Culturally responsive occupational therapy practice with First Nations Peoples-A scoping review.

INTRODUCTION: First Nations Peoples consistently demonstrate strength and resilience in navigating systemic health care inequities. Acknowledging racism as a health determinant underscores the urgent need for a counterforce-cultural safety. Indigenous Allied Health Australia (IAHA) contends that with cultural responsiveness, the health workforce can take action to create a culturally safe environment. OBJECTIVE: To explore features of culturally responsive occupational therapy (OT) practice when providing a service with First Nations People and examine alignment of those features with the IAHA Cultural Responsiveness in Action Framework. DESIGN: A systematic scoping review was undertaken using CINAHL, Emcare, MEDLINE, PsychInfo and Scopus databases. Examples of culturally responsive OT practice with First Nations Peoples were mapped to the six IAHA Framework capabilities and confirmed by First Nations co-authors. FINDINGS: OT practice with First Nations Peoples aligned with the six capabilities to varying degrees. The importance of OTs establishing relationships with First Nations People, applying self-reflection to uncover cultural biases, and addressing limitations of the profession's Western foundations was evident. DISCUSSION: Recognising the interrelatedness of the six capabilities, the absence of some may result in a culturally unsafe experience for First Nations People. OTs must acknowledge the leadership of First Nations Peoples by privileging their voices and consider how established practices may reinforce oppressive systems. CONCLUSION: To ensure a culturally safe environment for First Nations People, the OT profession must respect the leadership of First Nations Peoples and address the limitations of the profession's Western foundations to uphold the profession's core value of client-centred care.

Audit tools for culturally safe and responsive healthcare practices with Aboriginal and Torres Strait Islander people: a scoping review.

Aboriginal and Torres Strait Islander people in Australia face disparities in accessing culturally safe and appropriate health services. While current cultural safety and responsiveness frameworks set standards for improving healthcare practices, ensuring accountability and sustainability of changes, necessitates robust mechanisms for auditing and monitoring progress. This study examined existing cultural safety audit tools, and facilitators and barriers to implementation, in the context of providing culturally safe and responsive healthcare services with Aboriginal and Torres Strait Islander people. This will assist organisations, interested in developing tools, to assess culturally responsive practice. A scoping review was undertaken using Medline, Scopus, CINAHL, Informit and PsychInfo databases. Articles were included if they described an audit tool used for healthcare practices with Aboriginal and Torres Strait Islander people. Selected tools were evaluated based on alignment with the six capabilities of the Indigenous Allied Health Australia (IAHA) Cultural Responsiveness in Action Framework. Implementation barriers and facilitators were identified. 15 papers were included. Audit tools varied in length, terminology, domains assessed and whether they had been validated or evaluated. Seven papers reported strong reliability and validity of the tools, and one reported tool evaluation. Implementation facilitators included: tool comprehensiveness and structure; effective communication; clear organisational responsibility for implementation; commitment to prioritising cultural competence; and established accountability mechanisms. Barriers included: the tool being time-consuming and inflexible; responsibility for implementation falling on a small team or single staff member; deprioritising tool use; and lack of accountability for implementation. Two of the six IAHA capabilities (respect for the centrality of cultures and inclusive engagement) were strongly reflected in the tools. The limited tool evaluation highlights the need for further research to determine implementation effectiveness and sustainability. Action-oriented tools, which comprehensively reflect all cultural responsiveness capabilities, are lacking and further research is needed to progress meaningful change within the healthcare system.

Different meanings what we want in our lives a qualitative exploration of the experience of Aboriginal and/or Torres Strait Islander peoples in a co-designed community rehabilitation service.

PURPOSE: Promoting positive psychological, social and functional health outcomes for Aboriginal and Torres Strait Islander people requires health services to be culturally safe, respecting culture as central to the individuals and their communities. This study explored the experience of Aboriginal and Torres Strait Islander people, participating in a co-designed student-assisted community rehabilitation service in a remote Aboriginal community in Far North Queensland. MATERIALS AND METHODS: Observation, informal yarning and semi-structured interviews with older Aboriginal and Torres Strait Islander people (n = 6) engaged in the service was conducted over a 7 week period. Interpretive phenomenological analysis was applied through inductive thematic analysis. RESULTS: Four themes illustrated that experiences within the program promoted: A connection to people, both within the program and those significant in people's lives; a connection to past experiences, roles and events; a connection to the future of cultural knowledge; and a sense of achievement and fun. Participants shared their unique stories on their positive experience of the culturally responsive approach in the activities. CONCLUSIONS: These results suggest that knowledge translation and reciprocity provide a strong foundation for rehabilitation programs that support healthy ageing for Aboriginal and Torres Strait Islander people and encourage active and ongoing individual and community involvement.

Listening to and following the needs and wishes of Aboriginal and Torres Strait Islander rehabilitation participants, promotes the delivery of a service that is culturally and personally meaningful.Promoting two-way learning between participants and the people delivering the service promotes engagement with the service, reduces traditional power dynamics and increases the importance and meaning of the service for participants.Elevating cultural respect as an essential element of a rehabilitation service promotes service delivery that supports cultural relevance and safety.

How and why do women's groups (WGs) improve the quality of maternal and child health (MCH) care? A systematic review of the literature.

BACKGROUND: This systematic review was undertaken to assist the implementation of the WOmen's action for Mums and Bubs (WOMB) project which explores Aboriginal and Torres Strait Islander community women's group (WG) action to improve maternal and child health (MCH) outcomes. There is now considerable international evidence that WGs improve MCH outcomes, and we were interested in understanding how and why this occurs. The following questions guided the review: (1) What are the characteristics, contextual influences and group processes associated with the MCH outcomes of WGs? (2) What are the theoretical and conceptual approaches to WGs? (3) What are the implications likely to inform Aboriginal and Torres Strait Islander WGs? METHODS: We systematically searched electronic databases (MEDLINE (Ovid); CINAHL (Ebsco); Informit health suite, Scopus, Emcare (Ovid) and the Cochrane Library and Informit), online search registers and grey literature using the terms mother, child, group, participatory and community and their variations during all time periods to January 2021. The inclusion criteria were: (1) Population: studies involving community WGs in any country. (2) Intervention: a program/intervention involving any aspect of community WGs planning, acting, learning and reviewing MCH improvements. (3) Outcome: studies with WGs reported a component of: (i) MCH outcomes; or (ii) improvements in the quality of MCH care or (iii) improvements in socioemotional well-being of mothers and/or children. (4) Context: the primary focus of initiatives must be in community-based or primary health care settings. (5) Process: includes some description of the process of WGs or any factors influencing the process. (6) Language: English. (7) Study design: all types of quantitative and qualitative study designs involving primary research and data collection.Data were extracted under 14 headings and a narrative synthesis identified group characteristics and analysed the conceptual approach to community participation, the use of theory and group processes. An Australian typology of community participation, concepts from Aboriginal and Torres Strait Islander group work and an adapted framework of Cohen and Uphoff were used to synthesise results. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Tools. RESULTS: Thirty-five (35) documents were included with studies conducted in 19 countries. Fifteen WGs used participatory learning and action cycles and the remainder used cultural learning, community development or group health education. Group activities, structure and who facilitated groups was usually identified. Intergroup relationships and decision-making were less often described as were important concepts from an Aboriginal or Torres Strait Islander perspective (the primacy of culture, relationships and respect). All but two documents used an explicit theoretical approach. Using the typology of community participation, WGs were identified as predominantly developmental (22), instrumental (10), empowerment (2) and one was unclear. DISCUSSION: A framework to categorise links between contextual factors operating at micro, meso and macro levels, group processes and MCH improvements is required. Currently, despite a wealth of information about WGs, it was difficult to determine the methods through which they achieved their outcomes. This review adds to existing systematic reviews about the functioning of WGs in MCH improvement in that it covers WGs in both high-income and low-income settings, identifies the theory underpinning the WGs and classifies the conceptual approach to participation. It also introduces an Australian Indigenous perspective into analysis of WGs used to improve MCH. PROSPERO REGISTRATION NUMBER: CRD42019126533.

Developing a community rehabilitation and lifestyle service for a remote indigenous community.

PURPOSE: Community rehabilitation is an essential health service that is often not available to remote Australians. This paper describes the first cycle of a collaborative project, between local community members, allied health professionals and a university, to co-design a community rehabilitation and lifestyle service to support adults and older people to stay strong and age well in place. METHODS: An action research framework was used to develop the service for adults in two remote communities, one being a discrete Aboriginal community. The first cycle involved planning for, and trialling of a service, with observations, reflections and feedback from clients, community members, university students and health service providers, to inform the subsequent service. RESULTS: Over two years, stakeholders worked collaboratively to plan, trial, reflect and replan an allied health student-assisted community rehabilitation service. The trial identified the need for dedicated clinical and cultural supervision. During replanning, three key elements for culturally responsive care were embedded into the service: reciprocity and yarning; holistic community-wide service; and Aboriginal and Torres Strait Islander mentorship. CONCLUSIONS: An action-research approach to co-design has led to the establishment of a unique community rehabilitation service to address disability and rehabilitation needs in two remote Australian communities.Implications for rehabilitationCo-design of community rehabilitation services between Aboriginal and Torres Strait Islander community members and the local allied health professionals can lead to development of an innovative service model for remote Aboriginal communities.Culturally responsive community rehabilitation services in Aboriginal and Torres Strait Islander communities requires holistic and community-wide perspectives of wellbeing.Incorporating Aboriginal and Torres Strait Islander ways of engaging and communicating, and leadership and mentorship for non-Indigenous allied health professionals and students are essential components for students-assisted culturally responsive services.

A call for action that cannot go to voicemail: Research activism to urgently improve Indigenous perinatal health and wellbeing.

In this call to action, a coalition of Indigenous and non-Indigenous researchers from Australia, Aotearoa New Zealand, United States and Canada argue for the urgent need for adequately funded Indigenous-led solutions to perinatal health inequities for Indigenous families in well-resourced settler-colonial countries. Authors describe examples of successful community-driven programs making a difference and call on all peoples to support and resource Indigenous-led perinatal health services by providing practical actions for individuals and different groups.

Evaluation of the Aboriginal and Torres Strait Islander Mental Health First Aid Program.

OBJECTIVE: This study reports findings from an uncontrolled evaluation of a course designed to educate participants in how to recognise and respond to mental health problems until professional help is received. METHODS: Utilising a mixed methods design, participants in 21 different courses, delivered across two Australian states, were invited to complete pre-, post-, and follow-up surveys and provide qualitative feedback on their training experiences. RESULTS: Participants reported feeling more confident in their capacity to respond appropriately to a person presenting with a mental health need and believed they would be more likely to provide assistance. Satisfaction was attributed to the skills and sensitivities of instructors who had lived experience of mental health concerns in Aboriginal and Torres Strait Islander communities. CONCLUSION: This course holds promise in improving mental health literacy in relation to Aboriginal and Torres Strait Islander mental health. Implications for public health: Few courses are available that address issues relating to the social and emotional wellbeing of Aboriginal and Torres Strait Islander People. This study illustrates how community engagement with primary health and specialist mental health services might be strengthened.

Adolescent and young adult substance use in Australian Indigenous communities: a systematic review of demand control program outcomes.

OBJECTIVE: Identifying preventative approaches to substance use in Indigenous communities is the foundation for developing evidence-based responses. This study reports the findings of a systematic review of the published literature evaluating the impact of substance use programs on Australian Indigenous youth. METHODS: Evidence about the impact of substance use programs for Indigenous young people was identified from a systematic review of the literature conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS: Only four original studies that met the inclusion criteria were identified, although a further 19 papers that described characteristics of programs that may be associated with improved outcomes were reviewed. CONCLUSIONS: Evidence relevant to the outcomes of demand control programs that target Australian Indigenous youth substance use is both weak and inconsistent. There is a need to support the type of evaluation activity required to better understand program effectiveness and build the Indigenous knowledge base. Implications for public health: These findings are discussed in relation to the development of evidence-based practice and the type of knowledge that is likely to be of most use to those seeking to address problems associated with youth substance use.

Assessing violence risk with Aboriginal and Torres Strait Islander offenders: considerations for forensic practice.

Forensic professionals and courts have frequently expressed concern about the susceptibility of contemporary risk assessment tools to cultural bias. Furthermore, progress in the development of valid methods of assessment for offenders who identify from Aboriginal and Torres Strait Islander cultural backgrounds has been slow. This paper considers how cultural perspectives on risk are essential to the development of assessment methods that have greater validity and acceptance by both courts and the community. This will involve considering the social, cultural and political determinants of risk in each cultural group and the identification of those risk factors that are most relevant to forensic decision-making.

#IHMayDay: tweeting for empowerment and social and emotional wellbeing.

OBJECTIVE: This paper examines the themes of #IHMayDay, a day-long Twitter discussion about Indigenous health led by Aboriginal and Torres Strait Islander peoples on 1 May 2014. METHOD: The Symplur analytics tool was used to identify the Twitter activity associated with #IHMayDay. This paper reviews the content of 423 tweets that were tweeted and retweeted by 346 individuals and 108 organisations. RESULTS: Issues related to social and emotional wellbeing were dominant, and the analysis highlights the empowering nature of the strengths-based discourse. CONCLUSIONS: Twitter-based events such as #IHMayDay and initiatives such as the rotated, curated account @IndigenousX are powerful platforms for learning, exchange, advocacy and dialogue about the social and emotional wellbeing and mental health of Aboriginal and Torres Strait Islander peoples.

Yarning/Aboriginal storytelling: towards an understanding of an Indigenous perspective and its implications for research practice.

There is increasing recognition of Indigenous perspectives from various parts of the world in relation to storytelling, research and its effects on practice. The recent emergence of storytelling or yarning as a research method in Australian Aboriginal and Torres Strait Island studies and other Indigenous peoples of the world is gaining momentum. Narratives, stories, storytelling and yarning are emerging methods in research and has wide ranging potential to shape conventional research discourse making research more meaningful and accessible for researchers. In this paper we argue for the importance of Indigenous research methods and Indigenous method(ology), within collaborative respectful partnerships with non-Indigenous researchers. It is imperative to take these challenging steps together towards better outcomes for Indigenous people and their communities. In the Australian context we as researchers cannot afford to allow the gap between Aboriginal and Torres Strait Islanders and mainstream Australia health outcomes to grow even wider. One such pathway is the inclusion of Aboriginal storytelling or yarning from an Aboriginal and Torres Strait perspective within Indigenous and non-Indigenous research paradigms. Utilising Aboriginal storytelling or yarning will provide deeper understanding; complementing a two-way research paradigm for collaborative research. Furthermore, it has significant social implications for research and clinical practice amongst Indigenous populations; thus complementing the biomedical medical paradigm.

Amazingly resilient Indigenous people! Using transformative learning to facilitate positive student engagement with sensitive material.

If health professionals are to effectively contribute to improving the health of Indigenous people, understanding of the historical, political, and social disadvantage that has lead to health disparity is essential. This paper describes a teaching and learning experience in which four Australian Indigenous academics in collaboration with a non-Indigenous colleague delivered an intensive workshop for masters level post-graduate students. Drawing upon the paedagogy of Transformative Learning, the objectives of the day included facilitating students to explore their existing understandings of Indigenous people, the impact of ongoing colonisation, the diversity of Australia's Indigenous people, and developing respect for alternative worldviews. Drawing on a range of resources including personal stories, autobiography, film and interactive sessions, students were challenged intellectually and emotionally by the content. Students experienced the workshop as a significant educational event, and described feeling transformed by the content, better informed, more appreciative of other worldviews and Indigenous resilience and better equipped to contribute in a more meaningful way to improving the quality of health care for Indigenous people. Where this workshop differs from other Indigenous classes was in the involvement of an Indigenous teaching team. Rather than a lone academic who can often feel vulnerable teaching a large cohort of non-Indigenous students, an Indigenous teaching team reinforced Indigenous authority and created an emotionally and culturally safe space within which students were allowed to confront and explore difficult truths. Findings support the value of multiple teaching strategies underpinned by the theory of transformational learning, and the potential benefits of facilitating emotional as well as intellectual student engagement when presenting sensitive material.