Download Early childhood oral health in Aboriginal

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:
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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
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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
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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
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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
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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
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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