Public hearing 16: First Nations children, Virtual - Day 2

CHAIR:  Good morning, everybody.  I invite Commissioner Mason to make the Acknowledgment of Country.

COMMISSIONER MASON:  Thank you, Chair.

We acknowledge the first Nations people on the land on which this Royal Commission is sitting.

Nganana tjukarurungku kalkuni Anangu kuwaripa tjara nyinantja tjuta, ngura nyangangka.

We recognise Meeanjin, Brisbane.

Nganana ngurkantananyi ngura Meeanjin nga Brisbane ta.

We recognise the country north and south of the Brisbane River, as the home of both the Turrbal and Jagera Nations.

Nganana ngurkantananyi karu panya Brisbane River nya alintjara munu ulparira Anangu nguraritja tjuta nyinantja munu kuwari nyinanyi Turrbul nga munu Jagera nya.

We pay respects to the Gadigal people of the Eora Nation.  Their land is where the city of Sydney is now located.
We also pay respect to the Wurundjeri people of the Kulin Nation where the city of Melbourne is now located.

We pay deep respects to all Elders past, present and future and especially Elders, parents and young people and children with disability.

Thank you, Chair.

CHAIR:  Thank you, Commissioner Mason.  Yes, Mr Crowley.

MR CROWLEY:  Chair, we are getting some feedback at this end.  We are having some audio issues.

CHAIR:  I can hear you.

MR CROWLEY:  We are getting feedback at this end.

Chair, this morning the first session we have will be the evidence of Grace, who will speak about the experiences of Miriam, who was in her care.  That evidence will be dealt with by Ms Tarrago, who is calling Grace.

We are having some audio difficulties at this end.

 
CHAIR:  Shall we adjourn for a couple of minutes to see if that can be rectified?

MR CROWLEY:  Yes, because we are getting a reverberation at this end.

CHAIR:  Yes, We will adjourn and we will reconvene when someone lets us know that things have improved.

ADJOURNED    [10.03 AM]

RESUMED    [10.07 AM]

CHAIR:  Yes, Ms Tarrago.

MS TARRAGO:  Commissioners, this morning we will hear from Grace, who appears on the screen, who is the former carer of Miriam.  Grace will tell us about Miriam's out of home care experiences in the Northern Territory.  Her statement is at tender bundle part A, tab 50.  There are also a number of other documents that will be tendered in due course.  I understand Grace will be talking an oath this morning.

CHAIR:  Do you wish to tender Grace's statement at this stage or do you wish to do that later?

MS TARRAGO:  At a later point, Chair.

CHAIR:  Grace, thank you very much for coming to the Royal Commission to give evidence.  We appreciate your attendance.  If you would be good enough to follow the instructions that will be given to you for the administration of the oath.  Thank you very much.

"GRACE", AFFIRMED

CHAIR:  Thank you, Grace.  Just to explain where we all are, because it is a little complicated, there are three Commissioners at this hearing:  Commissioner Galbally is in Melbourne, Commissioner Mason is in our Brisbane hearing room, I am in the Sydney hearing room.  Ms Tarrago, who will now ask you some questions, is also in the Brisbane hearing room, and you are somewhere else, I assume.

GRACE:  Yes.

CHAIR:  Thank you.

 
EXAMINATION IN CHIEF BY MS TARRAGO

MS TARRAGO:  Grace, before I start, you have made a statement for the Royal Commission?

GRACE:  Yes.

MS TARRAGO:  That is a 25 page statement, dated 15 September 2021?

GRACE:  Yes.

MS TARRAGO:  Are the contents of the statement true and correct, to the best of your knowledge and belief?

GRACE:  Yes.

MS TARRAGO:  Chair, I tender the bundle part A at Tab 50 and ask that it be marked Exhibit 16.7.

CHAIR:  Very well.  The statement of Grace will be admitted into evidence and marked as Exhibit 16.7.

EXHIBIT #16.7   WITNESS STATEMENT OF "GRACE" DATED 15 SEPTEMBER 2021

MS TARRAGO:  Chair, I also tender 103 documents which relate to Miriam, which also includes a pre recorded statement from Miriam herself.  The materials are in Tender Bundle Part A, tabs 51 to 154.  I ask that those be marked Exhibits 16.7.1 to 16.7.103.

CHAIR:  Yes, the documents to which you have referred will be admitted into evidence and given the markings you have indicated, namely, 16.7.1 to 16.7.103.  Thank you.

EXHIBITS #16.7.1 TO #16.7.103   DOCUMENTS RELATING TO MIRIAM INCLUDING PRE RECORDED STATEMENT FROM MIRIAM

MS TARRAGO:  Thank you.  In tendering these materials, I draw attention to the pseudonym direction, which is document CTH DNP.00099, which is in place in relation to the identities of certain witnesses, including Grace and Miriam, as well as Caleb and Caroline.

 
CHAIR:  Thank you.

MS TARRAGO:  Grace, I would like to start off by asking some questions about yourself.  You are not a First Nations person?

GRACE:  I'm not.

MS TARRAGO:  You are a mother of three adult children?

GRACE:  My biological children, yes.

MS TARRAGO:  You are also a qualified teacher?

GRACE:  Yes.

MS TARRAGO:  How long have you worked as a teacher for?

GRACE:  I mainly --- a few years in Alice Springs, more relief teaching and release teaching part time.

MS TARRAGO:  Do you still teach?

GRACE:  No.

MS TARRAGO:  You also spent several years in the Victoria Police?

GRACE:  Yes.

MS TARRAGO:  For the most part, in recent times you have been a foster carer for many years?

GRACE:  Yes.

MS TARRAGO:  How many children would you say you have fostered over your lifetime?

GRACE:  About 33 children in Victoria; in the Northern Territory, there were possibly up to eight.

MS TARRAGO:  Over what period of time have you been a foster carer?

GRACE:  From around 2003 until I resigned in 2016, on and off, yes.

MS TARRAGO:  You are currently the guardian of Caleb?

GRACE:  Yes.

 
MS TARRAGO:  Caleb is a young person who you initially fostered and now have guardianship?

GRACE:  Yes.

MS TARRAGO:  Caleb has a disability?

GRACE:  Yes.

MS TARRAGO:  Are you able to explain his disability for the Commissioners?

GRACE:  Caleb has foetal alcohol spectrum disorder, he has ADHD and ODD, which is oppositional defiance disorder.  That was diagnosed in 2018.

MS TARRAGO:  Can you tell the Commission a little bit about Caleb, who he is as a young person?

GRACE:  Caleb is an outgoing, very social, friendly young man, very sporty.  He's actually competing in sports, representing his state today.  He's loving, he's affectionate, he's just a gorgeous young man.

MS TARRAGO:  From time to time, you were also caring for his older sister, Miriam?

GRACE:  That's right.

MS TARRAGO:  Miriam has been reunified with her family and is no longer in care; is that right?

GRACE:  Yes.

MS TARRAGO:  Miriam and Caleb are both First Nations children?

GRACE:  Yes.

MS TARRAGO:  Today you have been given permission by Miriam and Caleb's mother to speak on her behalf about her children?

GRACE:  Yes.

MS TARRAGO:  Why is that so important for you to have that permission?

GRACE:  That has always been important for me --- to me.  I have always worked with the families, with their children, and always been in communication, and I still am.  They ring me regularly, Caleb sees his family regularly, they have come and stayed with me, and we see them --- now that we are relocated, we still see them probably every 10 weeks in Alice Springs.
 

MS TARRAGO:  Grace, I would like to ask you some questions about how Miriam and Caleb came to know you.  You were based in Alice Springs, working at the Central Australian Aboriginal Congress?

GRACE:  Yes.

MS TARRAGO:  When did you start working there?

GRACE:  It would have been 2008 for about, I think, 18 months.

MS TARRAGO:  What was your role?

GRACE:  My role was to go into --- it was a new program, I believe, and it was to go into the town camps with a list of children that needed following up for ear health, called otitis media.

MS TARRAGO:  How did you come to know Miriam's family?

GRACE:  Through that and also through my church.

MS TARRAGO:  Who was Miriam living with at the time?

GRACE:  Her grandmother, who was actually her grandfather's sister but always called her grandmother.

MS TARRAGO:  After that time, you were then asked to care for Miriam?

GRACE:  Yes.  I received a phone call one day from her great aunt, another lady who I knew really well through the church, and she asked me to help out because Miriam wasn't sleeping and wasn't getting taken to school and it was important to that family that she attend school.

MS TARRAGO:  Was it your understanding that, at that point, it was just caring for Miriam on a short term basis?

GRACE:  I did ask them about that.  I said, "She can come for a holiday and I can help you out."  I went to see them and speak to them about it and that was always my understanding, yes.

MS TARRAGO:  Do you remember how old Miriam was at the time?

GRACE:  Yes, she had just turned five.  She was born in 2006.  She had a birthday in January, she came to me in February 2011.

MS TARRAGO:  When you started caring for Miriam, was the Department of Territory Families involved at that stage?
 

GRACE:  No.  Yes, they were, but I didn't know that.

MS TARRAGO:  After a couple of weeks, the Department informed you they were Miriam's guardian?

GRACE:  After a few weeks, I had a phone call.  I did ask the family and they told me she wasn't with the department, but I got a phone call to say, "Return her immediately to her grandmother", which I did.

MS TARRAGO:  In 2011, Caleb was born?

GRACE:  Yes.

MS TARRAGO:  You became his foster carer at that point in time?

GRACE:  No, not quite that point in time.  It was quite a process.  The family had told me that I was to grow that boy up, even when he was not born, I knew his Mum then.  And it was --- he was in hospital for three months before I took his sister Miriam to see him.  And then I just went through the process of getting --- becoming an official foster carer, so I could look after him.

MS TARRAGO:  Why was Caleb in hospital at the time?

GRACE:  I believe it was --- he had a heart operation when he was about six weeks old.  He had been down to Adelaide the day he was born and then he went to Melbourne when he was six weeks old for a heart operation.  And I believe it was because --- I think it was because the Department had taken him when he was born and I think that's why the family asked me to have him, because they knew he was going to be taken, and I think he was waiting there for a foster family.  That was my understanding.

MS TARRAGO:  In 2013, you were granted sole custody and legal guardianship over Caleb?

GRACE:  Yes.

MS TARRAGO:  At that stage, you hadn't applied for the same with Miriam?

GRACE:  No, I never applied officially, no.

MS TARRAGO:  Was there any particular reason at that point in time?

GRACE:  It was a totally different set of circumstances.  Caleb had some major heart issues and the family recognised that they couldn't give him that level of care.  It was always meant to be a long term proposition with Caleb.  With Miriam, she was always meant to go back to her grandmother, I thought.
 

MS TARRAGO:  You formally started caring for Miriam as a foster carer.  In your statement you talk about her staying with you for about 12 months until she wanted to return to her grandmother?

GRACE:  Yes.

MS TARRAGO:  During the period she was in your care, did you notice any problem with Miriam and your children?

GRACE:  Not initially.  I think that was the time it came out that the Department was starting to push for long term care and I approached my older children about that and that's when it came out that there were some major problems going on that I really hadn't, unfortunately, picked up on particularly.  There was some victimisation going on for my 15 year old daughter and as a result of that information, my daughter started to get some psychological counselling.  In that counselling ---

MS TARRAGO:  Would you like to take a short break?

GRACE:  In that counselling, the psychologist told me I had to choose between the two of them.

MS TARRAGO:  Are you okay?  Would you like to have a little break?

GRACE:  No, I'm okay.

CHAIR:  It's perfectly alright to take a break if you would like to.  Why don't we take a break for five minutes or so and then we will resume.

MS TARRAGO:  Thank you, Chair.

ADJOURNED    [10.21 AM]

RESUMED    [10.24 AM]

CHAIR:  Thank you very much, Grace.  If you need at any time to take a break, please let us know.  I will now ask Ms Tarrago to continue her questioning.

MS TARRAGO:  Thank you, Chair.

Grace, you were talking about some behaviours.  Can I also ask whether at that point in time you had been advised by anybody whether Miriam had been the subject of any sexual assault or abuse allegations?

 
GRACE:  No, not at that time, no.

MS TARRAGO:  Some time after Miriam left your care because she wanted to return to her grandmother; is that correct?

GRACE:  Yes, and her grandmother agreed to have her back, yes.

MS TARRAGO:  Also during that time Miriam was in your care, were you advised by the Department whether Miriam had any health conditions at that point?

GRACE:  No.

MS TARRAGO:  I would like to ask you some questions about Miriam's time in the group home.  Could you tell the Commissioners how that came about?

GRACE:  Sure.  From what I know, my understanding, it wasn't all to do with me because she wasn't with me at the time, but she was to go back to her grandmother.  Then I found out a long time later that that was never going to happen.  She then went to another foster carer, I think until the foster carer was --- until her Aunty was ready to have her.  Then, sadly, I think that was the time her foster carer was going overseas and her family didn't want Miriam to go with her, so I think --- and then it fell through with the Aunty as well, so I think then it went to --- that's when I found out that Miriam was going to what they call, what they told me was a safe home, which I later found out was a group home.  I was really, really upset and I spoke with her grandmother.  I believe her grandmother spoke to the Department, but I certainly did and I sent emails, asking for that little girl --- she was only seven, just turned seven.  And I heard that --- anyway, a little bit into that time, one of the Department workers rang me and asked me if I could have Miriam one night a week, I think it was, and I said yes.  That's when I noticed that Miriam was more and more reluctant to go back and she started to share some stuff with me that was happening at the home.  There was a lot of teenagers at the home.  She was the youngest, and she was saying that they would slide under her shower and join her in the shower, that they would pick on her, that they would chase her.  There was nowhere safe she could go.  So I tried to help her and say, "Go and speak to the workers," but there was no safe place for her to run to.

Finally, it would have been after maybe a couple of months, I rang the Department and said, "Look, please can she stay with me until her foster carer gets back?", and they said "No."  I said, "Well, she can't go back, she's not safe there", and they wouldn't allow it.  I said, "All right, I will bring her back but I'm going to go via the police station and make a statement about the bullying that's going on", and that's when they said she could stay with me until her foster carer returned.  That's my recollection.

MS TARRAGO:  How old was Miriam at the time?

GRACE:  She would have been still seven.
 

MS TARRAGO:  Sorry, we didn't quite hear that.

GRACE:  Seven.

MS TARRAGO:  Did you have any discussions with her carer around that time with respect to the bullying?

GRACE:  I would have had at some point.  I don't remember a lot of that.

MS TARRAGO:  So Miriam ultimately returned to your care.

GRACE:  Actually, sorry, yes, I did with the foster carer because I remember her saying to me that she had come back from the home a broken little girl.

MS TARRAGO:  Did you have any explanation why she was a "broken little girl"?

GRACE:  I think just because of the ongoing bullying.

MS TARRAGO:  Were you aware of any other behaviours at that time that Miriam might have been displaying?

GRACE:  Yes, the foster carer started to share with me more and more how hard it was and how difficult she was and she was bullying --- she started bullying one of the carer's children, another foster child who was a lot older than Miriam and things were becoming very, very difficult there.  And I remember how upset the carer was and she would go to the Department and ask for help and she just didn't know what to do, and she was getting blamed, I believe, for her parenting and it became a total mess.

MS TARRAGO:  I want to take you to 2016, and Miriam is in your care, and a road trip that you had planned.

GRACE:  Yes.

MS TARRAGO:  Can you tell me what you had discovered about Miriam during that time on the road trip?

GRACE:  Sure.  She was becoming --- I discovered that she was actually what we call sniffing volatile substances, and when I did find this out --- and possibly chroming, which is aerosol cans.  When I found this out, I immediately told the Department.  In a way, I was thinking we've got something we can work with now, we can get this child some help and support.  I was so concerned for her that she receive that support.

MS TARRAGO:  In your statement you talk about the chroming and sniffing of volatile substances to have been linked to her time in the group home.
 

GRACE:  Yes, that's right.  She told me --- I said, "How did you learn how to do this?", and she said, "The kids taught me in the group home."

MS TARRAGO:  Did you receive any supports to deal with that particular issue?

GRACE:  No.

MS TARRAGO:  Do you remember whether there was any referral to drug and alcohol substance abuse centres or services?

GRACE:  I remember they, the Department, mentioned a --- I think it was --- what was it called?  Anyway, I rang them, the volatile substance abuse people, and I spoke to someone.  I forget his name now.  So I did all the follow up, and then I booked her in for counselling with a counsellor for it.  At that counselling appointment, one of the Department workers turned up and he sat in on the appointment, and that's where she disclosed to the counsellor that she had learned to sniff at the group home.

MS TARRAGO:  Did she disclose anything else with respect to sexual abuse at all at that point in time?

GRACE:  Not to the counsellor.  She disclosed that to me Easter 2016.

MS TARRAGO:  Just going back to the volatile substances, were there any instances where Miriam whilst in your care, had been caught using?

GRACE:  Yes.

MS TARRAGO:  What happened on that occasion?

GRACE:  I just spoke with her and asked her what was going on and that's when she talked to me --- she didn't talk to me about it straight away but, yes, I tried to manage it.  I tried to remove the stuff that --- it's pretty tricky.  Every time she went to someone's house, she could take stuff from their office and stuff.  So it was a little bit hard to manage, but I tried.

Then we were supposed to go up to Darwin but I got to the turn off to Alice Springs from Queensland and I said, "No, we're going home to get you the help you need", and we cut our trip short and went straight back to Alice Springs.

MS TARRAGO:  Did you receive any advice from the Department about how to deal with Miriam's substance abuse?

GRACE:  I rang the hotline and they told me to just monitor her and not --- and find out where it was that she was using.  And they told me that if she was using, to ring an ambulance and go to hospital.
 

MS TARRAGO:  Did you ever have to call for an ambulance?

GRACE:  I think it was on the Easter Monday morning that I discovered she had been sniffing again and I called for an ambulance then.  They asked me if she had ever been violent and I said --- I didn't want to say yes but I realised that she was becoming quite aggressive, so I said yes, so a police officer attended as well.  I went with her to hospital and that's where I told her she wouldn't be coming back with me for a little while, until she had received some counselling for her sniffing addiction and her sexualised behaviour.

MS TARRAGO:  In respect of the disclosure you mentioned before in 2016, about a sexual abuse complaint, can you tell the Commissioners what happened?

GRACE:  I noticed Miriam leaving Caleb's room one night.  She had no reason to be in there.  I went in and spoke with him and he told me that she --- she had been touching him inappropriately.  I then went out and I spoke to Miriam and she burst into tears and told me what she had done.  She told me that it had happened to her when she was a little girl at the Town camp.

I took some notes and I immediately rang the --- I told her I would have to let the Department know and I immediately rang them and told them what it was, what had happened.  A while after that, I got a call from the police, wanting to interview Caleb, who was I think four --- yes, four at the time.  I took him in and they interviewed him on his own and they also --- I thought they were just talking to me, just to find out what had happened, and they --- I found out later that they investigated me as well.  And yes.

MS TARRAGO:  That's when you say was the first time you became aware she had been sexually abused?

GRACE:  Yes.

MS TARRAGO:  Can you tell the Commissioners about that experience of the police investigation, with respect to how you were feeling when you learned they were also investigating you?

GRACE:  I think the only reason I found out is because I rang the hotline to find out what had happened with that and they said to me, "Oh, don't worry, you're in the clear."  I said, "What do you mean?"  They said, "You've been investigated and you're in the clear."  I said, "Oh."  I wasn't ringing for that, I did not realise that.  Then we had a big meeting with the Department and one of the investigators was there, and it was an emotional meeting, and --- yeah, that's when I realised, yeah.

MS TARRAGO:  I would like to talk about Miriam's return to the group home in 2016.  How old was she at the time?

 
GRACE:  She had just turned 10.

MS TARRAGO:  Had you been given advice by the Department about her being placed in a group home again?

GRACE:  Yes, they told me on the night, I think it was, at the hospital that they were opening up a home just for her.  I told them that she needed to be in a caring family with no children, until the --- she had received counselling and was able to be strong enough and able to be returned to me.

MS TARRAGO:  Notwithstanding that she was no longer in your care, did you have contact visits for Caleb during that time?

GRACE:  Yes.  Yes, that's what I was trying hard to organise.  It was hard to organise that.

MS TARRAGO:  During the period in time when she was in the group home for the second time, her grandmother had passed away?

GRACE:  Yes, she passed away.  She was in a coma for two weeks.  It was almost on the same time that she was --- that Miriam was put into the group home.  I rang the Department and then I went to speak to them, because her grandmother was really her --- she was very close to her.  As far as I know, nothing was said to Miriam until I think it was --- I think she died about two weeks later, the grandmother, and I think it took two weeks for Miriam to be told.  I was really concerned because she went to a state school where kids from that camp were going and I was so worried she was going to be told at the school that her grandmother, who she loved so much, had died.

MS TARRAGO:  Other than being in the guardianship of the Department, her grandmother was the most predominant person in her life who had raised her?

GRACE:  Yes.

MS TARRAGO:  As I understand it, in June 2016 you made a complaint to the Office of the Children's Commissioner for the Northern Territory?

GRACE:  Yes.

MS TARRAGO:  Could you talk a little bit about what your complaint was about?

GRACE:  Sure.  It was about an investigation into the group home.  It was about the sexual abuse and why wasn't I informed about that, especially as I later found out that there had been some disclosures made to the other foster carer that involved Caleb when he was a baby.  That hadn't been passed on to me and I did wonder why, when the Department knew that, because I saw the complaint written by the foster carer then, why she was around Caleb when that had happened.
 

MS TARRAGO:  Do you recall being given a response by the Children's Commissioner?

GRACE:  They said that it was out of time to investigate the group home and they said that on the care plan, the box had been ticked for some sexualised behaviour, I think it was.  When I answered that letter, I said that it wasn't ticked on the first care plan I got, I think it was.  And it also took weeks for me to ask for that care plan.  It wasn't delivered to me on the day when Miriam came back.

MS TARRAGO:  You also met with the Northern Territory Chief Minister, Adam Giles, at the time?

GRACE:  Yes, I did.  I wrote him an email and I met with him in person in the Alice Springs office.  He rang the Department and asked what was going on.  I found out later that the Department was in an --- "uproar" was the word used.  Then he followed it up with a letter, basically saying, I think, that Elferink, the Minister --- it is John Elferink, had been informed and was investigating and it all seemed to be okay.

MS TARRAGO:  Ultimately, you resigned as a carer in August 2016?

GRACE:  Yes.

MS TARRAGO:  How did that affect you, that decision to cease being a carer?

GRACE:  It was a hard decision to make.  I felt that nothing was happening.  I was making complaints, I was talking to people, I was trying to get somewhere, but I think they call it the deafening silence.  When they answered, they said they would ring, they never rang.  It would go ages, I didn't know what was happening, I didn't know where to go.

In the meantime, I'm trying to parent three teenage children as well, and that doesn't come into the equation ever when you are a foster carer, who else you are caring for, who else is part of the family.  It's all just --- sorry, what was the question?

MS TARRAGO:  Just how you felt, making that decision to resign.

GRACE:  Yes.  Yes, it was awful.  I got the Foster Care Association lady to help me.  She advised not to put anything in there, just to basically say I'm resigning now, and I didn't list why, any reasons why.

MS TARRAGO:  Grace, I would like to talk about your concerns that Miriam also suffers from foetal alcohol spectrum disorder, also known as FASD.  What do you know about FASD?

GRACE:  Early days, not a lot.  But the behaviour of the two children --- and as a  
foster carer and also a Mum and a teacher, their behaviour wasn't normal.  It wasn't --- there was something wrong and I wasn't sure what was going on.  It was quite violent, it was quite --- you had the 2 year old temper tantrums that we all know about, but these were meltdowns and these meltdowns would last a long, long time.  There was often a reason for them.  Even if they got what they wanted, they couldn't stop it.  Some of the behaviour was quite destructive.  Miriam would target those who had upset her, in particular my 15 year old, and she would go out and scratch the car or break a window.

And intellectually, struggling at school.  Nowhere near the standard of a grade 3 or grade 4 year old.  I started to question that and look more into it.  I questioned it with her psychologist and I felt bad for questioning it because I felt like they wanted me --- I was labelling this child.  Then I spoke to the Department anyway, and I never got any information back about that.  But in the meantime, I had put Caleb on a waiting list for the Sunshine Coast diagnostic clinic, and we had to wait two years and we got him assessed in 2018.

MS TARRAGO:  When you had initially spoken to the psychologist, what year was that?

GRACE:  About Miriam?

MS TARRAGO:  Yes, about Miriam.

GRACE:  Yes.  I can't remember.

MS TARRAGO:  Was she still in your care at the time?

GRACE:  Yes, she was.

MS TARRAGO:  And ---

GRACE:  Yes, she was.  It would have been maybe end of 2015, maybe.  I'm not sure, sorry.

MS TARRAGO:  That's okay.  Do you know if Miriam has ultimately ever been assessed for FASD?

GRACE:  I doubt it.

MS TARRAGO:  You have spoken with Miriam for the purpose of this hearing about whether she would like to participate.  You have done a short prerecord with her and she has done some art work.

GRACE:  Mm hmm.

MS TARRAGO:  Can you tell the Commissioners what you had asked her to paint?
 

GRACE:  I asked her to paint how she felt when she was removed from her family and from me, because it wasn't just me she was removed from, it was also her Indigenous family, and that was what I was so upset about.  One of the workers told me that the group home kids were now her family and they would actually put their birthday parties over functions with her own Indigenous family.  Her Indigenous family would try to ring and they wouldn't let them talk to her at the group homes.  They were just shut out totally of any decision making, was my understanding, and they were very upset, which is why they wanted the kits with me in the first place, so they could have that ongoing contact.  It just seemed like once they removed the child, they removed them from their previous relationships as well.

And because Miriam was disclosing more and more stuff to me, I think they were embarrassed and worried.  They would come out with, "Miriam doesn't want to see you or her brother anymore."  And that very day, Miriam had managed to smuggle a note to me through another parent, to say, "I'm missing you so much, when can I see you and Caleb?"  The Department would say, "She doesn't want to see you", and I'd say, "I have a note here, the very day you are telling me this."  So that's what I was so upset about, that she was on her own and none of us were allowed to communicate with her, really.

MS TARRAGO:  Could the operator play the pre recorded video of Miriam, at IND.0111.0001.0001?

[VIDEORECORDING PLAYED]

GRACE:  Can you tell me what this picture is about?  You can point to it, if you want.  That one looks really angry, that one there.

MIRIAM:  Yes.

GRACE:  Is that an angry face?

MIRIAM:  Yeah.

GRACE:  This one here, that one looks really sad.  Is that a sad face?

MIRIAM:  Yeah.

GRACE:  Can you tell me why you drew an angry and a sad face?

MIRIAM:  Because I was sad I couldn't see my family, I was sad and angry.

GRACE:  What happened so that you couldn't see your family?

 
MIRIAM:  I was sad and angry.

GRACE:  Yes.  And what happened?  Why couldn't you see your family?  Do you want to say?  Are you sure?  Thank you for drawing that --- painting that.  Is there anything else you want to say?

MIRIAM:  No.

GRACE:  Okay.  Thank you for sharing.

[VIDEORECORDING ENDED]

CHAIR:  Ms Tarrago, can we establish when that was made, that interchange, please?

MS TARRAGO:  Grace, do you recall the date that pre recorded video was made?

GRACE:  It was made the last school holidays, this year.

MS TARRAGO:  Chair, as indicated in the Commission's notes, the date is 12 July 2021.

CHAIR:  Thank you.

MS TARRAGO:  Finally, Grace, there were some recommendations that you made in your statement.  Would you like to share those with the Commissioners?

GRACE:  Okay.  I think one of the important ones is money is thrown at child protection to remove kids, instead of coming alongside the families and helping to keep these families together.  Let's support the families to keep their kids, let's put the money there, especially when --- anyway, that would be one recommendation.

When a child comes into the care of a foster carer, they should go through a health check that can help to identify any significant health conditions, such as FASD, and proper supports be put in place from the beginning.  What a difference that would have made.

I think foster carers should be treated as fellow workers by child protection, that we are working together, that we have the day to day --- we are there day to day with these children, 24/7, and we know them so well.  They need to listen to the foster carers, they need to support the foster carer as well and their family, so they can continue to do what they are doing.  I never made a complaint against a foster carer --- I mean, against a worker until this all happened.  We try to get on, we try to do the best we can.

 
But there is a saying amongst foster carers that if you rock the boat, if you ask for help, if you advocate for the children, you will be discriminated against and you could have the child removed.  And it does happen.

I think that there should be personal accountability for child protection workers.  When they make these decisions, or don't, there should be accountability.  There is another thing: police, if they make the wrong decision, they have to answer for it in court, they can be charged; not hide behind an anonymous department.  I think maybe their decisions would be more accountable if that was to happen.  There are a few more I have listed, but maybe that will do for now.

MS TARRAGO:  Thank you, Grace.  They are all the questions I have.  Thank you, Chair.

CHAIR:  Thank you very much.  Grace, I will just ask the other Commissioners, if it's okay with you, if they have any questions for you.  Commissioner Galbally?

QUESTIONS BY THE COMMISSION

COMMISSIONER GALBALLY:  Thank you so much for your statement.  I would like to follow up that last point you made about advocacy being punished.  I think you said it with regard to foster carers, but would you extend that also to the families, that if they advocate, they are also punished?

GRACE:  Absolutely.  Of course that happens.  If they are struggling --- and a lot --- not "a lot", some of these parents have disabilities themselves and foetal alcohol spectrum disorder themselves, and it is a struggle to parent.  Where are the supports?  Where is the help?  And they recognise it and when they recognise it, well, they came to me and asked me, with Caleb, because they knew they would struggle.  They should be able to go to a child protection place and ask for help and not run the risk that when their kids are going to school, they get snatched from the school classroom or from child care or even in the camps or their houses.

COMMISSIONER GALBALLY:  Thank you.

CHAIR:  Commissioner Mason, do you have any questions?

COMMISSIONER MASON:  Thank you very much for your evidence this morning.  Thank you for your service to our First Nations children and families.

Just a question: you made reference about foster carers being seen as part of the child protection system as workers.  Just a question there around your resignation as a foster carer.  Was there any offer made by the Department to do something like an exit interview?

 
GRACE:  No.

COMMISSIONER MASON:  Would you have taken up the offer if that was given to you?

GRACE:  I think so.  I was still trying to advocate.  Even after I resigned, I kept trying to get access for Caleb.  I knew that Miriam and Caleb still wanted to see each other and they were missing each other.  I still tried to organise that in a supervised --- well, with me supervising, obviously.  But that became more and more difficult.

COMMISSIONER MASON:  The second question I have, Grace: there is now really significant recognition around the role of families and the responsibility of giving their knowledge and skills to a child, as far as developing the child culturally and socially.  In the child protection system, as a non Indigenous person, do you think that same approach and view would be beneficial for foster carers?  You mentioned about the children who are your biological children not being considered in the equation of that process of you being a foster carer.  Do you think, in light of what we know about First Nations families and cultures, that same approach should be given to foster carers who take on the care of First Nations children in relation to all of the members of the household of the foster carer?

GRACE:  Are you saying we should all receive cultural training, so that we can best meet the needs of Aboriginal children?

COMMISSIONER MASON:  Yes, that's right because you are, in a sense, living and are a part of that foster carer's child's life in your home, so all family members have a role to play.  In your experience, was that something that happened in relation to the support given by the Department?

GRACE:  No.  I remember I attended a cultural awareness course at one stage, which was actually quite good, and that was through the Department.  Everything else was done --- we had a lot to do through the church mainly, but a lot to do with Aboriginal kids, through programs we were running through the church, and we were doing language --- learning the languages and trying --- and running bush tucker days and they would teach us, and learning their --- but that all came from me.

COMMISSIONER MASON:  Thank you, Grace.

CHAIR:  Grace, in your statement I think you say that Caleb is now thriving and that is, at least in part, due to him being a participant in the NDIS.  Could you just tell us a little about how that has changed Caleb or assisted in him being what I think you have described as a happy, delightful child?

GRACE:  Because of the NDIS and the assessments that were made, he has been having regular occupational therapy, speech pathology, behavioural therapy.  It's made a huge difference.  He is now able to focus and concentrate a lot more.  He is attending school three days a week and doing well.  He still battles with meltdowns  
but he has strategies in place now to deal with that.  It's made a huge difference from his behaviour before that, yes.

CHAIR:  As I understand your statement, the assistance that Caleb is getting in such things as occupational therapy, behavioural intervention and so forth, followed a diagnosis of foetal alcohol spectrum disorder.  How did that diagnosis come about?

GRACE:  I had him on the waiting list for the Sunshine Coast assessment clinic.  I drove him over there to the clinic.  It was early days for the clinic in Alice Springs, it had only just started up.  So I went over there and I think it went from --- it was three or four days of assessments.  Because of that, too, it made me a lot more aware of how to parent a child with these disabilities, and that's made a profound difference, too, because it's a totally different way than you would mainstream parenting.  So it's been training for me, too.

CHAIR:  I think in your statement at paragraph 147, you say you travelled to the Sunshine Coast for this purpose in August 2018.

GRACE:  Yes.

CHAIR:  This was an initiative that you took yourself, I take it from your statement?

GRACE:  That's right, yes.

CHAIR:  Was there any involvement of the Department in any way?  Did you inform them or did they seek information about this?

GRACE:  No, not at all because by that stage Caleb was --- I had legal guardianship of Caleb and he wasn't in the Department at all.  If he had been, they might have taken him as well, when they took Miriam.

CHAIR:  Could you tell us, so far as you know, where Miriam now is?

GRACE:  Miriam self places.  She was placed back with her mother at the same time her mother was booked in for renal three times a week, so not very well.  Miriam self places and goes from Kintore, Yuendumu and Alice Springs mainly.  She stays with her mother when her mother is living in a house in Alice Springs.  I'm not sure where she stays out in the communities.  She does have family out there.

CHAIR:  The statement from a representative of the Northern Territory says that Miriam's care and protection order was revoked on 19 November 2019.  The documents which accompany that indicate that upon the revocation of that order, she was to be placed with kin, an uncle and an aunt.  Do you know whether that is still the position?

GRACE:  If that's the formal placement, I wouldn't know.  I just got told by the family that she was placed back with her Mum and wasn't with the Department  
anymore.

CHAIR:  Well, we may find out more from the Northern Territory, but once the order was revoked by --- I think there is a reference somewhere to the Family Court, but in fact it was the Family Division of --- family matters jurisdiction of the Local Court of the Northern Territory.  Once the order is revoked, as I understand it --- and I may be wrong --- the Department ceases to have any role in Miriam's care.

GRACE:  That was my understanding, yes.

CHAIR:  But you cannot help us any more with what has happened since that revocation order came into effect, apparently in November 2019?

GRACE:  Well, all I can help with is that she has been self placing, really.  When she's in Alice Springs, I do catch up with her, my family catch up with her, she comes to our house.  She hasn't been going to school since she left my care, really.  Her Mum did ask me to help her get into Wiltshire in South Australia, boarding school, which I tried but because she had no school history by then, that's one of the requirements that she has a school history.  So she hasn't been attending school since --- really, of any significance since 2016, mid 2016.  So she would have been 10.

CHAIR:  Yes.  Was Miriam, to your knowledge, attending a college toward the end of 2019?

GRACE:  Yirara was mentioned last time I spoke to her, that she was going to Yirara at either Yuendumu or Kintore, I think it was, but I have no further information about that.

CHAIR:  I draw to your attention --- and I know you won't have seen the documents --- the affidavit in support of the application for revocation of the order states that there was a school attendance for Miriam of 30 per cent in term 3 of 2019.  But beyond that, I don't know what further information there may be.

GRACE:  I don't know either.

CHAIR:  Thank you very much.  Thank you very much for coming and giving evidence.  I will just ask --- as you probably know, there are parties, usually governments, that have been given what is called leave to appear at these proceedings and that includes the Northern Territory.  I will ask if any of the representatives present wish to ask any questions of Grace.  Specifically, I will ask if the Northern Territory representatives have any questions.

MS CHALMERS:  Yes, thank you, Chair.

CHAIR:  Before we get underway, I would like to know what it is you want to ask Grace, what topics do you wish to cover?

 
MS CHALMERS:  Chair, this is Ms Chalmers from the Northern Territory.  I was going to let you know that we had discussions with Counsel Assisting and sent correspondence to the Commission's solicitors, regarding how we address certain factual disputes in relation to Grace's evidence.  That means we do not need to take up time today and we have not formally sought leave to cross examine.

CHAIR:  Does that mean you do not have any questions of Grace?

MS CHALMERS:  That's correct.

CHAIR:  Thank you very much.  I assume no other representatives have any questions of Grace in relation to the evidence she has given today?

MS FURNESS:  I have no questions, thank you, Chair.

CHAIR:  Thank you, Ms Furness.  I will assume that is the case, unless somebody jumps up and tells us the contrary.

In those circumstances, Grace, thank you very much.  Your evidence has finished.  We thank you for your attendance and we thank you very much for the assistance you have provided to the Royal Commission at this hearing.  Thank you.

GRACE:  Thank you.

THE WITNESS WITHDREW

CHAIR:  Ms Tarrago, will we now take a short break?

MS TARRAGO:  Yes, Chair, if I could recommend until 11.20 eastern standard time.

CHAIR:  It is now 11.10.  Let's make it until 11.25, so if anybody wants to have a cup of tea, they can get the kettle boiled.  We will resume at 11.25.

ADJOURNED    [11.09 AM]

RESUMED    [11.26 AM]

CHAIR:  Yes, Mr Power.

MR POWER:  Chair and Commissioners, we will be hearing from a panel of speakers from the Central Australian Aboriginal Congress.  Before we commence,  
Commissioner Mason wishes to make a statement.

CHAIR:  Yes.  Thank you, Commissioner Mason.

COMMISSIONER MASON:  Thank you, Chair.  Before the next witnesses, I wish to make a brief statement.  As a resident of Alice Springs, as a Ngaanyatjarra woman, I am a member of Central Australian Aboriginal Congress and it is my primary health service provider.  Thank you.

CHAIR:  Thank you very much.  Yes, Mr Power.

MR POWER:  The panel of speakers from Central Australian Aboriginal Congress, known as Congress, are Donna Ah Chee, Dr John Boffa, Amelia Paterson and Hannah Blaine.  They all provide evidence in their capacity as practitioners at the largest community controlled health organisation in the Northern Territory.

Commissioners, you will find a joint statement of Ms Donna Ah Chee and Dr John Boffa at Tender Bundle Part B, Tab 1.  I ask to tender that joint statement into evidence and that it be marked Exhibit 16.8.

CHAIR:  Yes, the joint statement will be admitted with that marking.

EXHIBIT #16.8   JOINT STATEMENT OF MS DONNA AH CHEE AND DR JOHN BOFFA

MR POWER:  There are then 22 additional documents as annexures to that joint statement, at tender bundle part B, tabs 2 to 23.  I ask to tender those annexures into evidence, market as Exhibit 16.8.1 to 16.8.22.

CHAIR:  Yes, those annexures will be admitted into evidence with the markings you have indicated.

EXHIBITS #16.8.1 TO #16.8.22   ANNEXURES TO JOINT STATEMENT OF MS DONNA AH CHEE AND DR JOHN BOFFA

MR POWER:  The other two witnesses from Congress are Amelia Paterson and Hannah Blaine, who have provided a joint statement at tender bundle part B, tab 24.  I ask that their statement be tendered into evidence as Exhibit 16.9.

CHAIR:  Yes, that joint statement can also be admitted into evidence with the marking Exhibit 16.9.

 
EXHIBIT #16.9   JOINT STATEMENT OF MS AMELIA PATERSON AND MS HANNAH BLAINE

MR POWER:  I ask that the witnesses be sworn or affirmed to give evidence.

CHAIR:  I understand that each of the witnesses wishes to take the affirmation.  If you would be good enough to follow the instructions of my associate, he will administer the affirmation.

MS DONNA AH CHEE, AFFIRMED

DR JOHN BOFFA, AFFIRMED

MS AMELIA PATERSON, AFFIRMED

MS HANNAH BLAINE, AFFIRMED

CHAIR:  Thank you very much and thank you for coming to give evidence before the Royal Commission.  Just to explain where we all are, because it is a little complicated, Commissioner Galbally is joining the proceedings from Melbourne; Commissioner Mason is in our Brisbane hearing room, as is Mr Power who, will ask you some questions; I am in our Sydney hearing room; and you are, presumably, in Alice Springs.  So there we are.

Mr Power will now ask you some questions.  Thank you.

MR POWER:  Thank you.

EXAMINATION IN CHIEF BY MR POWER

MR POWER:  Could I ask that each of you introduce yourselves and explain your role with the Central Australian Aboriginal Congress.  Perhaps we can do it in the order of Ms Ah Chee, Dr Boffa, Ms Paterson and then Ms Blaine.

MS AH CHEE:  My name is Donna Ah Chee, I am the Chief Executive Officer of Central Australian Aboriginal Congress.  I have been the CEO for the last eight years.  I am a Bundjalung woman from the far north coast of New South Wales, who has been living on beautiful Arrernte country for over 30 years.

 
DR BOFFA:  My name is John Boffa.  I am the Chief Medical Officer for public health at Central Australian Aboriginal Congress.  I have been here since 1994 and before that I was in Tennant Creek.  I have been with Congress since 1998.  In my role, I am mainly involved in health policy, research, health promotion and quality improvement.

MS PATERSON:  My name is Amelia Paterson.  I am a paediatric clinical neuropsychologist here at the Central Australian Aboriginal Congress.  I have been with Congress for just over two years, initially in the adult neuropsychology space and then moving to paediatric assessment.

MS BLAINE:  My name is Hannah Blaine.  I am a paediatric clinical neuropsychologist working in the CYATS team for Congress.  I moved here just under 12 months ago.  Prior to that, I was working for the foetal alcohol spectrum disorder clinic on the Gold Coast.

MR POWER:  Thank you.  Ms Ah Chee, as the CEO, could you briefly explain what Central Australian Aboriginal Congress is and, briefly, how it came into being, its history?

MS AH CHEE:  Central Australian Aboriginal Congress started back in 1973, on the basis of the voice of Central Australian Aboriginal people, recognising that they needed an organisation that would express the views of the community.  It wasn't until two years later, in 1975, that we started a medical service.  It was the start of a primary healthcare service with a doctor, transport and a medical receptionist.

We have now grown into being, I think, one of the most comprehensive primary healthcare services in the country, with over 450 staff and a budget of $65 million, ranging from services that directly relate to clinical services, as well as social and preventative programs, that is then complemented with the work around advocating on the things that make people sick, which is the social determinants of health.

MR POWER:  Is it correct that the health service, Congress, delivers comprehensive primary healthcare to more than 17,000 Aboriginal people in Alice Springs and also in six remote communities in Central Australia?

MS AH CHEE:  Yes, that's correct.

MR POWER:  I will ask questions based on topic headings and I will direct my questions to people as we go.  But if anyone feels someone else can best answer that question, please feel free to throw to someone else in your group.

MS AH CHEE:  Sorry, do you mind if I make an opening statement?

MR POWER:  Yes, of course.

MS AH CHEE:  For the record?
 

MR POWER:  Thank you.

MS AH CHEE:  Thank you.  I would first like to begin by acknowledging the Central Arrernte traditional owners of the land on which we are giving evidence here today, and pay my respects to their Elders past, present and emerging, and thank the Commission for giving me the opportunity to make a brief opening statement.

I would like to highlight three key points in the areas that we think are vitally important.  The first and most important area is to ensure that all Aboriginal children with developmental delay under the age of seven are detected as early as possible and then quickly get on to an early childhood early intervention plan, so they can receive the extra support they need, as well as a comprehensive assessment.

After four years of struggle --- and I mean four years of big struggle --- of constantly writing to people, raising in various forums that I am involved in, I am pleased to say that over the past few months, about 40 Aboriginal children who are Congress clients are now accessing these plans and getting the support they need to give them the best chance of returning to a pathway of healthy development.

I think it is absolutely outrageous that it has taken a service like Congress that long to finally get the most vulnerable children in our communities --- and we see what the data is in relation to the Australian early childhood development census, in terms of the developmental vulnerability for a lot of our kids in central Australia, that it has taken this long to get to this point.

It is the role and the responsibility of the primary healthcare system to make sure that all children are screening regularly at different ages, using a validated tool known as the ASQ TRAK.  This can be done in about 45 minutes by appropriately trained Aboriginal health workers and nurses, and is the gateway into the NDIS for children who need it.

The majority of Aboriginal children in Central Australia are yet to be assessed using this tool and if they have been, are yet to be referred for an ECEI plan.  The challenge is to put in place the systems that make sure this is being done at a population level for all Aboriginal children who present to health services regularly, through their early years.

The second key issue is the need to ensure that there is capacity to undertake comprehensive multi disciplinary assessments for children who need this, based on what is now considered the best practice model developed by Congress in our child and youth assessment treatment service, or CYATS.  You will hear from our two fantastic neuropsychs today.

Of the group of children with developmental delay, some will have more serious underlying neuro developmental disorders and these need to be diagnosed as soon as possible as well.  This is the next level of assessment for a much smaller group of  
children, following population screening.  It is often not possible to make a formal diagnosis of a disability until children get closer to the age of seven.  But in the most severe cases, it is possible to make a diagnosis earlier.

At present, there is no Commonwealth or State or Territory funding agency responsible for funding these vital services.  A recent national tender process by the NDIA to fund assessment panels was so structurally flawed that it was never going to fund a service like CYATS.

CHAIR:  I think I will have to ask you to bring this to a conclusion.  Please make the third point.  The difficulty is that this is a forum for receiving evidence.  I understand the points you are making and we have a whole submissions process, but we are not in a position to test material that is coming to us in this form.  By all means, make the third point as briefly as you can, then Mr Power will ask questions and if there are matters you wish to raise, please do.

MS AH CHEE:  Okay.  Thanks, Chair.  The third and final issue I would like to highlight is the key need to establish secure care rehabilitation facilities for young people with neurodevelopmental and other disabilities, so we can get them out of detention centres once and for all.

MR POWER:  Thank you, Ms Ah Chee.  Much of what you have said in that opening statement are key points that are in the statements from Congress.  I want to go into, essentially, each of the topics you have raised.

The first area is something you have already raised, which is the prevention and early intervention to prevent entry into out of home care and to avoid, where possible, negative impacts of developmental delay.  For the record, this is dealt with in your joint statement with Dr Boffa at paragraphs 33 to 36, 58 to 61 and 66.

Perhaps I can turn to Dr Boffa.  In the joint statement, you talk about the link that is seen between higher levels of disadvantage and the prevalence of developmental vulnerability.  In your experience as a medical practitioner, but also in your role with Congress, could you explain to the Commission what you have seen in that regard and why what is set out in your statement is made in that way?

DR BOFFA:  Firstly, when we are talking about developmental delay, it is prevalent, but we have to make sure we are assessing it properly.  When we did child health checks, until the last few years when we have had the advantage of having a validated tool, which is the ASQ TRAK, it was assessed in a very ad hoc manner, not in a manner that was objective and not in a manner that you could really act on.

Part of the reason for that was there was not much point in picking up kids with developmental delay because there was very little in the way of interventions for them anyway, so it was almost unethical to screen and find it because what would you do next?  The NDIS has been a game changer in that regard.

 
Now, we estimate that probably 20 per cent of all Aboriginal children are going to be below the key cut off points on two or more domains in their developmental assessment.  And we are talking physical development, social development, emotional development; there is a range of different areas that are assessed in that tool.  It might be slightly below that, but it is going to be somewhere of that order.

As Donna mentioned in her opening address, the AEDC scores for this area, which is the first year of school, have suggested 35 to 40 per cent of children are developmentally vulnerable on two or more domains in the first year of school.  Obviously children are a little bit older then.  The earlier you start, the harder it is to detect.

But with a valid screening tool, I think we will find a very significant number of children who are developmentally vulnerable early on, or developmentally delayed, and it is particularly in the emotional area and the language and cognitive area that we are finding issues.

Some of those things are because if children have been understimulated at home and not had the sort of responsive care they need, but particularly understimulation, they won't have had the opportunity to develop normally in a healthy manner.  As we know, at birth, 25 per cent of the brain is developed; by age 4, 92 per cent of the brain is developed.  In those early years, there is massive development, as long as the child has a good diet and plenty of iron --- and that's another issue --- and responsive care and stimulation, neural networks are being laid down to create a healthy young person.

It is incredibly important that that stimulation happens and it is important that it happens at the critical period.  So the sooner we pick up children who are not quite on the developmental pathway they need to be, and the sooner we provide additional support, the more chance there is of getting that child back to normal.

That is why Donna mentioned that population level screening is vital.  We have to find the kids who are developmentally delayed early and we have to support them.  A lot of kids will improve.  The ones that don't improve are the ones you have to deep dive into more comprehensive assessments and they might have underlying conditions and they will need more support.

So the whole system, now we have the NDIS, can work and it is a game changer.  We just have to make sure in the primary healthcare setting, we are actually assessing children properly and with a validated tool.

MR POWER:  We will come to that validated tool slightly later in your evidence.  But you used an acronym AEDC.  That's the Australian Early Development Census; is that correct?

DR BOFFA:  Yes.

 
MR POWER:  In your statement at paragraph 60, you note that the results for 2015 showed that before they started school, Aboriginal children in Alice Springs were six times as likely to be vulnerable on two or more developmental domains and 60 per cent of Aboriginal children in the region are developmentally vulnerable on at least one domain.

DR BOFFA:  Yes.

MR POWER:  From what you have said, you are indicating --- and you indicate in your statement --- that there are a number of underlying causes for those delays and that is why population level screening is so important, to be able to detect these problems very early and take appropriate steps.  Is that correct?

DR BOFFA:  Yes, that's right.  As I said, it's prevalent and we have known that since 2015 and we have been giving that data to the NDIS from the moment it was established, to show them there is a very significant population health issue for the development of children and it should have led to early childhood early intervention services and programs a long time ago.

MR POWER:  Can I turn to Ms Paterson and Ms Blaine ---

CHAIR:  Before you do that, I wonder if you could help me, Dr Boffa.  You refer in paragraph 60 to Aboriginal children in Alice Springs being six times more likely to be vulnerable on two or more developmental domains.  Can you explain a little bit more about the developmental domains, how many are there, what do they indicate?

DR BOFFA:  Yes, there are five.  Do you want to do that?

MS BLAINE:  Yes.  On the ASQ TRAK, we have the cognitive domain, there are fine motor skills, gross motor skills, language, and social and emotional skills.  It's generally going into the milestones of where we would expect kids to be at, at each age, in those certain domains.  It's about the person assessing or speaking with the family at the time, whether it be a child health nurse, seeing whether they can observe some of those skills during the session with the child and the family, and whether they can elicit history from the family as to whether or not those skills are happening at home.  From that, they will get a score that suggests whether they are meeting developmental milestones age appropriately in each of those areas.

There can be a slightly below cut off and those are the kids that might not quite be where they should be for their age in those different areas, and so some more work needs to be done.  That might be giving the parent some ideas around what they can do to increase the stimulation in those areas at home.

Then there is the low cut off, which suggests that some early intervention does need to happen, in order to have some specialist support for the children to continue to grow across the domains where they are falling below cut off.

 
DR BOFFA:  In the AEDC, they are slightly different.  There is physical, language, cognitive, emotional, social and community development, which is analogous to what we have heard is in the ASQ TRAK.  That is assessed over three days, so children have to be at school for three days in a row.

It is assessed on all children across the country, but the data is not broken down into Aboriginal and non Aboriginal.  That data we have given you, luckily the Menzies School of Health Research gave us the identified data, otherwise we would not have been able to tell you that Aboriginal children are six times more vulnerable on two domains in the first year of school.

That data has not been made public.  It is done every three years, so the 2018 data I couldn't tell you because they don't break it down into Aboriginal and non Aboriginal, and they don't even give it to services like us to see.  We have our own data now because we have been doing our own population screening using the ASQ TRAK, so we are getting our own idea of that.  But it is important that there is transparency in the AEDC data, and there isn't.

CHAIR:  That is very helpful, thank you.  Who compiles the relevant domains and criteria in the census?

MS BLAINE:  The Commonwealth.

DR BOFFA:  The Department of Education.

CHAIR:  That is a national standard that is applied to all children in Australia, is it?

DR BOFFA:  Yes.  It was introduced by Julia Gillard when she was the Minister for Education.  It is based on the Canadian system.  Canada has done it for many years.  Long term follow up shows if children enter school developmentally vulnerable on two or more domains in transition, they are very unlikely to complete year 10.  This is something the Australian education system hasn't come to terms with.  It doesn't matter how good the school is, how good the teachers are, on average, if children enter at that level, it is very difficult to get them to year 10, unless they have very incentive support in the first two years.

So, it is an incredibly important tool.  It lays bare the problem we have nationally in early childhood, but particularly in Aboriginal communities.  It does reflect poverty, disadvantage, inter generational trauma and all of that, and many other issues as well, domestic violence, alcohol abuse, the adverse early childhood events are writ large in those scores.  But it's not ---

CHAIR:  The 2015 study that you have referred to, who did that?

DR BOFFA:  That was actually done by the Menzies School of Health Research with the Department of Education.  But since then, 2018, I think it was done by teachers mainly, with less support.  So Menzies were enlisted in the Northern Territory to  
help do this properly with the schools, with the teachers, so the teachers were well trained and well supported to be able to help do those assessments.

CHAIR:  Do I understand from what you have said that the data is available and if there was someone to distinguish between Aboriginal children and non Indigenous children, what was done in 2015 could be done in later years as well?

DR BOFFA:  Yes, it could be, and it could be done at the level of towns, it could be done at Yuendumu, it could be done in any community that is there.  It could be done.  You could ask for it.

CHAIR:  I understand.  Thank you very much.  Sorry, Mr Power, to take up your time.

MR POWER:  No, thank you, Chair.

The AEDC, the Australian Early Development Census, I think you said that occurs every three years?

DR BOFFA:  Yes.

MR POWER:  If there was one in 2018, one would expect there should be one in 2021?

DR BOFFA:  There should be, unless COVID is going to stop it from happening, but I don't think it should.

MR POWER:  As the Chair has said, if the Commonwealth was able to analyse the data for --- whether it is by people who identified as First Nations or, alternatively, by identifying places that have a very high proportion of First Nations, the effect of the data you were able to do in 2015 could be done for the 2018 data?

DR BOFFA:  Absolutely.  And it could be done for 2012.  You can look at the trend over time.

MR POWER:  You have mentioned 2012.  Obviously the same for 2021.  If it has not occurred yet, in particular the way the data is structured, one would hope if they had that aim to begin with, they could make that disaggregation and identification of First Nations children easier by making sure it was noted in an appropriate way in the first place?

DR BOFFA:  Yes.  It began in 2009, so you have 2009, 2012, 2015 and 2018.  You have a time series which could be disaggregated by locality, by Aboriginality and it would give you very useful information and you would see where it is progressing, where it is going backwards.  We have made progress here, particularly in Alice Springs.  I'm not sure we have made progress in remote communities.

 
MS AH CHEE:  I think this issue of being able to identify communities, too, we would probably need to aggregate it up to get a regional perspective, to see it regionally, rather than data can specifically identify a community.  Notwithstanding that we should still be able to see community level data, but it doesn't need to be made public.  We could work together ---

MR POWER:  I was going to raise that, too.  Ms Ah Chee, the issue you are raising is an issue of data sovereignty.

MS AH CHEE:  Yes.

MR POWER:  Is what you are indicating that this sort of data needs to be treated very carefully to avoid stigmatisation of what may be quite small remote communities, and that could have a very negative effect.  But that an organisation such as yours, an Aboriginal controlled health organisation, if it were, with appropriate safeguards, given access to this information, that would be very useful to your health service?

MS AH CHEE:  Exactly, Mr Power, I think it would be invaluable.

MR POWER:  We have talked about this AEDC.  Could I perhaps ask Ms Paterson and Ms Blaine, the ASQ TRAK, would one of you be able to explain how that system works, what it is and how it was developed and how it is utilised?

MS BLAINE:  We don't directly use the ASQ TRAK.  It is really is a screening measure that is designed for the primary health service, so that when children come for a health check at designated ages, and it is screened by months old, so I think it's up to about three and a half, so the child will come and have their health check, whether it be with the child health nurse or the GP and they will go through a set of questions across different developmental domains.  As I said before, cognitive, language, social, emotional and fine and gross motor.

The idea is to determine whether or not the child is meeting milestones that would be expected for their age.  So the child health nurse will sit with the parent or the carer and go through specific skills and identify whether or not the child --- they can observe that in the clinic at the time the child and the family are there, or elicit history from the family as to whether those skills are happening at home and/or school or child care, or not as yet.

They will get a score at the end of it and that score will work out whether they are meeting milestones, so developing age appropriately in that area, whether there are some concerns and that can be slightly below cut off score, or more concerns which would put them below cut off and suggest they need early intervention.

We have been developing this pathway where, hopefully through the ASQ TRAK, children under the age that they are able to go through and have that, if there are concerns around their development from the ASQ TRAK score, they can go straight  
into the ECEI pathway, instead of coming in for multi disciplinary assessment through our CYATS service.  The reason for that   

MR POWER:  Sorry, if we could just pause there.  The acronym ECEI has been used a couple of times.  Could you explain what the ECEI is?

MS BLAINE:  That's the pathway under NDIS for early intervention, so the Early Childhood Early Intervention pathway for children under seven.  The idea is that they would have early intervention in the hope they won't need a lifelong disability service to provide funding for them to be able to live as independently as possible.  For us, it is getting those children through that ECEI pathway so they can get straight into intervention.  But many ---

MR POWER:  Again, if we could pause there for a moment, I will come back to the issue of access to NDIS but perhaps as a marker at this point, in brief terms, is it that Congress has achieved the situation for children under the age of seven, the testing using the ASQ TRAK is sufficient to get NDIS funding for those children, but that once they have got beyond that age point, more costly and lengthier assessments are required before NDIS can be funded?  Is that roughly the situation?

MS BLAINE:  Yes, that's right.  And should they be identified as needing further assessment because there are ongoing concerns, they will certainly come back through our service for comprehensive multi disciplinary assessment.

MS AH CHEE:  Is the distinction that it doesn't require a diagnosis?

DR BOFFA:  Yes.  The ASQ TRAK identifies developmental delay, not a specific diagnosis, which this team does.  To answer your earlier question, the ASQ TRAK has been developed based on the ASQ, which is an internationally recognised tool.  It stands for Ages & Stages Questionnaires.  It is used all over the world, it is validated in many countries and it is used for children till 6 years old.  It is used in primary healthcare settings all over the world, but it was not validated for Aboriginal children and there are all sorts of cross cultural issues in using a mainstream tool to assess these areas of development.

Dr Anita D'Aprano, who is a developmental paediatrician at the University of Melbourne, worked initially on her own and then later with us to validate this tool.  They have validated it at certain ages, not all the ages.  They have only validated 6 months, 9 months, 12 months, 18 months, two years, three years and four years, and you have to do one month either side.  As those ages we can do a very accurate assessment with a tool which has been validated for Aboriginal children, which will pick up developmental delay very accurately.  That is the trigger, that plus a functional impairment narrative, will trigger an early childhood early intervention plan, and it is triggering it within 24 hours or even a couple of days.

But then the trouble is there is a very significant delay for the planning meeting.  Until the planning meeting has happened, you don't actually get a plan.  So there is a  
suggestion to address that in our statement, which is to have an early childhood early intervention preliminary plan --- what is the word for it?  Anyway, they are talking about offering an amount of money, say $20,000, straight upfront before the planning meeting happens, so the child can access immediate care and further assessment, while the planning meeting is being organised, which is taking more than two months.

These kids need help quickly.  The quicker they get help, the quicker you can turn around an abnormal trajectory, because there are critical periods in development and once you go too far beyond those critical periods, you don't get it back again.

MR POWER:  Thank you.  ASQ TRAK was developed in conjunction with Congress itself?

DR BOFFA:  Yes, it was with Dr Anita D'Aprano.

MR POWER:  One of the advantages we heard from Ms Blaine is it doesn't need a clinical paediatrician, clinical neuropsychologist like she and Ms Paterson.  What sort of people are able to administer the ASQ TRAK in a culturally appropriate way?

DR BOFFA:  Trained health professionals, Aboriginal practitioners, nurses, Aboriginal family support workers.  They need training.  It's not two or three days training, you have to know what you're doing and you have to be able to do it properly and reliably, in a way that is validated.

I think very soon we will probably move to accreditation and the NDIS might not accept this being done by nonaccredited workers, which is a reasonable thing because it has significant implications, obviously.  If you do it well and do it properly, and you have to know the limitations of the tool.  But it can be done very easily by the primary healthcare team.  You wouldn't use doctors to do it, you would use nurses, Aboriginal health workers, Aboriginal family support workers, Aboriginal case workers and it can be done reliably and well.

CHAIR:  Can we take a couple of steps back, so someone like me, who perhaps is not quite as familiar with these tests, might follow where they fit.  You said ASQ is an internationally recognised approach?

DR BOFFA:  Yes.

CHAIR:  Is that used generally for Australian children, whether Indigenous or non Indigenous?

DR BOFFA:  Yes, it is.  It used to be done --- Australia used to have a system of child and infant nurses across the country and they used to do it.  Now, a lot of those systems have been defunded.  They still exist in Victoria and some of the bigger states.

 
CHAIR:  How is the determination made that any child should be assessed in accordance with the ASQ protocol, if I can describe it that way?  Who determines it?

DR BOFFA:  A GP would, or an infant nurse.  When a child comes in for their immunisations at 6 months, 9 months, 12 months, 18 months, in the mainstream, this probably isn't done unless someone is worried.  It is not done routinely at a population level in the mainstream.  But if you have a population where you expect to find one in five children with significant issues, you have an obligation to do it at a population level.  In Aboriginal communities and in all disadvantaged communities, in pockets of disadvantage in the cities, it should be done on all children.  It's an issue of ---

CHAIR:  The argument you are making, and this is what I want to understand, is that for the mainstream, as you describe it, it is okay to depend upon someone being worried and taking it to a GP or someone else, to determine whether the child needs to be assessed in this way.  But where you have communities such as First Nations communities with a high proportion of children likely to benefit from this assessment, your view is this should be done across the entirety of the cohort of children?

DR BOFFA:  Yes, that's our view.  There is already recognition of that.  There is a Medicare funded child health check item for Aboriginal and Torres Strait Islander children, so this fits beautifully.  Really, these days, you should not do a child health check without doing an ASQ TRAK.  It is almost unethical now because it is the ASQ TRAK that will lead to interventions much more so --- in the old days, you used to weigh kids, measure them, all that sort of stuff, look for skin --- and we still do all that.  It's important.

But much more important now in that child health check process is to make sure the emotional, cognitive and language development particularly are properly assessed, not just their physical development and whether they have a heart murmur or skin disorders, those sorts of things.  They are all still done.

CHAIR:  If Medicare provides for all Aboriginal children to have this process, why isn't it universal now?

DR BOFFA:  It's not.  The Medicare item doesn't require a validated tool to be used.  In the Medicare child health, you can do a developmental screen in the old way I was talking about before, pretty much just a few questions, it's a fairly rudimentary way of assessing.  You ask how many --- a 2 year old child, how many words they are saying, you want to know what they are doing in a gross motor way.  So you ask things that will pick up gross levels of abnormality but not in a sensitive way that is able to pick up children with lesser levels of delay, which is what this tool really can do.

So it is not required in that Medicare item.  It probably should become standard, that this is something that we do across the board.  But then you will get a lot of pushback  
from --- a lot of the Remote nurses will say, "We are so busy, we are so overworked and we are only here for a couple of months and then we're moving on."  They will argue they don't have the time and capacity to do it.

We are trying to say, look, there is nothing more important.  If a child comes into the clinic, as well as giving them an immunisation, this has to be done.  Because we are finding now finally it is a gateway to early childhood early intervention plans and further assessment, and really, really important interventions in that child's life.

CHAIR:  We had better allow Mr Power the occasional intervention in this hearing.

MR POWER:  Thanks, Chair.  Flowing from that, one of the things that arose in my mind was that for this ASQ TRAK to work, there has to be trust between the child's parents or carer and the person they are speaking to.  Would you agree with that?

MS BLAINE:  Yes, I agree with that, Mr Power.

MR POWER:  You deal with this in your statement, but is that why an organisation such as Congress or the Danila Dilba in Darwin is so important, because there is that sense of trust from an Aboriginal controlled health organisation?

MS PATERSON:  Absolutely, because those families and those kids come to our service on a regular basis, so this is where we see --- we had a demographer come and look at our data and that person said that we could easily say we see every Aboriginal person in our health service delivery area, and that's what Aboriginal community controlled health services do.  That's why they have been established, because of that ability to build that trust with our own mob.

MS BLAINE:  We do get different information, compared to a mainstream health provider.  When we have families talking with Congress with an Aboriginal family support worker there, as a representative of Congress easily identifiable, they tell us different information than what they are willing to talk to a mainstream doctor at the hospital about.  So we have some pretty good evidence that it is working better to do this within an Aboriginal community controlled health service.

MR POWER:  The other question I have, Dr Boffa, is you said it was validated, essentially, up to age four.  But the ASQ itself, the internationally used base model, is validated up to age six.  Is it something where you think there would be a benefit in having it validated, at least for that upper age limit of six, to try and catch anybody who had not been reached in a population wide approach at age six?

DR BOFFA:  Yes.  One of the most important uses of research funding should be to fund Anita D'Aprano to continue to validate.  It should be validated to match every age of the ASQ.  That will help us.  Really, if a child comes into our service at 11 months --- at 12 months, we can't do it, we have to wait until 18 months.  They have gone past the 12 months tool and the next one is 18 months.  So even though they have come to our service, we can't --- we don't have a validated tool to use at that  
stage, or at 18 months, or say they come in at two and a half, we don't have a tool at two and a half, whereas the ASQ does.  We need to continue to validate across the whole spectrum of the equivalent of the ASQ.  That would be very helpful.

MS BLAINE:  I would like to add that I am seeing children, particularly those kids that have very obvious delays and we would say that they are unassessable, due to not having developed enough language yet, but they have gone past the ASQ TRAK age.  We then have to engage families in our service to gather some information, so resources are being spent on a child that clearly needs to go through that ECEI pathway, but they need somebody to document where they are at the moment.  Because the ASQ TRAK doesn't go beyond four years old, we might have a five year old who is very clearly delayed, is not at the level of ability yet that they can engage in our multi disciplinary assessment, but we are having to use our resources to gather some information for that to happen.

Certainly between the ages of 4 and 6, it is definitely needed to catch those kids that are not yet ready for assessment, but CYATS is probably not the best placed to serve this.  It should be through the primary healthcare network.

MR POWER:  --- (overspeaking) ---

DR BOFFA:  A recommendation on that one to fully validate the ASQ TRAK would be very helpful.

MR POWER:  Another acronym arose then, which is the CYATS.  I'm going to come to that further.  But could you just at the moment, one --- I will ask Ms Paterson, what is CYATS?

MS PATERSON:  We use CYATS, which is the Child and Youth Assessment and Treatment Service.  So we are a multi disciplinary team as part of Congress, so there are two neuropsychologists, Hannah and I; two speech pathologists, two occupational therapists, two clinical case coordinators, an Aboriginal family support worker and a team leader, and we also have in kind support from the paediatrics at the Alice Springs Hospital.  That's CYATS.

MR POWER:  I will return back to that.  If I can return to the two of you, that is Ms Paterson and Ms Blaine, as part of this general topic of early childhood intervention, at paragraphs 45 and 46 of your statement, you talk about barriers to treatments or support.

Could you just speak about what barriers you see exist there for First Nations children?  Just to put it in context, in paragraph 45 you note that there is developmental delay, which is able to be seen.  It may or may not mean that there is an underlying disability.  Of course, one hopes from what has been described that those developmental delays can be dealt with in an appropriate way such that they don't result in some long term problem throughout childhood, and it is noted that it is most effective in the first five years.  It is paragraph 46 where you talk about some of  
the barriers, particularly you note in the final sentence:

Congress has observed that access to childcare and early learning centres is particularly difficult for children who are in kinship care arrangements.

Could you speak to that and explain why that is the case?

MS BLAINE:  Really, I guess access to child care in Alice Springs, in general for anyone, is quite challenging.  There is a long wait list, so if a child is in out of home care, then there are many child care centres but the wait list to access that is quite lengthy.  For those kids that are in kinship care, not necessarily accessing child care because they are being cared for by family.  And so may not be aware of, for instance, Congress has its own child care and preschool that Aboriginal children here can access.  But it is whether or not they know that these programs are available, whether they have transport or know that there is transport support to be able to get kids along to these programs.  I think in that sense it can be challenging to access the appropriate programs and services that are available, whether the awareness is there that they can access these programs and then being able to do that consistently.

I think, just having a child with developmental delays requires significant extra load to be able to just get --- to get organised and get going for the day, so being able to operate on the usual timeframes, getting a child to child care by a certain time in the morning.  If you have got a child that is having significant emotional meltdowns because of something that has happened in the morning, then it can be, again, whether that family has the appropriate supports that allow them to get the child ready in a timely way, that then they are supported to get to the child care, can be a significant undertaking.  So if they don't have those supports in place to help the family to do that, sometimes it can be just an impossible task.

MR POWER:  Is there a solution to the problem, because obviously one of the fundamental issues is trying to give families support so that the child doesn't go into out of home care.  Do you, with your team, see that there are some practical steps that can be taken?

MS PATTERSON:  Yes, the availability of places in child care and in early intervention programs, is just having more places available would make a big difference.  The capacity for a family to be going through the application process and then to be told they are on a wait list, that they need to keep following up on, ongoing, especially if they move or that's another crisis that comes up, the expectation to do that is very high.  Whereas if we simply had more places in preschool, childcare and early intervention programs, it would make that a lot easier on families.

MR POWER:  You mentioned that Congress itself has a preschool?

MS AH CHEE:  It's a preschool readiness program, it's not a preschool.

 
MR POWER:  Sorry, I apologise.

MS AH CHEE:  That's all right, we probably caused that confusion.

MS PATERSON:  It is a preschool readiness program, so we make sure that the three and four year old kids have had the child health check.  Any developmental vulnerabilities that have been identified, we then put them in this intensive preschool readiness program so that when they are ready to enrol into preschool, they can maximise their learning opportunities, once they get there.

MR POWER:  Is part of the aim of that --- of what was being discussed earlier about a rich environment for a child at those key ages, rich environment in terms of play with other children, receiving language, receiving art, all of those things in a culturally appropriate way.  Is that what the aim of that program is?

MS AH CHEE:  Exactly, Mr Power.  We also have another program called the child health and development program.  So it is based on the Abecedarian evidence around enriched care giving, conversational reading and play games, as well as language priority, and so that is another --- I guess, an evidence based early childhood program where we could put kids into this program when they have been identified as having developmental vulnerabilities.

DR BOFFA:  That has a waiting list of about 40 kids at the moment, and it is only for 50 children and that is for non working families.  A lot of these kids in non working families are not eligible for mainstream child care because their parents aren't working.  They are the kids that need a program like this, they need extra stimulation, they need extra support, play based learning, interaction with --- being read to all the time.  It makes a huge difference.  The randomised controlled trials show that if you do that for children aged six months to three, you are talking about a 30 points IQ difference, so you are talking about the child at the lower end of the development spectrum getting back to average.  We have got one of those centres, but we only got one, and there is a wait list for that.

Part of what is in our submission is --- we thought the NDIA were going to fund it and they --- we found out early this year, it all fell over.  Programs like that are absolutely vital for children in disadvantaged families.  They only need to go for about 20 hours a week.  They are home most of the time.  It's only about 20 hours a week is enough to make a big difference, before they go to preschool.  This is well before they go to preschool.  We have got one of those centre, it has been evaluated twice, it is very effective, but it has a waiting list of about 40 children.

MR POWER:  When you say it was a waiting list of 40 children, that is First Nations children living in Alice Springs who, if there were spaces, would be there, is that what you are saying?

DR BOFFA:  Yes, that's it, from non working families.  There is a different waiting list, if you are a working family, you are on the mainstream child care waiting list.   
What is the waiting list?

MS PATERSON:  I have friends who wait anywhere from 12 to 18 months for child care.  So generally people put their child on a wait list when they are pregnant, hoping that by the time their child gets to 8 to 12 months, there will be a place available.

CHAIR:  Can I just clarify something else.  I take it from what you have been saying that you are proposing programs or strategies to address the issues of possible developmental delay, and associated with that, possible intellectual disabilities of all First Nations children.  Have I got that right?

MS PATERSON:  Yes, Chair.  There needs to be a systems approach.

CHAIR:  How does this relate to out of home care?

MS PATERSON:  We are seeing many children who are in out of home care in kinship, so many of the issues are similar across.  And the kids we are seeing in out of home care are presenting with significant developmental disabilities.  So we are wanting, one, to prevent kids from having to go into out of home care but knowing that they may still be presenting with similar challenges, so that's why we see it as a systems approach.

CHAIR:  Are you suggesting that there is a causal relationship between First Nations children and out of home care and the extent of their developmental delays or intellectual disability?  Or is this something where we are talking here about children in out of home care being in essentially the same position as First Nations children who are not in out of home care?

DR BOFFA:  Yes, that's it.  The latter.

MS BLAINE:  We think both.  We often see children who have undiagnosed disabilities are not offered the same level of support.  If a family is not offered the same level of support for their childhood disabilities, it is much more likely that that family will have a notification for something like neglect, because they can't meet the care needs of that child because the care needs are higher.  Certainly we need to have equitable access, so that the ability to provide the appropriate level of care is not a consideration for children being removed.

DR BOFFA:  Just to give you one anecdote.

MR POWER:  Sorry, Dr Boffa, just before you go on, because we have Auslan interpreters who do an amazing job, but you speak very quickly.  If you could slow down just a bit.

CHAIR:  I want to assure you this is not the first time this issue has arisen in the Royal Commission, so you are not alone.
 

DR BOFFA:  Children living in poverty have really got extra needs.  If you look at studies that show children who grow up in a family where one or both parents has a university degree, compared to children growing up in a family where neither parent has year 12, by age four they have been exposed to 32 million more words.  So there is a massive difference going on in terms of the level of stimulation, language, and being read to is the most important way you promote brain development.

So the difference, the gap you are talking about, even children living in poverty in a house that neither parent has year 12, without extra stimulation, are not going to develop in the same way as children in a household where they are just being bombarded every day with conversational language, with being read to, with regular routines, all of that is --- so you have got to find ways, we are not talking about, you don't need to remove children to achieve this, you have to provide extra support, which is what our child health and development centres are all about.  Children go there, they are read to, there are learning games, conversational reading, they get an iron rich meal to try and overcome problems with iron deficiency, which also affects brain development.  That approach at a population level would help prevent a significant proportion of children who go on with developmental delay or even more severe impairments.

We have been doing that since 2017, 2018, with one centre and there are very few centres like it across the country.  That is a really important program.  That becomes a place where you can have speech pathologists and occupational therapists go into the centre, on top of the normal staff, and access children and their parents to do interventions which you couldn't do at home, because the home environment is not a place where you can meaningfully do that for a lot of these children.  Homes are overcrowded, there are a lot of people there, you don't get the space.  So the centre provides a locus for a range of other services and programs to interact with parents and these children, but we only have one such centre.

MR POWER:  In terms of linking it back to First Nations children in out of home care, you have mentioned that there is a real difficulty for non working parents to have their children in the preparation for preschool program that Congress runs.  Are those parents --- are the children of those parents, in the experience of Congress, at greater risk of having their children removed into care as a group, that is, parents who aren't working?

DR BOFFA:  Yes, absolutely.  There is no doubt about that.  It is one of the big determinants --- unemployment, educational disadvantage, is one of the big determinants of whether children do or don't get removed.

MS BLAINE:  It can be extremely challenging when there is not a specialised program available for a child with developmental delay or disability, for parents to work because of the high care needs that are involved and often --- this will happen for foster carers who are caring for children in out of home care, that working can be extremely difficult because they are constantly getting phone calls to come and pick  
their children up because they are in a mainstream program, for instance.  If there is behaviour, aggression, they just can't tolerate full days, for instance, then even for the kids we are seeing that are in primary school, they may be on reduced attendance programs because they can't tolerate full days at school, so it can be extremely challenging to hold consistent work when you have to tell your manager "I have to go, the school has called me" or "the child care has called me to come and take the child home".

MR POWER:  What you have said there echoes what you said at paragraph 50 of your statement.  You say:

Disability contributes to a higher level of need and a child with disability requires a higher level of supervision.  If a family does not have the resources or access to supports, this may be perceived as neglect and increase the risk of removal.  However, CYATS is not seeing this as a direct cause of removal.

From what you have said, in what you have just said and also in paragraph 50 of your statement, would it be correct to say that --- that in a sense, almost respite that the parents would have from children with higher needs would benefit both the parental and child relationship, as well as the child's development?

MS BLAINE:  Certainly, and especially if the child is going to a care situation where the educators understand their difficulties, and that's --- for the children under --- four and under, that's where the ASQ TRAK is very important, so that they have a very clear understanding of where the child is at developmentally.  That lack of education for the carers, for the people working with the child, is one of the biggest contributors to the secondary issues that we see for young people with developmental delay or disability, and that is around their mental health and their development of self esteem and self concept, and without that really clear understanding, it's often very easy to say that's a child that is being naughty or defiant or oppositional and we constantly see these labels, and we refer to it in our submission, where, particularly for children in out of home care, we are seeing the biggest age range is children between 10 and 12 years old, which is likely a product of CYATS only coming into play in 2018.  But it means that they have had years and years of reinforcement around their behaviour, being oppositional, defiant, not complying, being naughty, but its their carers, their family, their education --- nobody has had a clear understanding until they have these really important assessments.

MR POWER:  Is it the case that at least in some cases those things that arise out of a disability, because they are difficult to deal with and treat, are seen as an inability of parents to appropriately care for a child?

MS BLAINE:  Absolutely.  We absolutely see parents who are --- I would say doing their best with a child with a disability, where that child does require full time supervision 24 hours a day, cannot be left unsupervised for a moment, to walk away and make a cup of tea, where the child will exhibit some maladaptive behaviour related to their disabilities, where it then becomes a case where there's a notification  
made to child protection, they might come into contact with the police, we definitely see that happening because a child does need that extra level of supervision.  That is more than what we would expect any family to be providing without disability specific support.

MR POWER:  If we move to CYATS, we will hear this afternoon from Dr Webster of Danila Dilba, who speaks about the Child and Youth Assessment and Treatment Service as being a best practice model that his service would like to emulate.

Can I perhaps ask Ms Ah Chee, how did this system, that is CYATS, come into being?  Obviously didn't just happen, it needed something that Congress focused on.  How did it come into being?

MS AH CHEE:  Initially through a partnership with PATCHES, with Commonwealth funding, that went to that organisation, and a lot of lobbying of the Northern Territory Government to get $300,000 from Territory Families, which they continue to fund.  But over time, since its inception, we have been able to then get additional funding through all the lobbying that we have been doing, and advocacy.  The issue there is that you have got multiple sources of funding and not one, sort of, Government department that funds this service.  And we know we have seen in studies that have been done, a report that was done by Lowitja Institute, our National Aboriginal and Torres Strait Islander research institute, a major report that was called "Burden In Reporting", and that's because of all the different little funding sources that come through our organisation, through our primary healthcare services across the country.  This is another prime example of that, where we have got bits and pieces of money coming from here, coming from there, to make up what we have got.  As you have heard today, and hearing from others, it is a fabulous service that is making a difference to young people and children, and their families.  If that's one thing that the Commission, the Royal Commission, could help us on, is to sort out the sort of way in which a service like this is funded.

DR BOFFA:  Also, in a remote area, you can employ staff on a two year contract at most, which is incredibly --- staff on permanent contracts, their turnover is about 22 per cent.  Staff on limited term contracts, their turnover is about 40 per cent.  We are lucky to have people who really have a lot of faith in Donna's ability to maintain funding because the funding runs out every two years, every three years, it's not recurrent.  And so that creates a whole level of uncertainty in trying to retain staff in a remote area, which just makes it all that much harder.

MR POWER:  To touch on that, is it the case that it is in fact quite difficult to fill positions in remote areas, even at the best of times?

DR BOFFA:  Yes.

MS AH CHEE:  Yes, absolutely.  And when you look now in the context of COVID and workforce issues that have just exacerbated and magnified it.

 
MS PATTERSON:  When we recruited for Hanna's position, we did actually have five applicants for that position.  So we do struggle with some disciplines more so than others.  But we have had the case here where when we are advertising and when a position is funded, we can fill it.  The people who want to work here, they do exist, and we can recruit them.

DR BOFFA:  We did say to the mental health Royal Commission or the Senate inquiry, the big problem is if you create salaried positions at a reasonable level, you will get people.  But the health system doesn't have salary positions outside the public hospitals in the major cities.  So we have done that, we have scrounged together the money and created salaried positions, and we are getting applicants.  People throw up their hands and say no one will come, but there are not salaried positions.  People won't come for private practice in areas like this, it's too big a risk, and you are not going to be able to service the most disadvantaged children, their families can't pay, so there is no private practice market.  There has to be grant funding for salaried positions and then we will be able to get people.  Five neuropsychologists is pretty amazing to apply for one position in a really remote area.

MR POWER:  To put it in terms of a thin market, Alice Springs and the surrounding areas are a very thin market for private practice, but you are saying that Congress, or organisations like Congress, could create a salaried position can fill that thin market gap by having salaried employees?

DR BOFFA:  Yes.

MS PATERSON:  And also offering the network around the salaried employees, so they can do good practice in this space.  So doing good practice as a neuropsychologist in a remote area with Aboriginal children as a private practitioner would be extremely difficult.  The reason we are able to do what we do is because we are part of Congress, with the access to an Aboriginal family support worker.  When I have discussed with colleagues doing private practice in an area like this, they would be quite reluctant to do so because of the high chance of doing malpractice, if they are not working within an organisation like Congress.

MR POWER:  If I can then turn to CYATS --- with regard to children in out of home care, is part of CYATS' work with children in out of home care?

MS PATERSON:  Yes, it is.

MR POWER:  Could you explain what role you play with children who are in out of home care in Alice Springs and, where applicable, in remote areas?

MS BLAINE:  CYATS is funded to service First Nations children living in Alice Springs.  So while there is certainly --- we have received phone calls and emails about assessments for children in remote areas, we just don't have the funding or staff capacity to do that at this time, so we are servicing children only in Alice Springs.   
For those children in out of home care, our team leader receives referrals from Territory Families, generally from their case manager.  But at the moment, there is work around cross checking databases, we only had 13 children from Territory Families on our wait list, so through that cross check they have identified potentially another 25 children that should have been referred at some point and haven't been.

MR POWER:  What you are saying is that a certain number were referred directly by Territory Families, but Congress itself was able to check First Nations children who had been patients of Congress with children who are now in out of home care, and from Congress' records of those children as patients, saw that they should be, in fact, being looked after by CYATS?

MS PATERSON:  No, sorry, this is our team leader, Gayle Simpson working directly with Territory Families to do a cross check of their children who are First Nations children and who are in out of home care.  So through that Territory Families have identified an additional around 25 children that should be on our wait list.  So those referrals need to be made.

MR POWER:  That was Congress proactively talking to Territory Families to say, "Can you look at your files for First Nations children to see if there are more children?"

MS BLAINE:  That's right, because we do have a certain number of Territory Families funded children that we need to assess throughout the year.  So quarterly, our team leader will do a check on how we are tracking to meet that by the end of the year, because obviously these assessments can't just happen overnight, we have to do a lot of forward planning to allow enough time across the year, we work in a six weekly cycle of getting a caseload of children.  So Gayle will do that work to identify where we are at in meeting that target and whether or not, how many kids are currently on our wait list from Territory Families that need to be assessed.

MS BLAINE:  When we have referrals from Territory Families or any referral source and it is a child in care, so the referral came from a paediatrician or a school teacher, if they are a child in out of home care, they get preferential treatment through CYATS, so they come to the top of our wait list and are generally seen as a priority.  How those children are prioritised is something Gayle proactively determines with Territory Families.

MR POWER:  With these children in out of home care, are they children that Congress has seen before or are they sometimes children that Congress has never seen before that referral?

MS BLAINE:  Generally they will have been through a GP clinic and had a health check, so usually they would be clients of Congress.

MR POWER:  I think --- I will direct this to Dr Boffa --- is it correct that the ASQ TRAK system only came into operation in about 2018; is that right?
 

DR BOFFA:  Yes, 2018/19 and it has taken us a while, even Congress, from the CEO down we are committed to this, but even at that level it has taken us a while to systematise it and start to make it --- we are still only doing an ASQ check on 50 per cent of the children every year that should have it done, so we have still to do work.  So yeah, it is growing within our own service, both in town and remote.  And we have to get train the trainers, you have to people train to train others and that has been a challenge and COVID hasn't helped that, but we now have two staff who are train the trainers, who can train the trainers.  It has taken us a while because there has not been much institutional support for this, it is us doing it off our own backs.  It's not like that is a system wide commitment to making this happen across the system and that's what we need.

MS AH CHEE:  And we are so serious about it that we established a dedicated child health position in our continuous quality improvement unit to really get a system approach throughout Congress around the training, around looking at on a regular basis how many ASQ TRAKs we are doing, dealing with clinics on a regular basis.

DR BOFFA:  We also had to make the connection between, there was a time when we were doing ASQ TRAKs, but it wasn't leading to anything, and that makes practitioners very, very hesitant because they don't like identifying significant issues that doesn't lead somewhere.  It is only in the last few months that we cracked the ECEI problem, that was a major barrier.  You have to make sure that children who have got issues rapidly get a plan and get support and get intervention to make it ethical.

MR POWER:  You have mentioned the ethical issue that if you are doing this sort of assessment but are unable to do anything, that's a real problem.  Could either yourself or Ms Ah Chee briefly explain what success was achieved in having the NDIS recognise this and what the result in a practical terms was?

MS AH CHEE:  We got 40 children finally getting access being assessed and getting on an ECEI plan in order to get assessed and get much needed intervention.  I was only asking Dr Boffa how many kids we have out there which is what, under 7, up to 7, about approximately 1,100.  If we were to get all of those assessments done, I'm sure we would have a lot more that would be able to --- should be able to access this ECEI program.  But I think the issue for us is how do we make it seem so it's not something we have got to take ages to get these kids accessing much needed services?  I think what Dr Boffa mentioned earlier, although this has been a success, after a lot of --- four years of trying to get access to that much needed resource in the NDIS, is the issue now about making sure that those planning meetings are now happening in a much more timely way.

MR POWER:  To go back to Ms Paterson and Ms Blaine, focusing particularly on First Nations children in out of home care, are you seeing or is your team seeing children who have Foetal Alcohol spectrum Disorder being mixed up or recognised only at a relatively late stage?
 

MS BLAINE:  Certainly.  I think that seeing the majority of children in out of home care are generally between the ages of 10 and 12 for our service, but we are a 0 to 18 service so we can see children or young people up to the age of 18.  Generally the split for Amelia and I is I prefer to see children under 11 and she prefers to see children older.  So we are certainly not seeing referrals.  This may be a product of the service only being around since 2018, so prior to that the options for assessment, particularly comprehensive assessment that involves neuropsychology, we do see children who have been exposed to alcohol in pregnancy in out of home care, but we --- what is more concerning for us is we see reference to Foetal Alcohol Spectrum Disorder in First Nations children in out of home care where that has been referenced previously, but when you work with families directly from us, as in Congress, staff working directly with families, even when the children is in out of home care, we do everything in our power to make contact with biological family.  We find that many times we are coming across families that say, "I definitely didn't drink during pregnancy", and there's documentation when you do the work.  So there's this label for the child, without assessment having been done or without proper consideration of where that information has come from, and we see that quite often for children in out of home care where the label of FASD is put on them without the assessment and without appropriate research into whether or not that prenatal alcohol exposure even occurred.

MR POWER:  What you are identifying there is the potential for assumptions leading to a misdiagnosis of FASD?

MS PATERSON:  Certainly.  And we see that across, if it's been mentioned in a medical letter, we are seeing this kind of imputed diagnosis through education, where children are being --- I guess their education plans are set up with the idea that they have a FASD diagnosis, and then when we come involved and do the comprehensive assessment which includes the history taking, we are having to go back and provide re education around whether or not they even meet criteria for a developmental diagnosis and if they do, what the actual cause of their disability is and explaining then how the school environment, for instance, or the out of home care environment should be set up in a way to best support the young person or child.

DR BOFFA:  So those children sometimes have ADHD rather than FASD or they have nothing?

MS PATERSON:  They have     genetic testing may be done or they may have a genetic condition which explains it, they might have had an acquired brain injury or traumatic brain injury that happened in infancy or early childhood that wasn't identified, it may be that they need investigations for epilepsy, whether that is an underlying cause, or for some kids we have a label of unspecified neurodevelopmental disorder where they have a collection of impairments across several areas, but there is no known cause at this stage as to why they are presenting the way they are.  That is certainly an accepted diagnosis under NDIS, so for that children that is the diagnostic label they get at the end of the assessment.
 

DR BOFFA:  Children at age 10 or 11, who for the first time ever get a diagnosis of FASD    

MS PATERSON:  Definitely, yeah.

DR BOFFA:     diagnosed that late compared to 7, what are the implications for the child?

MS PATERSON:  We are seeing children all the way up to 16 and 17 who have a diagnosis of FASD that hasn't been identified any earlier, and here we are.  So the services simply weren't there.  So when we are seeing the older children, often they have been in a stable foster care placement, and the kinds of things foster parents say to me is "I have been asking for this assessment, I know they have needed this assessment the whole time they have been in my care, it just hasn't existed", and so we are doing FASD diagnoses at 16 and 17 years of age, after that, from the time a child is 18 years of age they are no longer eligible for our service, so I would presume there is certainly undiagnosed FASD and undiagnosed neurodevelopmental disability in adults that we have missed entirely because they have aged out of our service.

MR POWER:  That comes to my final question.  As paediatric clinical neuropsychologists, Ms Paterson and Ms Blaine, do you think that there would be value in First Nations children who are in out of home care, so hence already disadvantaged, having it mandatory that Territory Families arrange that those children receive a multi disciplinary assessment at the time or shortly after they enter out of home care?

MS PATERSON:  I think mandatory is a difficult --- if a child is not in the right place to be assessed, so we are often seeing children who at the point of removal are quite traumatised and have quite challenging behaviours, so at the point of removal, they go from placement to place amount and are moved three or four times.  At that point, is there something going on for that child, a neurodevelopmental disability or disorder, it's quite possible there is, but with the upheaval that they've experienced, doing those assessments might not be timely, and it is possible that could not be in the best interests of that child, it could misidentify difficulties that are circumstantial.

So I think every child that is in out of home care probably should have an assessment at some point when clinically indicated.  But mandatory at the point they enter care might not be the most helpful way us to us do that.

MS BLAINE:  And I think what would be more useful as a mandatory base level system to be put in place is that all carers go through appropriate training that allow them to understand typical development as a first, and then understand neurodevelopmental disability, because we know for these kids the environment is the key to ensuring that, regardless of what has happened to them, that their environment is set up in order for them to be well understood and to thrive in that  
environment.

So certainly we can see lots of challenging behaviours that are identified as oppositional, defiant, non compliant, but that is the child's way of communicating that they are not coping, that the expectations are too great and that something in the environment is not working for them.  By having that education, we come across many carers, and they say "yes, I have heard of Foetal Alcohol Spectrum Disorder or any other type of neurodevelopmental disability, but I don't know what to do in response to that".  With the lag for some kids in getting assessments, they have had to trial and error over the years to see what works, so generally by the time they get to us, they will have a system in place, routines and structures set up that allow them to best --- to cope and to put things into place that allow the child to function at the best level that they can day to day.  But we also find out that burn out is extreme, their mental health is not looked after, that the opportunity for respite often sends back a child that is dysregulated, so the time that they got for a break was actually pointless, not worth it.  Because it is not necessarily going to be with somebody that the child knows, that is trusted, that is a slow transition.

So I think that supporting the carers to know typical development, and then to know what to do if a child is not tracking in that way is probably more useful because this means they are going to be geared to provide the best level of care from the moment the child comes, whether or not they are ready for assessment.

MR POWER:  You do think that all children in home care, at some point, should be assessed?

MS PATERSON:  It does makes sense as clinically indicated and with the assessment that is indicated for that child.  Sometimes we presume that it is a cognitive or neurodevelopmental disability, when what they might need as a higher priority is a mental health assessment as well.  So yes, some form of assessment does make sense, but targeting that for the child.

MS BLAINE:  We are seeing kids coming from out of home care and they have not necessarily had their 12 monthly child health check, so even that, as a minimum starting point, so the general practitioner is well aware that the placement has changed, where the child's at, and they can be the key person that the family can go to in the interim to work out whether or not an assessment is indicated.  If a child is settled, the school understands them, they are performing well, we would not necessarily assess a child if it's not clinically indicated.  But certainly, if the contrary was happening and the GP is recognising that, then the referral system into CYATS is very simple, and so that can be done by a teacher at school, or by the case manager at Territory Families, or it can be done by the paediatrician or GP.

MR POWER:  Perhaps a case worker having a standardised form which they have to tick boxes in order to say "it's not appropriate for a multi disciplinary assessment to happen because none of these problems exist"; something like that?

 
MS PATERSON:  Certainly it would be most common for it to be indicated, so it does make sense for it to be more of an opt out, that it's not indicated.

MR POWER:  Thank you.  That's all the questions I had, Chair.

CHAIR:  Yes, thank you very much.

I will just ask the Commissioners, my colleagues, if they have any questions, perhaps starting this time with Commissioner Mason.

QUESTIONS BY THE COMMISSION

COMMISSIONER MASON:  No, thank you, Chair.

CHAIR:  Commissioner Galbally?

COMMISSIONER GALBALLY:  I would like to ask a little more about school.  I was struck by the reduced attendance notion and wondered whether Congress works with schools and whether the training in the assessment tool, the incorporation of primary health advice into education.

What do you think about that and whether there's been any anything done about that.  It's like pushing primary health into every corner of life, but that's, sort of, sounds like it would be really valuable.

MS PATERSON:  It's quite common for us to see children with disabilities who are on reduced hours.  Like we talked about with parents, the need for increased supervision and the need for increased one on one time with children with disability is quite high.  We are often talking about schools who are doing the best with what the resources they have.  But if they are only funded for that child to receive one to one in classroom support for so many hours of the day, it is sometimes quite difficult for them to make sure they keep that child and the other children engaged in learning, focused and safe as well.  We sometimes see children with disability who are sent home from school at 12 o'clock, because the school doesn't feel like they can sustain the child's attention in a way that is safe and meaningful for that child and the other children beyond that time of day.  There are quite extreme behaviours that we sometimes see in kids, so it can be quite traumatising for other kids to witness as well.  I'm talking about upending classrooms, throwing chairs, and the children need to be removed from the classroom to keep them safe.  It might be that mismatch of environment.

Certainly in Alice Springs, which I haven't seen done in my previous work, they have satellite classes, where the child is verified through the Acasa Hill Special School here, but the classes happen in the mainstream school but in a specialised way, so the class numbers are reduced to six to eight children, there is a teacher and a teacher  
aide.  The curriculum is targeted in a way that the children understand and they are able to access it, which is a lot harder to do in a mainstream classroom of 25 kids where four kids have neurodevelopmental disability and you have one teacher aide who is expected to help support all of those children.  You can imagine for a child with a neurodevelopmental disability and if you add a trauma history of on top of that, it can be extremely challenging for them to remain in that environment for a whole host of reasons, and so you see the range of behaviours as a result of that.

The idea with the reduced attendance plans for the schools that we work with is to increase that over time, but it reflects that these satellite classes are at capacity, Acacia Hill School is at capacity, so they don't have anymore placements, and we are seeing kids in every cycle where we are recommending verification through special education in order for these kids to access the appropriate education service.  But when they are at capacity, I guess it is similar to other services in town, there is not a lot they can do, so schools have to work with the resources they have.

DR BOFFA:  NDIS plans have the potential to fund classroom supports and that is largely untapped.  It is happening a little bit.

MS BLAINE:  We are being told they can't.  We are being told it would be double dipping for the Government to fund education in two different ways --- education is funded through education, and disability through NDIS, and that they should not cross over.  That's what we're being told.

DR BOFFA:  That is a big problem for the Northern Territory because the Northern Territory Education Department has very limited resources and capacity to deal with higher needs special needs children, and it was thought the NDIS would be a pathway to help with this.

MS PATTERSON:  I think it's the way we are trying to think about this creatively, and again it kind of fits with that reduced attendance plan is that if a young person accesses a youth support worker under the NDIS package for capacity building community access, that a child has a reduced stay at school, and then the support worker can come to take them from school and do recreational activities, or do that one to one support at the library or at home, and support them with school work.

So we are trying to think creatively about how kids can get more of that one to one support, because schools are very limited in terms of their resources.  When you hear about them being able to access funding support, it is very rarely one to one and it is usually one to one in the context of a teacher aide that can offer half an hour here, maybe an hour there, or they will run a small group of four to five kids.  But for some of the kids we are seeing, they might be in year 6 or year 7 but learning at a transition year 1 or year 2 level, so you can imagine the education adjustments that are required for a child to sit in a mainstream classroom, sit and listen to curriculum that is not at their developmental level, and then have the adjusted curriculum provided to them after all of the other kids receive their classroom tasks.  So it's a lot of working around and it's usually more than one child that has a  
neurodevelopmental disability in that mainstream class.

MS BLAINE:  On that note ---

CHAIR:  I think we might --- if you don't mind, we might bring it to a halt here.  We are a little bit over time.  I think it is a fairly comprehensive answer to Commissioner Galbally's question.

COMMISSIONER GALBALLY:  Yes, thank you.

CHAIR:  Thank you very much.  Just one question from me.  In response to questions from Mr Power, you indicated that as far as Aboriginal children in out of home care are concerned, then the appropriate time for a multi disciplinary assessment is when there are clinical indicators that such an assessment should take place.  Did I understand that correctly?

MS BLAINE:  That's right.

CHAIR:  That would be the same for Aboriginal children not in out of home care?

MS BLAINE:  Yes, any child, any child living in Australia.

CHAIR:  I follow, thank you very much.  I will ask Ms Chalmers, whether you have any questions to ask of our panel?

MS CHALMERS:  Thank you, Chair.  For the reasons stated in correspondence, no.

CHAIR:  Thank you.  In that case, Ms Ah Chee, Dr Boffa, Ms Paterson and Ms Blaine, thank you very much for participating in the panel and sharing your views with us.  We appreciate your assistance to the Commission and the work that you do in Alice Springs.  Thank you very much for your contribution.

THE WITNESSES WITHDREW

CHAIR:  Mr Power, what is the position now?

MR POWER:  If we could break for lunch until 1.45 pm, we will return with Ms Martina O'Brien, who is a representative from the Department of Territory Families from the Northern Territory.

CHAIR:  It is now 1.05 pm AEST.  Let's resume at 1.50 pm, that gives everybody 45 minutes to have lunch.

CHAIR:  When we resume, it would be helpful to have an indication from Mr Crowley and/or Ms Tarrago as to where we are with whatever arrangements have  
been made concerning findings or lack thereof.  You remember that I asked Mr Crowley on Friday what we, as Commissioners, are going to be asked to do when we are not being asked to make findings about evidence that has been given by witnesses as to the experiences of children in out of home care.  It would be helpful to know just what arrangements have been made between Counsel Assisting and parties who have been given leave to appear, and that may have a bearing on what approach is to be taken to Ms O'Brien, from whom we shall hear at 1.50 pm or shortly thereafter.  We will adjourn now until 1.50 pm.

ADJOURNED    [1.06 PM]

RESUMED    [1.50 PM]

CHAIR:  Yes, Mr Crowley.

MR CROWLEY:  Thank you, Chair.

This afternoon there are two witnesses that we will hear from.  The first will be Ms O'Brien from the Department of Territory Families.  Mr Power will deal with that evidence.  We will then hear further from Mr Power taking the evidence of Dr Webster.

Chair, the issue that you raised earlier today and also on Friday, I have had some discussions with some of the parties at present but not with all.  I want to provide what assistance I can at this stage by providing a further statement which may assist yourself and the other Commissioners as well as the parties as to the approach to be taken with respect to the witnesses that we have heard from to date.

CHAIR:  Yes, thank you.

MR CROWLEY:  They are the witnesses IL, Audrey, Brandon, Miriam and Grace.  That evidence, as I indicated in the opening, has been presented to the Commission in this Public Hearing to enable Commissioners to hear directly from First Nations people with disability in out of home care and from their families and carers, so as to allow Commissioners to understand the issues from the perspective and experiences of those people.  The Public Hearing provides an opportunity for First Nations people with disability to participate in the Disability Royal Commission and for First Nations voices to be heard so that Commissioners may be informed about matters the subject of this inquiry by listening to First Nations people.

Although the Commission will not be asked to make particular factual findings in respect of the evidence of these witnesses, the evidence is nevertheless relied upon to inform the Commission and to illustrate and assist the Commissioners with respect to their understanding of broader issues that are the subject of the Commission's  
inquiry, according to its Terms of Reference, including providing examples of lived experiences which support systemic issues expected to be addressed by other witnesses in Public Hearing 16.

In this way, it is expected that the evidence of these witnesses will be relied upon by Counsel Assisting in respect of submissions to be made in due course concerning findings about systemic issues faced by First Nations children with disability in out of home care and national recommendations.

CHAIR:  Thank you.

MR CROWLEY:  Chair, there may be further matters to add to that, once I have had further discussions with other parties and it may be that other parties may wish to address you on the issue now at this stage.

CHAIR:  If any party wishes to do so, they certainly can have that opportunity.  Is there anybody who wants to take advantage of the invitation?

MS FURNESS:  If I might say, Chair, I have not had the opportunity of receiving a call from Senior Counsel Assisting, so this is the first I have heard of it.  So I am not in a position to make any submissions now, but I would like to reserve my right to do so after I have considered the matter further and after I have received instructions.

CHAIR:  Thank you very much.  Does any other representative wish to say something?  If not, we can proceed.

I should say, Mr Crowley, that the point of my question was, in part, that it is not very clear to me at the moment what the Commissioners can do with evidence of what are said to be specific examples of experiences, if those are disputed and we are not invited to make any findings.  But that is something that no doubt can be postponed until a later stage.  But that is the issue that is troubling me just a little.

MR CROWLEY:  Yes, I see.  Thank you, Chair.

CHAIR:  Let's proceed.

MR CROWLEY:  I will hand over to Mr Power.

CHAIR:  Mr Power, you are back again.

MR POWER:  Chair, the next witness we will be hearing from is Martina O'Brien.  Up on the screen is a notation "Cecilia Gore", but I assume that will be Martina O'Brien.  There is obviously no one in the picture at the moment but while that is occurring ---

CHAIR:  I did see a shadow briefly across the screen.  Whether there is substance behind the shadow, I'm not sure.
 

MR POWER:  Yes.  It has the distinctive background of the NT hearing room, so I think it must be Ms O'Brien.  I will deal with the administrative matters first.

CHAIR:  Yes.

MR POWER:  Martina O'Brien is a witness from the Northern Territory Department of Territory Families, Housing and Communities, who will give evidence in respect of her review of the case file for Miriam.  Commissioners, you will find a copy of Ms O'Brien's statement at tender bundle part A, tab 155.  There are five annexures to Ms O'Brien's statement at part A of the tender bundle, at tabs 481 to 485.  I would ask that her statement be tendered as Exhibit 16.10 and the annexures to her statement tendered at Exhibit 16.10.1 to 16.10.5.

CHAIR:  Yes, that can be done, thank you.

EXHIBIT #16.10   STATEMENT OF MARTINA O'BRIEN

EXHIBITS #16.10.1 TO 16.10.5   FIVE ANNEXURES TO MARTINA O'BRIEN'S STATEMENT, PART A, TABS 481 TO 485

CHAIR:  I think we have Ms O'Brien on screen.

MR POWER:  I ask that she be sworn or affirmed.

CHAIR:  Ms O'Brien, thank you very much for coming to the Commission to give evidence.  I understand you wish to take the oath.  Would you be good enough to follow the instructions of my associate, who is remote from you, he will administer the oath.  Thank you.

MARTINA O'BRIEN, SWORN

CHAIR:  Thank you, Ms O'Brien.  Just to explain where everybody is, Commissioner Galbally, whom you can see on the screen, is joining us from Melbourne; Commissioner Mason is in our Brisbane hearing room; I am in the hearing room in Sydney of the Royal Commission; and Mr Power, who will ask you some questions, is also in the Brisbane hearing room.  Mr Power will now ask you some questions.

EXAMINATION IN CHIEF BY MR POWER

 

MR POWER:  Ms O'Brien, could you tell the Commission your full name and your occupation?

MS O'BRIEN:  Martina O'Brien.  I am employed as the Director for Central Australia Urban Team, Territory Families, Housing and Communities.

MR POWER:  Is the Department frequently colloquially known as Territory Families?

MS O'BRIEN:  Yes.

MR POWER:  I will refer to the Department as "Territory Families", but noting its full title.  Prior to your present role, you worked as a social worker in Ireland, a child protection officer in Victoria and as a team leader and manager for Territory Families at Tennant Creek?

MS O'BRIEN:  Yes.

MR POWER:  In some of those roles you were a line worker yourself in dealing with children in need of protection?

MS O'BRIEN:  That is correct.

MR POWER:  You yourself have had no contact with Miriam, who is the case study for this matter, but you have reviewed the Territory files for Miriam; is that correct?

MS O'BRIEN:  That's correct.

MR POWER:  In that review, you have produced a statement with a particular focus on three questions that had been raised by the Royal Commission.  I propose to commence with a broad overview of the information set out in your statement, for the benefit of those listening who have not had the opportunity to read it.  I will ask you after each proposition to confirm it is correct.

Miriam was under a protection order for approximately nine and a half years from when she was four years old in 2010 until she was aged 13 in November 2019?

MS O'BRIEN:  Yes, that's correct.

MR POWER:  The protection order was revoked on the application of the chief executive in 2019, when Miriam was 13.  That was so she would go out of the care of the Department and was with relatives, and that was on the basis she had been in kinship care with those same relatives for approximately one year, from November 2018 to November 2019?

MS O'BRIEN:  That's correct.  They were assessed as able to meet her needs.
 

MR POWER:  Whilst the under care of Territory Families, Miriam was in a "group home" care situation for approximately 22 months of the nine and a half years, made up of four months in 2013, when she was seven; 17 months in 2016/2017, when she was aged 10 and 11; and one month in 2018, when she was aged 12?

MS O'BRIEN:  That's correct.

MR POWER:  In terms of the three issues that Territory Families was asked to respond to, this is a paraphrase but: one, whether Miriam was assessed for foetal alcohol spectrum disorder, FASD, and if not, why that had not been done; two, whether Miriam was given appropriate counselling for childhood sexual abuse; and, three, why Miriam was placed in a group home situation when she was seven years of age.

Your statement on behalf of Territory Families covers 11 pages and annexes five documents.  It also footnotes a number of Territory Families file documents.  In order to put the questions into perspective, I want to commence with a brief summary of the response to those three issues.  To confirm, through your counsel, these summaries have been given to you so that you are not hearing them for the first time right now; is that right?

MS O'BRIEN:  Yes, that's right.

MR POWER:  Issue 1, with regards to FASD, you indicate in your statement that the state of knowledge about FASD and the relevant policies of Territory Families on FASD assessments have changed since 2018.  Territory Families acknowledge that were Miriam a child taken into care at the time of the new policy, post 2018, her behaviours and risk factors which you list at paragraph 22 of your statement, would now have led to a FASD assessment.

At paragraph 23, you note that Territory Families has said it would still be possible for them to assist Miriam to be assessed for FASD or any other disorders through a multi disciplinary assessment conducted through Congress health service, and that is as a result of post care assistance that can be given by Territory Families.  Is that brief summary correct?

MS O'BRIEN:  Yes, it is.

MR POWER:  And, two, with regard to the appropriate counselling for sexual abuse, your statement addresses the records held by Territory Families in relation to what assessments and counselling was done.  Your statement notes that the last departmental record of any counselling for sexual abuse dates from 20 December 2016, when Miriam was 11 years old --- sorry, 10 years old, not far off turning 11.  The last record recommended a specialist risk assessment but it is not clear from Territory Families' records if that assessment ever occurred.  Is that correct as a brief summary?
 

MS O'BRIEN:  Yes, that's correct.

MR POWER:  With regard to the third issue, that is Miriam being placed in a group home for four months at age seven, your statement details the reasons why this occurred, with reference to documents.  The main immediate reason offered is that there was a late withdrawal of a potential kinship carer.  Further, it is noted that the particular group home had a dual role in assisting kinship care placements.  There is also an explanation given about the lack of available carers and the higher number of children in out of home care in Alice Springs at the time that this occurred, compared with the number there are now.

Your statement does note that the ages of certain of the other children in the group home at the time when Miriam was present there was not in accordance with the contractual restrictions on older children being cared for in the same group home.  In relation to issue 3, is that, as a brief summary, correct?

MS O'BRIEN:  Yes, it is.

MR POWER:  Is it correct that to assist with this examination, your counsel has been provided with a list of 13 documents taken from the Territory Families' larger file and that you have those documents available to you.

MS O'BRIEN:  Yes, I do.

MR POWER:  For the purpose of ease of reference via ABL, each one of them has been listed as 1 to 13, so I will refer to them by that number but I will also give the full title and the document ID number.  Just to confirm, you have those documents with you?

MS O'BRIEN:  Yes, I do.

MR POWER:  I will not place any of the documents on screen, to ensure that Miriam's identity is not inadvertently disclosed.

First, I want to go to issue number 2, that is the prior sexual abuse and the counselling that was provided for that.  Document 1 is a document from 3 January 2013, when Miriam was six, turning seven.  It is tender bundle A, tab 67, document 16.7.16, NTT.0002.0008.0694.  To confirm, this is a Territory Families' progress note which records that Miriam's carer at the time, who was not Grace but a prior carer, told Territory Families of certain specific, very concerning sexual behaviour by Miriam that had been seen by an older daughter of the carer and that Miriam had also asked another child who was in out of home care under the same carer that they mutually touch each other on the vagina.

The document also states that Miriam told her carer that whilst living in a particular named locality, a woman who she did not know "would touch her on the bottom" and  
the other children at that named place would touch each other on the vagina.  The carer indicated that the proposed kinship carer had a son and so the kinship carer "would need to be aware of the concerns".  Is that a part of what document 1, that progress note from 3 January states?

MS O'BRIEN:  Yes.

MR POWER:  Moving to document 2, this is a document from 4 January 2013.  Tender bundle A, tab 68, document 16.7.17, NTT.0002.0008.2583.  Is it correct that this is a Territory Families intake document, essentially responding to the progress note I have just read from and it states on the second page that the concerns have also been sent to police for further follow up/discussion.

MS O'BRIEN:  Yes, that's correct.

MR POWER:  I will come back to document 3.  Can I move to document 4, tender bundle A, tab 72, document 16.7.20, NTT.0002.0008.0864.  Document 4 is an affidavit filed in the Local Court at Darwin from the prior carer and that affidavit contains a number of paragraphs.

Can I take you to paragraph 10 of that affidavit, which states that in January 2013, the carer spoke with Miriam in private after having certain disclosures made to her.

COMMISSIONER MASON:  Mr Power, I am concerned with the stage where we are of the evidence being given and we may not have done a content warning at the beginning.

MR POWER:  I'm sorry, yes.

COMMISSIONER MASON:  Could that be done now?

MR POWER:  I will perhaps do that now.

COMMISSIONER MASON:  I can read that.

MR POWER:  Thank you very much, Commissioner Mason.

COMMISSIONER MASON:  This is a First Nations content warning.  This hearing will include evidence that may bring about different responses for people.  It will include accounts of violence, abuse, neglect and exploitation of First Nations people with disability and it will also include references to First Nations people who are deceased.  If the evidence raises concerns for you, please contact the National Counselling and Referral Service on 1800 421 468.  You can also contact Lifeline on 13 11 14; Beyond Blue on 1300 224 636; or for First Nations viewers, your local Aboriginal Medical Services for Social and Emotional Wellbeing Support.

Thank you, Mr Power.
 

MR POWER:  Thank you.  What is set out in that filed court affidavit, in paragraph 10, is that the prior carer asked Miriam whether she had been touched in a private place, and that:

.... she explained to me that, yes, she had.  Miriam said it had happened when she was younger, living at [a specified place], and that a lady she did not know the name of or was not willing to tell me had touched her bottom and fingered her.  She gave me the impression this had happened more than once.  She became very teary at this stage and started to curl up on the front passenger seat.  She also told me that the kids at the [named place] also touched each other regularly in the vagina and bottom.  And when I asked her if she had ever touched anyone in the private parts, she admitted touching Caleb, her younger brother, who she lived with in Grace's care, on the penis and only when Grace was not looking.  She said that nobody knew she was doing it.  I rang Grace also to let her know that this had occurred and to keep an eye on Caleb for any impact, even though he is still very young.  All of this was explained to the named Territory Families case worker at the time.

Is that correct that that is what is contained in that paragraph of the affidavit?

MS O'BRIEN:  Yes.

MR POWER:  Taking you back to document 3, a Northern Territory Police report dated 19 May 2013, titled "Completion of investigation".  It is tender bundle A, tab 76, document 16.7.25, NTT.0002.0008.2624.

Looking at that document, the circumstances the police are investigating are set out in that document.  You can see it is set out there:

Circumstances are that an OCF intake has been received stating that the subject child is currently in care.  Told her previous case worker that her other OCF child had seen the subject child doing a specified thing and also requested that this child touch her front.

It is clear from --- this police report ends with "Nil further police action required", and that includes:

The subject child was spoken to and she made no disclosures, nor said anything of concern.

It is clear, isn't it, that this police officer was not aware of either the sexual abuse of Miriam when she was a child at a specified place or of the disclosure that Miriam had touched her younger brother Caleb sexually?  That is apparent from that document, isn't it?

MS O'BRIEN:  The police investigation would have been on foot off the intake  
document.  That's the document that goes to police when they initiate a CAD investigation.

MR POWER:  This document is titled "Report to NT Families and Children, Completion of investigation".  When the case worker received this document, whether or not the police had been correctly informed of what had occurred, this document would indicate on its face that the police had not looked at the issue of childhood sexual abuse of Miriam herself, doesn't it?

MS O'BRIEN:  The paragraph read:

The subject child was spoken to and she made no disclosures, nor said anything of concern.

I interpret that as relating to any possible harm that she experienced herself.

MR POWER:  Yes, but you can see that the circumstances that this police officer understands are being referred to is limited to the observed sexual behaviour and the request of other children to touch her front.  Of course, by this time, Territory Families was aware that serious allegation of sexual abuse of Miriam as a child had occurred, yet that is not noted here at all.

MS O'BRIEN:  So the first paragraph references the intake.

MR POWER:  Yes.

MS O'BRIEN:  The content of the intake does discuss her disclosures in relation to prior sexual assault.

MR POWER:  Yes, but this document where the police officer is looking at it --- this is a 7 year old child.  They cannot be prosecuted under NT law, anyway, they are too young.  So the circumstances of this document do not reflect the allegation of sexual abuse at all.  It is the most important thing they would be looking at, yet it is not mentioned.  Do you agree it is not mentioned?

MS O'BRIEN:  It is not specifically mentioned, other than the intake.

MR POWER:  Well, it is not mentioned at all.

MS O'BRIEN:  Yes.

MR POWER:  Because there was no investigation, it was not established when this sexual offending against Miriam by an adult occurred.  Would you agree that Miriam was living at the place that is named, not in the police material but in the other material, from when she came into Territory Families care on May 2010, when she was four, until she moved in Grace's care for the first time at age five.  That's correct, isn't it?
 

MS O'BRIEN:  I believe it's the same location, yes.

MR POWER:  So it is certainly possible that the disclosed sexual abuse occurred to Miriam whilst she was on a protection order with Territory Families?

MS O'BRIEN:  It's possible.  But my understanding is she identified it occurred when she was two or three years of age.

MR POWER:  Well, because there was no investigation, the timing of it is unknown.  Territory Families certainly never returned this issue to Territory police, separate from Miriam, to say, "Look, there's this allegation of sexual abuse by an adult, as well as sexual behaviours by children of unknown ages in this named location."  Territory Families never referred that to the police, did they?  Or don't you know?

MS O'BRIEN:  What was referred to the police is what's in the intake document.

MR POWER:  But when it came back to Territory Families, it's clear from that completion report that that particular officer did not understand that to be the case?  I will move on.

CHAIR:  Is the point you are making, Mr Power, not so much about what the particular officer did or did not think?  I doubt Ms O'Brien can help us with that since she has had no involvement with the officer or with the officer's investigation.

The point you are making, if I follow it, is that Territory Families, once they got the completion of investigation document, being the document behind tab 3, should have realised there was a serious allegation of a sexual act or acts committed on Miriam, that had not, for whatever reason, been investigated.  Is that the point you are making?

MR POWER:  That is the point I am making, Chair.

CHAIR:  What is it that you want to put to Ms O'Brien that she can help with?  Is there any issue that Territory Families did not carry the matter further?  Is that in dispute?

MR POWER:  Ms O'Brien, in relation to these 2013 allegations, from your review of the records, Territory Families did not carry it further in regards to any response to the police, did they?

MS O'BRIEN:  In relation to police, I haven't found anything in the notes about any further contact.  We did make a referral for a psychological assessment to look out for disclosure of sexual abuse.

MR POWER:  I will come to that but I want to do it in order of the disclosures.  As I said, I will come to what was done in terms of treatment.  I first want to go to the  
next disclosure by Miriam of sexual abuse committed against her.

The records reflect that in December 2014, Miriam was placed in the care of Grace.  Do you agree with that?

MS O'BRIEN:  Yes.

MR POWER:  In terms of what the Territory Families records show for Miriam, the Territory Families records show nothing about Grace being told by Territory Families about Miriam's disclosure of sexual abuse by her of Caleb or of sexual abuse of herself as a child?  With regard to records for Miriam, there is no record that she was ever told anything on that; is that correct?

MS O'BRIEN:  In relation to Miriam's file, I didn't find that information.  However, when I looked up her sibling's file, I was able to see that that conversation had occurred.

MR POWER:  The sibling we are referring to is the sibling referred to by the pseudonym "Caleb".  Is it correct that Territory Families will provide some information about that, but it is not information that is presently with the Royal Commission?

MS O'BRIEN:  I don't think it is.

MR POWER:  Moving on to 2016, I want to refer to two documents, and they are documents 5 and 6.  Document 5 is a child protection investigation summary report.  Tender bundle A, tab 119, document 16.7.68, NTT.0002.0008.1478.

Also, a SARC referral form, dated --- it's hard to find the precise date but it seems to be 13 January 2016.  Tender bundle A, tab 114, document 16.7.63, NTT.0002.0008.1349.

Is it correct that these two documents record that Grace received disclosures from Caleb that led Grace to speak to Miriam and Miriam made disclosures to Grace, with the effect of those disclosures being that Miriam said she had been acting towards Caleb in a sexual way, including touching his penis and penetrative acts, and that she also made a disclosure of sexual abuse against herself.  On this occasion, it was disclosure of sexual abuse against her as a child, about an adult male having sexually abused her in the family home at the locality that is stated, and it involved fondling her breasts and penetration of her anus.

Page 1 of the SARC referral form states:

Miriam met with the CAT team but was unable to be interviewed due the level of distress displayed by the child.  Miriam indicated she would like someone to speak with and agreed to an SARC referral.

 
Is that a correct summary of contents of those two documents?

MS O'BRIEN:  That is correct.

MR POWER:  Can I go to the next document, document 7 ---

CHAIR:  What is an SARC referral?

MR POWER:  Is it correct that SARC is Sexual Assault Referral Centre, which is a centre with the Northern Territory Department of Health?

MS O'BRIEN:  Yes, that's correct.

CHAIR:  Sorry, I want to understand this.  This records that Miriam met with a team, was unable to be interviewed because of her distress, but she agreed to a referral.  How does a 10 year old child agree to a referral for a sexual abuse team?  What does that mean?

MR POWER:  Ms O'Brien, are you able to assist with what that means?

MS O'BRIEN:  According to the document, she agreed that she would speak with a counsellor.

MR POWER:  Moving to document 7, it is the same type of document as in 2013; that is, a report to NT Families and Children, Completion of Investigation document from the NT police, but it is dated 9 June 2016.  Tender bundle A, tab 127, document 16.7.76, NTT.0002.0008.2482.

This indicates that Miriam was again taken to a police officer.  This time the document does refer to disclosures about sexual abuse of her as a younger child and it states:

CATS and DCF spoke with Miriam and she became very upset and did not wish to talk further.  She was referred to counselling with SARC at this stage.  The matter will be finalised and CATS will be notified, if and when Miriam is ready to disclosure her matter.  Nil further police action required.  DCF notified of outcome.

Is that correct that that's what the document states?

MS O'BRIEN:  Yes, that's correct.

MR POWER:  CATS, what is that?

MS O'BRIEN:  That is the Child Abuse Taskforce.

MR POWER:  Is that a police task force or is that a Territory Families task force?
 

MS O'BRIEN:  It is made up of police who have forensic interview training and child protection staff.

MR POWER:  DCF is the Department which we are referring to as Territory Families?

MS O'BRIEN:  Yes.

MR POWER:  At this point in time, Miriam had made two disclosures to her carers about serious sexual abuse of her as a child.  Do you agree with that?

MS O'BRIEN:  Yes.

MR POWER:  The effect of these disclosures was that two different adults had sexually abused against her at a named locality and, in the most recent disclosure, the abuse was identified as having occurred in her home.  Do you agree with that?

MS O'BRIEN:  Yes.

MR POWER:  Again, because there was no further investigation, Territory Families cannot be sure whether or not this sexual abuse occurred when Miriam was four or five, when she was still living at the named locality and was under a protection order from Territory Families, can it?

MS O'BRIEN:  There was reference to the timeframe, I believe, in the psychological assessment.

MR POWER:  Right.  We will come to that in a moment.  But do you agree that, quite apart from anything else, there was a risk that these adults might sexually offend against other children?

MS O'BRIEN:  The --- (overspeaking) ---

MR POWER:  Do you agree?

MS O'BRIEN:  Yes.

MR POWER:  It's possible?  Yes.

I will come now to the psychological treatment.  Before I do that, I will take you to tab 13 of the document bundle.  This is two Territory Families general case closure summary documents, from 15 August 2016 and October 2016.  It is document 13 in tender bundle A, tab 137, document 16.7.86, NTT.0002.0008.1369.

Can I take you to page 4.  The document refers to a visit by certain named case officers to Miriam on 5 September 2016.  Part of that was she was asked about a  
contact visit with her brother Caleb that she had missed.  Near the top of page 4 in the second paragraph, the case worker asked why it was she missed that last access visit.  Miriam is recorded as having replied by saying that she was "ashamed and tired".  That was on 5 September 2016.  Do you agree that file note reflects that?

MS O'BRIEN:  Yes.

MR POWER:  At this point in time in September 2016, Miriam was 10 years old.  If a child was talking about feeling ashamed about having contact with her younger brother, who was her closest sibling, and that was why she was not seeing her brother, that is a matter of great concern for Territory Families, wouldn't it be?

MS O'BRIEN:  Yes.

MR POWER:  Let's go the documents about counselling and therapy.  Can I take you, first, to document 8 in the bundle of documents.  This is a report of Mr Thomas Sibbald, a clinical psychologist, dated 23 July 2013 and filed with the Magistrates' Court at Darwin on 15 August 2013.  Tender bundle A, tab 86, document 16.7.35, NTT.0002.0008.0761.

Your statement, at paragraph 20(a), says this report was requested by Territory Families in or about May 2013.  On the first page of the report itself, you see a statement as to what the concerns are which form the basis for the evaluation, and then there is a section in quotations.  Do you see that part of the report on page 1?

MS O'BRIEN:  Yes.  The limitations of the current assessment, yes.

MR POWER:  No, above that:

Miriam's OCF case manager in Alice Springs [named case worker] provided the following concerns which form the basis for this evaluation.

Then you see the section in the quotations?

MS O'BRIEN:  Yes.

MR POWER:  Do you agree that description does not include the carer's description of Miriam's sexualised behaviour towards Caleb, which was set out in paragraph 10 of the carer's affidavit on 27 April 2013 in the same court proceedings that this was filed?  Do you agree it doesn't refer at all to that?

MS O'BRIEN:  That paragraph doesn't include that, yes.

MR POWER:  And nowhere else in the report does either?

MS O'BRIEN:  The psychologist did have direct contact with that carer.

 
MR POWER:  They did, yes, but there is nothing on the face of this report which shows they were informed about the sexual contact towards Caleb, was there?

MS O'BRIEN:  That paragraph doesn't include that.

MR POWER:  No.  Would you then go to page 5 of the report, under the heading "Opinion", one of the paragraphs reads:

Given the lack of pattern of sexually inappropriate, explorative or sexualised behaviours, there is no reason to conclude that Miriam's isolated, inappropriate sexualised behaviours represent a specific risk factor.  However, the events in the period ahead will either provide her with protective or further risk factors associated with sexualised behaviours.

Unbeknownst to Mr Sibbald, this was not isolated.  There was another set of sexualised behaviours, which was touching the penis of Caleb, her younger brother, but "only when Grace was not looking".  Territory Families was aware of this, but Mr Sibbald was not.  One can see from that paragraph, but also the basis on which he was asked to form the basis of the evaluation, it shows that he was unaware that it was not just the one observed sexual behaviour and making a request of another child, which is what he set out on page 1; in fact, there was another set of sexualised behaviours being hidden from adults.  Do you agree with that?

MS O'BRIEN:  I agree that it is not mentioned in that initial paragraph, but he did have a separate meeting with the original notifier --- (overspeaking) ---

MR POWER:  Are you saying that ---

CHAIR:  Please let Ms O'Brien complete her answer.  Please complete her answer.

MS O'BRIEN:  That paragraph on the first page doesn't include the reference to her sibling.  However, the person that notified of those concerns had an individual meeting with the psychologist as part of his assessment.

MR POWER:  You have no way of knowing whether or not that carer thought there was an obligation from her to provide this person with a history of the abuse?  You have no way of knowing whether she thought she had an obligation to do it or whether she thought the Department would have briefed the psychologist?

MS O'BRIEN:  Yes, I can't answer that.

MR POWER:  No.  But you would agree that, on the face of the report, it does not appear that Mr Sibbald has --- he certainly has not listed anywhere this significant factual basis and, in fact, what is under his opinion would seem to suggest he was not aware of it?

MS O'BRIEN:  There was confirmation with the previous carer, Grace, to establish  
whether there had been a pattern of that behaviour in that placement.  I am not sure if that is what he is referring to.

MR POWER:  He never spoke to Grace.  If you look at page 2, it is a meeting with the prior named carer.  The entirety of the "direct stakeholder interviews" were conducted on 18 July and include what is listed there; speaking with the grandmother, speaking with the prior carer, and Miriam, and the carer's other child, as well as various emails and telephone conversations with a named case worker.  So there is no --- he did not speak to Grace.

MS O'BRIEN:  No, but he spoke with the case manager, who spoke with Grace.

MR POWER:  Alright.  The Territory Families records show that Miriam was referred to a centre called Holyoake for what was described as sand play therapy?

MS O'BRIEN:  Yes, she was.

MR POWER:  You have had a chance to review the documents from Holyoake and any referrals to them?

MS O'BRIEN:  Yes.  She attended for weekly sessions in two different periods.

MR POWER:  Nowhere in those records do they say she has been referred there for childhood sexual abuse, nor does any exit interview from Holyoake refer to it.  It just refers to "trauma", doesn't it?

MS O'BRIEN:  Can you refer me to the document?

MR POWER:  Well, I suggest they don't, but you are welcome to take the question on notice and if any of the Holyoake documents refer to what therapy was done for sexual abuse, you could let the Commission know.  Would you like to take that question on notice?

MS O'BRIEN:  Yes, I'll take that question on notice, thank you.

MR POWER:  We then move to tab 9, which is a report from a psychiatrist, Dr Sally Cleworth of 19 December 2014.  Tender bundle A, tab 105, document 16.7.54, NTT.0002.0008.1192.  That document gives a brief life history, a description of challenging behaviours, but the report makes no reference at all to any disclosures of childhood sexual abuse, sexualised behaviours and also there is no reference at all to any therapy with Holyoake.  Do you agree with that?

MS O'BRIEN:  Yes, there is no reference to Holyoake or to sexualised behaviours.

MR POWER:  Yes.  That strongly suggest, does it not, given the context of the report, that Dr Cleworth was not informed of those matters by Territory Families?

 
MS O'BRIEN:  It doesn't mention it at all so, yes, it's possible that she had no prior knowledge of that.

MR POWER:  If we move to document 10, that is a further report from the same psychiatrist, Dr Cleworth.  Tender bundle A, tab 128, document 16.7.77, NTT.0002.0008.2184.  On page 3 of that report, there is a paragraph which is bolded, with the bolded words "In summary", which reads:

In summary, Miriam's history suggests a very prolonged pattern of sexualised behaviour, probably resulting from being a victim herself of intense, recurrent sexual abuse from a very young age.  Her repeated sexualised behaviour pattern towards Caleb and sexual comments to an older foster child years ago suggest she may well struggle to control this kind of behaviour in the future, that children around her, younger and older of both genders could be at high risk and that seeing Caleb could be a trigger for future sexualised behaviour.  Miriam's ability to effectively conceal her behaviour from adults is a notable feature and all adults responsible for the safety and care of Miriam and other children around her need to be acutely aware of this issue at all times.

Given what is said there and elsewhere in Dr Cleworth's report, you would agree, in light of that report, that Territory Families would want Miriam to engage in therapy and for Territory Families to have some sort of final report, showing the therapy had been successful and no further therapy was required?  Would you agree with that?

MS O'BRIEN:  Yes.

MR POWER:  This report by Dr Cleworth was 10 June 2016, so when Miriam was 10 years of age.  At paragraph 28 of your statement --- perhaps the redacted version could be placed on the screen.  Do you have your statement there, paragraph 28?  What we have is obviously the disclosure itself.  It notes:

Miriam did not make any disclosures ....

On or about 27 March 2016, Miriam was referred to SARC.

That is the first step that was taken in terms of the referral to SARC.  Some six weeks later, we then have a referral meeting to identify session times.  Then it notes that Miriam attended two appointments with SARC, 15 June and 1 September.  The rest of the appointments were cancelled by SARC.

That is based on your review of the documents held by Territory Families?

MS O'BRIEN:  Yes, that's correct.

MR POWER:  If we go to paragraph (b) --- that is the extent of the referral to SARC.  In paragraph (b) on the following page:

 
On 17 August 2016, Miriam was referred to In Care Support ....

What is In Care Support?

MS O'BRIEN:  It was therapeutic support provided by the Department for children in out of home care.

MR POWER:  It notes that there was a delay in the acceptance of this referral.  On 3 October 2016, Miriam's referral was accepted and she was allocated to a named therapist.  By this point in time, we are at 3 October and there have been two therapy sessions.  Do you agree with that?

MS O'BRIEN:  It was very difficult to, I guess, find all the information on the notes.  There was one case note which said she had had six or seven sessions, but then different case notes that said she hadn't engaged, so it was really difficult to get the overall picture.

MR POWER:  In paragraph (c), we have "CCIS note a phone call from", and then things are blacked out but they are a named person at SARC to the named therapist from In Care Support on 21 October 2016, where SARC supported In Care Support taking over Miriam's case for the provision of therapy.

Do the records show whether there was actually any therapy between 3 October 2016 and this conversation on 21 October 2016?

MS O'BRIEN:  Again, it wasn't clear.  From what I could gather, the In Care Support met with the case manager but it wasn't clear if they met with the child.

MR POWER:  Going to the final paragraph, (d), we know that:

On 20 December 2016, In Care Support recommended that Miriam's case be closed to allow Case Management to seek a specialised risk assessment.

From your review, it is not apparent from the Territory Families' records whether a risk assessment occurred, or the context that lead to this recommendation; that's correct?

MS O'BRIEN:  That's correct.

MR POWER:  Can I take you to document 11 in the bundle, which is the next out of home care plan for January 2017.  Tender bundle A, tab 146, document 16.7.795, NTT.0002.0008.2244.  On page 4 of that document, and it is set out in columns, the second full paragraph down reads, and this is the report for January 2017:

Miriam continues to, nearly on a daily basis, abscond from placements with other clients who are older and a concern around this is that Miriam does not  
demonstrate any protective behaviours or demonstrate any awareness of stranger danger.  Miriam has previously attended several sessions at the Sexual Assault Referral Centre (SARC) in relation to protective behaviours.  CM referred Miriam to In Care Support (ICS) for support in relation to protective behaviours and making herself safe: peer pressure, bullying and self esteem with the goal to make her feel more confident in expressing her views and wishes.  ICS expressed they did not have the capacity to commence services for Miriam and she needs more support than the short term support offered by ICS.

Firstly, certainly on the face of it, that does not seem to be the sort of high level counselling and support that someone who had suffered the degree of sexual abuse described in Dr Cleworth's statement needed, does it?

MS O'BRIEN:  Well, the case manager made the appropriate referrals but it doesn't seem like the service, ICS was delivered, by either service.

MR POWER:  This is, of course, a Territory Families document.  With regard to the care of Miriam for this issue of sexual abuse, do you agree that from 20 December 2016 onwards, so far as Territory Families records show, she received no further treatment at all for her childhood sexual abuse or for her sexualised behaviours?

MS O'BRIEN:  I didn't see anything in my notes for further sexual counselling.

MR POWER:  With regard to the issue of Territory Families dealing with Miriam as a child who has disclosed sexual abuse, do you agree that in this area of Miriam's care, her care and protection was not well achieved?

MS O'BRIEN:  I think, on review of the notes and the documents, that despite the case management team making the appropriate referrals, she didn't receive the appropriate service.

MR POWER:  Would you agree that the failures in this aspect of Miriam's care and protection could accurately be described as neglect?

MS O'BRIEN:  As I say, it was --- the case management did make the appropriate referrals, but they didn't get the service that had been accepted and agreed.

MR POWER:  But they knew that and they still made no further efforts so far as Territory Families records show; isn't that right?

MS O'BRIEN:  As far as the records show, it does mention that there was recurring monthly case conferences convened, but I don't --- I can't identify that further assessment where counselling was organised.

MR POWER:  Those case conferences appear to be case conferences with the case workers, not with Miriam?
 

MS O'BRIEN:  It would be with, yes, the care team, the professional team.

MR POWER:  Similarly to what has been offered in relation to Miriam's post protection order care, is Territory Families prepared to facilitate psychiatric or psychological treatment if it is seen as needed for Miriam in relation to this issue of being a survivor of childhood sexual abuse, or do you need to take instructions on that?

MS O'BRIEN:  No.  Under the provisions of after care, we can support Miriam in this regard.

MR POWER:  Chair, I have reached the time limit.  Ms Chalmers, counsel for NT, has provided some notes in relation to answers to the other two issues.  I can perhaps work with Ms Chalmers to provide either addendum information or addendum statement, to ensure that the FASD and placement issues are properly addressed from some further discussions that Ms Chalmers was able to have with Ms O'Brien, which updates that slightly.

CHAIR:  Yes, very well.

MR POWER:  Those are my questions.

QUESTIONS BY THE COMMISSION

CHAIR:  Thank you.  Ms O'Brien, we have been jumping about a bit chronologically and I may have missed something.  But in the documentation we have a report from Dr Cleworth, dated 19 December 2014, which is the document behind tab 9.  That document does not appear to indicate that Dr Cleworth appreciated that there may have been child sexual abuse perpetrated upon Miriam when she was very young and certainly on more than one occasion.

Yet by the time of the report from Dr Cleworth of 10 June 2016, which appears behind tab 10, and also there is a copy in my version in tab 9 as well, she does appear to appreciate the likelihood that Miriam did experience multiple sexual abuse.

Is there anything to indicate how Dr Cleworth, between 2014 and 2016, came to appreciate that this was likely to be the situation?

MS O'BRIEN:  My understanding, from reviewing the document, is that she is aware of why the placement broke down.

CHAIR:  Broke down when?

MS O'BRIEN:  With the context --- with Grace, which is related to the disclosures  
against the younger sibling.

CHAIR:  Yes, but when were those disclosures made?

MS O'BRIEN:  In March.

CHAIR:  2016?

MS O'BRIEN:  2016.  And her report references that she started seeing Miriam again in April.

CHAIR:  You would infer from the documentation that Dr Cleworth, on the basis of what was revealed in March 2016, came to the conclusion that she expresses in the letter of 10 June 2016 and, thus, has a different appreciation of Miriam's circumstances than in 2014?  Is that your assessment of the record?

MS O'BRIEN:  Yes.

CHAIR:  Just take me, please, to what is said in the March document that indicates that?  Which tab are we in when you refer to the March document?

MS O'BRIEN:  I am looking at the document dated 10 June 2016.

CHAIR:  That is the letter from Dr Cleworth?

MS O'BRIEN:  Yes.  So in her first paragraph, she gives the context about why she was seeing Miriam again.

CHAIR:  Yes.  I'm sorry, where does that indicate that Miriam had been subjected to more sexual abuse than had previously been indicated?  That is what I am trying to understand.

MS O'BRIEN:  I believe she has made her opinion based on the most recent disclosures from March 2016.

CHAIR:  It may be I have overlooked something and the difficulty here, and I think for the other Commissioners as well, is we have only received some of these documents very recently and we are trying to follow them.  What was it that was revealed in March?  Which is the document you are referring to when you reference disclosures that were made in March 2016?

MR POWER:  Chair, if I could assist, tab 5 of the smaller bundle is the child protection investigation summary report.  The investigation commenced on 27 March 2016 and that sets out that Grace has reported certain things to Territory Families.  Then it tracks through what Territory Families were told and what occurred thereafter.  That is a six page document.

 
CHAIR:  Yes, I know but which part of it is --- again, it is not made any easier by the fact that the version I have, and I assume my colleagues have, seems to combine pages and is not sequentially numbered.  Which part of that document is most relevant on this issue?

There are plenty of disclosures about Miriam touching Caleb and there is a disclosure by Miriam of an incident of sexual harm.  There may be a disclosure, but where is there a disclosure that Miriam may have been subjected to more than one instance of sexual abuse and over a period of time may have been subjected to sexual abuse?

Perhaps we will leave it there.  You might, in conjunction with Ms O'Brien, let us have a note about where an analysis of the documentation leads us on that issue, because I personally would be assisted by understanding what led to Dr Cleworth's change of assessment, because at the moment it is not obvious to me.

Do you happen to know where Dr Cleworth is now, Ms O'Brien?

MS O'BRIEN:  As far as I know, she still provides a service to Central Australia.

CHAIR:  She is in Alice Springs, is she?

MS O'BRIEN:  She flies in and out.

CHAIR:  So she comes into Alice Springs from time to time?

MS O'BRIEN:  Yes.

CHAIR:  I see.  Thank you.  Do you know --- I don't want names --- who the officers were responsible for the care of Miriam during the time she was subject to orders that placed her within the decision making responsibility of the Department?  Were there particular officers responsible?

MS O'BRIEN:  For taking her into care?

CHAIR:  No, who prepared these documents, who look after the file, who make decisions about referrals.  Were there particular persons, over the period that Miriam was in care, responsible?

MS O'BRIEN:  There were allocated case managers and team leaders and child protection officers.

CHAIR:  Over that period was there one such case manager, a series of case managers?

MS O'BRIEN:  There was a number of case managers.

CHAIR:  Are any of them still with the Department?
 

MS O'BRIEN:  I don't believe so.

CHAIR:  Thank you.  Yes, I understand, Ms Chalmers, do you want to ask some questions?

MS CHALMERS:  Sir, I will liaise with Counsel Assisting Mr Power, about an addendum statement.

CHAIR:  I should ask my colleagues whether they have any questions to put to Ms O'Brien.  First of all, Commissioner Mason, do you have any questions you wish to put?

COMMISSIONER MASON:  No, thank.

CHAIR:  Commissioner Galbally?

COMMISSIONER GALBALLY:  No, thank you.

CHAIR:  Alright.  Ms Chalmers, you will discuss matters with Mr Power, is that what you are communicating?

MS CHALMERS:  Yes, and we will attempt to answer the questions you have been trying to get to the bottom of most recently, Chair.

CHAIR:  Thank you very much.  In that case, Ms O'Brien --- assuming there is nobody else who wants to ask Ms O'Brien any questions --- that will conclude your evidence.  Thank you very much for attending the Royal Commission and giving your evidence and assisting the Commission in its inquiry.  Thank you.

THE WITNESS WITHDREW

CHAIR:  Mr Power, do we adjourn for a short time?

MR POWER:  If we could have a short break of five minutes and return with Dr Andrew Webster.

CHAIR:  By my watch, it is 3.07 EST.  We will resume at 3.15 EST.

MR POWER:  Thank you, Chair.

ADJOURNED    [3.08 PM]

 
RESUMED    [3.16 PM]

CHAIR:  Yes, Mr Power.

MR POWER:  Thank you, Chair.  The final witness the Commission will hear from this afternoon is Dr Andrew Webster of the Danila Dilba Health Service.  He is the senior medical officer of the organisation and he will give evidence from the perspective of an Aboriginal community controlled health organisation.

Commissioners, Dr Webster's statement is at tender bundle B, tab 25.  There is an additional document referred to in his statement which is at tender bundle part B, tab 26.  I would ask that the statement be tendered as Exhibit 16.11 and the other document as Exhibit 16.11.1.

CHAIR:  Yes, both those documents will be admitted into evidence with the markings you have indicated.

EXHIBIT #16.11   STATEMENT OF DR ANDREW WEBSTER

EXHIBIT #16.11.1   ADDITIONAL DOCUMENT AT TENDER BUNDLE PART B, TAB 26

MR POWER:  Thank you.  I ask that Dr Webster be sworn or affirmed.

CHAIR:  Dr Webster, thank you very much for coming to Royal Commission to give evidence.  I understand you wish to take an affirmation.  Would you be good enough to follow the instructions of my associate, who will administer the affirmation to you.

ANDREW WEBSTER, AFFIRMED

CHAIR:  Thank you, Dr Webster.  Just to explain where we are all located, Commissioner Galbally is in Melbourne; Commissioner Mason is participating in the hearing from the Brisbane hearing room; I am participating from the Sydney hearing room; Mr Power, who will ask you some questions, is also in the Brisbane hearing room.

EXAMINATION IN CHIEF BY MR POWER

MR POWER:  Dr Webster, could you tell the Commission your full name and your  
occupation.

DR WEBSTER:  I am Dr Andrew Webster, I am a general practitioner and the senior medical officer at Danila Dilba Health Service.

MR POWER:  Dr Webster, what is Danila Dilba?

DR WEBSTER:  Danila Dilba is an Aboriginal community controlled health service, which means we have an Aboriginal board and an Aboriginal CEO.  We run a health service in the greater Darwin region, funded predominantly by the Commonwealth Government, with some additional funding through the Territory government and some other sources.  We provide health services to the Aboriginal and Torres Strait Islander community of the greater Darwin and Palmerston region of the Northern Territory.

MR POWER:  Is it correct that you have a client population of more than 15,000 First Nations people, of whom 9,000 are regular clients, through nine clinic locations?

DR WEBSTER:  Yes, that's correct.  Over 15,000 current clients but about 9,000 to 10,000 of those are regular clients, which means we have seen them three times in the last two years.  You are correct, we have nine clinic locations in the Darwin and Palmerston region.

MR POWER:  We have heard from Congress and is it correct, that Danila Dilba, in simple terms, is the service for Darwin that Congress is to Alice Springs and its surrounding area?

DR WEBSTER:  Yes, that's correct.  There are a few fundamental differences that are worth pointing out.  We are very similar organisations in terms of structure and purpose.  Congress does have remote clinics, so they have a number of their clinics in remote locations, whereas we are focused on the urban area.  Where I am at the moment in Humpty Doo is the most remote we have, and that's about 55 kilometres outside of Darwin.  We really don't extend into the very remote areas, we are much more of urban AMS, compared to Congress, which has both urban and remote clinics.

MR POWER:  You have given a 38 page statement, which covers a considerable number of areas, but I want to focus your oral evidence today on two areas.  The first is pathways into the child protection system and what Danila Dilba does do and is able to do in relation to First Nations children in out of home care.  Then, secondly, Danila Dilba's experience and the evidence you can give about the safe care model.  If I don't cover something that is in your statement, it is because I am seeking to focus primarily on those two areas.

Firstly, does Danila Dilba provide a service for children in out of home care in the greater Darwin area?
 

DR WEBSTER:  Yes, we absolutely do.  We regularly, across our clinics, see children in out of home care, both those who have been in out of home care for a period of time, but also children who have very recently entered out of home care.  That is one of the more common scenarios that we would see in our clinics, where a child has entered out of home care and the carers then bring the child in for a health assessment as they enter care, which is one of the requirements of them entering care.  So we see children in that circumstance.

Also, we do sometimes see children repeatedly when they are in out of home care.  Then, of course, when children are returned --- hopefully this is what happens, children are returned to their families or to family custody --- we continue to see these children.  We absolutely see children across a wide range of their lives.  I think one of the unique factors of our organisation is we also see the parents and the other family members of children who are in out of home care, so we have the benefit of having quite a comprehensive understanding about the factors that are involved and how they influence families and how they impact on families.

MR POWER:  In terms of how a First Nations child enters into the child protection system, are you able to offer a comment from Danila Dilba's perspective on why that occurs at such a high rate for First Nations children, compared to non First Nations children?

DR WEBSTER:  Yes.  Obviously we are here in a Disability Royal Commission, so disability is going to be a key thing that I would like to mention.  There are a number of factors, but a long history of trauma, dispossession, colonialisation, all of these factors contribute to poorer parental health and mental health outcomes, which then has flow on effects to children.

I think there are absolutely understandable mental health factors that go on here, both for children and their parents, but also physical and more diagnosable disability factors as well.  I'm thinking about conditions such as FASD, which has a relationship between maternal alcohol use and then childhood disability.

There are a number of different bits and pieces that go into this.  But in terms of what leads to an overrepresentation of Aboriginal and Torres Strait Islander people in out of home care, there are large numbers of notifications that occur.  There is mandatory reporting in the Northern Territory for family violence and there is also child sexual abuse of course.

I think the family violence notifications potentially lead to some children ending up in out of home care, whether they get notified in the hospital setting or through a primary carer or through another situation, through police.  But also I think there are real challenges of parents, who are suffering from their own significant physical and mental health issues or illnesses, caring for children who may have disability.  I think the capacity of the family unit or of a single parent or both parents caring for a child who may have developmental delay or a genuine overt disability is limited, and there  
are limited supports available, frankly, for those parents of children with disability to be able to care for them appropriately.  That also has flow on effects to children being removed from parents' custody and ending up in out of home care as well.

Further to that, a final point perhaps is that I think, of course, there is a big relationship here with disability and the justice system, which we may talk about further as well.  When children have either a diagnosed disability or not, but they have behavioural issues or behavioural challenges, they are often brushing up against the criminal justice system and that can lead to notifications or, in some circumstances, arrest and ending up in Don Dale and then perhaps that spirals into ending up in out of home care at some point as well.

We think about this, certainly in our service, as a continuum.  There is out of home care, safe care houses, Don Dale and then adult prison.  That is a kind of trajectory that, unfortunately, we see happening for a number of kids who come through our service and who are known to our service.

MR POWER:  In terms of the structure of your statement, you discuss the vulnerability of certain First Nations children and note that without early intervention, in the provision of culturally appropriate supports, it is more likely that First Nations children will experience negative outcomes.  At paragraph 15, you note the relationship between early childhood trauma, delayed or impaired development and substantiated child protection notifications, which then not infrequently, without the appropriate supports, lead to out of home care.

Danila Dilba, what services does it offer that can try and break that cycle?

DR WEBSTER:  Thanks.  We view ourselves as a whole of lifespan service.  So we do care for people throughout --- even before birth.  From conception, essentially, all the way to death.  We have a number of services that can do early intervention which, as you just mentioned, is so critically important in interrupting this trajectory or this pattern we see repeated.

One example is the ANFPP, which is the Australian Nurse Family Partnership Program, which is team of nurses and Indigenous family workers who start seeing a mother who is pregnant with an Aboriginal child from 16 weeks gestation, so 16 weeks into the pregnancy, all the way through until that child is two years of age.  What they help with is mother crafting, assisting the family to get appropriate supports around emotional supports or wellbeing supports, mental health, but also access to social work and getting access to money, that kind of thing.

They also help to do early identification of developmental delay.  The midwives who visit with this program into children's homes, importantly they do lots of home visits, they can help to identify anything like speech delay or gross motor delay that might be something that is starting to show up in the early stages.

Then we recently have self funded some paediatricians and the child health service,  
which we are now able to use to do some diagnostic things.  We are in the infancy of where we would like to be with that, but we are able to do some diagnostic parts of this whole process, of understanding what is going on with children, whether they have a disability.

Then we are also able to do some therapy.  Again, this is an area we are trying to expand in.  Speech pathology, occupational therapy and neuropsychology are three really important pillars of early intervention for children with complex neurodevelopmental delay or just normal developmental delay.  They are things we would really like to get into more.  We are at the infancy of what we would like to do, and we can do bits and pieces, but we cannot provide a comprehensive service at the moment, frankly because we are not funded to do so.

We are very envious of what Congress is able to provide with their CYATS service.  They have a much better sustainably funded, more comprehensive service that can do both diagnosis and therapy.  We would love to be able to move towards that but, unfortunately, our funding application for that was recently unsuccessful, so we have not been able to move in that direction as quickly as we would like.

MR POWER:  The CYATS is something we heard about from Congress this morning.  Is it a model that you think could work in a larger urban area of Darwin?

DR WEBSTER:  Absolutely.  I think that is so evident from the amount of buy in, the amount of success that model has had in Central Australia.  We would love to be able to do the same thing.  My sense is, as a clinician and as someone working in our service, that we could, with very few modifications, make that model work in Darwin almost immediately.  If we were funded for it, we could press 'Play' and have that fantastic service tomorrow, to deliver both therapy and diagnosis for young people.  I think it would have really measurable effects on the long term outcomes of these kids, in terms of educational attainment, interactions with the justice system, et cetera.  It would be a really meaningful thing if we were able to achieve that.

MR POWER:  In that context, I want to go to paragraphs 34 to 37 of your statement, which talk about the overrepresentation of First Nations children with disability in out of home care.  You commence by noting that in 2020, around 88 per cent of children and young people in out of home care in the Northern Territory were First Nations.  You then go to some internal data that Danila Dilba holds, at paragraph 35, which notes that over 60 per cent of Danila Dilba clients who are in out of home care have a recorded disability.  Could you expand on that fact and how you derive that data and whether that is a true representation, as far as you can tell?

DR WEBSTER:  I think the first thing to say is it is very likely to be an underrepresentation.  Our clinical information system, the software we use when we are seeing patients, allows us to identify children who are in out of home care.  There is an item we can use within their file in the system that will identify them as being in out of home care.  We do that to allow us to flag for other practitioners that this child is in out of home care, but also to identify who the carer is and who the  
Territory Families case manager is, so if we need to contact them, we know the contact details.

Also in the same software, we are able to identify if people have certain diagnoses.  Typically, for the general population, this would be that this person has heart disease, diabetes, high cholesterol.  But in the disability context, it might be things like autism spectrum disorder, foetal alcohol spectrum disorder or ADHD.

By looking at our whole file, our whole system, of those 15,000 or so patients, we have looked at the number who have been identified as being in out of home care and looked at the number of those who have a diagnosed disability and that figure is just over 60 per cent on our current data.

The reason I think it is an underestimate is partly because coding for disability typically happens very late.  So you need a formal diagnosis for me, as a practitioner, to put a disability diagnosis into our clinical information system.  If someone had suspected FASD or suspected ADHD, I wouldn't put that diagnosis into their file in all likelihood, I would wait until they had a diagnosis.  So I suspect that a number of the children who are identified as being in out of home care are in the diagnostic process of having a disability diagnosed, but haven't yet reached that threshold of a formal diagnosis to mean we would identify them as such in our software.

It's difficult to know exactly what the prevalence is at the moment in our population, but I would say it would be higher.  It would be much more like 80 per cent, in reality, and I think 60 per cent is probably an undercount.

MR POWER:  What we are talking about is children or young people in out of home care, seen by Danila Dilba.  At paragraph 37 of your statement, you say a very high proportion, greater than 80 per cent, would have some sort of disability and that is based on your own personal role as a general practitioner, but also in your oversight role.

One of the issues we asked Congress about was whether, when children enter out of home care or at some suitable time after they have entered out of home care, there should be, given the high rates that you are referring to, an automatic or a presumptive basis that a full multi disciplinary assessment is conducted?  Do you have a view on that?

DR WEBSTER:  Yes.  I think this requires a little bit of nuance, the reason being that my own personal experience, and I think the experience of many of our clinicians, is that those early contacts with children who have entered out of home care can be quite challenging.  Children have often come from an environment which is highly traumatic and that has caused their removal or led to their removal.

I think requiring a child to have a comprehensive multi disciplinary assessment early on in that process of transition to out of home care would be really difficult.  I think you might not get a good assessment.  But, likewise, I think it might be harmful to  
the relationship between the practitioners or the service and the child, because of them being in that very elevated, very distressed state when they are entering out of home care. 

I think my caveat would be that there should be some flexibility around the timing of when that assessment occurs.  But I do feel like, because of the really high rates of disability I think we are observing in this group, having that assessment being something that is expected, if not required, at some point in their period of being in out of home care should be something that should be recommended and strongly suggested by the Commission.

I think, at the very least, it should be something that Territory Families or its equivalent should have to make as a recommendation to always happen, unless there is a good reason not to do it, and that should be something that is made in consultation with the treating team.  In general, I think having a required assessment at some point, at an appropriate time, would be a really good requirement of these services.

MR POWER:  On that issue of in consultation with the practitioner, at paragraphs 45 and 46 of your statement you talk about the best practice approach to assessing and diagnosing many developmental disabilities.  Then at paragraph 46, you say that case managers for children in out of home care must be more involved in the healthcare of their wards.  Can you speak to that?  In terms of a case manager and, because it is a system you know best, Territory Families, what should be the involvement of a case manager with a child's healthcare or multi disciplinary care?

DR WEBSTER:  At the moment our experience is that it is very much an arm's length.  I think I have mentioned elsewhere in my statement my frustration, as a GP, trying to contact case managers on many, many occasions to often get something as simple as some information about the child.

It is worth noting here that a number of children we see who are in out of home care may have come from areas outside of Darwin and might not be known to our service already.  So they may have come from remote parts of the Top End or the Northern Territory and enter care in Darwin because that is where a placement is available.  As a result we may have no health information about them whatsoever.

It can be very difficult to get in contact with a case manager.  I know carers experience a similar frustration because it is a common conversation I have with carers about case managers changing or not knowing how to contact them or not having them be as available as they would like.

I have never, to the best of my recollection, had a case manager attend a general practice appointment with me and a carer and a child in out of home care.  I acknowledge that a lot of case managers probably have significant workloads and they are probably very overburdened, not just in the Northern Territory but elsewhere.  But there is a huge opportunity for information sharing and support and  
collaboration if case managers were to attend clinic appointments with the carer and with the child.  I think that would give them a much better view and understanding about what some of the health factors are that are involved with that particular young person.

I know that our paediatricians, who I mentioned before are developing a service at the moment, have been really actively trying to engage Territory Families case managers into doing this kind of thing.  I think they are starting to see some success.  But it is very fragmented and very individual to the case manager as well.

I guess to summarise, my sense is the children, particularly those we suspect of having a disability or who already have a diagnosed disability and are in out of home care, I would really like to see at least a periodic case management or case conference situation occur.  Maybe that is something that happens quarterly or it could happen more frequently than that, but a regular case review with the Territory Families case manager and carer, while children are in out of home care, should be --- could be a really useful thing for everyone involved.

MR POWER:  If Territory Families reached out to Danila Dilba, that is something that Danila Dilba would welcome and facilitate?

DR WEBSTER:  Absolutely.  I know our practitioners try and do this on an individual basis and, as I have alluded to, they often don't get much success.  If there was something that was more protocolised, I think that would be really useful for everyone involved.  I would be able to schedule in a quarterly review with the case manager, the carer and the child.  I would know I could set aside 30 minutes to an hour, whatever it would require to do a comprehensive review for that child, to make sure we all understand their health and disability needs.

MR POWER:  In terms of how children in out of home care come to Danila Dilba, how does that occur?

DR WEBSTER:  They are usually brought in by a carer --- depends.  If they are a new entry into out of home care, and that is the typical scenario, they will generally be brought in by a carer under the guise of them needing to have a comprehensive health assessment on entry into out of home care.

As I just mentioned, in many situations we will not know the child, so there is a big information gathering piece there.  But in some cases we will know the child very well, so it's more a chance to do a check in and make sure we have everything covered.  Generally it is them being brought by a carer and the carer has been told by Territory Families, "This is something we require you to do in the first week or so of them entering out of home care."

MR POWER:  Just briefly, if the child is new to Danila Dilba, what would that first contact consist of?

 
DR WEBSTER:  We would do the standard health assessment items, an evaluation of the physical health of the child.  Depending on their age, we tailor that, so we have tailored assessments for every year of age, essentially, and including a much more granular assessment in the first year of life, because development occurs so quickly during that period.  So we would do that assessment.

But also there is a big piece of information gathering.  If we have not met the child before but they go to another health service, like they may come from East Arnhem Land and they go to the Miwatj Health Service or they might come from Central Australia and go to Congress, then we would usually do a request for information form and require a guardian to sign that, so we can get the files from that practice to come to us.

We do use My Health Record very frequently in this situation.  It has been a really big bonus of My Health Record for our services, that we can usually get immunisation records, any key diagnoses or medications from My Health Record.  That can be a very valuable piece of information or piece of the puzzle.

But it generally takes multiple visits to get enough information to have a good view of the child.  The unfortunate situation is that we may not see that child again.  Again, I allude to this in my statement, but it is up to the carers, essentially, where they take the child after that first comprehensive assessment.  Generally, we do see the child for the first comprehensive assessment because we are very well set up for doing that.  We have Aboriginal health practitioners and nurses who can do the first part and a doctor can complete the second part, whereas many other practices don't necessarily provide that kind of service.

But the unfortunate thing is then we may not see that child again at all or may not see them for a couple of years because they might start going to a different practice that might be more convenient or more co located to where the child's carers are living, which means we get this really fractured care, of course.  We might see them intermittently, without the ability to make a relationship and get information about the child.

MR POWER:  We heard this morning from Congress about an early childhood development assessment tool called ASQ TRAK, which the Commission was informed was developed by academics from Melbourne University, in combination with field research and validation with Congress.  Does Danila Dilba use ASQ TRAK?

DR WEBSTER:  Yes, we do.  We have just started using it in the last year.  To use ASQ TRAK, you need to be trained in how to do it.  It is not something you can just pick up off the shelf and start using it.  You need to have some education in doing it.  We have had some staff trained and we are trying to train more people to be able to use it.

To pre empt your next question, I think it is a valuable thing to have and there is  
such a dearth of culturally and linguistically appropriate assessment tools for developmental delay for Aboriginal people.  This is a really valuable, fantastic tool and we would love to use it more.  We will try to expand that.  Again, there is a factor of funding because you have to pay to access ASQ TRAK, it is not publicly available.  You have to buy assessment kits as well, which have an additional cost.  But it is something we would love to see expanded across our service and see it happening in all of our clinics, if not just specifically for children who are at increased risk of disability.  And I think, as I have mentioned, children who are in out of home care, I believe, are at an increased risk of having a disability.

MR POWER:  Is one of the advantages of ASQ TRAK, or two key advantages --- one, as you have said, is it is culturally appropriate and it has been validated for First Nations children.  Secondly, that it can be done by people other than doctors.  First Nations staff with a community controlled health organisation can be trained to deliver it, is that another advantage?

DR WEBSTER:  Absolutely.  Absolutely the case.  I mentioned our model of providing comprehensive health assessments before, where an Aboriginal health practitioner or nurse will do the initial part of the assessment and then a doctor will do the second part.  We are really fortunate at Danila Dilba that over 50 per cent of our staff are Aboriginal and Torres Strait Islander, and that is the same with our clinical staff.  That often means that when we do the assessments, it is Aboriginal staff members who are taking the lead on them.

Frankly, that provides much better information and engagement than me doing it by myself.  In spite of the vast amounts of university time and additional training I have done, there is absolutely no substitute for Aboriginal and Torres Strait Islander people delivering services and doing assessments like ASQ TRAK on Aboriginal and Torres Strait Islander people.  There are things I would miss or omit or not understand or things that are not said, a whole lot of different bits and pieces that are much better performed by Aboriginal and Torres Strait Islander staff, and that model is absolutely the preferred one.

MR POWER:  Paragraph 75 of your statement deals with disability assessments for children in out of home care.  You have told the Commission that the timing of this is critical and having the assessment done at a time when the child or young person is going to relate best to the practitioner who is administering the test.  So it can't be one size fits all: you enter, you get it; rather it needs to be something that should occur, but it is the timing of when it occurs, and you have said that requires Territory Families to be significantly involved in the child and young person's healthcare.

Paragraph 75, however, goes to another thing, which is the dollars and cents of doing this.  You mention what exists in Medicare.  Could you speak about that, as you have set it out, or develop on what you have said in paragraph 75?

DR WEBSTER:  Yes, certainly.  It is unfortunate to have to talk about the dollars and cents here because it really should just be about the quality of the care that  
children receive.  But the reality is that services like ours do need to find ways to fund what they are doing or to be able to get rebates for the care they are providing.

There is not a disability specific Medicare item for general practitioners that do the assessment, nor is there for Aboriginal health practitioners or nurses.  So it does limit us a little bit in terms of using Medicare to fund this kind of activity.

We can get a Medicare item for a comprehensive health assessment, it is called the 715, the Aboriginal health assessment, but not specifically for disability.  There are a few bits to that.

Disability, of course, is not static.  You can't take a photo and say, yes, it is there or it is not.  It's not like an x ray where there is a fracture or not a fracture.  It is something that is very dynamic over time and, as a result, often it requires multiple assessments with multiple different team members, gaining a broader view of what is happening for a young person and gathering lots of information from different sources. 

One of the challenges of kids in out of home care is you don't have a parent to ask how they have been for a long period of time or how they compare to their peers or their siblings, particularly in the circumstance where we are seeing a child for the first time and they are new to a carer as well, and there isn't the ability to get that collateral history from the family.  That makes it very challenging.

Sorry, back to your question about the dollars and cents.  The lack of funding or the lack of ability to tie a particular Medicare item to this activity, I think, means it does get --- "de prioritised" is probably not the right word, but not prioritised strongly enough by health services, and I would put our own service in that boat.  We would like to do more in this area but because we are constrained by funding, we need to rationalise the way we direct our energies and I think that disability services or disability assessments are missing out at the moment.

MR POWER:  I want to turn to the issue of safe care, secure residential facilities.  As a way of introducing that, can I ask about Danila Dilba's role and experience with dealing with children and young people in detention in the Northern Territory.

DR WEBSTER:  Yes, certainly.  To provide the context here, our frame of thinking about this is that it is a continuum: out of home care, Safe Care Houses or supported bail accommodation, Don Dale, which is the youth detention centre and the adult prison, they are all a spectrum of a similar kind of process that is occurring.

We became involved in Don Dale after the Royal Commission in 2017.  There was a settlement and part of that settlement with the detainees at the time of the Royal Commission was that there would be Community Controlled Health Services involved in delivering care in the youth detention setting.

Danila Dilba worked with Territory Families over a period of years to get to the point where we were able to take over the health services in the youth detention centre and  
that occurred in July last year, on 1 July 2020.  Prior to that, health services were provided by the Northern Territory Government, the Department of Health.

We have now been providing health services in Don Dale for about 15 months.  We have a full time GP, so five days a week general practitioner, a full time nurse and an allied health or psychology role.  We also provide a limited after hours service as well.

We have had a really big change over that period of time in the level of involvement in Don Dale, from initially some reluctance and suspicion from the young people and from Territory Families staff, to now being very integrated within the operations of the centre, but also having really good relationships with young people, where our staff now walk around and get fist bumps from the young people in detention and everyone knows each other by name.  It is a very engaged, good rapport environment and it has had a very material difference on the care we are able to provide, in terms of children are up to date with vaccinations now; a number of them are taking medications that they had been prescribed but hadn't taken for years.  There are a number of new diagnoses of significant disabilities and mental health issues.  And we have had a lot of benefits in terms of integrating our service with the paediatricians, the psychiatrists and other services as well.  So it's been a very steep learning curve but I think a very positive experience for ourselves and also for Territory Families, who provide the operations of the youth detention centre.

MR POWER:  Paragraph 107 of your statement notes that through work at Don Dale, Danila Dilba has been very concerned that the vast majority of children coming into youth detention centres are in out of home care prior to their detention and also that the vast majority have a diagnosed or undiagnosed disability and that nearly 100 per cent of those children are First Nations persons.  That is a reflection of what you have said elsewhere in your statement about the role that undiagnosed disability plays in getting someone into out of home care and then, unfortunately, what is described as the care criminalisation pathway that enters them into Don Dale and ultimately into adult prison.  Is that what you have observed?

DR WEBSTER:  Yes.  Just to explain that a little bit, our observation or our experiences of the service is that children who may have a disability, whether it is diagnosed or not, will start to have behavioural issues.  And that might be related to poor impulse control or an inability to regulate emotions and this manifests itself in what is often viewed as being bad behaviour, whether that is in the school or with carers.  That might mean the children are difficult to care for and families are not supported sufficiently to be cable to care for children, which might lead to them being in out of home care.

The projection of that, or the next step to that, is that they end up being involved with the criminal justice system, and that might be through the poor impulse control leading to drug taking and risk taking behaviour or the emotional dysregulation or behavioural dysregulation meaning they might be involved in criminal acts.  Then the environment of out of home care doesn't necessarily always allow them to  
intervene or receive the therapy they require to halt that trajectory into Don Dale.  And then they end up in Don Dale and unfortunately their recidivism rate is very high, and we see the same kids cycling through Don Dale, where they come from out of home care and they go into Don Dale, then they leave Don Dale, back into out of home care and then back into Don Dale.  It's a really tragic cycle, unfortunately.

CHAIR:  Dr Webster, you say in paragraph 107 that, through your work, DDHS has been concerned to observe that the vast majority of children coming into youth detention in the Northern Territory are in out of home care prior to their detention.  To your knowledge, has any study been done to determine the proportion of children who get into youth detention, the proportion of children who have been in out of home care prior to detention?

DR WEBSTER:  I don't what the current figures are.  That would be worth asking Territory Families, I'm sure they would have that data because they deliver out of home care and they deliver the services in Don Dale.  The challenge we would have from our own internal data of answering that question is that children in Don Dale come from all over the Northern Territory, not only from the Darwin region.

CHAIR:  I wasn't suggesting you should gather it.  I was wondering if there was a study.

DR WEBSTER:  Not to my knowledge of current data.  I would be very keen and interested to know if there are some current data but I don't know of any.

CHAIR:  Do you know of any study that has compared rates of disability of Aboriginal children who are in out of home care compared to those who are not?

DR WEBSTER:  I don't know of any published peer reviewed study that has suggested that.  Again I think it is a useful question to ask and it is probably not a hard question to answer but I'm not aware of that being published anywhere.

CHAIR:  Thank you.

MR POWER:  In the paragraphs that follow paragraph 107, the paragraph the Chair referred to, you talk about the very high rates of severe neurodevelopmental impairment in the Western Australian youth detention centre and you have observed that, although a similar study has not been undertaken in the Northern Territory, the experience of your health service is you think it would be likely to be replicated.  You then go on to say that Danila Dilba would be very well placed to provide that sort of multi disciplinary assessment for those neurodevelopmental impairments.  Could you explain why that is?

DR WEBSTER:  Yes.  First of all, yes, we often mention this Banksia Hill study because it is unique in the sense it is good quality evidence of the prevalence of neurodevelopmental disorders, disabilities and particularly FASD in the youth  
detention setting.  We would love to be able to replicate something similar in the Northern Territory.  However, again that's about funding for a research study which is very comprehensive and not easy to come by.

MR POWER:  Could I pause there.  Is that a research study that Danila Dilba would be able to do in conjunction with some academics?  Is that something that Danila Dilba would facilitate?

DR WEBSTER:  Certainly.  The way it was done in Banksia Hill was the Telethon Institute collaborated with WA's equivalent of Territory Families who were running the detention centre and they were able to gather information over a long period of time, which is what is required.  Because to reach a diagnosis of FASD, as I'm sure you have been hearing in these hearings, there are often multiple assessments from multiple different providers over a period of sometimes 12 to 18 months, so it is not a short study.  We already have the health service there and we have the relationship with the young people, it is something that could be feasibly done.  It would be about finding the funding to do it.

You have to ponder, what is the value of doing the research, what question would this answer that's going to be useful?  I think the prevalence question of disability among children in out of home care, as the Chair just asked, I think that is still a pretty thin area of evidence and it would be useful in terms of public policy and funding to be able to describe that a bit better.  Therefore I think this kind of study in our context in Don Dale, which as we have mentioned has almost 100 per cent Aboriginal and Torres Strait Islander population, would be a useful one to do.

MR POWER:  Not only in terms of the pure knowledge of this cohort at the time of the study but it would presumably allow that cohort to receive a diagnosis and receive treatment and support for those diagnoses that otherwise they exit Don Dale into the adult system without ever having a diagnosis.

DR WEBSTER:  Yes.  I have mentioned this elsewhere in my statement.  If you don't get a diagnosis for many of the neurodevelopmental conditions during childhood or adolescence, it becomes nearly impossible to do so as an adult.  If you don't get a diagnosis through the various opportunities for funding or public services that are available for paediatric assessment then getting them funded for an adult is extremely expensive and it is beyond the means of most of our patients to be able to access that.  For example, I have a patient at the moment who had been in out of home care and, interestingly, who probably has autism spectrum disorder and didn't receive a diagnosis as a child, and now the quote for him to be able to receive an assessment is around $2,000 which he or his family can't afford.  And of course our health service can't afford to pay that for this person and probably the many others who are in this situation as well.

MR POWER:  The final topic I want to deal with is paragraphs 120 to 128 of your statement deal with secure residential care facilities in the Northern Territory.  Could you tell the Commission, in this space, what Danila Dilba perceives as the  
opportunities and the risks of developing these sorts of models and what role Danila Dilba could play?

DR WEBSTER:  Thank you.  This has been a big area of passion, certainly for our former CEO, Olga Havnen, and many of our other senior leaders in the organisation, for some time.  Partly it is driven by the recognition that Don Dale Youth Detention Centre remains a really inappropriate and unsatisfactory environment for children.  It is secure but it is definitely not therapeutic in any way.  And even in spite of our presence there and the work we are trying to do, and acknowledging the work that Territory Families has done to try to improve the environment of that setting, it is not set up to be a therapeutic facility and it will never be able to do one.  It is still very much a decommissioned adult prison, which is the reality of what it is.

There is also the Darwin Safe Care House, which is I guess a kind of step down in terms of environment from Don Dale.  It again has a very limited therapeutic model, I would say.  We have no involvement in that Safe Care House.  We have made approaches and we have requested to be involved in either providing services or being engaged in that service in the past but haven't been met with much traction or much success.

Our view is that we are really well placed, we can provide a range of services.  As I mentioned, we would like to provide more.  But we can do some diagnosis and some therapy and we have a large number of Aboriginal staff who can provide the cultural safety and cultural engagement, which is really valuable for young people in particular who may be experiencing disability or experiencing hardship of other kinds.  We have expressed an interest in being involved more and we would be well placed to be involved more.

But there is also such a huge opportunity for the secure therapeutic facility, secure residential facility, being expanded in Darwin.  I have mentioned in my statement just one example of a case of a young person who is unfit to stand trial, but there was no suitable other location for him to be housed so he stayed in Don Dale for a very long period, which is extremely unfortunate that there was no alternative.

We are attracted by some of the things that have been demonstrated through the Sherwood House model in New South Wales and also internationally with the Diagrama model coming out of Spain, and that has been used in the UK and some other areas.

MR POWER:  What is the Spanish model?

DR WEBSTER:  Diagrama is the name of the organisation.  It is a not for profit organisation that now runs a number of youth detention centres in Spain and the UK, and I believe a couple of other parts of Europe.  What they do is they take a much more therapeutic than detention approach.  They are often in locations like an agricultural area of Spain, so they have access to horses and gardens.  But they have a much bigger staffing model around the therapy serves that I mentioned ---  
occupational therapy, speech pathology, neuropsychology and healthcare and medical care --- and much less emphasis on youth justice officers.  That is not to say the children who are offenders or the people who have been sentenced in those areas are any less at risk of violence in the centre, they just manage it in a very different way.  There are opportunities for Australia more broadly to learn about how we could look at justice models that might be more therapeutic and more rehabilitative.

MR POWER:  Thank you.  Chair, that is all the questions I have.

CHAIR:  Thank you very much.  Commissioner Galbally, do you have any questions of Dr Webster?

QUESTIONS BY THE COMMISSION

COMMISSIONER GALBALLY:  Dr Webster, thank you very much for your evidence.

I would like to ask about parents with a disability and their children going into out of home care, almost as an automatic response sometimes, and whether you can comment on that.

DR WEBSTER:  I can comment to say that we absolutely see that.  As I mentioned, we are in the fortunate position of being often the care provider for parents or for families and for children who might end up in out of home care, so we get a good sense of the family unit and the family dynamics that are going on there.

I think your statement is probably correct, it is what we observe and what we experience.  Parents with a disability I would say are more likely to have the children end up in out of home care.  I don't know whether that is causal or association; I'm not sure what the factors are that contribute to that.  But I suspect that again it comes back to a lack of support services for those parents with disability.

My feeling is that if there were more wraparound support services for those parents with disability to be able to care for and look after their children, we would see a lot fewer children ending up in out of home care.  It is something we try to provide some supports in but we are very limited in how much we can provide for individual families around their supports, outside of the ANFPP program and a few other programs we have.  And it is something that I don't see Territory Families or other social services organisations being very involved in.  It is a real shame.  I think there is another big opportunity there as well.

COMMISSIONER GALBALLY:  Thank you.

CHAIR:  Commissioner Mason.

 
COMMISSIONER MASON:  Yes, thank you.  Just one question.  Thank you for your evidence today, I really appreciate and am grateful for the time you have given to the Royal Commission, both in preparing your statement and also today.

I'm interested in the national picture, about this issue that the Central Australian Aboriginal Congress started the CYATS, and in your statement at paragraph 85 you mention that Danila Dilba would like to establish a similar service, an in house comprehensive disability assessment team.

I am interested in the Aboriginal Community Controlled Health Organisations discussions at the national level, with your peak organisation, and the discussions amongst colleagues about what the picture looks like in other regional areas where there are large populations of Aboriginal and Torres Strait Islander people with similar profiles, as we have been hearing about today in the Top End and in Central Australia.

DR WEBSTER:  Thanks for that question.  There are discussions on this and I think it is a widely recognised area of opportunity and a recognised area of a need to grow into this space.  Tied up with this is a recognition of the need for Aboriginal community controlled health services or organisations to also become NDIS service providers and we haven't mentioned that here but I think it is really interlinked.

If we had the CYATS model that Congress has, we could do diagnosis and some therapy while doing the diagnosis part.  Once the diagnosis is achieved, we would probably want to be transitioning people to accessing services through the NDIS.  In Darwin, and it's the same almost everywhere else April the country, there are very few Aboriginal and Torres Strait Islander led or staffed allied health service providers.  That is a huge impediment to being able to provide really good care for these children and their families.

I think what it is going to mean, if we go down the route of being able to have Aboriginal Community Controlled Health Services provide better diagnostic services through a CYATS type of model, we will also need to see a transition to becoming more mature as organisations to be able to provide NDIS services as an NDIS service provider.  That process is really, really challenging.  It is something that we are exploring at the moment.  I know some other community controlled health services have done down that route with some success, KAMS in the Kimberly being one of them, but it is a really difficult model to take on and make successful.

There could be a lot more support.  I know that NACCHO have been talking about this and have been doing some work over the last five years or so, but it is an area of opportunity and an area for lot more growth.  Because the diagnosis by itself is not useful.  It might be useful in terms of from a data perspective or from an accounting perspective.  But the thing that actually matters is the therapy, it's the intervention, the ability to help children and their families with behaviours or issues that they are experiencing, to be able to have more functional and more happy and healthy lives, of course.
 

So we need to move much more into that space and it is a difficult road but one what we need to go down, I would say, in the next few years; not just us but our whole sector, I imagine.

COMMISSIONER MASON:  Thank you.

CHAIR:  Dr Webster, I see that you have a Master of Business Administration from Cambridge.  Does it help?

DR WEBSTER:  I think about it almost every day.  That's not an exaggeration.  So much of what we talk about does seem to come down to funding, so frequently.  It's about government allocating resources, it's about us being able to access funding through certain areas, it's also about us trying to be persuasive in terms of marketing yourself or being able to put together a funding submission.  So it has helped.  And I think having the international perspective as well has helped.  I met a lot of people through that course who came from a wide variety of different backgrounds and different health services.  Perhaps your question was a little flippant but ---

CHAIR:  No, it wasn't flippant at all, because I would have thought that the skills associated with a Masters of Business Administration, at least at a moderately respectable university like Cambridge, would help to a considerable extent.

DR WEBSTER:  It has.  It's probably beyond the scope of this particular Royal Commission but I think it is something that a lot of leaders in health could get value from, doing some formal training in business.  Because, whether we like it or not, it is necessary to think about funding and the way that our business models or care delivery models work in terms of providing good value for money.  It is not going to change because healthcare is going to continue to cost more and more so we need to be really clever about how we use that money.

CHAIR:  It would go to the way in which you use the resources, what sort of programs you develop, how you assess outcomes, all of those things, I imagine would benefit from something like the postgraduate degree that you have.

Can I direct your attention to paragraph 13 of your statement and note 4.  You refer there to nearly half of all First Nations children in the Darwin region being developmentally vulnerable on one or more domains.  We heard this morning from Congress that they had done a study in 2015, or based on the 2015 census material, that led to a similar conclusion.  They said, as I understood it, that it would be very good to do that with the 2018 data.  Did you or somebody actually conduct the study of the 2018 data to disaggregate First Nations children from other children who are covered by that census?

DR WEBSTER:  I can't recall exactly how we looked at this data.  My suspicion and my recollection is that perhaps there was more granular data for the Darwin region than for the Alice Springs or Central Australian region, so maybe we were able to do  
it.  That might have been a weight of numbers thing.  The census sometimes doesn't publish information if they feel like the numbers are very small and they feel like it won't be indicative of something.  I would have to check.  But I don't think we did the evaluation ourselves, I think it was something that was available through the census itself.

CHAIR:  If you were able to let us know, through our Office of Solicitor Assisting, the source of that material, it would be interesting because it would link into what we were told this morning and it may help us compile a rather more complete picture than otherwise would be available.

DR WEBSTER:  Absolutely.  I will make a note of that and I can certainly get back to you.

CHAIR:  Thank you very much.  May I assume that, Ms Chalmers, you don't need to ask Dr Webster any questions?

MS CHALMERS:  No.

CHAIR:  Thank you.  In that case, Dr Webster, thank you very much for giving evidence and thank you very much for the detailed statement you have and the thought that has obviously gone into it.  We very much appreciate your assistance and the very interesting evidence you have given this afternoon.  Thank you.

DR WEBSTER:  Thank you.  Thanks very much for your time.

THE WITNESS WITHDREW

CHAIR:  Mr Crowley, what are we going to do tomorrow?  From my point of view and possibly from my colleagues' point of view, what material do we have to look at by way of homework for tomorrow?

MR CROWLEY:  Tomorrow we have two case studies.  We have Leah in the morning, who will be speaking about her being the carer of Connor.  And we will then hear from two witnesses from the Western Australian Department of Communities in respect of that matter.  Then in the afternoon we will have evidence from Maggie, which is about the care of Elliott.

CHAIR:  That last session is prerecorded, as I understand it?

MR CROWLEY:  Yes, that's right, Chair.

CHAIR:  With the evidence that will be given in the morning, Leah, is there a statement or will that be wholly oral evidence?

 
MR CROWLEY:  There is a statement that has been provided.

CHAIR:  So there is a statement from Leah.  Thank you.  And also from Mr Mace and Ms Samuels, they each have statements?

MR CROWLEY:  It is Mr Mace primarily who has the statement.  Ms Samuels is attending to give evidence as part of the panel, to provide more of the operational perspective.  She has done a covering statement but not a substantive statement.

CHAIR:  Mr Mace is the one who has provided the more substantive statement?

MR CROWLEY:  Yes.

CHAIR:  Thank you very much.  We will resume at 10.00 am tomorrow, EST.  We will adjourn until then.

HEARING ADJOURNED AT 4.22 PM UNTIL TUESDAY, 21 SEPTEMBER 2021 AT 10.00 AM (AEST)