Provision of services for Aboriginal and Torres Strait Islander populations

Communication is essential for Aboriginal and Torres Strait Islander people’s sense of identity as it facilitates engagement and connectedness to their family, community, culture and history. Additionally, leadership of Elders who can listen and provide advice and act as role models is important for the health of families and communities (Australian Health Ministers’ Advisory Council, 2011).

Provision of services for ATSI populations: 

• Aboriginal and Torres Strait Islander people are less likely to be assessed by an allied health professional during the first 48 hours post stroke (Kilkenny et al., 2012).
• Aphasia is under-identified in Aboriginal and Torres Strait Islander populations.·     
• Few Aboriginal and Torres Strait Islander Australians receive ongoing communication rehabilitation services (Armstrong et al., 2012).
• There is little published research in the area.
• After stroke Aboriginal and Torres Strait Islander Australians are often lost to the system post hospital discharge. A recent pilot study reported awareness of communication problems or relevant services following stroke in an urban Aboriginal community in Western Australia; of the 14 Aboriginal people interviewed, none had participated in ongoing Speech Pathology after leaving hospital (Armstrong, Hersh, Hayward, Fraser & Brown, 2010).

• The existing disability support system in Australia does not meet the unique needs of Aboriginal and Torres Strait Islander people, leading to personal and systemic disempowerment (First Peoples Disability Network 2013 as cited in Bohanna et al., 2013). 
• Under reporting of disability in Aboriginal and Torres Strait communities may be influenced by an unwillingness to self-identify with another potentially discriminatory or stigmatizing aspect of life (Aboriginal Disability Network New South Wales, 2007 as cited in Bohanna et al., 2013).·        
• General communication breakdown between Aboriginal clients after stroke and non-Aboriginal health service providers often occurs due to cultural and linguistic differences (Coffin et al., 2004).
• Health communication breakdown after stroke is consistent with such breakdown associated with other diseases (Shahid & Thompson, 2009a;  Shahid, Bessarab, Howat & Thompson, 2009b; Shahid, Finn, Bessarab & Thompson, 2011;Taylor et al., 2009;) related to cancer and cardiac conditions specifically.
• Communication is not just the vehicle of ensuring compliance with a medically based intervention; in the case of aphasia, communication constitutes the intervention and service.

The current situation involving a high incidence of stroke and aphasia in Aboriginal and Torres Strait Islander Australian populations, accompanied by a lack of uptake of speech rehabilitation services, highlights the need for speech pathologists and other health workers to better understand the issues involved in ACD and the current context of service delivery. There is also a need to have a variety of service delivery options available to assist people with ACD. In addition, poor cross-cultural health communication practices (Shahid & Thompson, 2009a, Shahid, Finn, Bessarab & Thompson, 2011) are endemic to the health system (Lowell, Maypilama, Yilaniwuy, Rrapa, Williams, & Dunn, 2012), making service delivery less than ideal across a variety of health conditions.  

References:

1. Armstrong, E., Hersh, D., Hayward, C., Fraser, J., & Brown, M. (2012).  Living with aphasia: Three Indigenous Australian stories. International Journal of Speech Language Pathology, 14(3), 271-280.
2. Australian Health Ministers’ Advisory Council (2011). Aboriginal and Torres Strait Islander Health Performance Framework Report 2010, AHMAC, Canberra.
3. Bohanna, I., Stephens, A., Wargent, R., Catherall, J., Timms, C., Graham, D. & Clough, A. (2013). Assessment of acquired brain injury in Aboriginal and Torres Strait Islander Australian: Guidance for DisabilityCare Australia.  James Cook University Australia & The Cairns Institute.
4. Coffin, J., Hermeston, W., Merritt, G., Baraga, J., Quartermaine, M., Dhu, J., Allen, S., Black, C., McDonald, A., Ronan, M., & Ashwin, S. (2004). National Stroke Unit Program Aboriginal Stroke Project, Melbourne: National Stroke Foundation.
5. Kilkenny, M. F., Harris, D. M., Ritchie. D. A., Price. C.,& Cadhilac, D. A. (2012). Hospital management and outcomes of stroke in Indigenous Australians: evidence from the 2009 Acute Care National Stroke Audit. Int J Stroke; EPub 2012 Feb 2. doi: 10.1111/j.1747-4949.2011.00717.x.
6. Lowell, A., Maypilama, E., Yilaniwuy, S., Rrapa, E., Williams, R., & Dunn, S. (2012). “Hiding the story”: Indigenous consumer concerns about communication related to chronic disease in one remote region of Australia. International Journal of Speech Language Pathology, 14(3), 200-209.
7. Shahid, S., & Thompson, S. C. (2009a).  An overview of Indigenous cancer and their beliefs around the disease, a cross-country comparison: Australia, Canada, New Zealand and the United States. Aust NZ J Public Health, 33, 109-18.
8. Shahid, S., Bessarab, D., Howat, P., & Thompson, S. C. (2009b). Exploration of the beliefs and experiences of Indigenous people with cancer in Western Australia: a methodology to acknowledge cultural difference and build understanding. BMC Medical Research Methodology, 9(60), 1-8.
9. Shahid, S., Finn, L., Bessarab, D., & Thompson, S. C. (2011).  ‘Nowhere to room . . . nobody told them’: logistical and cultural impediments to Aboriginal peoples’ participation in cancer treatment. Australian Health Review, 35, 235–241.
10. Taylor, K. P., Thompson, S. C., Smith, J. S., Dimer, L., Ali, M., & Wood, M. M. (2009). Exploring the impact of an Aboriginal Health Worker on hospitalised Aboriginal experiences: lessons from cardiology. Australian Health Rev, 33(4): 549-557.

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