This paper provides policy makers with key findings about what works to overcome Indigenous disadvantage and assesses the gaps in the evidence.
• Community involvement and engagement. For example, key success factors in Indigenous community-based alcohol and substance-abuse programs were strong leadership, strong community– member engagement, appropriate infrastructure and use of a paid workforce to ensure long-term sustainability.
• Adequate resourcing and planned and comprehensive interventions. For example, a systematic approach with appropriate funding arrests the escalating epidemic of end-stage kidney failure, reduces suffering for Indigenous people and saves resources. A strong sense of community ownership and control is a key element in overcoming Indigenous disadvantage.
• Respect for language and culture. For example, capacity building of Indigenous families and respect for culture and different learning style were considered to be important for engaging Indigenous families in school readiness programs.
• Working together through partnerships, networks and shared leadership. For example, an Aboriginal-driven program increased knowledge about nutrition, exercise, obesity and chronic diseases, including diabetes. The educational component, participation of local Indigenous people in the program and committed partnerships with the organisations involved were important to the program’s success.
• Development of social capital. For example the Communities for Children initiative, under the Australian Government’s former strategy (the Stronger Families and Communities Strategy 2004–2009) highlighted the importance of a collaborative approach to maternal and child health, child-friendly communities, early learning and care, supporting families and parents, and working together in partnership.
• Recognising underlying social determinants. For example, data from the Longitudinal Study of Australian Children demonstrated that financial disadvantage was one factor among other variables that may affect school readiness and progress for young children.
• Commitment to doing projects with, not for, Indigenous people. For example, the evaluation of the NSW Count Me In Too Indigenous numeracy program found that contextual learning was successful and critical, professional development for teachers was essential, effective relationships were vital and Aboriginal community buy-in was also essential for ongoing success.
• Creative collaboration that builds bridges between public agencies and the community and coordination between communities, non-government and government to prevent duplication of effort. For example, a collaborative project between health and education workers at a primary public school in South Australia (The Wadu Wellness project), in which a number of children were screened, has resulted in follow-up and support for children for hearing problems and dental treatment, and social and emotional support.
• Understanding that issues are complex and contextual. For example, frequent house moves, neighbourhood conflict, functionality of housing amenities and high rental costs were found to have an impact on children’s schooling.
What doesn’t work:
• ‘One size fits all’ approaches. For example, residential treatment for alcohol and other drugs dependency is generally not more effective than non-residential treatment. However, evidence indicates that residential treatment is more effective for clients with more severe deterioration, less social stability and high relapse risk. As these are characteristics of many Indigenous clients, residential treatment may be most appropriate.
• Lack of collaboration and poor access to services. For example, successful interventions require the integration of health services to provide continuity of care, community involvement and local leadership in health-care delivery and culturally appropriate mainstream services. These steps help to ensure the suitability and availability of services, which can thereby improve access by Indigenous Australians.
• External authorities imposing change and reporting requirements. For example, a review of evidence from seven rigorously evaluated programs that linked school attendance with welfare payments in the United States found that sanction-only programs have a negligible effect on attendance, but that case management was the most critical variable.
• Interventions without local Indigenous community control and culturally appropriate adaptation. For example, evidence indicated external imposition of ‘local dry area bans’ (where consumption of alcohol is prohibited within a set distance of licensed premises) was ineffective and only served to move the site of public drinking, often to areas where the risk of harm was greater.
• Short-term, one-off funding, piecemeal interventions, provision of services in isolation and failure to develop Indigenous capacity to provide services. For example, a one-off health assessment with community feedback and an increase in health service use was unlikely to produce long-term health benefits and improvements. An ongoing focus on community development and sustained population health intervention are needed.