National Guide

Chapter 7 | The health of young people

Social and emotional wellbeing







National Guide to preventive healthcare for Aboriginal and <br/>Torres Strait Islander people
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      3. Social and emotional wellbeing

The health of young people | Social and emotional wellbeing in adolescence 

Dr Annapurna Nori, Dr Talila Milroy  

Key messages

  • Cultural connection and family cohesion are strongly protective for the social and emotional wellbeing of young people.1,2
  • Primary care providers should have a clear, culturally informed understanding of social and emotional wellbeing, and its relevance and role in the health of Aboriginal and Torres Strait Islander young people.
  • Strengths-based approaches should be used in assessing social and emotional wellbeing.2
  • Culturally specific and appropriate youth assessments are available and incorporate social and emotional wellbeing as central to the assessment.
Type of preventive activity - Screening
Who/target population What When Strength of recommendation Key source(s) and reference(s) Rationale/key considerations informing recommendation
Young people aged 12–24 years Conduct a strengths-based social emotional wellbeing assessment to obtain a whole-person understanding of health and risk factors affecting wellbeing using a structured approach such as HEEADSSS (Home; Education and employment; Eating and exercise; Activities; Drugs and alcohol; Sexuality and gender; Suicide, depression and self-harm; and Safety)

Refer to Useful resources)		 Opportunistically Strong National strategic framework and narrative reviews1,3,4 A health promoting approach that supports resilience and early detection of health risks is beneficial to longer-term health
Type of preventive activity - Behavioural
Who/target population What When Strength of recommendation Key source(s) and reference(s) Rationale/key considerations informing recommendation
Primary care service providers Establish rapport, trust, cultural safety and the terms of confidentiality when working with young people In all healthcare interactions Strong Narrative review and position statement4,5 High levels of engagement and trust, and clarity about confidentiality, are key elements in working effectively with young people
Type of preventive activity - Environmental 
Who/target population What When Strength of recommendation Key source(s) and reference(s) Rationale/key considerations informing recommendation
Primary care service providers Review the structure, environment and skills of the organisation to ensure the service is youth friendly and culturally safe for Aboriginal and Torres Strait Islander youth Regularly as part of continuous quality improvement Strong National principles and literature review6,7 Youth-friendly and culturally safe practice environments have a significant role in supporting youth engagement with health services

Background

Aboriginal and Torres Strait Islander people commonly use the term ‘social and emotional wellbeing’ (SEWB) to describe their social, emotional, spiritual and cultural wellbeing.1 The National strategic framework for Aboriginal and Torres Strait Islander peoples’ mental health and social and emotional wellbeing 2017–23 describes SEWB as ‘the foundation for physical and mental health for Aboriginal and Torres Strait Islander peoples’ and identifies culture and cultural identity as critical to SEWB.1

Hence, SEWB is integral to and cannot be separated from a person’s health and is based on connectedness between individuals and their family, community, land, culture and spirituality. It is a protective factor, and having good SEWB is important for the development of resilience to deal with life’s challenges.8

SEWB can be strengthened by connection to culture, Country and community, as well as by opportunities to engage in cultural activities, connect with family members, including Elders, and building cultural knowledge.9 A survey of Aboriginal and Torres Strait Islander adolescents regarding self-harm and suicidality showed that male gender and strong relationships and family cohesion are protective factors.2

Compared with non-Indigenous young Australians, Aboriginal and Torres Strait Islander young people are more likely to have multiple major life events related to trauma, adverse childhood experiences (ACEs) and loss of family members. These, along with the ongoing effects of colonisation, the continued exposure to racism, lower levels of education in primary carers and social determinants such as housing and food insecurity, can adversely affect SEWB.2,9

Poorer SEWB is a risk factor for mental illness, substance use and sexually transmissible infections.2,8 Exploring SEWB as part of assessing health is important in identifying strengths and risks for the young person’s physical and mental health and wellbeing.1

Therefore, a comprehensive assessment that explores multiple psychosocial areas of a young person’s life is considered an essential part of providing effective primary healthcare to young people.3,10 Strong engagement with young people, with their families and communities, and intersectoral approaches, especially between the health and education, social services and justice sectors, are recommended to support and improve the health of young people.4,11 Cultural safety in the experience of healthcare for young people is essential. Primary care providers are well placed to implement this model of engagement and work in partnership and collaboration with Aboriginal and Torres Strait Islander community workers and organisations.

Screening

Primary care providers can offer screening to young people opportunistically and in structured health assessments, such as annual health checks. A comprehensive assessment provides an ideal opportunity to discuss the health protective and health risk elements impacting on the young person.

The HEEADSSS assessment is the most widely recommended psychosocial assessment tool both nationally and internationally.6,12 It is a systematic, structured and graded approach, and designed so that topics perceived to be non-threatening are broached first before moving to more sensitive issues.

In 2012–13, the ‘Y health – Staying deadly’ research project developed a culturally valid and culturally specific version of the HEEADSSS assessment, namely the strengths-based Youth Social Emotional Wellbeing assessment.12 Additional screening tools include the Westerman Aboriginal Symptom Checklist (WASC-Y), which is aimed at the early identification of depression, anxiety, suicidal behaviours and self-esteem issues in Aboriginal young people aged between 13 and 17 years.3,13–15

  1. National Indigenous Australians Agency. National strategic framework for Aboriginal and Torres Strait Islander peoples’ mental health and social and emotional wellbeing 2017–2023. Australian Government, 2017 [Accessed March 2023].
  2. Islam MI, Sharwood L, Chadwick V, Esgin T, Martiniuk A. Protective factors against self-harm and suicidality among Australian Indigenous adolescents: A strengths-based analysis of the longitudinal study of indigenous children. Int J Environ Res Public Health 2022;19(15):9131. doi: 10.3390/ijerph19159131.
  3. Holland C, Dudgeon P, Milroy H. The mental health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples, families and communities: Supplementary paper to A contributing life: The 2012 national report card on mental health and suicide prevention. National Mental Health Commission, 2013 [Accessed March 2023].
  4. Murrup-Stewart C, Whyman T, Jobson L, Adams K. ‘Connection to culture is like a massive lifeline’: Yarning with Aboriginal young people about culture and social and emotional wellbeing. Qual Health Res 2021;31(10):1833–46. doi: 10.1177/10497323211009475.
  5. Connolly H. Health Hub – ideas for creating more child and youth friendly health services. Commissioner for Children and Young People, 2021 [Accessed 26 April 2024].
  6. Milroy H, Dudgeon P, Walker R. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd edn. Telethon Kids Institute, 2014 [Accessed 26 April 2024].
  7. Azzopardi P, Blow N, Purcell T, Brown N, Ritchie T, Brown A. Investing in the health of Aboriginal and Torres Strait Islander adolescents: A foundation for achieving health equity. Med J Aust 2020;212(5):202–204.e1. doi: 10.5694/mja2.50500.
  8. Dobia B, O’Rourke V. Promoting the mental health and wellbeing of Indigenous children in Australian primary schools. Commonwealth of Australia, 2011 [Accessed 26 April 2024].
  9. The Royal Australasian College of Physicians (RACP). Routine adolescent and young adult psychosocial and health assessment: Position statement. RACP, 2021 [Accessed March 2023].
  10. Chown P, Kang M, Sanci L, Newnham V, Bennett DL. Adolescent health: Enhancing the skills of general practitioners in caring for young people from culturally diverse backgrounds, GP resource kit. 2nd edn. NSW Centre for the Advancement of Adolescent Health and Transcultural Mental Health Centre, 2008 [Accessed 26 April 2024].
  11. Nori A, Piovesan R, O’Connor J, et al. 'Y health – staying deadly' : An Aboriginal youth focussed translational action research project. ANU, 2013 [Accessed March 2023].
  12. Westerman T. Engaging Australian Aboriginal youth in mental health services. Aust Psychol 2010;45(3):212–22. doi: 10.1080/00050060903451790.
  13. The Royal Australasian College of Physicians (RACP). Confidential health care for adolescents and young adults (12–24 years). RACP, 2021 [Accessed 26 April 2024].
  14. National Office for Child Safety. Keeping our kids safe: Cultural safety and the national principles for child safe organisations. Australian Government, 2021 [Accessed 26 April 2024].
  15. Walker R, Reibel T. Young people’s experiences with health services – a literature review. Telethon Institute for Child Health Research, 2013 [Accessed 26 April 2024].




 

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