Professor Sally Redman
Participating Aboriginal Community Controlled Health Organisations (in alphabetical order):
- Aboriginal Medical Service Western Sydney
- Awabakal Newcastle Aboriginal Co-Operative
- Riverina Medical and Dental Aboriginal Corporation
- Tharawal Aboriginal Corporation
$300,000 plus $75,000 in-kind
Australian National Health and Medical Research Council, the Rio Tinto Aboriginal Foundation, beyondblue, the Federal Office for Aboriginal and Torres Strait Islander Health, the Federal Department of Education, Employment and Workforce Relations, the Australian National University, and the NSW Ministry of Health.
Project completion year
Quantitative evidence on the social and emotional wellbeing of Aboriginal children is limited, particularly for those living in urban areas. The most comprehensive study to date on this issue is the Western Australian Aboriginal Child Health Survey (WAACHS1), which indicates that Aboriginal children experience higher rates of social and emotional difficulties than non-Aboriginal children.
The Study of Environment on Aboriginal Resilience and Child Health (SEARCH) is a long term prospective study of the health of urban Aboriginal children in NSW. The aim of SEARCH is to describe and investigate the causes of health and illness in approximately 1700 urban Aboriginal children aged 0-17 years.
As at February 2012, 1628 children have parental consent to participate in the study. The following describes preliminary findings from the first baseline phase of SEARCH.
a) The development work undertaken to explore concepts of social and emotional wellbeing in urban Aboriginal children and to test the primary measure of the Strengths and Difficulties Questionnaire (SDQ)
A qualitative study was conducted in three Aboriginal Community Controlled Health Organisations (ACCHOs) using focus groups and small group interviews (n=47)2, 3 to elicit participants’ views on the appropriateness of the SDQ and any additional issues of importance to Aboriginal child and adolescent mental health. Overall the SDQ was considered to be an acceptable measure of social and emotional wellbeing. However, the wording of some questions was considered ambiguous and some issues critical to the Aboriginal communities in conceptualising social and emotion wellbeing in their children were not explored, particularly the peer relationships subscale. In other quantitative work4, there was found only mixed support for the hypothesised five factor model of the SDQ, but the acceptability, internal consistency reliability and convergent validity of the instrument were all satisfactory suggesting the SDQ is a promising tool for assessing the social and emotional wellbeing of urban Aboriginal children in NSW.
b) The social and emotional wellbeing of participating children using the SDQ
The primary measure of social and emotional wellbeing used in SEARCH is the Strengths and Difficulties Questionnaire (SDQ), a 25 item behavioural screening instrument. The SDQ was completed only for children aged 4-17 and 865 children had full completion of the SDQ scale. Of these, 27 per cent were categorised as at high risk of emotional or behavioural problems, 12 per cent of children at moderate risk and 61 per cent at low risk. This compares with 24 per cent of Aboriginal children being categorised as at high risk in WAACHS1; surveys of non-Aboriginal children using SDQ report corresponding rates of 7.6 per cent at high risk5 and 15 per cent at moderate risk WACHS6,7,8. The difficulties were reported as causing a lot or great deal of distress to the child or disruption to the family in about 20 per cent of those experiencing difficulties.
c) The factors associated with being at risk on the SDQ including carer mental health status
Having a high score on the SDQ was associated with a foster carer being defined as the carer, a shorter duration of time with the current carer, more housing changes and experiencing three or more stressful life events. A higher score was also more likely in boys than girls and in those children with health problems. A greater number of children in the high risk score group had been reported by their parent/carer as having below normal range speech, language and hearing.
d) The social and emotional wellbeing of participating children as measured by other items included in the survey
Using a list of items developed by WAACHS, the most frequently reported adverse behaviour in the current study was not wanting to attend school, with 36 per cent of children reported by their carer to have not wanted to go to school in the past six months. A high proportion of the children experienced stressful life events in the past 12 months.
e) The psychological wellbeing of the carer using the Kessler 10
Seven per cent of the carers met Kessler 10 criteria for very high levels of psychological distress in the past two weeks and 12 per cent met criteria for high levels. In comparison, the NSW Population Health Survey9 estimated that 3 per cent of the state’s population met criteria for very high and 7.7 per cent for high levels of psychological distress. In total, 19 per cent of the carers in SEARCH had high or very high levels compared with 10.7 per cent in the NSW Population Health Survey, although there are likely to be some demographic differences between the two samples.
Many children in SEARCH have high levels of social and emotional wellbeing, with 61 per cent categorised as at low risk of experiencing emotional or behavioural difficulties. Factors promoting social and emotional wellbeing based on this cross sectional analysis appear to include a more stable home environment (fewer moves or carers) and less psychosocial distress in the carer. Girls are also less likely to be at risk than boys. It seems likely that good hearing and, often related to this; speech development, are also associated with good social and emotional wellbeing.
However, a higher proportion of children in SEARCH are at risk of developing psychosocial problems based on the SDQ than are non-Aboriginal children, highlighting the need for early detection, appropriate referral and culturally appropriate programs. The preliminary data suggests that interventions designed to improve hearing and speech development may be an effective means for preventing and/or correcting this health inequality.
1 Zubrick, S., S. R. Silburn, Lawrence, D.M., Mitrou, F.G., Dalby, R.B., Blair, E.M., Griffin, J., Milroy, H., De Maio, J.A., Cox, A., Li, J. (2005). The Western Australian Aboriginal Child Health Survey: The Social and Emotional Wellbeing of Aboriginal Children and Young People. Perth, Curtin University of Technology and Telethon Institute for Child Health Research
2 Williamson, A., S. Redman, et al. The reliability and validity of the Strengths and Difficulties Questionnaire for Aboriginal children living in urban New South Wales, Australia. Australian and New Zealand Journal of Psychiatry. Under review.
3 Williamson, A., S. Redman, et al. (2010). The acceptability of an emotional and behavioural screening tool for children in Aboriginal Community Controlled Health Services in Urban NSW. Australian and New Zealand Journal of Psychiatry 44: 894-900
4 Williamson AB. Raphael B. Redman S. Daniels J. Eades SJ. Mayers N Emerging themes in Aboriginal child and adolescent mental health: findings from a qualitative study in Sydney, New South Wales. Medical Journal of Australia. 192(10):603-5, 2010 May 17.
5 Centre for Epidemiology and Research (2008). 2005–2006 Report on Child Health from the New South Wales Population Health Survey. Sydney, NSW Department of Health.
6 Zubrick S, Silburn S, Garton A et al Western Australian Child Health survey: developing health and wellbeing in the nineties. Perth: Australian Bureau of Statistics and the Institute for child Health Research 1995
7 Zubrick S, Silburn S, Garton A et al Western Australian Child Health survey: family and community health. Perth: Australian Bureau of Statistics and the TWW Telethon Institute for Child Health Research 1996
8 Zubrick S, Silburn S, Gurrin L et al Western Australian Child Health survey: education, health and competence. Perth: Australian Bureau of Statistics and the TWW Telethon Institute for Child Health Research 1997
9 Public Health Division, Report on the 1997 and 1998 NSW Health Surveys. NSW Health Department, Sydney, 2000.