1. Culturally appropriate training for remote Australian Aboriginal Health Workers: Evaluation of an early child development training intervention Dr Anita D’Aprano IDP Congress Dec 2015 Istanbul

4. Remote Aboriginal Australia www.theaustralian.com.au Remote communities dispersed Vary in size – few hundred to few thousand people Access to goods and services limited Health centres staffed by Aboriginal Health Workers and Remote Area Nurses = 8-10 staff Visiting Specialist staff

5. Remote Area Nurses and Aboriginal Health Workers responsible for all primary health care in remote health centres in NT Aboriginal Health Workers – key role as interpreters and cultural brokers Aboriginal Health Workers and Nurses expected to deliver developmental services but not trained Background

6. Earlier study – cross-cultural adaptation of Ages and Stages Questionnaire-3 (ASQ-3) for use with remote dwelling Australian Aboriginal children  ASQ-TRAK ASQ-TRAK – high face validity – culturally acceptable and relevant to Aboriginal parents, Aboriginal Health Workers and ECD experts Background

7. 1.design a culturally appropriate training program in ECD and in the administration of the ASQ-TRAK, for remote Australian Aboriginal Health Workers and other remote health practitioners and 2.evaluate the implementation of the training program Aim

8. Methods Remote Aboriginal Community A – Northern Australia Remote Aboriginal Community B – Central Australia 2 Study Sites Aboriginal Health Workers Participants Other remote health practitioners Aboriginal early education staff Interviews Methods Observational data Feedback surveys

9. Based on – Training needs analysis – Literature review of culturally sensitive training – Consultations with early childhood experts with a long history of training in children’s services and early childhood education in the remote Aboriginal context – Healthy Under 5 Kids education package – Trainer expertise: Paediatrician and qualifications in Adult Training and Assessment TRAK training program

10. TRAK training included: 1.Principles of Growth and Development 2.Risk factors to child development and early brain development 3.Typical developmental milestones 4.Principles of developmental monitoring 5.Using the ASQ-TRAK TRAK training

11. Overall implementation Reach, Dose and Fidelity of the training TRAK Evaluation

12. Overall implementation Reach, Dose and Fidelity of the training Initial training outcomes Guided by Guskey’s 5-level model TRAK Evaluation

13. Guskey’s model: 1.Reactions 2.Learning 3.Behaviour Change 4.Organisational support and change 5.Organisational Impact

14. Guskey’s model: 1.Reactions 2.Learning 3.Behaviour Change 4.Organisational support and change 5.Organisational Impact

15. Guskey’s model: 1.Participant Reactions = “customer satisfaction” measures how participants react to training; extent to which they find it relevant, useful and of adequate quality 2.Participant Learning extent to which the participants improve knowledge/skill and change attitudes 3.Behaviour Change 4.Organisational support and change 5.Organisational Impact

16. TRAK training workshop

17. Findings Community ACommunity BTotal Workshops (n)314 Participants (n)13619 Aboriginal participants (n) 8513 Aboriginal Health Workers (n) 347 Attendance at training workshop 100% Booster training Participants (n)-33 Feedback surveys12517 Interviews5510

18. Findings Community ACommunity BTotal Workshops (n)314 Participants (n)13619 Aboriginal participants (n) 8513 Aboriginal Health Workers (n) 347 Attendance at training workshop 100% Booster training Participants (n)-33 Feedback surveys12517 Interviews5510

19. Findings Community ACommunity BTotal Workshops (n)314 Participants (n)13619 Aboriginal participants (n) 8513 Aboriginal Health Workers (n) 347 Attendance at training workshop 100% Booster training Participants (n)-33 Feedback surveys12517 Interviews5510

20. Findings Community ACommunity BTotal Workshops (n)314 Participants (n)13619 Aboriginal participants (n) 8513 Aboriginal Health Workers (n) 347 Attendance at training workshop 100% Booster training Participants (n)-33 Feedback surveys12517 Interviews5510

21. Findings Community ACommunity BTotal Workshops (n)314 Participants (n)13619 Aboriginal participants (n) 8513 Aboriginal Health Workers (n) 347 Attendance at training workshop 100% Booster training Participants (n)-33 Feedback surveys12517 Interviews5510

22. 100% attendance at classroom training = High level of satisfaction “I mean if you wanted to go over everything with a magnifying glass, you could probably always change something. But…I think it’s pretty deadly*- it worked out pretty well.” (AHW) *Deadly is an Aboriginal English word for ‘fantastic’ or ‘awesome’. Participant REACTIONS

23. Relevant to their role Valuable training “I’ve learnt heaps! Yeah…from doing it and from you.” (RAN) Design of training appropriate practical demonstrations and role-plays supervised practice coaching delivery methods and materials used mixed practitioner group Participant REACTIONS

24. Improvements in Knowledge and Skill – Improved knowledge of typical child development – Greater understanding of ECD policies and guidelines – Skills to communicate with parents about their child’s development – Able to transfer their learning to the workplace Participant LEARNING

25. “Yeah…It’s changed. So the change is, I feel confident. I can get the parents and kids and ask those questions…and if I find any problems in there I write it in a note. So, yeah…I feel confident with that area…” (AHW) Participant LEARNING

26. Increased Confidence – explain why the ASQ-TRAK was necessary – inquire about development – pick up developmental problems – provide feedback and simple advice – generally more confident dealing with children “…after the training, I felt – even though I don’t usually see kids – felt more...confident talking to them about their kids and just telling what’s normal and what’s not. (AHW) Participant LEARNING

27. Practical, culturally appropriate training led to positive learning outcomes in developmental practice for AHWs and other remote health practitioners Discussion

28. Practical, culturally appropriate training led to positive learning outcomes in developmental practice for AHWs and other remote health practitioners Implementation research suggests effective training = – presenting information – providing demonstration – opportunity to practice key skills  This training satisfied all these factors Discussion

29. Improving knowledge and skill will not automatically improve practice – BUT essential endeavour to change behaviour Conclusion

30. Improving knowledge and skill will not automatically improve practice – BUT essential endeavour to change behaviour This training could lead to changes in developmental practice in remote Aboriginal health services and in similar settings with limited child health-trained staff. Conclusion

31. © Copyright The University of Melbourne 2011 The community members who gave their time to be involved in the TRAK study The study participants, including the staff of the health centres, and families and children. Menzies School of Health Research The Lowitja Institute and NT Research and Innovation Board for providing project funds anita.daprano@unimelb.edu.au Acknowledgements

32. ASQ-3 ASQ-TRAKSQ3- TRAK

33. ASQ-3 ASQ-TRAK

34. ASQ-TRAK cards