I think the major issues, or some of the problems with the current approach for example have been that it's a unilateral decision, that there's been very little consultation between government departments let alone with any Aboriginal communities or organisations. Ngiare. Everyone agrees that rebuilding a future for the victims of abuse is a slow and difficult process. Norman Swan: Is there any evidence Ngiare that the advent of this Medicare number and in fact it's quite a comprehensive form I've got it with me just now, that people have to fill in to do this Medicare check, is there any evidence that the uncovering and documenting of the health issues that a child may have is translating to better care? Helen Milroy: Yes I did Norman. Last Aired Thursday 14 June 2018 — NITV. They are resigned to their lot as prey to the monsters who live among them. And at the university level we often have to give them an extra year of study just to up skill the educational deficits that they've been receiving within our education system. Judge me all you want, but this is a major part of who I am and I am done keeping it inside.

Ngiare Brown: That may certainly be the case, what exists in the Northern Territory and few people know about is that there's actually a Medicare item number now anyway for child health checks which is promoting the concept of comprehensive primary health care for children and all other community members for example. What's an evidence-based response?

And they are actually finding that it has remained static or in fact in some instances they've gone backwards because they've been stripped of any control or ability to participate in decision making processes, they've had administrators in and basically we've regressed in terms of how we're treating those communities. ... Country Australia. Helen Milroy: Oh I think we've had a massive underspent given the level of burden that's there and the actual level of intervention that would have been required to turn this around.

What the survey did show in terms of volume too which was on social and emotional well being and mental health was that Aboriginal children were at increased risk for these sorts of difficulties.

Helen Milroy: Yes, and if schools worked really well that probably would be the case but certainly working in my clinical service I see a lot of children whose experiences within the schooling system are quite discriminatory and their experiences in school are not supportive or nurturing. Deputy Director of the Centre for Community Child Health Royal Children's Hospital Melbourne, Child and Adolescent Psychiatrist Centre for Aboriginal and Dental Health University of Western Australia Perth, Senior Research Fellow Supported by the Telethon Institute for Child Health Perth Dr Brown is based at the Menzies Institute in Darwin. Norman Swan: Helen you've spent many years as a forensic doctor working in sexual abuse. And so right from as I said pre-school, all the way through to secondary school there's been a huge problem in Aboriginal communities with children actually attending schools and there's been a variety of programs to try and encourage that a bit more. My understanding is there isn't really a test for sexual abuse unless it's in the situation that Helen was talking about where it might have been acute.

The nature of the offences, involving the rape of girls and boys, indecent sexual assault and indecency, are scarcely believable, and yet, damningly, all too familiar and believable — a four-year-old girl raped, another girl, aged seven, diagnosed with chlamydia. What will work, what won't, how to make life safe and build for the future and whether significant action such as we're seeing now might not be the circuit breaker that's needed.

Because that's really the objective data we've got and people say it may or may not apply elsewhere in Australia. The evidence pointed to children living in "dysfunctional communities where there is considerable violence and fear, drug and alcohol abuse and a sense of hopelessness.

And these are the diseases that actually plague our communities. This had been presented to the Chief Minister of the Northern Territory on 30 April 2007 and publicly released on 15 June 2007. South Australian Premier Mike Rann has sent police and child protection officers to APY communities and federal Indigenous Affairs Minister Jenny Macklin has weighed in with initiatives such as the building of a new police station.

Helen Milroy: If I can just add a comment there, there's certainly enough evidence now to say that for those children who grow up in chronically stressful situations they're much more at risk of chronic disease, things like diabetes, heart disease, depression. Once again disturbing evidence of sexual abuse of indigenous children has been revealed, this time in South Australia. So I think it's a two way street and we have a lot to offer to the rest of the community. Perhaps "growing up" is too optimistic a term. In this program we try to clear away the emotion, the hype surrounding the Australian Government's emergency response to child sexual abuse in Aboriginal communities. So for instance if it goes unchecked throughout childhood and you get into adolescence you're going to get a lot more acting out behaviour in adolescence if there's been those unresolved issues in childhood. But on skinny resources when they're under-staffed and under-supported they're providing the bare minimum they are not able to provide comprehensive primary care and they either have permanent nursing staff and Aboriginal health workers for example with fly in/fly out DMOs or District Medical Officers with some specialist outreach service support on any regular basis for example.

Jill Sewell: That's true Norman, if there's an acute situation where trauma has occurred then there may be some obvious signs of sexual abuse but most of the children who are referred to sexual abuse agencies through the health system either there's been an allegation maybe of sexual abuse or the child may be displaying some behaviours which are a little bit unusual where sexual abuse might be thought of as a possibility. But what would be a typical back up primary health care service in a remote community? And so the general principles are about making it a political priority, are about having cross jurisdictional responsibilities, about funding to meet the level of need and reduce disparities, workforce issues, environmental infrastructure and all of these could have been met from a small percentage of our budget surplus for example. When I was a GP early in my career in medicine I spent five years working at the Children's Hospital in the child sexual abuse clinic and so I saw a number of children over those five years. Speaking on the report in Parliament, Mr Rann said he was "sickened" at its contents and he urged members of the communities to give evidence "so we can lock the bastards up".

We have to assume that the Prime Minister is deeply moved by this, you cannot but be deeply moved from reading this report that the Minister for Aboriginal Affairs is also moved by this, and they want to do something, they want to get rubber on the road here and they are going to try and make things safe. With me here in Perth is Child and Adolescent Psychiatrist Associate Professor Helen Milroy who runs the Centre for Aboriginal and Dental Health at the University of Western Australia. I think that the link between early childhood disadvantage and later significant health diseases like cardiovascular disease and diabetes is very much through education. Norman Swan: Helen Milroy, schooling was certainly a strong emphasis in the Little Children are Sacred Report, many of the recommendations relate to school as a … Helen Milroy: It can be very difficult, it's very emotionally distressing for the children and the families who are sometimes brought in, sometimes the families present themselves, sometimes they are brought in by child protective services. Download Little children are sacred.

Ngiare Brown: That's one model of it absolutely but it would be the communities who identify their priorities and how they would like those services to be set up so that they are accessible and available, appropriate and a culturally safe environment and then are best able to integrate with other sectors of health and other jurisdictions.

Ngiare Brown: I have, now if it were up to me then certainly I would be investing in comprehensive primary health care services with community control and input and the integration of those services. We have over 30 years worth of reports and framework agreements for example that identify not only the issues and their disparities but identify appropriate and achievable remedies. We're talking about the Little Children are Sacred Report and the interventions that are occurring under the emergency response from the Federal government. Ngiare's interests revolve around Aboriginal health and human rights - welcome to you all. What's next if you were giving the advice about where investment goes given the multiplicity of problems and the fact that we should focus on early childhood? When a pattern of behaviour becomes entrenched in a community it can seem the norm, and what has to be changed is breaking that mould of perception. And quotes Fred Chaney in front of the report, a former liberal minister who's recently retired from the National Native Title Tribunal who said, and they quote and I quote, "once you try to do it by remote control through visiting ministers and visiting bureaucrats who fly in and fly out, forget it". Some of the abused were younger than 10 and many, the report said, probably had been abused repeatedly. What's an evidence-based response? It stresses at the outset that what's needed are local solutions with outcomes to find locally and owned by the community.
Jill Sewell: That would certainly be my advice, I think if this is going to happen then a general health check which would include a good history and an understanding of the child's circumstances and environment and checking in the usual sort of way for the high risk things that we would think about in Aboriginal communities such as ear infections and eye infections and skin infestations and nutrition and growth with a careful ear out for possible abuse situations but certainly not going directly for that. So I've been waiting to get this out for a while, and now I'm going to. (13.43 MB).

What did that find in terms of the prevalence of problems and the issues? And in which case the children are referred to a specialised paediatric forensic service who use specialised equipment to do it because if you do have to do a specific examination you need to do it once, and you need to do it well, and you need to be able to collect the forensic evidence that you need at the same time.

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