In three diverse locations in Australia, a new Indigenous education program conceived in the US is achieving unprecedented success in engaging mothers of Indigenous newborns. Quest travelled to central Australia to meet program worker, Carmel Barry and participant, Sylvia Drover.
Sylvia arrives to tell her story at the Old Telegraph Station on the parched red banks of the Todd River, Alice Springs with one-year-old Marika, her cherubic fourth daughter, on her hip. Sprawled on a picnic rug in the bright winter sun, the baby does not give her a moment’s peace, but her scrambling interruptions are fitting, as Marika is the key to her mother’s learning.
Sylvia is one of the first round of participants of an intensive mothers’ education program based on a model that has been highly successful in the US for over thirty years. The Australian Nurse-Family Partnerships Program (or FPP, as it is locally known) is run by Central Australian Aboriginal Congress and provides two years of home-based education for mothers of Indigenous babies.
Women enrol when they are three months pregnant and are visited fortnightly by a dedicated nurse-educator until they graduate when their child turns two. The FPP differs from other home-visit programs in that it is primarily focused on the mother rather than the baby.
Sylvia was paired with program worker, Elise, eighteen months ago. “Elise takes all the things to do. Pictures, photos, activities—all part of the learning,” says Sylvia.
Nurse, Carmel Barry describes the sessions. “We sit with people for up to an hour and a half and talk about a certain topic, depending on their stage in their pregnancy or the baby’s age.”
The content for each visit is highly structured around six learning domains, adapted for an Australian context. The first is Personal Health, which encompasses emotional health and substance use. Where literacy is a barrier, nurses use pictures to represent concepts such as foetal nutrition. “The women are fascinated,” says Carmel. “If they eat oranges; that contributes folic acid to help the baby’s spine to grow healthy. We haven’t given them enough credit in the past to want that information.”
Part of the program’s approach is to specifically ask participants what they want to learn about their own health. Carmel describes one woman for whom this was a challenge. “I wasn’t sure what she needed from this program because she seemed pretty together. She didn’t smoke or drink or have a violent relationship. I laid down a heap of cards and asked her what she wanted to learn about. And she picked out that she wanted to make friends. She had three children, heavily pregnant and stuck in the home. She was isolated and it was affecting her health. I thought what am I going to do about this?”
Carmel invited the woman to the FPP Christmas party to connect with others on the programme. “Now she’s joining an exercise group, she’s lost weight, she’s breastfeeding her baby, which she hasn’t done with the others. She feels very proud of herself. It’s a transformation. I just shake my head and go, I can’t believe it.”
For Carmel, the goal-identification is key. “I’ve worked in this area for fifteen years and we’ve never actually sat down and asked people what do you want? I’ve been struck by how important it is to give people the time to say what they want. I could have gone on visiting and not really been aware of what was at the heart of what was hardest for her.”
The Environmental Health domain encompasses safety in the home and housing needs. “Most women that I visit don’t have their own home, so it’s like Maslow’s triangle of needs,” says Carmel, “there’s no point talking about caring for the baby if they don’t have a house, and the same with their study desires.” Where the home environment is not conducive to learning, nurses often drive the women to local parks or cafes for sessions.
The Maternal Roles domain talks about baby’s needs and development, which teases out into playing and floor time. The fourth domain is Life Course Development, including baby spacing, managing fertility and accessing courses or study. Again, the nurses begin with basic questions; “How many children do you want to have? Do you have a desire to finish any education or start a course? And that process is really amazing. Women are telling us that they do want to study,” explains Carmel.
Part of the nurses’ role is to be aware of further learning opportunities available in the community, but this has presented some challenges in Alice Springs.
The strong network of community colleges and neighbourhood houses that exists in several other states is not as established in the Northern Territory. This narrows referral options for workers such as Carmel. In Alice Springs, community education is largely provided by bigger institution such as Bachelor College.
“It’s been hard for these mothers to access learning at a training organisation because the services are not very flexible. We get a bit frustrated because women tell us they want to study, but to actually get them to link in and sustain it is very difficult. They often don’t have access to transport and they have to manage their children’s care.”
When Carmel connected with Angela Harrison, literacy teacher at the Bachelor Institute, she found someone who was willing to try and address these barriers
“Ange was one of the only ones that really understood what this group needed,” explains Carmel. “She sat down with the women and she said how can we get you here? What’s going to make that possible?”
Angela went on to organise a literacy program where mothers could bring their babies and arranged a bus. “Getting access to that bus was not easy,” says Carmel. “Whether due to funding constraints or priorities, the bigger training organisations seem generally unable, or unwilling to give the support needed for these people to be able to undertake study.”
The last two learning domains are Family and Friends, which is about relationships and Health and Human Services which links families into what’s available in the area, such as libraries, local transport etc.
The FPP program is currently being run in Wellington, NSW and Cairns, QLD but it has been taken up particularly well in NT with over 100 clients on the program. “We’ve now got people that self-refer,” says Carmel. “It’s gaining a name of its own.”
In America, the program is called the Nurse Family Partnership Program and was developed by David Olds. After thirty years of longitudinal research, it has been shown to produce dramatic affects including improved prenatal health, fewer childhood injuries, fewer subsequent pregnancies, increased intervals between births, increased maternal employment and improved school readiness.
Follow-up research continues today, studying the long-term outcomes for mothers and children in three separate ongoing trials.
As well as the longevity of the program, Carmel also attributes its success to the relationship that is built between client and educator. “You’re very close by the end of the two and a half years. I think the trust is important.”
Sylvia concurs; “She’s been really good to me; Elise. She makes me laugh. Talks stories. Makes me happy.”
Although the workers on the program are nurses, not educators, there is no clinical component to the visits. They are there purely to facilitate learning.
“Elise changed my life,” says Sylvia.
“These women totally inspire me with their uptake of information,” says Carmel. “I drive away thinking I can’t believe this! This has been a pretty hard group in the past but it’s not very hard to visit them. It’s easy on the whole. Despite the fact that they’ve got so much going on in their lives, they’ll make room for us because they feel it’s valuable.”
Currently, like many mothers, Sylvia is fully occupied by the demands of caring for young children, but one day she’d like to return to learning. “I’d like to do more reading and writing. Listen to what people are saying and doing. I’d like to go back to school.”
Carmel describes the program as a strengths-based model. “We walk beside the woman because she’s having a baby, not a crisis or a mental illness. Not because something is wrong.”