Evaluation of the Child Health Check Initiative and the Expanding Health Service Delivery Initiative - Final Report

3.1 The NTER—the CHCI and EHSDI story, assumptions and theory

Evaluation of the Child Health Check Initiative and the Expanding Health Service Delivery Initiative - Final Report

Page last updated: 17 April 2012

3.1.1 Background and context of the NTER—understanding the problem
3.1.2 The political window
3.1.3 The policy solution—the NTER

3.1.1 Background and context of the NTER—understanding the problem

The NTER grew from a long-standing set of concerns held by people who worked with or were otherwise linked to Aboriginal communities as well as the Aboriginal communities themselves. Several reports highlighting violence and abuse within Indigenous communities had been released in the 20 years preceding the NTER, including:
  • the Atkinson report in 1990 (Atkinson 1990)
  • the 1999 Robertson inquiry (Robertson 1999)
  • the 2001 Memmott report (Memmott et al 2001).
An Australian Government summit on Indigenous domestic violence was held in 2003 and in 2004 the Council of Australian Governments (COAG) signed a National Framework on Indigenous Family Violence and Child Protection (COAG 2004). These reports and activities received only sporadic media attention, indicating that the issue of and responses to violence and abuse in Aboriginal communities were largely unnoticed by the majority of Australians. Part of the policy problem was that the difficulties being experienced and documented in Aboriginal communities were largely invisible on the national stage, and were not given sustained national attention by the Australian Government.

This changed in 2006 when a series of reports by the Australian Broadcasting Corporation’s (ABC) current affairs show Lateline turned attention to child abuse in Aboriginal communities. The first, on 15 May 2006, featured Central Australia Crown Prosecutor Nanette Rogers describing an epidemic of drugs, sexual and physical abuse in Aboriginal communities (‘Paper reveals sexual abuse, violence in NT Indigenous communities’, Lateline, 15 May 2006; ‘Crown Prosecutor speaks out about abuse in Central Australia’, Lateline, 15 May 2006). Drawing from her 12 years of experience in Alice Springs, Ms Rogers revealed graphic details of a series of cases of abuse, rape and murder of women and children in Aboriginal communities in Central Australia. This included a description of how a six-year-old girl drowned while being raped by an 18-year-old man; a 12-year-old girl was taken from her community, tied to a tree for several weeks and repeatedly raped; and a two-year-old girl who required ‘internal and external’ surgery after being sexually abused by a young man while her mother and father were drunk.

The story was picked up by other media outlets in Australia and internationally, resulting in an unprecedented level of attention on the issue of child sexual abuse in the NT. Ms Rogers commented in widely publicised interviews that Aboriginal communities, especially the men, must accept responsibility for the violence. She said the causes of the violence could be traced to a culture that promoted male authority over women, and that out of this culture often emerged a pattern where the young men ‘beat their wives’ and their sisters were ‘beaten by their husbands’. Young men were given a status in the community where they were not made accountable for their actions. Ms Rogers told the ABC:
      Small children become so inured to the violence. It doesn’t augur well for Aboriginal people to be functional human beings with the attributes for turning around and caring for children themselves (‘Crown Prosecutor speaks out about abuse in Central Australia’, Lateline, 15 May 2006).
A further Lateline show on 21 June 2006 reported alleged sexual abuse in Mutitjulu, an Aboriginal community near Uluru (Ayers Rock). In this report, the Central Desert area was described by an Aboriginal elder of the community as being a ‘war zone’. Politicians and welfare organisations demanded action. Peter Yu, Kimberly Land Council Director, called for military intervention, stating that the Australian Government must do ‘just like we have done in the Solomon Islands, just like we have done in East Timor, just like we are doing in Afghanistan and Iraq’, (‘Official response to Aboriginal child sexual abuse in Australia—more law and order’, World Socialist Website, 22 May 2006).

The media highlighting the perceived weaknesses of Aboriginal culture strengthened calls for a mainstream policy response and the role men were playing in the problem. These views were reflected in interviews we had with officials involved in the design of the NTER and the CHCI.

The attention prompted the NT Government to appoint a Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse. The Board of Inquiry conducted 260 meetings with Aboriginal communities, service delivery organisations, government agencies and individuals in the NT. Attendance was high in many communities and moderate in others, with audiences engaging in open discussion on the problems communities were facing, including sexual abuse. Communities were eager to be part of any solution and were open to government assistance to institute programs and initiatives to address the problem. They specified that this assistance should be delivered in a way that traditional family and authority could be restored.

The Board of Inquiry’s Little Children are Sacred report, released in mid-2007, concluded that child abuse in Aboriginal communities throughout the NT was at crisis level. The Inquiry did not attempt to quantify the level of child sexual abuse; however it concluded, as had previous inquiries in other jurisdictions, (such as the NSW Indigenous Child Sexual Assault Taskforce 2006 & Gordon Inquiry 2002) that child sexual abuse in the NT was, at that time, serious, widespread and often unreported. It also concluded that:
  • Most Aboriginal people are willing and committed to solving problems and helping their children. They are also eager to better educate themselves.
  • Aboriginal people are not the only victims and not the only perpetrators of sexual abuse.
  • Much of the violence and sexual abuse occurring in NT communities is a reflection of past, current and continuing social problems which have developed over many decades.
  • The combined effects of poor health, alcohol and drug abuse, unemployment, gambling, pornography, poor education and housing, and a general loss of identity and control have contributed to violence and sexual abuse in many forms.
  • Existing government programs to help Aboriginal people break the cycle of poverty and violence needed to work more effectively. There was not enough coordination and communication between government departments and agencies, causing a breakdown in services and poor crisis intervention. Improvements in health and social services were desperately needed.
  • Programs needed access to adequate funding and resources and to be a long-term commitment.

The direct experience of politicians and senior policy makers with NT remote communities

Before the announcement of the NTER, senior politicians and government officials made a number of visits to remote Aboriginal communities in the NT. These visits helped politicians and officials develop a view that the social situations in these communities were deteriorating and that the women and children were at risk, including at risk of sexual abuse.

Officials involved in these visits related their experiences of being approached by Aboriginal women and being told in confidence that the behaviour of the men in their communities was a serious and current risk to them and their children. The women were not able to raise the issues in a public forum where Aboriginal men’s voices dominate. As a result, the officials felt a degree of direct responsibility to intervene to protect the children in particular from harm and believed that to do so they would need to bypass existing structures and organisations. The officials stated that they were privy to information that was not in the public arena and was not officially documented, quantified or validated. As such, part of the Australian Government’s motivation for the NTER was to facilitate documentation of the actual level of child sexual abuse in remote communities.

Officials also reported that they had negative experiences and perceptions of the effectiveness of national Aboriginal controlled organisations. The Aboriginal and Torres Strait Islander Commission (ATSIC), which was disbanded in 2004 following accusations of sexual impropriety and corruption by some of its board members (Pratt and Bennett 2004), was seen as typifying the failure of Indigenous representation.

Then-Prime Minister John Howard stated at the time that:
      We believe very strongly that the experiment in separate representation, elected representation, for Indigenous people has been a failure. We will not replace ATSIC with an alternative body. We will appoint a group of distinguished Indigenous people to advise the government on a purely advisory basis in relation to Indigenous affairs. Programs will be mainstreamed. (John Howard, speech at press conference 15 April 2004).
The decision to abolish ATSIC and to ‘mainstream’ Indigenous affairs was supported by both the main political parties at the time, despite being contrary to a 2003 Australian Government review of ATSIC (Hannaford et al 2003). The review had found that ATSIC should be continued, and recommended a package of reforms to give greater control of ATSIC to Aboriginal and Torres Strait Islander people at a regional level.Top of page

The COAG trials

The perception of problems with community control was also influenced by government officials’ observations of the lack of progress at the COAG trial sites in the NT. The COAG trials had been underway since 2002, aiming to explore new ways for the federal, state and territory governments to work together with communities to address the needs of Indigenous Australians. There was evidence, however, to show that while progress at the trial sites was slow, it was not absent.

An evaluation of the COAG trials showed that there had been some improvement in intergovernmental partnerships and the development of a higher level of trust between government and community partners. The review was supportive of a coordinated and engaged approach involving Indigenous communities and the federal, state and territory governments. It argued strongly for realistic time frames to be set for working towards community control. The review authors felt that Indigenous engagement had to be strengthened to support sustainable development of Indigenous communities (Morgan Disney and Associates 2006).

An exception to this was the COAG trial site in the NT at Wadeye, which showed little or no progress in addressing serious issues such as personal security and housing (Gray & WJG and Associates 2006). The review found that this particular site was characterised by a general lack of progress on joint projects between Australian Government and NT Government agencies, and an enduring sense of desperation that nothing was changing. The review noted that the local Indigenous regional council was keen to see the issues addressed by the government as a ‘crisis approach’:
      Thamarrurr Regional Council has raised the question as to why governments can’t respond to the crisis currently facing the town of Wadeye in the same way as governments have responded to the Aceh disaster in Indonesia and cyclone devastated Innisfail in Queensland. There is a strong feeling within the council that unless a ‘crisis’ approach is adopted by both the Commonwealth and NT Governments there will be little improvement to the health and wellbeing of the community for years to come.

Senior Australian Government politicians and officials visited Wadeye in July 2006. These visits reinforced officials’ views that coordinated and engaged approaches to issues facing the NT Indigenous population were slow and ineffective. This was clearly seen by politicians and the media as part of the policy problem that the NTER was intended to address:
      The logic stemmed from the landscape: education had all but broken down in the remote NT; community part-time work was becoming a dependency system, alcoholism and substance abuse were out of control; the population growth rate was terrifying. Reports of endemic sexual abuse were no more than the final spur to action (‘No question of turning back’, The Australian, 21 June 2007).
Informants also noted that their understanding of the problems was influenced by academic and public commentary leading up to the NTER. Noel Pearson, Aboriginal activist and founder of the Cape York Institute for Policy and Leadership, had previously raised concerns about the damaging impact of passive welfare7 on Indigenous communities (Pearson 2000). Peter Sutton, an anthropologist specialising in Aboriginal language and culture, questioned the balance of structural versus cultural reasons for the observed differences between the health of Indigenous and non-Indigenous Australians (Sutton 2001; Sutton 2005). A widely-held view among government officials was that the self-determination approach taken by and since the Whitlam government in the early-to-mid-1970s amounted to a ‘disease that had been inflicted on Indigenous people’ (interview, government official).Top of page

The catalyst for NTER—sexual abuse rates among NT Aboriginal children

While there were a number of issues that made up the policy problem in the NT, it was concerns about the sexual abuse of Aboriginal children that provided the catalyst for the announcement of the NTER. It is therefore pertinent to consider the abuse statistics preceding the intervention. Table 5 shows that from 1997–2007 there were between 14 and 39 substantiated sexual abuse cases8 per year for Indigenous children aged 0–16 years in the NT. There is no clear trend although spikes are evident in 2003–04 and 2006–07.

Table 5: Number and rate of substantiated sexual abuse cases, NT Indigenous children aged 0–16 years (1997–2007)
Number of cases

(a) - In 1998–99 data was collected for 6 months only. Source: AIHW (1999–2008).

Caveats are required in interpreting sexual abuse rates. Gordon (2006) notes that these figures are based on reported instances of child abuse and neglect and are likely to be an underestimate of actual levels of abuse.

Research estimates that less than 30 per cent of cases of sexual abuse of children are reported and that this rate is lower in Indigenous communities (Stanley et al 2003). This appears to be particularly relevant in the NT. Pocock (2003) points out that although recorded cases of substantiated abuse are low in the NT, the prevalence of factors which cause child abuse and neglect (such as poor housing, lack of employment, low educational levels and poor access to healthcare) are disproportionately high, suggesting that actual levels of abuse are likely to be higher than reported. Pocock also raises concerns regarding the ability of the NT child protection system to effectively respond to reports of child abuse, stating that it is common practice not to report child abuse and neglect in Aboriginal communities as doing so ‘results in no discernible response or an intervention from police or child protection which makes matters worse’ (Pocock, p. 13).

Child abuse has wide ranging impacts and effects. The damage is not limited to the abused child but also to witnesses who may be children, family members, and the community. Gilbert et al (2009) link child maltreatment to effects on mental health, drug and alcohol misuse, obesity and criminal behaviour. It is important to note, however, that even though the abuse statistics outlined above are a conservative estimate, the actual number of sexual abuse cases in the NT represent a small fraction of Aboriginal children (estimated at 16,000 in the NTER prescribed areas). Although any level of abuse is appalling and justifies decisive action, policy responses need to consider that the vast majority of Aboriginal children are not subjected to sexual abuse and the great majority of adults in Aboriginal communities do not commit abuse.Top of page

3.1.2 The political window

The culmination of reports, inquiries, and political and public outrage created a point at which politicians were compelled to intervene to address the policy problem. The social and political climate provided an
opportunity to implement programs of a type, and at a pace, which had not previously have been acceptable
or possible.

We interviewed a number of government officials and other stakeholders who put forward the view that the NT Government did not have the skills or competency to manage the situation effectively. The perception that the NT Government was incapable of mounting an adequate response to the problems being identified in the media reinforced the view that the problem could only be effectively addressed by Australian Government intervention. This view was further supported by the perceived lack of action by the NT Government following the release of the Board of Inquiry’s report (interview, key informant).

The NTER was developed without any engagement with the NT Government. Then-Prime Minister John Howard’s announcement of the intervention stated that the Australian Government was stepping in because ‘we do not think the territory has responded to the crisis affecting the children in the territory’. While acknowledging that the NTER did usurp the role of the NT Government, Mr Howard alleged that this was necessary because the protection of children should take precedence over political niceties (‘Indigenous child abuse “emergency” prompts PM reaction, ABC News, 21 June 2007). Mal Brough criticised the NT Government’s lack of action on dysfunction in Aboriginal communities, stating that there had been ‘no improvement’ during the time he had been Indigenous Affairs Minister (‘Indigenous child abuse “emergency” prompts PM reaction’, ABC News, 21 June 2007).Top of page

3.1.3 The policy solution—the NTER

The policy solution—the Northern Territory Emergency Response—was announced at a press conference on 21 June 2007 by Prime Minister John Howard. The package included compulsory health checks for all Aboriginal children aged 0–15 years to identify and treat any effects of sexual abuse.

The policy solution was developed by senior policy officials in the days leading up to the announcement. As noted previously, the evaluation team has not been able to obtain any specific written discussion of the policy issues, or development and assessment of alternative solutions or approaches developed or discussed by officials before the announcement. We are therefore unable to comment on the thoroughness of the analysis underpinning the development of the NTER.

The health check aspects of the NTER largely arose as a response to allegations that there was a high level of undisclosed child sexual abuse in Aboriginal communities. The immediate priorities were to establish the extent to which abuse was occurring, and to put a stop to the abuse. Officials and politicians did not appear to see a need for the initial policy to consider the detailed clinical aspects of the health check, assuming that these would be worked out once the initial announcement was made. Consequently, before the initial announcement of the NTER health measures, the design of the child health check was not discussed with experts in the health sector, the NT Government, or with any health officials in the NT (interviews, two government officials).

The speed and size of the intervention were seen as important influences on the approach taken. It was felt that the intervention needed to be of a sufficient scale and scope so that it would, in the words of one government official, ‘radically change the direction of Commonwealth/state relations, the approach of the last 40 years, and surprise and overwhelm the system to set a new direction’ (interview, government official).Top of page

The framing of the NTER as an emergency response

The NTER was portrayed by the Australian Government as a necessary response to a situation that required immediate and drastic action. The Little Children are Sacred report’s recommendation that the abuse of Aboriginal children ‘be designated as an issue of urgent national significance by both the Australian and Northern Territory Governments’ (Anderson and Wild 2006) underpinned the Australian Government’s rationale for the speed with which the NTER was launched.

The Northern Territory National Emergency Response Act 2007, covering provisions for the quarantining of welfare payments, alcohol and pornography bans, deployment of additional police and the removal of the permit system9, was passed in August 2007. Any opposition to the legislation was cast as ‘protecting paedophiles’ (‘A national emergency: Howard acts’, The Age, 22 June 2007) with the measures receiving support from both Opposition leader Kevin Rudd and Labor’s Indigenous Affairs spokesperson Jenny Macklin, who echoed Howard’s description of the situation as ‘a crisis’ (‘More issues than abuse to tackle’, Adelaide Now, 21 June 2007).

John Howard did, at times, characterise the situation as a chronic problem rather than an emergency. During the initial announcement of the measures Howard noted that ‘many Australians were appalled by the cumulative neglect of the situation and the inability of governments to respond effectively over a long period’ (‘A national emergency: Howard acts’, The Age, 22 June 2007).

In response to criticism of the lack of consultation over the NTER measures, Howard compared the failure to act on Aboriginal child abuse to the Bush administration’s botched response to Hurricane Katrina in 2005 (‘Aborigines threaten tourist ban’, BBC News, 26 June 2007). The Prime Minister declared that many Australians ‘looked aghast at the failure of the American federal system of government to cope adequately with Hurricane Katrina ... we have our Katrina here and now. Without urgent action to restore social order, the nightmare will go on’ (‘It’s our Katrina says emotion charged PM’, The Age, 26 June 2007). Both John Howard and then-Indigenous Affairs Minister Mal Brough drew on military terminology to describe the measures, using terms such as ‘intervention’, ‘stabilisation’ and ‘operation’. This was reinforced with the deployment of military and police personnel to roll out Phase 1 one of the NTER (‘Army rolls into outback crisis’, The Daily Telegraph, 28 June 2007).

The view of child abuse in the NT as an emergency was echoed by some Aboriginal commentators. Former Labor Party national president and Aboriginal leader Warren Mundine expressed support for the NTER, stating that the situation ‘is a national emergency, it is across Australia, it needs a national response’ (‘A national emergency: Howard acts’, The Age, 22 June 2007).

In the end, the Little Children are Sacred report that was the spark for the NTER did not appear to significantly inform the policy choices that were made, with the exception of the urgency in the response and the initial focus on sexual abuse. Its recommendations, most critically that a response should focus on community engagement and better coordination, were not taken up as an initial part of the NTER. Top of page

7 - Pearson (2001) describes passive welfare as ‘unconditional cash pay-outs to needy citizens of whom nothing further will be required’.
8 - ‘Substantiated abuse cases’ are those which have been subject to investigation by the department responsible for child protection and where it is concluded that the child has been, is being, or is likely to be abused, neglected or otherwise harmed.
9 - The permit system required those who wished to enter Aboriginal land to gain written permission from the traditional owners.