Conceptualising bullying in an Aboriginal context as reported by the Yamaji community, to inform the development of a bullying prevention program that is culturally sensitive to the needs of Aboriginal students

The Solid Kids Solid Schools project aimed to capture the unheard voices of Aboriginal children and community members on the issues surrounding ‘bullying’. In an Aboriginal context bullying is different and the outcomes are different, yet mainstream programs are utilized to combat the issue. We need to know how bullying is different for Aboriginal children and young people, why it is different and what does this difference mean in terms of addressing this issue in a school and community setting? A community based steering group guided the direction of this study and the larger Solid Kids Solid Schools project. Snowball sampling and volunteer recruitment (Sarantakos 1993) were used to secure consent and interviews with over 190 Aboriginal respondents in the Yamaji (Midwest) region of Western Australia. Respondents included children, youth, Elders and parent/caregivers. Face to face interviews were conducted and transcribed by Aboriginal researchers to ensure cultural validity. Interviews were used to understand Aboriginal respondents’ experiences with bullying, its effects and what was needed to reduce its prevalence and harm to those who are targeted. While bullying was found to be an issue for all children, bullying perpetration and victimisation among Aboriginal children and youth appears to be different. Further, Aboriginal children and youth seem to be affected differently to non-Aboriginal children and youth. Bullying is not thought to be cultural or acceptable and the long term effects were not widely recognised among community members. Bullying appears to have a pattern of acceptance among young people and intra-racial bullying was found to be the most hurtful to Aboriginal children and youth. Long-term violence and community acceptance of bullying allows other anti-social behaviours to manifest and the belief in the need for young people to ‘fight all the way up’ is expected by the community. Intra-racial bullying and other forms of aggression need to be dealt with by both the school and the wider community setting and recognized as a serious issue facing many Aboriginal children and families. Without fully understanding this very personal, emotive and critical issue in an Aboriginal context we cannot take action to reduce its negative impact. This shared understanding must be developed with sensitivity whilst maintaining cultural integrity for Aboriginal people. While the effects of bullying are widely known for mainstream children and communities, this study provides the first major insight into how this harmful behaviour is perceived and experienced by Aboriginal people. Only with this understanding can we begin to develop community-based interventions to help young people to deal with this problem behaviour

Nguudu Barndimanmanha – Making Good with Horses

This presentation is a first-hand account of a one year equine psychotherapy trial using horses to intervene in the lives of young Aboriginal people, to build up hope, self-worth and identity and to instill a sense of pride in schooling and family, and to help with mental health disparities and suicide. Based in the Midwest/Murchison, this trial was exclusively with Aboriginal youth, (with carers and older family members). Students referred were identified as being at risk, or needing re-entry into schooling due to lack of attendance and repeated suspensions/relationship issues. Additionally, this trial was utilised as a reward and leadership incentive

Creating Cultural Empathy and Challenging Attitudes Through Indigenous Narrative Project

The gap in life expectancy between Indigenous and non-Indigenous Australians is too large to ignore. This has been attributed to social and economic disadvantage, access to health care and lack of cultural appropriateness of health services and providers. Creating culturally secure healthcare requires that we explore new ways for health professionals to relate to Aboriginal people. This article describes the development, implementation and early results from the Creating cultural empathy and challenging attitudes though Indigenous narrative project. The purpose of the project is to collect and trial narrative resources to engage students in stories of Indigenous people’s perceptions and experience of healthcare. Storytelling has a long tradition within Indigenous culture and narrative approaches can be successful in engaging students changing attitudes. These stories are intended to trigger classroom discussions to encourage students to reflect on their own assumptions and values and to enhance empathy, thereby enabling future health providers to improve their management of Indigenous patients. Key to this project has been working collaboratively with Indigenous people as active participants in the project with roles as project leads, team members, Indigenous Reference Group members, external evaluators and providers of the narratives

Perspectives of health service providers in delivering best-practice care for Aboriginal mothers and their babies during the postnatal period

Background: Evidence suggests that Aboriginal babies in Western Australia are not receiving adequate primary health care in their first 3 months of life, leading to questions about enablers and constraints to delivering such care. This paper presents findings from a qualitative research project investigating health providers’ perceptions and experiences of best and current practice in discharge planning, postnatal care and health education for Aboriginal mothers and their newborn babies. Methods: Constructivist grounded theory guided this research involving 58 semi-structured interviews conducted with health providers who deliver care to Aboriginal mothers and infants. Participants were recruited from hospital-based and primary health sites in metropolitan Perth, and regional and remote locations in Western Australia. Results: Structural factors enabling best practice in discharge planning, postnatal care, and health education for mothers included health providers following best practice guidelines and adequate staffing levels. Organisational enablers included continuity of care throughout pregnancy, birth and postnatally. In particular, good communication between services around discharge planning, birth notifications, and training in culturally respectful care. Structural and organisational constraints to delivering best practice and compromising continuity of care were identified as beyond individual control. These included poor communication between different health and social services, insufficient hospital staffing levels leading to early discharge, inadequate cultural training, delayed receipt of birth notifications and discharge summaries received by Aboriginal primary health services. Conclusion: Findings highlight the importance of examining current policies and practices to promote best practice in postnatal care to improve health outcomes for mothers and their Aboriginal babies

The unmet needs of Aboriginal Australians with musculoskeletal pain: A mixed method systematic review

Objective: Musculoskeletal pain (MSP) conditions are the biggest cause of disability and internationally, Indigenous peoples experience a higher burden. There are conflicting reports about Aboriginal Australians and MSP. We conducted a systematic review to describe the prevalence, associated factors, impacts, care access, health care experiences, and factors associated with MSP among Aboriginal Australians. Methods: A systematic search of quantitative and qualitative scientific and grey literature (PROSPERO number: CRD42016038342). Articles were appraised using the Mixed Methods Appraisal Tool. Due to study heterogeneity a narrative synthesis was conducted. Results: Of 536 articles identified, 18 were included (14 quantitative, 4 qualitative), of high (n=11), medium (n=2) and low (n=5) quality. Prevalences of MSP in Aboriginal populations were similar to or slightly higher than the non‐Aboriginal population (prevalence rate ratio 1.1 for back pain, 1.2‐1.5 for osteoarthritis (OA), 1.0‐2.0 for rheumatoid arthritis). Aboriginal people accessed primary care for knee or hip OA at around half the rate of non‐Aboriginal people, and were less than half as likely to have knee or hip replacement surgery. Communication difficulties with health practitioners were the main reason why Aboriginal people with MSP choose not to access care. No articles reported interventions. Conclusions: Findings provide preliminary evidence of an increased MSP burden amongst Aboriginal Australians and, particularly for OA, a mismatch between the disease burden and access to health care. To increase accessibility, health services should initially focus on improving Aboriginal patients’ experiences of care, in particular by improving patient‐practitioner communication. Implications for care and research are outlined

General practitioners’ perceptions of their communication with Australian Aboriginal patients with acquired neurogenic communication disorders

Objective: Aboriginal people have high rates of stroke and traumatic brain injury (TBI), often with residual, chronic communication deficits and multiple co-morbidities. This study examined general practitioners’ (GPs’) perceptions of their communication with Aboriginal patients with acquired communication disorders (ACD) after brain injury. Effective communication underpins good care but no previous research has explored this specific context. Methods: A qualitative descriptive approach was employed using interviews and focus groups with 23 GPs from metropolitan Perth and five regional sites in Western Australia. Data were analysed thematically. Results: GPs reported low visibility of Aboriginal patients with ACD in their practices, minimal training on neurogenic ACD, and difficulty distinguishing ACD from cultural-linguistic factors. They had few communication resources, and depended on families and Aboriginal Health Workers to assist in interactions. They rarely used formal interpreting services or referred to speech pathology. They reported communication (dis)ability having low priority in consultations. Conclusion: GPs report difficulty recognising ACD and their lack of prioritising assessment and treatment of communication ability after brain injury potentially compounds the disadvantage and disempowerment experienced by many Aboriginal people. Practice implications: GPs require further communication and cultural training. Improved access to speech pathology and formal interpreting services would be beneficial

Development of the Aboriginal Communication Assessment After Brain Injury (ACAABI): A screening tool for identifying acquired communication disorders in Aboriginal Australians

Purpose: Acquired communication disorders (ACD), following stroke and traumatic brain injury, may not be correctly identified in Aboriginal Australians due to a lack of linguistically and culturally appropriate assessment tools. Within this paper we explore key issues that were considered in the development of the Aboriginal Communication Assessment After Brain Injury (ACAABI) – a screening tool designed to assess the presence of ACD in Aboriginal populations. Method: A literature review and consultation with key stakeholders were undertaken to explore directions needed to develop a new tool, based on existing tools and recommendations for future developments. Result: The literature searches revealed no existing screening tool for ACD in these populations, but identified tools in the areas of cognition and social-emotional wellbeing. Articles retrieved described details of the content and style of these tools, with recommendations for the development and administration of a new tool. The findings from the interview and focus group views were consistent with the approach recommended in the literature. Conclusions: There is a need for a screening tool for ACD to be developed but any tool must be informed by knowledge of Aboriginal language, culture and community input in order to be acceptable and valid

“You felt like a prisoner in your own self, trapped”: The experiences of Aboriginal people with acquired communication disorders

Purpose: Aboriginal Australians are under-represented in brain injury rehabilitation services despite a high incidence of both stroke and traumatic brain injury in this population. This study aimed to explore the experiences of Aboriginal Australian adults with acquired communication disorders (ACDs) after brain injury for the first time to inform the development of accessible and culturally secure service delivery models. Methods and materials: Semi-structured interviews were undertaken with 32 Aboriginal people who had experienced a brain injury resulting in ACDs (aged 35–79 years) and 18 family members/carers across Western Australia. Thematic analysis identified common themes across participants. Results: Overall themes related to communication (both related to the communication disorder and general healthcare interactions), health and social contexts, recovery, and support, being away from family and country, knowledge and beliefs about brain injury, and follow-up. Conclusions: An increase in healthcare staff’s appreciation of the health and social contexts of Aboriginal people after brain injury is needed in order to improve communication with Aboriginal patients and the ability to offer accessible rehabilitation services. Ongoing support is required, with cultural identity noted as key to ensuring cultural security and ultimately recovery. Involvement of family and other Aboriginal people in recovery processes, as well as access to relevant Aboriginal languages and proximity to ancestral lands is central. Implications for rehabilitation Acknowledgment of cultural identity and strengths through involvement of extended family and Aboriginal Hospital Liaison Officers, access to language and proximity to country all central to rehabilitation planning for Aboriginal people after brain injury. Cultural security training for rehabilitation staff is recommended focusing on clear two-way communication skills to make medical information accessible for Aboriginal patients and to listen to patients’ concerns in a way that respects cultural context. Information regarding practical support and implications for ongoing management of life after brain injury (for the person and their family) is essential, and should supplement the medical-related information provided. Follow-up post discharge from hospital best facilitated through establishing contact with local Aboriginal community through Aboriginal community controlled health services, community elders, and Aboriginal health workers across organisations

Improving access to primary care for Aboriginal babies in Western Australia: Study protocol for a randomized controlled trial

Background: Despite a decade of substantial investments in programs to improve access to primary care for Aboriginal mothers and infants, more than 50 % of Western Australian Aboriginal babies are still not receiving primary and preventative care in the early months of life. Western Australian hospitals now input birth data into the Western Australian electronic clinical management system within 48 hours of birth. However, difficulties have arisen in ensuring that the appropriate primary care providers receive birth notification and clinical information by the time babies are discharged from the hospital. No consistent process exists to ensure that choices about primary care are discussed with Aboriginal families. Methods/Design: We will undertake a population-based, stepped wedge, cluster randomized controlled trial of an enhanced model of early infant primary care. The intervention is targeted support and care coordination for Aboriginal families with new babies starting as soon as possible during the antenatal period or after birth. Dedicated health professionals and research staff will consult with families about the families\u27 healthcare needs, provide information about healthcare in the first 3 months of life, offer assistance with birth and Medicare forms, consult with families about their choice for primary care provider, offer to notify the chosen primary care provider about the baby\u27s health needs, and offer assistance with healthcare coordination at the time of discharge from the hospital. We will evaluate this model of care using a rigorous stepped wedge approach. Our primary outcome measure is a reduced hospitalization rate in infants younger than 3 months of age. Secondary outcome measures include completed Aboriginal and Torres Strait Islander child health screening assessments, immunization coverage, and satisfaction of the families about early infant primary care. We will also assess the cost effectiveness of the model of care. Discussion: This study will be conducted over a 4-year period in partnership with birthing hospitals and primary care providers including Western Australian Aboriginal Community Controlled Health Services and the new Primary Health Networks. The results of our trial will be used to develop improved primary care models and to improve health outcomes for all Aboriginal infants. These are vital steps toward more equitable health service delivery for the Aboriginal and Torres Strait Islander children in Australia. Trial Registration: Australian New Zealand Clinical Trials Registry Registration number: ACTRN12615000976583Date registered: 17 September 2015. © 2016 McAullay et al

Statistical analysis plan for the stepped-wedge clinical trial Healing Right Way - Enhancing rehabilitation services for Aboriginal Australians after brain injury

Background: Aboriginal Australians are known to suffer high levels of acquired brain injury (stroke and traumatic brain injury) yet experience significant barriers in accessing rehabilitation services. The aim of the Healing Right Way trial is to evaluate a culturally secure intervention for Aboriginal people with newly acquired brain injury to improve their rehabilitation experience and quality of life. Following publication of the trial protocol, this paper outlines the statistical analysis plan prior to locking the database. Methods: The trial involves a stepped wedge design with four steps over 3 years. Participants were 108 adult Aboriginal Australians admitted to one of eight hospitals (four rural, four urban) in Western Australia within 6 weeks of onset of a new stroke or traumatic brain injury who consented to follow-up for 26 weeks. All hospital sites started in a control phase, with the intervention assigned to pairs of sites (one metropolitan, one rural) every 26 weeks until all sites received the intervention. The two-component intervention involves training in culturally safe care for hospital sites and enhanced support provided to participants by Aboriginal Brain Injury Coordinators during their hospital stay and after discharge. The primary outcome is quality of life as measured by the Euro QOL–5D-3L VAS. A mixed effects linear regression model will be used to assess the between-group difference at 26 weeks post-injury. The model will control for injury type and severity, age at recruitment and time since commencement of the trial, as fixed effects. Recruitment site and participant will be included as random effects. Secondary outcomes include measurements of function, independence, anxiety and depression, carer strain, allied health occasions of service received and hospital compliance with minimum processes of care based on clinical guidelines and best practice models of care. Discussion: The trial will provide the first data surrounding the effectiveness of an intervention package for Aboriginal people with brain injury and inform future planning of rehabilitation services for this population. The statistical analysis plan outlines the analyses to be undertaken. Trial registration: Australia New Zealand Clinical Trials Registry ACTRN12618000139279. Registered 30 January, 2018