Building Systems for Effective Early Intervention and Support for Parents: Extending the Lets Start Program to Aboriginal Families & communities Gary Robinson, Yomei Jones, Anita D’Aprano, Kate McGuinness, Roger Tipungwuti, Sven Silburn, Steve Zubrick, Bill Tyler, Carolin Stock, Carmen Cubillo. Menzies School of Health Research

What is Let’s Start? Trial of a targetted intervention for Indigenous parents and 4-6 y.o. children at risk o Funded by FaHCSIA, CRCAH, NTG, ARC Funding extended to 2012 by FaHCSIA under FSP & NT Emergency Response Sites to 2009: Malak, Palmerston, Nguiu, Milikapiti, Pirlangimpi, Palumpa, Jabiru Further trials of a redesigned program: pilots from July 2010, implementation in partner sites from 2011

Trained Indigenous group leaders

Work in Groups Interactive: children playing with parents; parents in control, leaders assist, manage transitions Child: peer play, feelings, stop-think-do, etc. Parents: observe, discuss parenting, child behaviour, strategies, family of origin etc.

Working with differences

Parent & child responsiveness

Works with her dad …

Repairing relationships, supporting families

Evaluation Sample Total Referrals Included in Evaluation Sample N = 225 Participated in ≥ 1 Sessions = 48 Participated in ≥ 1 Sessions = 15 Participated in ≥ 1 Sessions = 47 Completed ≥ 4 Sessions = 36 Completed ≥ 4 Sessions = 40 Completed ≥ 4 Sessions = 10 Tiwi Indigenous = 77Urban Indigenous = 49 Non Indigenous = 99

Problems at referral

Findings Engagement strategies need to be tailored for different contexts to improve participation and retention Important differences: urban Aboriginal kids Improved parenting & reduced stress: large effect size K6 measure of parents’ psychological distress Reduced behavioural problems in primary and preschool children: o Moderate-large effect sizes at program end, larger effects at 6 months, program outcomes not only sustained but increase Dose-response effect: the more people attend the better the outcomes Variable response to treatment according to gender and Aboriginality: need to revise aspects of intervention strategy The challenge of developing the evidence base is to contextualize process and research strategies while retaining fidelity: structure, intensity & quality

Service learning Evidence-based programs for remote centres, “hubs”: o It is possible to support evidence-based interventions in diverse contexts o By developing local partnerships, “integration” with health & education services o With centrally provided professional training, support & supervision

Directions Develop SEWB protocols for CQI Screening & assessments (d’Aprano) Identify referral pathways for SEWB Redesigning Let’s Start: Parents talk & Interact: a focus of parent mental health and parent-child interaction for 4-8s Imagining my child: early years intervention to strengthen attachment for 0-4s Parenting support from birth to young adulthood

Building systems for delivery of professionally supported programs Training & capacity- building Research & evaluation Program delivery Assesment, referral & intake; datagathering & analysis; verification of quality, feedback. Community setup: leadership; capacity assessments; agreement between agencies; teambuilding; training; location & resources Ongoing professional support for community team to guide practices of engagement with families and maintain practice standards

Models for integration: CQI & systems of practice Wellbeing and early intervention program 1. Imagining my child 0-4 year olds 2. Let’s Start 4-8 y.o. 3. Adult and child wellbeing services Program intake &/or ffurther referral. Community child health care Well child checks, healthy under 5s: audit of services according to CQI cycle developed for SEWB, behavioural development & parenting Menzies CRCATSIH One21Seventy 1. Review and trial of audit protocols and guidelines: queries about behaviour, social- emotional development & family support. 2. Pilot of assessment and referral to early intervention programs. Evaluation, feedback & practice support  One21seventy: Continuous quality improvement audit and feedback cycle  Let’s Start evaluation program: evaluation and clinical support  Developmental screening and assessment pilots  Imagining my child: An early intervention to assess and to support early mother-child attachment  AEDI:: community level developmental status data on NT children

Research and evaluation outputs Evaluation Report: Robinson, G., Zubrick, S. R., Silburn, S., Tyler, W., Jones, Y., D’Aprano, A., Cubillo, C., McGuinness, K., Bell, M., Stock, C., 2009, “Let’s Start: Exploring Together. An Early Intervention program for Northern Territory Children and Families. Final Evaluation Report”, Darwin: School for Social and Policy Research, Institute of Advanced Studies, Charles Darwin University. evaluation-report-2010.pdf evaluation-report-2010.pdf Let’s Start: Parents talk & Interact. Manual and guidelines - a program for Aboriginal parents and communities (June 2010) Let’s Start working with kids: capacity assessment, training and community engagement (June 2010) Imagining my child: An early intervention trial (2011) Systems for integrated child and family support: Protocols & instruments for SEWB in primary health care (2010/2011)