Evaluating a social and emotional well-being model of service piloted in Aboriginal Community Controlled Health Services in Western Australia: an Aboriginal Participatory Action Research approach.

INTRODUCTION: The delivery of services to improve Aboriginal health and well-being must centre culture and integrate a social and emotional well-being understanding and approaches. These approaches are essential in increasing access to, and engagement with, health services, as well as ensuring culturally safe, person-centred and community-centred care. This study will evaluate the Aboriginal Health Council of Western Australia's social and emotional well-being model of service being piloted in five Aboriginal Community Controlled Health Services across five of Western Australia's regions. The model of service includes the establishment of interdisciplinary social and emotional well-being teams and a four-pillar approach to service delivery. METHODS AND ANALYSIS: An Aboriginal Participatory Action Research methodology will be undertaken which calls for Indigenous leadership and governance, capacity-building of community co-researchers and engagement in reflexive practice. The evaluation will take a mixed-methods approach to data collection, including at each pilot site, yarns with up to five clients engaging with social and emotional well-being services; qualitative interviews with up to five service providers at each site, and up to five key knowledge holders from stakeholders including funders and commissioning bodies; the collection of clinical data; facilitated discussion using the social and emotional well-being Systems Assessment Tool; and document analysis and cost-estimation. Analysis will be guided by a client journey mapping framework, and data will be collectively analysed through a socioecological framework to understand the connections and inter-relatedness between client outcomes and experiences, social and emotional well-being team and service provider experiences, service systems and governance structures. ETHICS AND DISSEMINATION: This evaluation was approved by the Western Australian Aboriginal Health Ethics Committee (HREC1204). The findings will be disseminated through the production of an evaluation report and academic publications and presentations. Findings will also be disseminated through community forums and plain language summaries. These outputs will detail evaluation findings and recommendations, the process of evaluation through an Aboriginal Participatory Action Research approach and the collaborative stakeholder relationship-building that underpinned the project.

Implementation of the 'Kimberley Mum's Mood Scale' across primary health care services in the Kimberley region of Western Australia: A mixed methods assessment.

The Kimberley Mum's Mood Scale (KMMS) was co-designed with Aboriginal women and healthcare professionals to improve culturally appropriate screening practices for perinatal depression and anxiety. This paper describes the implementation of the KMMS across the remote Kimberley region of Western Australia from January 2018 to December 2021. We used the Dynamic Sustainability Framework to progress the implementation and assess at the intervention, practice setting and ecological system level using a mixed methods approach to analyse implementation. Rates of administration and results of screening were described using a retrospective audit of electronic medical records. Analyses of KMMS training registry, stakeholder engagement and sustainability initiatives were descriptive. KMMS acceptability was assessed using qualitative descriptive approaches to analyse patient feedback forms (n = 39), healthcare professional surveys (n = 15) and qualitative interviews with healthcare professionals (n = 6). We found a significant increase in overall recorded perinatal screening (pre-implementation: 30.4% v Year 3: 46.5%, P < 0.001) and use of the KMMS (pre-implementation: 16.4% v Year 3: 46.4%, P < 0.001). There was improved fidelity in completing the KMMS (from 2.3% to 61.8%, P < 0.001), with 23.6% of women screened recorded as being at increased risk of depression and anxiety. Most healthcare professionals noted the high levels of perinatal mental health concerns, stress, and trauma that their patients experienced, and identified the KMMS as the most appropriate perinatal screening tool. Aboriginal women reported that it was important for clinics to ask about mood and feelings during the perinatal period, and that the KMMS was appropriate. Aboriginal women consistently reported that it was good to have someone to talk to. This study demonstrates that innovation in perinatal depression and anxiety screening for Aboriginal women is possible and can be implemented into routine clinical care with the support of a sustained multi-year investment and strong partnerships.

Exploring Mental Health Presentations in Remote Aboriginal Community Controlled Health Services in the Kimberley Region of Western Australia Using an Audit and File Reviews.

The study aims to explore the role of mental health care in remote Aboriginal health services in the Kimberley region of Western Australia and provide a more nuanced understanding of the patients presenting for care, their needs, and the clinical response. Little is currently known about primary health care presentations for mental health, suicide, and self-harm for remote dwelling Aboriginal residents of the Kimberley region, despite high rates of psychological distress, self-harm, and suicide across the area. This study was progressed through a retrospective, cross-sectional audit of the electronic medical records system used by three remote clinics to explore the interactions recorded by the clinics about a patient's mental health. In addition, an in-depth file review was conducted on a stratified purposive sample of 30 patients identified through the audit. Mental ill-health and psychological distress were found to be prominent within clinical presentations. Psychosocial factors were frequently identified in relation to a patient's mental health presentation. Optimizing patients' recovery and wellness through service improvements, including an enhanced mental health model of care, is an important next step.

Equity in Access: A Mixed Methods Exploration of the National Disability Insurance Scheme Access Program for the Kimberley Region, Western Australia.

This study explored the process and early outcomes of work undertaken by a program to increase Aboriginal people's awareness of, and access to, the National Disability Insurance Scheme (NDIS). This 'Access Program' was implemented through the Aboriginal Community Controlled Sector in the remote Kimberley region of Western Australia. Access Program staff were interviewed to explore the strengths, challenges, and future directions of the program. The demographics, primary disability types, and NDIS access outcomes for clients who engaged with the program in the first 12 months of its implementation have been described. The Access Program engaged with 373 clients during the study period and assisted 118 of these to achieve access to the NDIS. The program was reported as successful by staff in its aim of connecting eligible people with the NDIS. Vital to this success was program implementation by the Aboriginal Community Controlled Sector. Staff in these organisations held community trust, provided culturally appropriate services, and utilised strengths-based approaches to overcome barriers that have historically hindered Aboriginal people's engagement with disability services. Our results demonstrate the Access Program is a successful start in increasing awareness of, and access to, the NDIS for Aboriginal people in the Kimberley region. Much work remains to assist the large number of Aboriginal people in the Kimberley region believed to be eligible for NDIS support who are yet to achieve access.

Aboriginal women's experiences of strengths and challenges of antenatal care in the Kimberley: A qualitative study.

BACKGROUND: High-quality, culturally safe antenatal care has an important role in improving health outcomes of Aboriginal and Torres Strait Islander people. We sought to describe Aboriginal women's experiences of antenatal care in the Kimberley region of Western Australia, to better understand current systems and opportunities for enhancing antenatal care. METHODS: Throughout the Kimberley, 124 Aboriginal women who had accessed antenatal care in 2015-2018 were recruited. They provided qualitative data during a health assessment or standalone interview. Transcripts were descriptively coded and thematically analysed. FINDINGS: Most women expressed that overall they had a positive antenatal care experience. Key themes were the importance of positive relationships with antenatal care providers, the valuable role of family support during the antenatal period, challenges travelling for care and limitations of the Patient Assisted Travel Scheme, communication of pregnancy related information, and the provision of services. Almost all antenatal care providers described were non-Aboriginal. A few women spoke about involvement of Aboriginal Health Workers in their antenatal care, including recommending expansion of these roles. CONCLUSIONS: The experiences shared by these Aboriginal women in the Kimberley contribute to broader evidence of a need to improve culturally safe antenatal care delivery for Aboriginal Australian women. Although excellent care was provided by a number of dedicated midwives, there were few Aboriginal antenatal staff and significant staff turnover. To improve the quality of care more local Aboriginal antenatal care providers, and additional support for the large number of women and their families required to travel, are required.

Why validation is not enough: Setting the scene for the implementation of the Kimberley Mum's Mood Scale.

BACKGROUND: The two part Kimberley Mum's Mood Scale (KMMS) has been developed and validated as a culturally appropriate perinatal depression and anxiety screening tool for Aboriginal women living in the sparsely populated Kimberley region of North West Australia. As part of implementation aspects of user acceptability were explored to improve clinical utilisation of the KMMS. METHODS: Eighteen health professionals involved in perinatal care participated in an online survey or a qualitative semi-structured interview. Ten Aboriginal women (who held administrative, professional or executive roles) were subsequently interviewed in depth to further explore aspects of KMMS user acceptability. RESULTS: Many of the health professionals were not using the second part of the KMMS (the psychosocial discussion tool). Time constraints and a perception that the KMMS is only appropriate for women with literacy issues were identified by health professionals as significant barriers to KMMS uptake. In contrast the Aboriginal women interviewed considered the KMMS to be important for literate Aboriginal women and placed high value on having the time and space to 'yarn' with health professionals about issues that are important to them. CONCLUSION: Implementing the KMMS across the Kimberley region requires health professionals to be trained. It also requires strategic engagement with health services to ensure health professionals and mangers understand the rationale and significance of the KMMS and are engaged in its successful implementation.

Study protocol: a clinical trial for improving mental health screening for Aboriginal and Torres Strait Islander pregnant women and mothers of young children using the Kimberley Mum's Mood Scale.

BACKGROUND: Improving the rates of, and instruments used in, screening for perinatal depression and anxiety among Aboriginal and Torres Strait Islander women are important public health priorities. The Kimberley Mum's Mood Scale (KMMS) was developed and later validated as an effective and acceptable perinatal depression and anxiety screening tool for the Kimberley region under research conditions. Other regions have expressed interest in using the KMMS with perinatal Aboriginal and Torres Strait Islander women. It is, however, important to re-evaluate the KMMS in a larger Kimberley sample via a real world implementation study, and to test for applicability in other remote and regional environments before recommendations for wider use can be made. This paper outlines the protocol for evaluating the process of implementation and establishing the 'real world' validity and acceptability of the KMMS in the Kimberley, Pilbara and Far North Queensland in northern Australia. METHODS: The study will use a range of quantitative and qualitative methods across all sites. KMMS validation/revalidation internal consistency of Part 1 will be determined using Cronbach's alpha. Equivalence for identifying risk of depression and anxiety compared to a standard reference assessment will be determined from receiver operating characteristic curves. Sensitivity and specificity will be determined based on these cut-points. Qualitative methods of phenomenology will be used to explore concepts of KMMS user acceptability (women and health professionals). Additional process evaluation methods will collate, assess and report on KMMS quality review data, consultations with health service administrators and management, field notes, and other documentation from the research team. This information will be reported on using the Dynamic Sustainability Framework. DISCUSSION: This project is contributing to the important public health priority of screening Aboriginal and Torres Strait Islander women for perinatal depression and anxiety with tools that are meaningful and responsive to cultural and clinical needs. Identifying and addressing barriers to implementation contributes to our understanding of the complexity of improving routine clinical practie. TRIAL REGISTRATION: The study was registered retrospectively on 15/05/2019 with the Australian and New Zealand Clinical Trial registry (ACTRN12619000580178).