Walking together in friendship: Learning about cultural safety in mainstream mental health services through Aboriginal Participatory Action Research.

OBJECTIVE: Culturally safe service provision is essential to improving social and emotional wellbeing among Aboriginal and Torres Strait Islander communities, and to eliminating health inequities. Cultural safety is about ensuring that all people have a safe and healing journey through services, regardless of their cultural background. In this project, we aim to (1) understand how Aboriginal and Torres Strait Islander peoples conceptualise cultural safety, and (2) co-design a qualitative interview for the next phase of this project, where we plan to learn about experiences of cultural safety within mental health services. METHODS: We conducted six focus groups (in one metro and two regional areas, Western Australia). Following an Aboriginal Participatory Action Research methodology, we yarned with Aboriginal and Torres Strait Islander mental health service users, carers, community members, mental health professionals and Cultural Healers about cultural safety. RESULTS: Participants described a culturally safe service as one where Aboriginal cultural knowledges, life experiences, issues and protocols are understood and acknowledged, and reported that mainstream mental health services are not currently culturally safe. Participants emphasised the importance of building trust, rapport, reciprocity and following appropriate relational processes when designing a qualitative interview for the next phase. CONCLUSIONS: A lack of cultural safety in mental health services is likely to contribute to the disparity in outcomes between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Embedding cultural safety into research design allows for authentic community engagement and facilitates knowledge sharing around ways to improve cultural safety in mental health services.

Identifying the key characteristics of a culturally safe mental health service for Aboriginal and Torres Strait Islander peoples: A qualitative systematic review protocol.

BACKGROUND: Mental health inequities between Indigenous and non-Indigenous populations are well documented. There is growing recognition of the role that culturally safety plays in achieving equitable outcomes. However, a clear understanding of the key characteristics of culturally safe mental health care is currently lacking. This protocol outlines a qualitative systematic review that aims to identify the key characteristics of culturally safe mental health care for Aboriginal and Torres Strait Islander peoples, at the individual, service, and systems level. This knowledge will improve the cultural safety of mental health care provided to Indigenous peoples, with a focus on Aboriginal and Torres Strait Islander peoples in Australia. METHODS AND EXPECTED OUTPUTS: Through a review of academic, grey, and cultural literature, we will identify the key characteristics of culturally safe mental health care for Aboriginal and Torres Strait Islander peoples in Australia. We will consider the characteristics of culturally safe care at the individual practitioner, service, and systems levels. PROSPERO REGISTRATION NUMBER: CRD42021258724.

Co-designing research with Aboriginal and Torres Strait Islander consumers of mental health services, mental health workers, elders and cultural healers.

INTRODUCTION: The disparity in mental health outcomes compared with non-Indigenous Australians means that there is an urgent need to develop an evidence base around how services can better support Aboriginal and Torres Strait Islander communities. A critical first step is to embed cultural safety into research methodologies. OBJECTIVE: Here, we aim to establish the foundation of a research project through co-designing a qualitative interview with Aboriginal and Torres Strait Islander consumers and community members about experiences of cultural safety with mainstream mental health services. DESIGN: Voices of Aboriginal and Torres Strait Islander peoples must be empowered across all stages of research. An Aboriginal-led research team conducted focus groups to understand clear, sensitive, and culturally appropriate ways of asking about experiences in mental health care, to co-design an interview on this topic. Participants were Aboriginal and Torres Strait Islander consumers of mental health services, carers, mental health workers, Elders and Cultural Healers, living in Metropolitan and Regional Western Australia. FINDINGS: Results suggest that Indigenous governance, together with investing in ongoing, and meaningful cultural awareness and cultural safety training (cultural awareness being a first step towards safety) for non-Indigenous researchers, together with taking the time to build respectful partnerships with communities through ongoing consultation, were appropriate and comprehensive methods of co-designing an interview. DISCUSSION: The process of working with Aboriginal and Torres Strait Islander peoples in research is as important as the outcome. Aboriginal and Torres Strait Islander leadership, self-determination, and relationship building with communities are essential. CONCLUSION: Empowering co-design methodologies are flexible, iterative, and ensure that the experiences and views of participants are valued, leading to more meaningful results.

Children's dynamic use of face- and behavior-based cues in an economic trust game.

Who do children trust? We investigated the extent to which children use face-based versus behavior-based cues when deciding whom to trust in a multiturn economic trust game. Children's (N = 42; aged 8 to 10 years; 31 females; predominantly White) trust decisions were informed by an interaction between face-based and behavior-based cues to trustworthiness, similarly to those of adults (N = 41; aged 17 to 48 years; 23 females; predominantly White). Facial trustworthiness guided children's investment decisions initially, such that they invested highly with trustworthy-looking partners and less with untrustworthy-looking partners. However, by the end of the trust game, after children had experienced game partners' fair or unfair return behavior, they overcame this bias and instead used partners' previous behavior to guide their trust decisions. Using partners' return behavior to guide decisions was the most rational strategy, because partners' facial trustworthiness was not an accurate cue to their actual trustworthiness. This dynamic use of different cues to trustworthiness suggests sophisticated levels of social cognition in children, which may reflect the social importance of trust impressions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Individual differences in trust evaluations are shaped mostly by environments, not genes.

People evaluate a stranger's trustworthiness from their facial features in a fraction of a second, despite common advice "not to judge a book by its cover." Evaluations of trustworthiness have critical and widespread social impact, predicting financial lending, mate selection, and even criminal justice outcomes. Consequently, understanding how people perceive trustworthiness from faces has been a major focus of scientific inquiry, and detailed models explain how consensus impressions of trustworthiness are driven by facial attributes. However, facial impression models do not consider variation between observers. Here, we develop a sensitive test of trustworthiness evaluation and use it to document substantial, stable individual differences in trustworthiness impressions. Via a twin study, we show that these individual differences are largely shaped by variation in personal experience, rather than genes or shared environments. Finally, using multivariate twin modeling, we show that variation in trustworthiness evaluation is specific, dissociating from other key facial evaluations of dominance and attractiveness. Our finding that variation in facial trustworthiness evaluation is driven mostly by personal experience represents a rare example of a core social perceptual capacity being predominantly shaped by a person's unique environment. Notably, it stands in sharp contrast to variation in facial recognition ability, which is driven mostly by genes. Our study provides insights into the development of the social brain, offers a different perspective on disagreement in trust in wider society, and motivates new research into the origins and potential malleability of face evaluation, a critical aspect of human social cognition.