA framework to categorise links between contextual factors operating at micro, meso and macro levels, group processes and MCH improvements is required. Currently, despite a wealth of information about WGs, it was difficult to determine the methods through which they achieved their outcomes. This review adds to existing systematic reviews about the functioning of WGs in MCH improvement in that it covers WGs in both high-income and low-income settings, identifies the theory underpinning the WGs and classifies the conceptual approach to participation. It also introduces an Australian Indigenous perspective into analysis of WGs used to improve MCH.PROSPERO registration numberCRD42019126533.

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Preventing alcohol-related harm in Aboriginal and Torres Strait Islander communities: The experience of an Aboriginal Community Controlled Health Service in Central Australia

Cited by 9 publications

References 6 publications

Adverse childhood experiences, associated stressors and comorbidities in children and youth with fetal alcohol spectrum disorder across the justice and child protection settings in Western Australia

Adverse childhood experiences, associated stressors and comorbidities in children and youth with fetal alcohol spectrum disorder across the justice and child protection settings in Western Australia

Adverse Childhood Experiences, Associated Stressors and Comorbidities in Children and Youth with Fetal Alcohol Spectrum Disorder across the Child Protection and Justice Settings in Western Australia

How and why do women’s groups (WGs) improve the quality of maternal and child health (MCH) care? A systematic review of the literature

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