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University of Melbourne Early Childhood Oral Health Research Symposium 2016 Dr Chris Bourke Talk structure • My story • Remote area dentistry • Aboriginal child oral health • Care and protection Dr Chris Bourke • MLA for Ginninderra, ACT Legislative Assembly • Minister for: • • • • • Aboriginal & Torres Strait Islander Affairs Children & Young People Disability Small Business & Arts Veterans & Seniors • B.D.Sc., Grad. Dip. Public Health, Grad. Dip. Clin. Dent. (Oral Implants) • Past President - IDAA • Past Chairman - ADA (ACT division) • Former Member - ACT Dental Board • Former Member - Campaign for Indigenous Health Equality (Close the Gap) • Honorary Clinical Associate Professor, Melbourne Dental School • Mentor, Poche Centre for Indigenous Oral Health – University of Sydney 1982 1982 Remote area dentistry • Skill set – Extractions - surgical – Oral medicine • Cultural safety • Support – People, materials, equipment, protocols, referral – Fixed vs mobile clinics • Tips & tricks - evidence base – Ag Fl, St/St crowns – Single visit endodontics Aboriginal Child Oral Health Aboriginal Child Oral Health • Unmet need, caries prevalence and severity of caries experience among Australian Indigenous children attending the SDS, were consistently higher than that of non-Indigenous children for all ages, type of dentition and location. ARCPOH 2014 Aboriginal Child Oral Health • A cross sectional study of pre-school Aboriginal children preschoolers in remote, rural and metropolitan NSW. • High prevalence of dental caries, mostly untreated. Smith et al. 2015 • Aboriginal children had 1.9 times the dmft and twice the DMFT of non-Aboriginal children. Arrow 2016 Aboriginal Child Oral Health ARCPOH 2014 2008 National Indigenous Health Summit 2008 Oral Health Policy Summary: Oral Health Goals • • • • • Fluoridation Workforce Oral health promotion National goals and data collection Culturally appropriate oral health services Oral Health Goals: Fluoridation • Greatest public health measure of the 20th century. • Decay reduction - 60% child, 40% adults. • Benefits to cost ratio 40:1; $1 spent = $40 less disease reduction • Cost ratio positive in small communities of 1000. Higher cost ratio in Indigenous communities with higher decay levels. Oral Health Goals: Workforce • More Indigenous people in the oral health workforce. • Australian workforce insufficient for current demand. • Long term under funding of oral health education. • Shortage of dental educators. • Cultural safety. Oral Health Goals: Oral Health Promotion • Coherent oral health promotion strategy. • Integrated within other health promotion activities: – Healthy food, – Tobacco control, – Oral hygiene. Oral Health Goals: National goals & data collection • National goals for Indigenous oral health, – Use quality of life indices such as the oral health impact profile. • Indigenous oral health data set. Oral Health Goals: Culturally appropriate oral health services • High quality, comprehensive and culturally appropriate oral health care. • Partnerships between Indigenous specific and other providers at a regional level. • Improved access and outcomes. Aboriginal Child Oral Health • ‘Social isolation, culturally inappropriate oral health service provision, remote location, no access to fluoride, and exposure to westernized diet.’ ARCPOH 2014 • When ‘SES was controlled for, Indigenous children had up to three times the dental disease experience of non-Indigenous children’. More about the ‘ongoing impacts of colonisation, discrimination and marginalisation on the Indigenous population’. Jamieson et al. 2007 Australian Early Development Census • • • • AEDC every 3 years All children in first year of school 96% in 2015, n>300,000 Developmental vulnerabilities – Physical, social, emotional, language & communication • Vulnerable on 1 or more domains? – 42% Indigenous vs 20% non-Indigenous Child protection services • Protect children and young people aged 0–17 years – at risk of abuse and neglect – Includes emotional abuse and neglect – Drug/alcohol abuse, mental illness and family violence • Concern reports – Mandatory reports – General public – 18,000 / year ACT • Investigation and assessment of each report – parent willing and able to protect? – Family support services to build capacity Child protection services • Trauma informed approach – Developmental risk to young children – Drug/alcohol abuse, mental illness and family violence • Child removal – out of home care – – – – – • • • • Emergency action – 48 hours Children’s court – magistrate Legal representation, parents & independent child solicitor Independent oversight, decisions appealable 12 months before orders to 18 years Kinship care Foster care Residential care Adoption or enduring parental responsibility orders Child protection services • • • • Over 700 ACT children in formal out of home care 25% Indigenous Most in kinship care, majority with Aboriginal family Strategy to reduce intake, launched 2015 – Reunification • Newpin – More support for at risk families • In home supports – Strengthening Vulnerable Families • Out of home support – Karinya House Child protection services • Clinical implications – Parental responsibility • ACT changes – Child behaviour management • History of emotional trauma • Different behaviour – Learned that adults are not reliable – Hard to self manage emotions – Poor response to attention withdrawal Future • Reconciliation – Acknowledgement – Apology – Atonement – Forgiveness • Constitutional change • Treaty or treaties References • • • • Arrow, P. 2016, Oral health of schoolchildren in Western Australia. Australian Dental Journal, 61: 333–341. doi:10.1111/adj.12368 Australian Research Centre for Population Oral Health 2014, Oral health of Australian Indigenous children compared to non-Indigenous children enrolled in school dental services. Australian Dental Journal, 59: 395–400. doi:10.1111/adj.12205 Jamieson, L. M., Armfield, J. M., & Roberts-Thomson, K. F. 2007, Indigenous and Non-Indigenous Child Oral Health in Three Australian States and Territories. Ethnicity & Health, 12(1), 89-107. doi:10.1080/13557850601002197 Smith, L., Blinkhorn, A., Moir, R., Brown, N., & Blinkhorn, F. 2015, An assessment of dental caries among young Aboriginal children in New South Wales, Australia: a cross-sectional study. BMC Public Health, 15, 1314. http://doi.org/10.1186/s12889-015-2673-6