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Positive behaviour changes within the childcare setting The representatives of the three services, and the Undoonoo Day Care director in particular, felt the staff had an improved ability to identify children with ear health and communication difficulties and to refer to the appropriate health service provider. They also identified greater flexibility in the thinking of staff when it comes to strategies to support ear health and early development: “It [the partnership] has given the staff ideas to go outside of the box and look for different strategies especially with ears and language development”. It was also reported that the partnership enabled open communication between the three services, which had a flow-on effect in that the staff at Undoonoo are now being “recognised as educators not babysitters” by the community. Staff are “valued by the community and the community learns what good work they do. This inspires them to continue working when times are difficult”. In addition to the benefits outlined above, the partnership has been able to (indirectly) influence children in other Indigenous communities. Rural support teachers have reported that the series of VTCs delivered by Deadly Ears staff have completely “transformed” their practice with respect to supporting staff with children who have language difficulties, and they have been more readily able to identify children with OM and refer them for appropriate treatment. Another teacher reported that this model of service delivery was “looking at the condition holistically” and she “believes it is vital that we [rural support teachers] incorporate this program into education programs for early childhood centres not only concentrating on remote area centres but also urban, as the condition [OM] is everywhere”. Potential areas for improvement The areas identified for the partnership’s continued growth include strategies to: 1) ensure alternative views are expressed; 2) develop a way of reviewing the range of potential partners to add to the collaboration; and 3) bring in new members. Conclusion and future directions From the preliminary evaluation done to date, the partnership between Undoonoo Day Care centre, Deadly Ears program, and the CSSP appears to have delivered positive outcomes for the day care children, staff, and the wider Woorabinda community. This has been foremost in terms of the increased identification of OM and communication difficulties, and improved use of strategies to support the children in the centre. It has also been an effective means of empowering an ear health promoting environment in the community through collaboration on a range of community-driven strategies. Through a partnership we were able to build the capacity of the key stakeholders in the community, as well as the services within the partnership, which will enable more sustainable outcomes. The results of this evaluation are limited in scope

due to its preliminary nature, the small size of the partnership, and the brief evaluation timeframe. It should also be noted that the partnership exists within a context where extensive community engagement and relationship building has been completed prior to its initiation, and without this, the outcomes may have been different. Further evaluation over time is recommended; however, this model, with its positive benefits within the community and beyond, may be worth considering for implementation in other communities, to help support sustainable community outcomes. References Boswell, J.B., & Nienhuys, T.G. (1995). Onset of otitis media in the first eight weeks of life in Aboriginal and non- Aboriginal Australian infants. Annals of Otology, Rhinology & Laryngology , 104 , 542–549. Couzos, S., Metcalf, S., & Murray, R. (2001). Systematic review of existing evidence and primary care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations . Canberra: Office for Aboriginal and Torres Strait Islander Health Services, Commonwealth Department of Health and Family Service. Morris, P.S., Leach, A.J., Silberberg, P., Mellon, G., Wilson, C., Hamilton, E., & Beissbarth, J. (2005). Otitis medica in young Aboriginal children from remote communities in northern and central Australia: A cross- sectional survey. BMC Pediatrics . 2. Retrieved from http:// www.biomedcentral.com/1471-2431/5/27 Pyett P., Waples-Crowe, P., and Sterren, A. (2008). Challenging our own practices in Indigenous health promotion and research. Health Promotion Journal of Australia , 19 (3), 179–183. Queensland Health. (2009). Deadly ears deadly kids deadly communities: 2009–2013 . Brisbane: Queensland Government. VicHealth. (2004). The partnership analysis tool for partners in health promotion . Retrieved from http://www. vichealth.vic.gov.au Williams, C. J., & Jacobs, A.M. (2009). The impact of otitis media on cognitive and educational outcomes. MJA , 191 , s69-s72. Andrea Coleman completed her Bachelor of speech pathology in 2006 and is currently employed by the Deadly Ears Program. Jillian Scholes is a speech pathologist and the allied health team leader with the Deadly Ears program. Correspondence to: Jillian Scholes Speech Pathologist/Allied Health Team Leader Queensland Health Deadly Ears Program, PO Box 1507, Fortitude Valley 4006 phone: 0422 009 327 email: jillian_scholes@health.qld.gov.au 1 Indigenous refers to Aboriginal and Torres Strait Island people of Australia

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www.speechpathologyaustralia.org.au