Enabling choice for Aboriginal people living with disability Promoting access and inclusion Enabling choice for Aboriginal people living with disability Promoting access and inclusion 11 Enabling choice for Aboriginal people living with disability Promoting access and inclusion Disability Services Department of Human Services March 2011 2Enabling choice for Aboriginal people living with disability Promoting access and inclusion Cover artwork Helping Hands The centre circle with the spirit figure inside represents people with a range of disabilities who have input into their own healing, dreams and aspirations. Those figures reaching out to one another and surrounding the centre figure are family and friends who are supporting and encouraging the person to pursue their goals in life. The four corners are symbolic of Aboriginal communities in Victoria. The footsteps represent pathways for Aboriginal organisations and mainstream health services to create working partnerships. The honey ants acknowledge the team effort provided to ensure an environment that is inclusive of all people. The figures emerging from the communities represent health workers whose role is to ensure the emotional, spiritual and physical wellbeing of all people within their community. Painting and accompanying story by: Sister Designs: Joanne Dwyer & Laura Thompson, 2001 If you would like to receive this publication in another format, please phone 9096 7039 using the National Relay Service 13 36 77 if required, or email sally.rose@dhs.vic.gov.au This document is also available on the Internet at www.dhs.vic.gov.au Published by the Victorian Government Department of Human Services, Melbourne, Australia. © Copyright State of Victoria 2011. This publication is copyright. No part may be reproduced by any process except in accordance with the provisions of the Copyright Act 1968. Authorised by the Victorian Government, 50 Lonsdale Street, Melbourne. Printed on sustainable paper by Impact Digital, Unit 3–4, 306 Albert Street, Brunswick. March 2011 (0040311). Language used in this guide Aboriginal people Throughout the guide, the term Aboriginal refers to both Aboriginal and Torres Strait Islander people. Aboriginal is used in preference to Indigenous or Koori, however these are retained when part of a title, program or quotation. We recognise that all Aboriginal and Torres Strait Islander people with a disability residing in Victoria need access to culturally competent services. Disability Services Throughout the document there are references to divisional and regional disability services within the Department of Human Services as well as community-based disability services. In general the principles outlined are relevant to the delivery of all government and community-based disability services. Where necessary specific references to departmental or community-based disability services will be made. Mainstream The term mainstream includes services that are universally accessible to communities, and include health, housing, education, transport, child and family services. Aboriginal community controlled organisations Aboriginal community controlled organisations (ACCOs) will be used as a general term and, unless otherwise stated includes: • Aboriginal community controlled health organisations (ACCHOs) • Aboriginal community controlled organisations (ACCOs) • Aboriginal community services • Indigenous community housing organisations (ICHOs) • Local and regional Aboriginal organisations. 4Enabling choice for Aboriginal people living with disability Promoting access and inclusion Secretary’s foreword Aboriginal people with a disability and their families are valued members of their communities and the wider Victorian community. For people with a disability – children, young people and adults – active participation enriches their lives just as it represents an important contribution to Victoria. For the families of Aboriginal people with a disability, the care and support they provide for loved ones is equally significant. This document – Enabling choices for Aboriginal people living with disability: Promoting access and inclusion – provides guidance on how service agencies and practitioners can work with Aboriginal people with a disability and their families in ways that recognise and respect Aboriginal culture and strengthen their organisations. The Department of Human Services acknowledges that Aboriginal families care for and support their loved ones with a disability in positive and affirming ways. We understand that human services should add value to their efforts by providing supports and resources that contribute to the fulfilment and resiliency of families and individuals. We also recognise that Aboriginal people with a disability and their families may experience barriers in knowing where and how to access the assistance they need. This document reflects the department’s commitment to reducing those barriers and building the trust and accessibility needed to improve the experience of Aboriginal people of human services in Victoria. Enabling choices for Aboriginal people living with disability: Promoting access and inclusion provides guidance for department- and community-based disability service providers for designing, planning and delivering culturally competent and accessible services and supports. The document is based on consultation and partnership with Aboriginal people with a disability, their families and the service agencies and practitioners they have relationships with. We have ingrained in the document that in working with Aboriginal people with a disability and their families, service agencies must give primacy to the unique and individual needs of each person and be mindful of the collective sense of family, community and culture that is so important to many Aboriginal people. I thank the representatives from the Victorian Aboriginal Disability Network and Aboriginal community controlled organisations, Elders, and Aboriginal and non-Aboriginal staff from across the Department of Human Services and the Department of Health who contributed to the development of this document. It demonstrates our strong, shared commitment to improving the lives of Aboriginal people with a disability and their families. Gill Callister Secretary Department of Human Services Contents Secretary’s foreword 4 Acknowledgements 6 1. Introduction 7 2. Purpose and scope 8 3. Historical and cultural context 9 4. Disability within the Aboriginal community 10 5. Aboriginal community-controlled organisations 11 6. Self-direction and self-determination 12 Self-directed approaches 12 Building inclusive communities that support self-determination 12 Delivering and maintaining high-quality services 13 7. Principles for practice 14 Culture and community 14 Individuals and families 16 Building organisational and community capacity 19 8. Becoming a culturally competent disability service 22 References 23 Further reading 24 6Enabling choice for Aboriginal people living with disability Promoting access and inclusion Acknowledgements Many people and organisations provided advice and feedback in the development of the Enabling choice for Aboriginal people living with disability: Promoting access and inclusion resource. We would like to thank all of those who contributed. Aboriginal people with a disability and their families, ACCOs and community Elders provided advice about how disability services can be more inclusive of Aboriginal people with a disability and the underlying principles. Community-based disability services and the department’s Disability Services Division participated. All participants demonstrated a clear commitment to better understanding and improving the way that policy, planned supports and services can be delivered more effectively for Aboriginal people with a disability and their families. As strong partners to the department, the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and the Victorian Aboriginal Community Services Association Limited (VACSAL) provided advice and support throughout the consultation. Members of the newly established Victorian Aboriginal Disability Network also provided a valuable contribution as they generously and constructively responded to many requests for advice. Their ongoing participation and leadership will continue to inform the thinking and direction of the department’s disability services in the implementation of this resource and the future complimentary work. Central office and regional staff from the Department of Human Services and Department of Health also contributed, including: • Aboriginal Outcomes Branch – Department of Human Services • Regional Aboriginal Planning Network – Department of Human Services and Department of Health • Southern Metropolitan Disability Services/Home and Community Care (HACC) Aboriginal Network – Department of Human Services and Department of Health • Southern Metropolitan Region Disability Services – Department of Human Services • Eastern Metropolitan Aboriginal Services Planning Group – Department of Human Services and Department of Health • Eastern Metropolitan Aboriginal Reference Group – Department of Human Services and Department of Health • Eastern Metropolitan Region Disability Services – Department of Human Services • Hume Region Disability Services Client Services Forum – Department of Human Services • Barwon-South Western Disability Individual and Sector Support teams – Department of Human Services • North and West Metropolitan Region Disability and Aboriginal Planning teams – Department of Human Services and Department of Health • Grampians Region Disability Services – Department of Human Services • Mental Health and Drugs Division – Department of Health • Housing and Community Building – Department of Human Services • Disability Services Division – Department of Human Services. 1. Introduction The Department of Human Services is committed to improving quality of life outcomes for Aboriginal people, including Aboriginal people with a disability and their families. Achieving improved outcomes for Aboriginal people with a disability and their families is supported by fostering a partnership approach, underpinned by both person-centred and family-centred supports, that recognise diversity and are based on self-directed approaches. Disability services’ policy, planning and delivery need to include approaches that are inclusive, and actively engage Aboriginal people with a disability and their families. To achieve this, disability service providers need to take the journey toward becoming culturally competent through all aspects of their organisation. The foundation of this is active engagement between government and funded disability services with Aboriginal people with a disability and their families, ACCOs, Elders, community leaders and mainstream services in their local and regional areas. Enabling choice for Aboriginal people living with disability: Promoting access and inclusion provides guidance on how supports and services can be made more accessible and inclusive for Aboriginal people with a disability and their families. The factors contributing to Aboriginal use or non-use of disability support services are complex and they range from fear, racism, stereotyping, misinformation, shame, attitudes towards Aboriginal clients among service providers or the interpretation of what a disability is defined as within the Aboriginal community. (Department of Human Services, Southern Metropolitan Region, 2009) 8Enabling choice for Aboriginal people living with disability Promoting access and inclusion 2. Purpose and scope Enabling choice for Aboriginal people living with disability: Promoting access and inclusion confirms the department’s commitment to improving the access and participation of Aboriginal people with a disability and their families. The principles emphasise the importance of including Aboriginal people with a disability within policy development, planning and service delivery considerations across all disability services, funded organisations and providers. The principles for practice are grouped around three key themes: culture and community; individuals and families; and building organisational and community capacity. This resource is one tool that disability sector organisations and practitioners can use to strengthen their response to Aboriginal people with a disability and their families, in providing services that: • are more culturally competent • recognise the complex social health challenges and disadvantage experienced by many Aboriginal people • are developed through partnerships with Aboriginal communities and organisations • use self-directed approaches that enable and support Aboriginal self-determination • involve Aboriginal people with a disability themselves in naming problems as well as shaping solutions. During the development of this tool, direct feedback from Aboriginal people reinforced that they want equal access to both universal and targeted services. To support this, the principles are based on fundamental, good-practice approaches that include: • building respectful relationships over time • information sharing and active listening • a whole-of-person approach • shared planning, inclusive of family and community • collaborative decision making • timely follow through. Through the application of these principles of practice it is anticipated that the disability sector, in conjunction with broader government funded services, will achieve the following objectives: 1. Improve access to self-directed supports by Aboriginal people with a disability and their families. 2. Focus disability services’ attention on Aboriginal early years and young people with a disability in order to improve immediate and long-term outcomes. 3. Promote least intrusive and earliest effective support at any age in order to maximise quality of life outcomes and reduce secondary impacts. 4. Strengthen the capacity of individuals, families and communities to actively participate and contribute to individual, service and community planning and development. 5. Build culturally responsive disability services that work in partnership with Aboriginal organisations and communities to deliver relevant and timely services and supports. 3. Historical and cultural context Victoria is rich in Aboriginal culture and traditions. Aboriginal people continue to honour and maintain their culture through many and diverse means. While individuals and places are unique, Aboriginal people and organisations are united in their determination to develop and sustain healthy, strong and prosperous communities. Throughout Victoria, Aboriginal people are succeeding on many levels and making a difference in their own lives and communities. Although Aboriginal people have achieved much and continue to make significant contributions to the culture and vitality of their own and the broader Victorian community, it is evident that a significant level of disadvantage and hardship still exists in the lives of Aboriginal people. The most telling indicator of this disadvantage is that, on average, the life expectancy of Aboriginal people is 11.5 years less for men and 9.5 years less for women than non-Aboriginal people. Also, Aboriginal children born today can expect to live shorter lives: 11.5 years shorter if they are male and 9.7 years shorter if they are female (Australian Bureau of Statistics, 2009). Because of a history of dispossession, removal of children, other discriminatory government policies (Department of Human Services, 2006) and non-inclusive practices, many Aboriginal people may mistrust organisations and government. This can lead to self-exclusion from services. To overcome this, active engagement and outreach with Aboriginal families, communities and organisations is needed to ensure information is accessible, and that trust can be built through respectful relationships and patience over time. While culture and a collective sense of family and community is of utmost importance, Aboriginal people also recognise and celebrate the uniqueness and individuality of each Aboriginal person – their diverse aspirations, interests and chosen pathways. Service providers need to offer choices. Don’t homogenise. Each Aboriginal person needs to be seen as an individual with different needs, interests than another person. (home and community care (HACC) Aboriginal worker – Southern Metropolitan Region, 2010) 10Enabling choice for Aboriginal people living with disability Promoting access and inclusion 4. Disability within the Aboriginal community The concept of disability within Aboriginal communities can mean many different things. In some communities a word or cultural definition for disability does not exist. Generally the concept of disability is not delineated from health and other social concepts. In a discussion paper for the Western Australian Government, Stopher and D’Antoine (2009) state that rather than a generic term for ‘disability’ in Aboriginal cultures, ‘people were referred to as having a specific impairment or sickness that prevented them doing certain tasks, but that they were still involved in the kinship system with roles and responsibilities’. They suggest that for some Aboriginal people use of the generic term ‘disability’ is a devaluing experience. It is more responsive therefore to discuss and respond to specific disability impacts. Aboriginal people with a disability are generally cared for within communities and families with positive outcomes for individuals and communities. However people with a disability and their families also need opportunities to access services and supports that can further enhance their lives. The principles outlined below can guide disability service providers, and encourage them to reflect on how they might add value to the care and support already provided by Aboriginal families and communities, through delivery of targeted services and supports. Working with Aboriginal communities in relation to the role and function of Victorian disability services is an important part of building mutual understanding on how people with a disability and their families can best be supported. Disability within the Aboriginal community is often combined with the impacts of chronic disease and other health, social and economic challenges. These complex needs can amplify disability impacts for individuals and families requiring a holistic and integrated response. Comprehensive data on the prevalence and impacts of disability within the Aboriginal community is limited. The Disability Services Statewide population profiles (Department of Human Services, 2010), based on the 2006 Australian Bureau of Statistics Census data, indicates that nationally Aboriginal and Torres Strait Islander people have 1.4 times higher disability rates than the non-Indigenous population. This difference is greatest for intellectual disability with nearly four times the rate for non-Indigenous people (O’Kelly, Snashall-Woodhams, 2007). Aboriginal people with a disability and their families are under-represented in the uptake of primary and early intervention services, including disability services. Intervening early is critical to reducing the over-representation of Aboriginal people in child protection, acute health services and the criminal justice system. 5. Aboriginal community controlled organisations ACCOs are culturally appropriate, autonomous services that are initiated, planned and governed by Aboriginal communities through elected Aboriginal boards or committees. They are a practical expression of Aboriginal self-determination and are not operated by government. Aboriginal communities around Australia have been establishing community controlled services since 1971. Victorian ACCOs have a key leadership role on behalf of their communities in relation to developing, planning and delivering services. ACCOs are made up of a variety of different types of organisations that may be connected through state or national representative organisations and networks, which provide a collective voice to government on Aboriginal community priorities and emerging issues. Most ACCOs deliver services as well as work in partnership with disability and mainstream services. Aboriginal people may receive a range of complimentary services from mainstream and disability services, and/or ACCOs (Victorian Government Health Information, 2010). Access to services requires filling out forms and talking up your issues – community members are not comfortable talking about what is really going on because of the shame. They will tell you what they think you want to hear … mainstream workers assume people understand, but they don’t … it is all jargon. – Project participant (Rumbalara Aboriginal Cooperative, 2010) 12Enabling choice for Aboriginal people living with disability Promoting access and inclusion 6. Self-direction and self-determination Self-determination and self-directed approaches are about enabling individuals, families and communities to lead and participate actively in the key decisions that impact on their lives. It is recognising the authority of individuals, families and communities to make their own decisions, as well as enabling access to the supports that build and resource people’s capacity to make those decisions. Provision of culturally competent disability services that are person and family centred will expand the capacity of Aboriginal people with a disability and their families to make choices and self-determine their own lives, as well as that of their communities. Disability Services use words like ‘person-centred practice’ and ‘self-direction’, while Aboriginal culture is often centred around ‘collective decision-making’. Through engaging with Elders/grandparents as well as families, ‘person centred’ planning and decision-making can happen within a community and collective context. Client Services Manager, Care Connect, Eastern Metropolitan Region Self-directed approaches Aboriginal people with a disability and their families need information and support that enables them not only access to services, but also opportunities to actively participate in self-directed planning and support. This may require time and effort from service providers as they build the necessary relationships, knowledge and confidence of individuals and families. For many Aboriginal people with a disability, community Elders and ACCOs may also be important resources to enable these processes. Building inclusive communities that support self-determination Disability services have an important role in facilitating and supporting Aboriginal people to access and participate in Aboriginal and mainstream community organisations and activities. Disability services also have much to learn from Aboriginal communities to ensure they are inclusive of Aboriginal people. This can be done through facilitating shared learning opportunities, support and information. Metropolitan, rural and hearing-impaired access workers can support and facilitate partnerships and activities between disability services, ACCOs and community groups in order to expand opportunities for participation, leadership and, ultimately, the self-determination of Aboriginal people with a disability. Delivering and maintaining high-quality services The following disability service standards provide the foundation for implementing culturally competent governance, program management, planning and service delivery. • Outcome standards for disability services focus on enabling individuals to make their own decisions and realise their full citizenship, and provide a strong platform for fostering Aboriginal self-determination and participation. • Industry standards for disability services emphasise access, decision making and choice, dignity and confidentiality, participation and integration, and underpin culturally competent services in which Aboriginal people feel welcome, respected and safe. These standards are available on the department’s website: www.dhs.vic.gov.au 14Enabling choice for Aboriginal people living with disability Promoting access and inclusion 7. Principles for practice The following principles have been drawn and integrated from principles and approaches developed in partnership with ACCOs and Aboriginal people for the Department of Human Services, including: The Principles of Good Practice in Aboriginal Affairs 2009, the Reconciliation Action Plan 2010–11 and the Aboriginal Cultural Competence Framework 2008. Culture and community 7.1 Acknowledge Aboriginal history, celebrate Aboriginal culture There are many unique and diverse ways that Aboriginal people understand and experience family, community, language, disability and self-determination. Aboriginal culture is not a single culture and comprises many diverse communities, each with its own customs and ceremonies. However, central to these cultures is the importance of connection and obligation to family, which includes not just blood relatives but wider kinship groupings. While these, as well as contemporary values, contribute to the expression of Aboriginality for each person, each individual has their own unique aspirations, skills and interests. While understanding the cultural background of a person is important, getting to know them as an individual (along with their family and significant others) is of the most fundamental importance in determining the best way to provide support. One of the impacts of a history of dispossession, removal of children, social exclusion, other discriminatory government policies and non-inclusive practices is that many Aboriginal people mistrust organisations and government. This can lead to Aboriginal people excluding themselves from services and support. Understanding the historical, social and cultural context of Aboriginal communities is fundamental to understanding what factors will contribute positively to the developmental and wellbeing outcomes of Aboriginal people with a disability. Historical and cultural factors affect the way an Aboriginal person accesses (or chooses not to access) services, their satisfaction with the service and the outcomes of the service. These perceptions may then impact on the utilisation of services by other Aboriginal people in the community. All about culture In Broadmeadows, Hume City Council’s home and community care Aboriginal liaison officer facilitated a school holiday program that provided opportunities for children with a disability and their brothers and sisters to learn and participate in a range of cultural activities. Community Elders and families participated and contributed. It enabled parents to have a break but, most importantly, it strengthened culture and a sense of belonging for everyone who participated. 7.2 Reach out, talk and listen together Disability services need to engage with Aboriginal people through active outreach and participation in Aboriginal community networks, groups, activities and events. Building and re-building the trust necessary for engaging Aboriginal people with the disability services sector requires patience and persistence, focused on personal relationships, consistency and commitment over time. Sharing information and relating experiences through stories is part of a long Aboriginal oral tradition. Because of this, a range of communication strategies need to be used to promote and develop service responses, as well as disseminate information. These may include ‘wordof- mouth’ approaches among people with a disability, including engagement with Elders, community leaders and ACCOs who often have an important role in sharing information within their communities. Disability services need to recognise the importance of positive service experiences that will be shared by service users in their community, thereby encouraging other people with a disability to seek out services and supports. A range of formats can be used to communicate and promote services. Written materials with text and art work that is culturally appropriate are most useful when supported by relationship building and face-to-face communication, in settings that are culturally safe and supportive. Aboriginal organisations and communities need access to information in a form that is practical and meaningful to enable good decision making. Informing and engaging Aboriginal communities Employing Aboriginal people within the department and community-based disability services provides opportunities to communicate with, and connect Aboriginal people with a disability and their families to disability and mainstream services even further. Aboriginal staff can participate in Aboriginal gatherings, community events and network meetings, as well as work alongside non-Aboriginal staff in building their cultural competence and helping them establish relationships with Aboriginal people. 7.3 Promote access and inclusion in community and universal services Expanded opportunities to participate within both Aboriginal and mainstream communities will enable Aboriginal people with a disability to flourish and realise their right to full citizenship. Aboriginal people often experience lower rates of school completion, participation in early childhood programs, post-compulsory training, university and employment, and access to primary health services. Having a disability can amplify already high rates of exclusion and non- participation. Working together, disability services, ACCOs, universal services, Aboriginal networks and other community organisations and groups can, in conjunction with Aboriginal people with a disability and their families, explore and identify more inclusive pathways and supports to enable greater participation. Sharing culture through community art BRA-itude art workshop and forums in Barwon-South Western Region brought together Aboriginal Elders and people of all abilities from culturally and linguistically diverse backgrounds to reflect on their personal experiences through art. This included a local workshop with the Wathaurong community. An inspired work that emerged was the Moulin Rouge, which celebrated both the traditional and feminine side of being a Koori woman. The community building officer with Disability Services in Barwon-South Western Region says, ‘Community art projects can be a way of engaging people of all abilities and cultures’ as well as creating ‘a sense of belonging and being part of community.’ 16Enabling choice for Aboriginal people living with disability Promoting access and inclusion Individuals and families 7.4 Support Aboriginal self-determination through self-directed approaches Supporting the right to make decisions, participate and learn through self-directed approaches that are inclusive of family and community (where appropriate) provides valuable opportunities for building self-determination among Aboriginal people with a disability and their families. It is important to be mindful of the meaning and divergent interpretations of language and concepts. Flexibility in providing disability services involves flexibility in the way we adapt language and use words and concepts that are culturally meaningful. An example of this relates to the emphasis in Aboriginal culture on collective rather than individual decision making. Self-directed supports for Aboriginal people are about self-determination. Self-determination for many Aboriginal people is about community empowerment and so disability service providers may need to consider processes that involve communities in planning and decision-making. While culture and a collective sense of family and community are of utmost importance, Aboriginal people want the opportunity to express their individual needs, and to explore unique solutions through which they can realise their own aspirations and goals. Balancing the need for self-determination and aspirations of individuals, families and communities requires careful consideration when planning with Aboriginal people with a disability. Participating in a Koori community kitchen Sandy, an Aboriginal woman with a disability was attending a day service. In the same community a Koori community kitchen was bringing together Aboriginal people to prepare and share food, to yarn and share culture. With additional resources provided through the department’s Disability Services, the woman is now participating with her community in the Koori Community Kitchens Program. This has expanded her opportunities to participate in her broader community and culture, as well as enhanced her individual sense of wellbeing. 7.5 Contribute to strong Aboriginal family wellbeing and resilience Extended families and communities are critical to the wellbeing and healthy development of Aboriginal children, young people and adults. Many Aboriginal people with a disability are already recognised and included within strong families and communities in positive and affirming ways. The role of funded disability services is to add value to this by providing targeted supports and resources that contribute to the development and resilience of individuals and families. Using family-centred approaches disability services may need to engage with community Elders as well as resource the inclusion of siblings, parents and extended family members in service responses and supports. Aboriginal concepts of men’s and women’s business must also be considered and families and carers should be involved in discussions and decisions about planning and support where possible. Because many Aboriginal families can face the added challenges of chronic disease, mental illness, difficult socioeconomic factors and a range of other difficulties, disability service providers need to collaborate with Aboriginal, mainstream and specialist services in ‘whole-of-family’ planning and support. Building Mary’s and her family’s resilience ‘Mary’ a 17-year-old girl with a disability lived with her grandmother while her family lived four hours away. Mary had dropped out of school due to a range of complex issues. With a client-focused plan disability services were able to strengthen her relationships, access to the community and resilience. The plan centred on: • preserving links with her family through maintaining connections with extended family • more community involvement • a return to school through funding for activities with girls her own age, and tutoring • empowering Mary to better understand her disability, enabling her to develop positive strategies for problem solving and relationship building. 7.6 Coordinate disability, Aboriginal and mainstream services to intervene early Early identification and timely intervention of emerging need is central to supporting Aboriginal people with a disability. For many Aboriginal people, a lack of early intervention and developmental support can lead to significant secondary impacts, including poor health and exclusion from education and employment, as well as involvement with justice and child protection systems. An important part of any disability service provider and Aboriginal community partnership is building the knowledge and skill of ACCOs and other sectors, to work with people with a disability. Effective and timely intervention must respect cultural traditions and build the capacity of families, communities and Aboriginal organisations in order to promote development and social inclusion, and prevent negative secondary health, economic and social impacts. Doing it altogether Southern Metropolitan Region Disability Services, in partnership with OzChild, Brotherhood of St Laurence, Peninsula Health (Koori Unit), Commonwealth Carer Respite Centre and the Mornington Peninsula Shire Council Indigenous team, jointly funded, planned and facilitated a respite camp for children aged 7–12 years. It was family-focused and culturally sensitive. It involved parents, siblings and children with a disability. Community Elders participated and activities were about having fun, taking a break, service information and access, building skills, independence, relationships and cultural awareness. 7.7 Respond to complex needs through integrated and holistic planning A holistic approach requires more than just a focus on a person’s disability. It needs to consider outcomes that encompass the social, emotional, spiritual and cultural wellbeing of individuals and the community as a whole. Aboriginal communities experience higher rates of chronic disease, imprisonment, exclusion from employment and early death than the non-Aboriginal population. These complex needs add further stress to the impacts of a disability. No single agency or program has the capacity to address Aboriginal disadvantage in isolation. Government departments, service providers, non-government organisations (ACCOS, disability and mainstream) and private providers need to work together in a timely and coordinated way to share knowledge and deliver effective programs. It is important to 18Enabling choice for Aboriginal people living with disability Promoting access and inclusion deliver programs in a way that makes sense to Aboriginal people, addressing the complex nature of Aboriginal disadvantage and the barriers people face to accessing supports. An integrated response across services and organisations lessens the burden for Aboriginal people dealing with multiple organisations, and supports continuity of care (Department of Human Services, Building Better Partnerships, 2006). For Aboriginal people, disability can be a result of mental illness, chronic disease, age, social exclusion and/or temporary disabling conditions resulting from accidents or illness. While these types of disability may fall outside the government-managed and government-funded disability service target group, disability service providers have an important role in providing broader service information and active referral. Referral and support in helping Aboriginal people locate the most appropriate service builds trust and confidence between the Aboriginal community and the broader service system, of which disability services is an integral part. Contributing and participating positively to an integrated and more accessible human services system involves cross-sectoral communication, networking, mutual capacity-building opportunities and common processes. For people with multiple and complex needs access to the range of services and supports may require that disability service practitioners assist individuals and families to navigate their way through the broader service system. For people with complex needs, culturally competent case-coordination and management can be critical. Consideration of who has responsibility for these functions needs to be considered as part of partnership discussions with ACCOs and other service providers. Because of the reduced life expectancy gap, loss of family and community members through early death is a constant reality for Aboriginal people. Planning and service delivery needs to take into account the impacts of grief and loss, and the disruption to caring and support systems. Enabling Jesse to succeed ‘Jesse’ had been involved with police and the courts for a range of drug, alcohol and violence related offences. His family was unable to support him and he found himself homeless as a young teenager, often being taken advantage of because of his vulnerability. When he was assessed by Disability Services they identified a pleasant young man who could be easily led with low levels of comprehension. With support Jesse was able to address his behaviour and his drug and alcohol dependence. Through an individual support package Jesse began a TAFE pre-apprenticeship course and gained valuable work experience and skills. Jesse is repairing his relationship with his family and working toward goals that include finding work and obtaining a drivers licence. Building organisational and community capacity 7.8 Through strong partnerships, Aboriginal people with a disability, their families and community can contribute to policy, planning and service development In order to provide culturally responsive, flexible and accessible services and supports, disability services need to work in partnership with Aboriginal people with a disability, their families, ACCOs and communities. Successful partnering that leads to improved outcomes for Aboriginal people with a disability rests on genuine respect and support for Aboriginal knowledge, heritage and culture. Aboriginal people report that, over time, they have participated in many consultations about all areas of their lives. Disability Services, regional teams, funded agencies and providers need to have mechanisms in place for seeking advice from Aboriginal people with a disability in relation to policy, planning and service provision. Before establishing new processes it is necessary to identify existing sources of data, as well as Aboriginal planning and advisory structures that you can partner with for effective outcomes. This includes identifying opportunities to provide timely feedback to participants. Any engagement and collaboration with Aboriginal people needs to be based on the maxim of ‘do no harm’. It needs to involve carefully planned processes where intent and expectations are clear to everyone involved. Processes that work best are those that are facilitated through relationships and partnerships between individuals, communities and organisations over time, rather than one-off, short-term activities. Consideration of how the process itself can facilitate opportunities for increasing knowledge, networks and skills of participants requires preparation, planning and dissemination of information. It also needs to promote Aboriginal leadership and ownership of both process and content. Partnering to strengthen the voice of Aboriginal people with a disability In 2010 a group of Aboriginal people with a disability from across Victoria began meeting together in order to create a stronger voice for Aboriginal people with a disability. Emerging as the new Victorian Aboriginal Disability Network, their aim is to distil key issues, share stories, support each other and partner with government and community organisations, to improve outcomes for Aboriginal people with a disability. The department is collaborating closely with the new network, as are other disability and Aboriginal organisations. This is mutually beneficial in that the voice and leadership of Aboriginal people with a disability is strengthened while policy, planning and service delivery approaches can be designed to better meet the needs of Aboriginal people with a disability and their families. 7.9 Building the cultural competency of organisations and the workforce Through information sharing and collaborative learning: • the disability services sector can expand cultural knowledge in relation to engaging and responding effectively with Aboriginal people • Aboriginal organisations can expand their knowledge and understanding about early identification, referral and support for people with a disability. 20Enabling choice for Aboriginal people living with disability Promoting access and inclusion Ways that the disability services sector and Aboriginal organisations can improve their response to Aboriginal people with a disability might include: • facilitating shared learning and development opportunities for management, staff, service users and community leaders in better understanding and responding to Aboriginal people with a disability • building a diverse workforce that has recruitment, retention, management and support to facilitate positive participation by Aboriginal staff with and without a disability (Department of Human Services, 2010), and • governance and advisory processes that ensure Aboriginal people with a disability and their families have opportunities to be represented and to contribute to service planning and development. Creative strategies might include secondary consultation, practice resources, forums, advisory groups, training, staff rotations and shared positions, cross-sectoral case conferencing, peer support and mentoring, through to more formal partnerships and collaboration. Enabling Aboriginal organisations to plan and lead training may require resourcing and support. Departmental and community-based disability services also need to work in partnership with mainstream health, mental health and drugs, justice, housing, education, youth services, training and community organisations to ensure that planning and service provision is integrated and holistic. This requires innovative and creative approaches to sharing resources, information and skills. Barwon-South Western Region Cultural Competency Disability Service Workshops – Learning from Wathaurong people Staff from Disability Services in the Barwon-South Western Region participated in Aboriginal cultural awareness sessions facilitated through the Wathaurong Aboriginal Co-operative in North Geelong. A welcome smoking ceremony was followed by workshops in historical policies/practices and their continuing impacts, as well as visits to significant sites within the Bellarine area. The purpose of the awareness training was to improve the understanding of Disability Services staff about local Aboriginal culture and identity so that they could better support Aboriginal people in making choices inclusive of their culture and their beliefs. The outcome was not only increased confidence, skills and knowledge among Disability Services staff when working with Aboriginal people but also improved communication and relationships with the Wathaurong Aboriginal Co-operative and local Aboriginal community. This will lead to greater access and provision of supports to Aboriginal people with a disability and their families. The region is investigating ways for this training to become part of ongoing professional learning and development for regional Disability Services staff. 7.10 Ensure that policy, planning and service delivery is inclusive of Aboriginal people with a disability and is based on good practice and sound evidence Understanding the aspirations, needs and priorities of Aboriginal people with a disability is critical for effective and responsive service provision. Planning, designing and evaluating the effectiveness of policy, programs and services needs to be based on: • use of current Aboriginal demographic data and research • consistent and meaningful service data collection and analysis • engagement and support for research and consultations led by Aboriginal people with a disability and ACCOs • promotion of the inclusion of people with a disability as a key population group on the broader Aboriginal health and social determinants research agenda • collection, analysis, documentation and dissemination of ‘good practice’. Policy and program development needs to take into account the strengths, limitations and gaps in available evidence. Where data does not exist, it will be necessary to rely on anecdotal evidence from the Aboriginal community regarding the most pertinent issues, until such a time as themes emerge and more concrete data can be captured and analysed. Aboriginal communities are more likely to adopt service models where there is evidence of success from other Aboriginal programs. It is important to continue to gather data and monitor performance throughout program implementation and respond to the outcomes of the evaluation. Information about Aboriginal people gathered from evaluation should be owned as far as is possible by Aboriginal people and shared on their terms. Programs need to be sustainable and adaptable. Programs that are multifaceted and involve more than just one approach increase the awareness and involvement of Aboriginal people and the likelihood of success (Department of Human Services, 2009). Remember that it is better to do nothing if the only option is the delivery of poorly planned unsustainable responses that can do harm to individuals and communities. Knowing what you need to know Based on the need to learn more about the prevalence of disability within Aboriginal communities in the Grampians Region, the Grampians disAbility Advocacy Association Indigenous Liaison Program undertook a study to better understand population distribution and service use by Aboriginal people with a disability. Despite a scarceness of data the study was able to establish the likely numbers of Aboriginal people with a disability in the region not currently accessing disability supports, the under-utilisation of disability and home and community care services, and the low uptake of appropriate Commonwealth Government income supports. The research was able to identify the communities where people lived as well as information on carers. This evidence will be critical to informing the way Disability Services, in partnership with ACCOs in the Grampians Region, target, plan and design the provision of supports to Aboriginal people with a disability and their families. 22Enabling choice for Aboriginal people living with disability Promoting access and inclusion 8. Becoming a culturally competent disability service A culturally competent disability service is based on culturally competent governance, planning, monitoring and service delivery. The Aboriginal Cultural Competence Framework (2008) provides a set of standards by which disability services can consider and develop their organisation to ensure that it is accessible, responsive and safe for Aboriginal people with a disability and their families. A summary of the standards is provided below. A culturally competent organisation: • Commits to Aboriginal self-determination and respectful partnerships as reflected in policies and public service statements, protocols and formal agreements with ACCOs. • Embeds cultural respect within organisational and staff values and attitudes that promote the recognition of the strengths of Aboriginal culture and people. This might include encouraging disability service management and staff to participate in Aboriginal community activities and events, while supporting the recruitment of culturally respectful staff, and the implementation of a code of conduct that highlights the importance of cultural safety and timely responses to racism, discrimination and cultural abuse. • Reflects cultural responsiveness in the abilities and skills of staff as supported by policies and procedures for recruitment, induction and ongoing training and professional development facilitated in conjunction with local or other relevant Aboriginal organisations. • Promotes culturally safe environments and client experiences that include consideration of welcoming and culturally safe physical and social environments that are sensitive to the cultural norms of Aboriginal people. This may include working in community settings chosen by Aboriginal people and positive inclusion of family and community members. • Ensures that cross-cultural practice and care applies to all aspects of disability services including: - resources and public symbols that promote Aboriginal culture - maintaining and strengthening Aboriginal family and connections - assessments, planning and service delivery that consider parent-child, extended family and community relationships and dynamics -collaboration with Aboriginal organisations in the development and delivery of culturally competent responses. Further information, links and resources are on the department’s website: www.dhs.vic.gov.au References Australian Bureau of Statistics 2009, Deaths, Australia, ABS, Canberra, available at www.abs.gov.au/AUSSTATS/abs@.nsf Department of Human Services 2006, Building better partnerships - Working with Aboriginal communities and organisations: A communication guide for the Department of Human Services, State Government of Victoria, Melbourne. Department of Human Services 2009, Principles of good practice in Aboriginal affairs: a guide for developing, funding and delivering programs for Aboriginal people, State Government of Victoria, Melbourne. Department of Human Services, Southern Metropolitan Region 2009, Koori disability information kit, State Government of Victoria, Melbourne. Department of Human Services Disability Services 2010, Statewide population profiles, State Government of Victoria, Melbourne. Department of Human Services, Aboriginal Recruitment and Retention strategy 2010-2013, State Government of Victoria, Melbourne. Rumbalara Aboriginal Cooperative 2010, Enabling Aboriginal and Torres Strait Islander access to Disability Services report. Stopher K and D’Antoine H 2009, Aboriginal people with a disability: Unique approaches to unique issues, available at www.disability.wa.gov.au O’Kelly C and Snashall-Woodhams J 2007, Building Culturally Secure Disability Services for Indigenous Australians, prepared for the Disability Policy and Research Working Group by Swinburne University of Technology, Melbourne. Department of Human Services and the Victorian Child Care Agency 2008, Aboriginal cultural competence framework. Department of Health 2010, Victorian Government Health Information, Aboriginal community controlled organisations: their history and role, ICAP Key Result Area Guideline 1, available at www.health.vic.gov.au/koori 24Enabling choice for Aboriginal people living with disability Promoting access and inclusion Further reading Aboriginal Disability Network New South Wales 2006, Telling it like it is report, ADN, Strawberry Hills. Aboriginal Health Council of South Australia, Flinders University, Department of Human Services 2003, ‘Report on disability and the Aboriginal communities of South Australia – Need to know’ Adelaide. Australian Bureau of Statistics 2002, National Aboriginal and Torres Strait Islander Social Survey (NATSISS) and ABS data, Canberra. Australian Government 2003, National strategic framework for Aboriginal and Torres Strait Islander Health 2003–2013, Canberra. Department of Human Services 2008, Aboriginal Services Plan 2008–2010, State Government of Victoria, Melbourne. United Nations 2007, UN Convention on the Rights of Indigenous People, Geneva. United Nations 2008, UN Convention on the Rights of Persons with Disabilities, Geneva. Victorian Equal Opportunities and Human Rights Commission 2008, From principle to practice: Implementing the human rights based approach in community organisations, Melbourne. Victorian Government Disability Act 2006, State Government of Victoria, Melbourne. Victorian Government 2006, Victorian Charter of Human Rights and Responsibilities, State Government of Victoria, Melbourne.