Aboriginal and Torres Strait Islander health and wellbeing: social emotional wellbeing and strengths-based psychology

Objective: Addressing the continued health disparities between Australia's Indigenous and non-Indigenous peoples requires a multi-sector approach in which the discipline of psychology has a central role. These disparities are partially driven by a lack of culturally appropriate methods of health delivery. This study aimed to explore urban Aboriginal and Torres Strait Islanders' perceptions of health and wellbeing through social emotional wellbeing and strengths-based frameworks. Methods: A qualitative study was conducted with 19 urban Australian Aboriginal and Torres Strait Islander people. Data was collected via individual semi-structured interviews and focus groups. Thematic analysis was conducted to identify strengths-based themes within the data. Results: Several attributes and values emerged from participants’ understandings of enhancing mental health and wellbeing. These included acceptance, respect, forgiveness and integrity, honesty, courage, empathy, mindfulness, and spirituality. Conclusions: There are similarities between the central tenets of the strengths- and values-based frameworks and a model of social emotional wellbeing. It is important to note that these attributes and values are understood at the individual, community, and cultural level. Each of these attributes and values are intricately linked to being mentally healthy and having strong cultural identity. These similarities may provide an avenue for shared cross-cultural understandings and knowledges of mental health and wellbeing that will support culturally appropriate service delivery

Gugu Badhun: people of the Valley of Lagoons

This is a story of achievement in the face of adversity. It is the story of the Gugu Badhun people from the upper Burdekin River in North Queensland: an Aboriginal group which, like others, experienced the anguish of invasion, dispossession and discrimination but still maintained their solidarity, identity and connectedness to country. In the aftermath of colonisation, they successfully negotiated new roles for themselves and established new niches in a radically transformed social order. Theirs is a story shot through with tragedy, though with a stronger theme of triumph; a story of hardships and injustices met with resilience, courage and determination. The Gugu Badhun were among the first Aboriginal groups in inland northern Australia to encounter European intruders, specifically Ludwig Leichhardt’s exploratory party in 1845. After the pastoral invasion hit in the 1860s, the Gugu Badhun were among the Aboriginal groups that held out longest against the squatters, the rough and fissured character of their country facilitating a lengthy resistance. Following their incorporation into the pastoral economy, the Gugu Badhun continued to assert their autonomy, and members of the group were among the first Aboriginal people in the district to leave the pastoral stations to seek employment and opportunity in local towns. A Gugu Badhun man, Dick Hoolihan, became one of the most outspoken Aboriginal political leaders in North Queensland in the 1950s and 1960s. Those traditions – of autonomy and activism – are still cherished and maintained by Gugu Badhun people today, as this book explains. The story we tell is multi-faceted. It lays bare the violence and oppression experienced by Gugu Badhun people, but also acknowledges the inter-racial cooperation and friendships that were equally part of their experience. It tells of a people whose options were limited by state power and popular racism; but also of a people who remained proud and undaunted, making their own decisions for their own collective and individual benefit. It conveys new understandings of Aboriginal-European interactions, and of how Aboriginal people maintained their identities and exercised agency. This is a timely book for an Australia in which notions of Indigenous autonomy and self-determination are being re-imagined and re-configured

Ecosystems and indigenous well-being: An integrated framework

In Australia, role of natural resources in Indigenous well-being is completely ignored to date which further leads to inappropriate and ineffective well-being policies. This research addresses the need to develop an appropriate indigenous well-being approach that incorporates indigenous values in relation to natural systems. It focuses on Indigenous people in Australia and examines the available well-being frameworks from global as well as from local (i.e. Australian and Indigenous), perspectives. It applies a holistic approach to assess the role of natural systems in indigenous well-being demonstrating how people’s social, economic and cultural worlds, and how people’s capabilities relate to their natural systems. It integrates various social, economic and ecological values through the application of Capability Approach and the Millennium Assessment Approach. The study proposes an integrated framework that focuses on people’s belongingness to nature i.e. people’s values and capabilities that link to well-being. It emphasises the importance of each connection that people may have with their country in terms of people’s capabilities. The proposed framework can contribute to improved and better-informed policies on indigenous well-being as well as on the use, value and management of natural system

Enabling Lightweight Video Annotation and Presentation for Cultural Heritage

Collaboration-intensive research is increasingly becoming the norm in the humanities and social science arenas. eResearch tools such as online repositories offer researchers the opportunity to access and interact with data online. For the last 20 years video has formed an important part of humanities research, although dealing with multimedia in an online setting has proven difficult with existing tools. File size limitations, lack of interoperability with existing security systems, and the inability to include rich supportive detail regarding files have hampered the use of video. This paper describes a collaborative and data management solution for video and other files using a combination of existing tools (SRB and Plone integrated with Shibboleth) and a custom application for video upload and annotation (Mattotea). Rather than creating new proprietary systems, this development has examined the reuse of existing technologies with the addition of custom extensions to provide fullfeatured access to research data

Evidence-practice gaps for Australian General Practitioners (GP) in assisting pregnant women to quit

Background: Smoking prevalence among Indigenous pregnant women is high at 49%. Evidence-based smoking cessation interventions have not been effectively translated into the maternal Indigenous context. Aims: To explore GPs' knowledge, attitudes and practices of managing smoking in pregnant women. Methods: A random sample of 500 members of the RACGP National Faculty of Aboriginal and Torres Strait Islander Health were invited to an on-line survey. Inclusion criteria were GPs who consult with pregnant women. The response rate was low at 8% (N = 42), however alternative recruitment is ongoing. Results: One-third of the sample worked in Indigenous organisations; 62% of respondents were women. Most GPs (81%) always asked and gave brief advice about smoking in pregnancy. Less GPs (62%) always provided cessation support, assessed dependence (55%), discussed the psychosocial context of smoking (33%), followed up within 2 weeks (14%); 5% referred to the Quitline. Only 21% always recommended/prescribed nicotine replacement therapy (NRT), despite 93% agreeing that using NRT in pregnancy was safer than smoking; 71% believed NRT was moderately effective, and 69% were confident to prescribe NRT. More GPs in Indigenous organisations, compared to mainstream, agreed that discussing smoking benefits their relationship with pregnant clients (p < 0.05). Discussing psychosocial contexts was positively associated with prescribing NRT (p < 0.05). Only 10% GPs trained in smoking cessation for pregnancy; 83% agreed training was warranted, over two-thirds agreed access to oral NRT should be improved. Conclusions: Smoking cessation is a high priority for cancer prevention. NRT can be offered to pregnant smokers unable to quit. Low levels of assisted quitting may relate to scarcity of training for pregnancy, and policies governing access. Caution is advised due to small sample size. Translational research aspect: Training GPs in smoking cessation for pregnant women, and improving NRT access, may progress T2/3 translation of evidence-based methods for smokers in high prevalence groups

The availability, appropriateness, and integration of services to promote Indigenous Australian youth wellbeing and mental health : Indigenous youth and service provider perspectives

Concerns about the complexity, fragmentation and inefficiency of Australia’s current youth mental health service systems have led policy makers to seek improvements through a shift to community-based solutions. However, there is little evidence of how communities can make this shift. This paper examines the efforts of one Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) community—Yarrabah in north Queensland—to develop strategies for mental health and wellbeing service system improvements for school-aged youth (5–18 years). The research was co-designed with Yarrabah’s community-controlled health service and explores the perceptions of Yarrabah youth and service providers. Iterative grounded theory methods were used to collect and analyse data from 32 youth aged 11–24 years and 24 service providers. Youth were reluctant to seek help, and did so only if they felt a sense of safety, trust, relationality and consistency with providers. Young people’s four suggestions for improvement were access to (1) information and awareness about mental health; (2) youth facilities, spaces and activities; (3) safe and available points of contact; and (4) support for recovery from mental illness. Service providers highlighted an appetite for youth-guided community change and recommended five improvement strategies: (1) listening to youth, (2) linking with community members, (3) providing wellbeing promotion programs, (4) intervening early, and (5) advocating to address the determinants of youth mental health. Overall, both groups realised a disjunct between youth need and service provision, but a willingness to work together for systems change. This study demonstrates the importance of community-driven efforts that harness both youth and service providers’ perspectives, and suggests a need for ongoing dialogue as the basis for co-designing and implementing improvements to wellbeing supports and mental health services for Indigenous youth

“We are not stray leaves blowing about in the wind”: exploring the impact of Family Wellbeing empowerment research, 1998–2021

Background: An Aboriginal-developed empowerment and social and emotional wellbeing program, known as Family Wellbeing (FWB), has been found to strengthen the protective factors that help Indigenous Australians to deal with the legacy of colonisation and intergenerational trauma. This article reviews the research that has accompanied the implementation of the program, over a 23 year period. The aim is to assess the long-term impact of FWB research and identify the key enablers of research impact and the limitations of the impact assessment exercise. This will inform more comprehensive monitoring of research impact into the future. Methods: To assess impact, the study took an implementation science approach, incorporating theory of change and service utilisation frameworks, to create a logic model underpinned by Indigenous research principles. A research impact narrative was developed based on mixed methods analysis of publicly available data on: 1) FWB program participation; 2) research program funding; 3) program outcome evaluation (nine studies); and 4) accounts of research utilisation (seven studies). Results: Starting from a need for research on empowerment identified by research users, an investment of $2.3 million in research activities over 23 years produced a range of research outputs that evidenced social and emotional wellbeing benefits arising from participation in the FWB program. Accounts of research utilisation confirmed the role of research outputs in educating participants about the program, and thus, facilitating more demand (and funding acquisition) for FWB. Overall research contributed to 5,405 recorded participants accessing the intervention. The key enablers of research impact were; 1) the research was user- and community-driven; 2) a long-term mutually beneficial partnership between research users and researchers; 3) the creation of a body of knowledge that demonstrated the impact of the FWB intervention via different research methods; 4) the universality of the FWB approach which led to widespread application. Conclusions: The FWB research impact exercise reinforced the view that assessing research impact is best approached as a “wicked problem” for which there are no easy fixes. It requires flexible, open-ended, collaborative learning-by-doing approaches to build the evidence base over time. Steps and approaches that research groups might take to build the research impact knowledge base within their disciplines are discussed

Deaths in young people after contact with the youth justice system: a retrospective data linkage study

Introduction Young people who have contact with the youth justice system are distinguished by a high prevalence of complex, co-occurring health problems, including known risk factors for preventable mortality. However, almost nothing is known about health outcomes for these young people after separation from the youth justice system. Objectives and Approach We aimed to examine the incidence, timing, causes and risk factors for death in justice-involved young people. We linked youth justice records in Queensland, Australia 1993-2016 (N=48,963) with adult correctional records and the National Death Index. We split the cohort into three subgroups: those who had ever been in detention (n=7,643), those supervised in the community but never detained (n=12,953), and those charged with an offence but never convicted (n=28,367). We calculated all-cause and cause-specific crude mortality rates (CMRs), and indirectly standardised mortality ratios (SMRs). We used Cox regression to identify static and time-varying risk factors for death. Results During a median of 13.6 years of follow-up there were 1,452 deaths (3.0%). The all-cause CMR was 2.2 (95%CI 2.1-2.3) per 1000 person-years, and the all-cause SMR was 3.1 (95%CI 3.0-3.3). The leading external causes of death were suicide (32% of all deaths), transport accidents (16%), accidental drug-related causes (13%), and violence (3%). In adjusted analyses, independent risk factors for all-cause mortality included being male (HR=1.4, 95%CI 1.2-1.6) and older (>=15 vs. vs. charge only; HR=1.6, 95%CI 1.2-2.0) and subsequent incarceration as an adult (HR=1.8, 95%CI 1.4-2.4). Conclusion/Implications Young people who have contact with the youth justice system are at markedly increased risk of preventable death, after separation from that system. Efforts to improve long-term health outcomes for justice-involved youth have the potential to reduce preventable deaths in these highly vulnerable young people

Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children : protocol for a community-driven continuous quality improvement approach

Background: Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children works towards developing a spectrum of effective, community-based services and supports. These services and supports are organised into a coordinated network, build meaningful partnerships with families and address their cultural and linguistic needs, to help children to function better at home, in school, in the community, and throughout life. This study is conducted in partnership with primary healthcare (PHC) and other services in three diverse Indigenous Australian communities. It entails conceptualising, co-designing, implementing, and evaluating the effectiveness of systems integration to promote the mental health and wellbeing of Indigenous school-aged children (4–17 years). This paper outlines a protocol for implementing such complex community-driven research. Methods/design: Using continuous quality improvement processes, community co-designed strategies for improved systems integration will be informed by narratives from yarning circles with Indigenous children and service providers, and quantitative data from surveys of service providers and audits of PHC client records and intersectoral systems. Agreed strategies to improve the integration of community-based services and supports will be modelled using microsimulation software, with a preferred model implemented in each community. The evaluation will investigate changes in the: 1) availability of services that are community-driven, youth-informed and culturally competent; 2) extent of collaborative service networks; 3) identification by PHC services of children’s social and emotional wellbeing concerns; and 4) ratio of children receiving services to identified need. Costs and benefits of improvements to systems integration will also be calculated. Discussion: The study will provide evidence-informed, community-driven, and tested models that can be used for implementing systems integration to promote the mental health and wellbeing of Indigenous children. It will identify the situational enablers and barriers that impact systems integration and determine the extent to which systems integration improves service availability, systems and child outcomes. Evidence for the cost effectiveness of systems-level integration will contribute to national mental health policy reform

Effectiveness, cost-effectiveness and cost-benefit of a single annual professional intervention for the prevention of childhood dental caries in a remote rural Indigenous community

Background The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community in Australia, by application of a single annual dental preventive intervention. The study seeks to (1) assess the effectiveness of an annual oral health preventive intervention in slowing the incidence of dental caries in children in this community, (2) identify the mediating role of known risk factors for dental caries and (3) assess the cost-effectiveness and cost-benefit of the intervention. Methods/design The intervention is novel in that most dental preventive interventions require regular re-application, which is not possible in resource constrained communities. While tooth decay is preventable, self-care and healthy habits are lacking in these communities, placing more emphasis on health services to deliver an effective dental preventive intervention. Importantly, the study will assess cost-benefit and cost-effectiveness for broader implementation across similar communities in Australia and internationally. Discussion There is an urgent need to reduce the burden of dental decay in these communities, by implementing effective, cost-effective, feasible and sustainable dental prevention programs. Expected outcomes of this study include improved oral and general health of children within the community; an understanding of the costs associated with the intervention provided, and its comparison with the costs of allowing new lesions to develop, with associated treatment costs. Findings should be generalisable to similar communities around the world. The research is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number ACTRN12615000693527; date of registration: 3rd July 2015