"It's all about relationships": The place of boarding schools in promoting and managing health and wellbeing of Aboriginal and Torres Strait Islander secondary school students. (June 2020) - McCalman, Janya
Graphical abstract: Highlights: Boarding schools offer student healthcare, wellbeing support and health education. But impacts are not monitored or reported; there is much scope for improvement. Need: a multi-levelled relational model of school healthcare and wellbeing support. Enablers: school leadership, staff capabilities, resources, intersectoral system links. Strategies: links between students, families, school staff and health services. Student outcomes: school participation, healthcare, better headspace, responsible. Abstract: Introduction: In recent years, Australian government policies have promoted access to secondary education through boarding schools for Aboriginal and Torres Strait Islander (hereafter respectfully termed Indigenous) students from remote communities. These students experience the poorest health of any Australian adolescent group. This exploratory study examines how boarding schools across Queensland promote and manage healthcare and wellbeing support for Indigenous students. Methods: Qualitative grounded theory methods were used to sample and collect data from the healthcare and wellbeing support staff of eight Queensland boarding schools using semi-structured interviews. Data were coded using NVIVO software and compared to identify the context, conditions, core process, strategies and outcomes of boarding schools' healthcare and wellbeing support. Preliminary findings were fed back to school staff and students' family members for discussion and response at an annual Schools and Communities meeting. Results: Boarding school health staff support Indigenous student-centred healthcare and wellbeing by weaving a relational network with students, families, school staff and external healthcare providers. Either through on-site or school-linked centres, they provide students with access to healthcare services, support wellbeing, and offer health education. Through these strategies, they enable students' participation in education and learning, receive quality healthcare improvement, "move to a better head space", and become responsible for their own healthcare. Enabling conditions are the professional and cultural capabilities of school staff, school leadership and commitment, compatibility of intersectoral systems and resourcing of healthcare and wellbeing support. Conclusions: Boarding schools are doing considerable work to improve the promotion and management of healthcare and wellbeing support for Indigenous students, but there is considerable variation across schools, impacts are not formally monitored or reported, and there are many opportunities for improvement. Working towards a best practice framework, school staff identified a need for a multi-levelled relational model of healthcare and wellbeing support to be iteratively embedded at each stage of the school cycle: at intake; enrolment; term one; and throughout the school year (including in emergencies/crises).