Ngaripirliga'ajirri: Implementation of Exploring Together on the Tiwi Islands
Gary Robinson
Institute of Advanced Studies, Charles Darwin University, Darwin NT
William Tyler
School for Social and Policy Research, Institute of Advanced Studies, Charles Darwin University,
Darwin NT
PP: 061 - 071
Abstract
From 1999 to 2003, the Tiwi Health Board, in partnership with University researchers, undertook the implementation of the Exploring Together Program as part of a preventive strategy in response to serious social problems affecting young Tiwi people, their parents and families.
The implementation of the program necessitated engagement of Tiwi communities in ways that were responsive to issues such as the local context, culture, and patterns of family life, and at the same time maintained a commitment to the core elements of the intervention as a structured intervention requiring relatively advanced professional skills to achieve consistent high standards of delivery. The delivery team included both Tiwi community members and non-Tiwi personnel. They redeveloped a number of areas of content of the program to ensure adequate recognition of important themes in Tiwi parenting and family life while retaining the key elements of structure and content.
The adapted program - Ngaripirliga'ajirri - showed many highly promising outcomes and, within the limits of the research design, indicated that a structured early intervention program can be effective in remote Indigenous contexts.
Keywords
Indigenous mental health, Aboriginal mental health, children, parents, parenting, implementation, culture, evaluation, program evaluation
Article Text
In professional and policy discussions about Aboriginal health among activists, service providers and even policy makers, one frequently encounters the view that what is needed is already known, that further research is unnecessary and that it is time to act. There is not only impatience with research, but also a widespread view that stringent research designs are inappropriate. Indeed, many commentators argue that structured interventions per se are not appropriate in Aboriginal communities, that they conflict with concepts of time, relationship and obligation, the 'rhythm' of community life. In a discussion about early intervention, a senior Aboriginal person who has initiated numerous programs on behalf of the Northern Territory Government asserted that rigid programs are not compatible with Aboriginal community life, with 'the Aboriginal way'. Consistent with this widely held view, most family-focused interventions developed for Indigenous peoples, particularly in remote areas, are either more or less loosely structured community programs of talk and activity, largely untheorised in terms of therapeutic rationale; or they are reactive, individualised crisis interventions, such as child protection casework or, sometimes, mental health work. Lacking are programs with both firm professional input and culturally well-grounded methods and practices with a basis in theory and evidence.
The Exploring Together Program (ETP) is based on developmental principles and in content and approach resembles a number of well known interventions aiming to improve children's social-emotional learning and parenting (Littlefield, Trinder, Woolcock & Burke, 2000; Webster-Stratton, Reid & Hammond, 2004). Children showing some indication of behavioural and/or emotional difficulties are referred to the program by teachers, family members or others and attend with their parents in groups of 6 parent-child pairs over a 9-10 week school term. Its most distinctive characteristic is the multi-group structure: this consists of work with parents and children in an interactive group session followed by groups for children and parents in separate, parallel sessions facilitated by trained group leaders. The program is not primarily informative, didactic, or problem-focused, but incorporates a group-therapeutic dimension which is held to be a key change mechanism (Littlefield, Story, Woolcock et al., 2005). The evaluative component of the program consists of the use of standard instruments for referral and initial assessment and to measure changes in children's behaviour, wellbeing and parenting as a result of participation in the program.
It terms of the practicalities of organisation and delivery, ETP is a relatively complex and demanding program. The separate elements of the multi-group structure target different albeit related issues, and require the development of specific skills on the part of group leaders. It requires significant effort to coordinate referrals from schools and other sources, to secure consents and conduct interviews before bringing parents and children together in groups. Parents often need some support to secure their availability - whether in terms of childcare for young children, contact with an employer to secure time off, or transport to the program. In general terms, in service delivery contexts such as Darwin and the Tiwi Islands, where there is no ready niche for the program's operation, a high level of community engagement among schools, practitioner groups and community members is needed to promote and maintain support for it.
This paper will describe the adaptation and delivery of ETP in the Tiwi Islands - as an example of a targeted preventive intervention for parents and children - will report selected aspects of the evaluation project and consider some key outcomes of the program.
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