Indigenous-led six-domain framework reveals how Aboriginal health services prescribe social wellbeing

For more than fifty years, Aboriginal Community Controlled Health Organisations, known across Australia as ACCHOs, have quietly practised something that the rest of the health system is only now learning to name. Long before the term social prescribing entered mainstream policy vocabulary, these community-governed services were connecting people to housing support, art therapy, transport, legal aid, cultural connection, employment pathways, and community gardens, all as inseparable parts of health care. A new analysis published in The Lancet Regional Health – Western Pacific now offers the first structured framework for describing this work, mapping the full spectrum of social wellbeing and support services that ACCHOs deliver, and arguing that Australia’s emerging social prescribing landscape should learn from, rather than reinvent, these Indigenous models.

The stakes are considerable. Aboriginal and Torres Strait Islander peoples define health holistically, encompassing the social, emotional, spiritual, and cultural wellbeing of both individuals and whole communities. Yet the measurable health gap between Indigenous and non-Indigenous Australians remains stark: according to the Australian Institute of Health and Welfare, 35 percent of that gap is attributed to social determinants, while another 35 percent remains unexplained, potentially reflecting cultural determinants that national health surveys simply do not capture. Following colonisation, persistent political, economic, and health inequalities have been driven by structural disadvantage, systematic discrimination, and racism. Despite this, Aboriginal and Torres Strait Islander communities continue to demonstrate remarkable strengths and resilience, drawing on social, cultural, and economic protective factors that promote community health and wellbeing.

ACCHOs have been central to this since 1971, providing holistic, comprehensive, culturally safe primary care that attends to social, cultural, and biomedical determinants of health. In 2019, the National Aboriginal Community Controlled Health Organisation, NACCHO, formalised this commitment within the ACCHO Core Services and Outcomes Framework, enshrining a sector-wide mandate for community health promotion and empowerment. Internationally and within non-Indigenous Australian contexts, linking patients to social wellbeing and other support services such as housing, income support, employment, physical activity groups, art therapy, meditation, community gardens, and music has been referred to as social prescribing or social referral initiatives. These kinds of connections are already commonplace within ACCHOs’ model of care, but are rarely labelled as social prescribing. A recent national feasibility study on social prescribing in the Australian context advocates for learning from and supporting the integrated models of care pioneered by ACCHOs, and this new framework responds directly to that call.

To build the framework, the research team, led by Uday Narayan Yadav with colleagues including Chelsea Liu, Reece Griffin, Rosemary Wyber, Isabel Hanson, and Odette Pearson, conducted a targeted, concept-driven critical review across Google Scholar, PubMed, and publicly available ACCHO and NACCHO publications, identifying work that explicitly considered Aboriginal and Torres Strait Islander communities in relation to social and cultural determinants of health. Using a conventional content analysis approach, they systematically coded ACCHO service functions related to social wellbeing and other support services, identifying distinct meaningful categories of ACCHO involvement across diverse programs and activities. The team then tested the resonance of the emerging framework with two ACCHOs and a NACCHO representative during development, and presented it at the Lowitja Institute’s International Indigenous Health and Wellbeing Conference in 2025 to gather sector feedback from researchers, practitioners, and community-controlled stakeholders.

The result is a six-domain framework that maps the increasing levels of ACCHO involvement against the degree of control, oversight, and Aboriginal and Torres Strait Islander cultural input in program and service delivery. The first domain is direct delivery of services, where funded services or initiatives are provided directly by the ACCHO to individuals, consuming ACCHO resources directly, such as Tackling Indigenous Smoking and Social and Emotional Wellbeing programs. The second is delivery through hosting or partnerships, where ACCHOs provide services indirectly by partnering with other providers or co-locating them within the ACCHO space, such as the National Disability Insurance Scheme, aged care, health justice, and food insecurity responses. The third is commissioning of services, where ACCHOs allocate funding and contract with other organisations to provide services they cannot provide directly, including allied health, training for clinicians and staff, or research contracts for needs assessment and evaluation, giving them financial and contractual control but less day-to-day operational involvement.

The remaining three domains describe lighter-touch but still significant forms of engagement. The fourth is referral to other services, where ACCHOs navigate or connect people to other providers through a formal referral process, such as Rangers programs, homelessness support, Men’s and Women’s Shed programs, and walking groups. The fifth is promoting services, where ACCHOs passively provide information about other services through social media, pamphlets, information sessions, or posters, without partnering, referring, or contacting providers directly, such as displaying information about the Aboriginal Quitline. The sixth and broadest domain is improving social capital and social cohesion, encompassing employment creation, capacity-building training opportunities to obtain qualifications, supporting families in educating their children, community empowerment initiatives, cultural immersion workshops, and advocacy, including championing alcohol-related harm reduction in local Aboriginal communities.

The framework comes to life through concrete sector examples. In Perth, a social and emotional wellbeing team uses yarning-style conversations to assess holistic needs and provide services such as cultural connection through travel to country, engagement with family members, participation in cooking or hobby groups, and making new friends. In Far North Queensland, individuals are invited into programs depending on their needs, including Tackling Indigenous Smoking, a needle exchange, youth diversion, home maintenance, parenting groups, men’s and women’s groups, and healthy cooking groups. Some ACCHOs partner with legal service providers to offer on-site legal support for credit and debt, fines, payday loans, Centrelink issues, housing, family breakdown, family violence, child protection, and minor crime. Others support Elders in navigating residential aged care, home care, and day respite services, establishing referral clinics that connect health and community programs to aged care providers who assess Elders for cleaning, lawn mowing, home modifications, transport, showering, dressing, and mobility support. The Kimberley Aboriginal Medical Services established the Solid Connections program to help people discover new skills and career pathways.

Beyond these specific services, ACCHOs function as a hub or one-stop shop for patients, addressing social and cultural determinants through an extraordinarily wide remit. They are the largest employer of Aboriginal and Torres Strait Islander people in Australia, employing over 3,500 Aboriginal people who comprise 55 percent of the total ACCHO workforce, and they are the primary setting for training Aboriginal Health Workers through in-service traineeship models and pathways to tertiary education. Their activities extend to accommodations for homeless people, justice-related services including co-located services in clinics, communities, and prisons, and post-release support for incarcerated people and their families. In some settings, particularly remote areas, they provide breakfast programs, elders’ lunches, aged care facilities, and assistance for the homeless. They also contribute to disaster preparedness and response during bushfires, floods, cyclones, and the COVID-19 pandemic, and play a leading role in providing culturally appropriate health information through health promotion resources, social media, and informal conversations.

The authors argue that describing this spectrum has several important benefits. First, it enables ACCHOs to clearly articulate their level of input to community members and governance bodies, including the extent to which they have control or influence over particular services, which is important for accountability where externally provided services vary in cultural safety. Second, a structured framework can help make visible the often-unrecognised work undertaken by ACCHOs, such as when they host in-reach services or display promotional materials, implicitly endorsing those services through their trusted community relationships, creating cultural and reputational responsibilities that are frequently unfunded. Third, a systemic approach to defining roles may support inter-agency collaboration by establishing shared goals, values, language, and understanding of partnership, which is often challenged by complex and unstable service networks, insecure funding mechanisms, and limited accountability for the cultural safety of partner-delivered services. Recent evidence from Far North Queensland shows that over 80 percent of upstream social, emotional, and wellbeing services were delivered by non-governmental organisations, raising questions about Indigenous participation in decision-making and control over service delivery.

The authors also acknowledge significant challenges. ACCHOs are often expected to support a broad range of activities despite already stretched organisational resources, and this work is frequently not recognised in funding models that prioritise clinical key performance indicators over holistic, community-identified needs. Where ACCHOs hold advisory rather than controlling roles, their capacity to influence service quality through cultural standards may be limited, posing reputational risks that require clear governance and escalation pathways when external providers do not meet agreed standards. Funding structures, commissioning arrangements, and workforce shortages may limit ACCHOs’ ability to expand their full remit, even when community demand is strong, and the authors argue that coordinated action across policy, commissioning, and workforce bodies is needed, alongside a national funding model to adequately support the sector. Ultimately, the six-domain framework offers care providers, researchers, and policymakers an opportunity to test this approach and expand foundational consultations with ACCHOs, highlighting the need for national-level research to understand and showcase best-practice initiatives, control, and financial needs in addressing the social and cultural determinants of health across the broader Australian context.

Subject of Research: “Indigenous models of social prescribing”–a six-domain framework for social wellbeing and other support services delivered by Aboriginal Community Controlled Health Organisations

Article Title: “Indigenous models of social prescribing”–a six-domain framework for social wellbeing and other support services delivered by Aboriginal Community Controlled Health Organisations

Article References: Yadav, U. N., Liu, C., Griffin, R., Wyber, R., Hanson, I., & Pearson, O. (2026). “Indigenous models of social prescribing”–a six-domain framework for social wellbeing and other support services delivered by Aboriginal Community Controlled Health Organisations. The Lancet Regional Health – Western Pacific, 75, Article 101999. https://doi.org/10.1016/j.lanwpc.2026.101999

Image Credits: AI Generated

DOI: 10.1016/j.lanwpc.2026.101999

Keywords: Indigenous, models, social, prescribing, six-domain, framework, wellbeing, other, support, services, delivered, Aboriginal