Best Practice
Research

The CBPATSISP Clearing House for best practice research provides a central resource point that collects, organises and disseminates information about valuable research in the field of Aboriginal and Torres Strait Islander suicide prevention.

Research and a strong evidence base can enable communities, consumers and policy makers to readily distinguish programs and policies that are successful and are also in keeping with the aspirations of Aboriginal and Torres Strait Islander peoples.

The Clearing House for best practice research provides high quality and culturally relevant research publications to inform the work of Aboriginal and Torres Strait Islander communities,  organisations, mental health practitioners, policy makers and program providers. This includes:

  • Peer reviewed studies
  • Other relevant publications
  • Community project reports

Indigenous Research Ethics

In selecting the research featured in the Clearing House, the CBPATSISP is informed by the principles contained in the NH&MRC’s Ethical conduct in research with Aboriginal and Torres Strait Islander Peoples and communities: Guidelines for researchers and stakeholders.

The NHMRC guidelines include six core values:

  • Spirit & Integrity
  • Cultural Continuity
  • Equity
  • Reciprocity
  • Respect
  • Responsibility

The NHMRC guidelines acknowledge that historically research has not always benefited Indigenous peoples, and state that ethical research with Aboriginal and Torres Strait Islander peoples and communities should:

  • Improve the way all researchers work with Aboriginal and Torres Strait Islander people and their communities
  • Develop and/or strengthen research capabilities of Aboriginal and Torres Strait Islander people and their communities
  • Enhance the rights of Aboriginal and Torres Strait Islander people as researchers, research partners, collaborators and participants in research

Research Programs

Long-term research programs offer the opportunity to generate important results over time, for example through longitudinal cohort studies and community research, implementation and validation collaborations. Each of these programs may generate multiple research publications.

The Alliance for Suicide Prevention Sunshine Coast – Collective action for the Indigenous community
In 2019 Sunshine Coast’s Aboriginal, Torres Strait Islander and non-Indigenous communities and key organisations came together for a much-needed conversation about suicide prevention at the Triballink Activity Centre in Mapleton. Key findings from the Indigenous Community Consultation event, held to gain valuable perspectives on local Aboriginal and Torres Strait Islander suicide prevention efforts can be found here.

Getting It Right: The Validation Study (commenced in 2014 – ongoing)

Investigators – Maree Hackett, Sara Farnbach, Graham Gee, Alan Cass Timothy Skinner, Alex Brown Deborah Askew, Amrmando Teixeira–Pinto

Aims –  The primary aim of Getting it right: The Validation Study is to validate an extensively adapted and culturally appropriate, free to use, tool for use with Indigenous people attending primary care services, the adapted nine-item Patient Health Questionnaire (aPHQ-9), against a gold standard (criterion standard) the MINI International Neuropsychiatric Interview (MINI) 6.0.0., as a screening instrument for depression. The secondary aim is to evaluate the level of contribution of seven additional questions to the aPHQ-9 to the diagnosis of depression, as compared to the aPHQ-9.

Publications – Getting it Right: validating a culturally specific screening tool for depression (aPHQ-9) in Aboriginal and Torres Strait Islander Australians https://www.ncbi.nlm.nih.gov/pubmed/31165642 (Ongoing work)

More informationThe George Institute for Mental Health

Aims – The aim of this study is to trial and evaluate the Kimberley Mum’s Mood Scale (KMMS) which was developed and later validated as an effective and acceptable perinatal depression and anxiety screening tool for use with perinatal Aboriginal and Torres Strait Islander women in the Kimberley region under research conditions.

This study will document 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.

This project aims to contribute 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 culturally responsive to cultural and clinical needs. Identifying and addressing barriers to implementation contributes to our understanding of the complexity of improving routine clinical practice.

Investigators – Emma Carlin, Sarah J. Blondell, Yvonne Cadet-James, Sandra Campbell, Melissa Williams, Catherine Engelke, Des Taverner, Rhonda Marriott, Karen Edmonds, David Atkinson &  Julia V. Marley  (approved by Pilbara Aboriginal Health Planning Forum)

Publications –  Carlin,  E., Blondell, SJ., Cadet-James, Y.,  Campbell, S.  Williams, M., et al. 2019 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

Carlin E, Atkinson D, Marley JV. 2019 ‘Having a Quiet Word’: Yarning with Aboriginal Women in the Pilbara Region of Western Australia about Mental Health and Mental Health Screening during the Perinatal Period. Int J Environ Res Public Health. 2019 Nov 1;16(21). pii: E4253. doi: 10.3390/ijerph16214253.

Marley, J. V., Kotz, J., Engelke, C., Williams, M., Stephen, D., Coutinho, S., and Trust, S. K. (2017). Validity and acceptability of Kimberley mum’s mood scale to screen for perinatal anxiety and depression in remote aboriginal health care settings. PLoS One. 2017; 12(1): e0168969. Published online 2017 Jan 30. doi: 10.1371/journal.pone.0168969

Validation of the EPDS with Aboriginal Australian mothers and healthcare professionals.

Investigators – Ai Wen Chan, Peta Skerrington, Corinne Reid & Rhonda Marriott

Aim – To establish whether this tool has the potential to be an acceptable, valid and reliable indicator of depression for mothers and mothers-to-be. This mixed-methods research protocol seeks to explore the views and experiences of Aboriginal mothers and healthcare professionals in relation to the Edinburgh Postnatal Depression Scale (EPDS), and is intended to highlight potential barriers in perinatal mental health

Publications – Ai Wen Chan, Peta Skerrington, Corinne Reid & Rhonda Marriott. Research protocol for the exploration of experiences of Aboriginal Australian mothers and healthcare professionals when using the Edinburgh Postnatal Depression Scale: a process-oriented validation study using triangulated participatory mixed methods.

Cultural validation of the structured clinical interview for diagnostic and statistical manual of mental disorders in Indigenous Australians

Investigators – Maree Toombs, Bushra Nasir

Aim – To determine the cultural appropriateness of the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I) as an acceptable tool for diagnosing mental illness among Indigenous people.

Publications – Maree Toombs et al. (2019) – Cultural validation of the structured clinical interview for diagnostic and statistical manual of mental disorders in Indigenous Australians. https://www.ncbi.nlm.nih.gov/pubmed/31165642

Research Publications

The CBPATSISP Clearing House includes a wide range of peer reviewed articles and other publications that are relevant to research in Suicide Prevention, Wellbeing and Healing, Screening and Assessment Tools and Measures, Social Determinants, Systems Approaches, Diverse Groups, Indigenous Governance & Cultural Safety and Evaluations.

Publications Index

Suicide Prevention

Suicide Prevention broadly covers all work across the continuum of activities in Prevention and Early Intervention, SEWB/Healing, Postvention, Crisis Response, Training, and Clinical Services.

Armstrong, G., Ironfield, N., Kelly, C.M., Dart, K., Arabena, K., Bond, K., Reavley, N., & Jorm, A.F. (2018). Re-development of mental health first aid guidelines for supporting Aboriginal and Torres Strait Islanders who are experiencing suicidal thoughts and behaviourBMC Psychiatry, 18.

Background: Suicide is a leading cause of death among Indigenous Australians. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is suicidal. Culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islander persons who are experiencing suicidal thoughts or behaviour were developed in 2009. This study describes the re-development of these guidelines to ensure they contain the most current recommended helping actions. 

Methods: The Delphi consensus method was used to elicit consensus on potential helping statements to be included in the guidelines. These statements describe helping actions that Indigenous community members and non- Indigenous frontline workers can take, and information they should have, to help someone who is experiencing suicidal thoughts or displaying suicidal behaviour. A panel was formed, comprising 27 Aboriginal and Torres Strait Islander people who have expertise in Indigenous suicide prevention. The panellists were presented with the helping statements via online questionnaires and were encouraged to suggest re-wording of statements and any additional helping statements that were not included in the original questionnaire. Statements were only accepted for inclusion in the guidelines if they were endorsed by ≥90% of panellists as essential or important. 

Results: From a total of 301 statements shown to the expert panel, 172 were endorsed as helping statements to be including in the re-developed guidelines. 

Conclusions: Aboriginal and Torres Strait Islander suicide prevention experts were able to reach consensus on appropriate strategies for providing mental health first aid to an Aboriginal or Torres Strait Islander person experiencing suicidal thoughts or behaviour. The re-development of the guidelines has resulted in more comprehensive guidance than the earlier version, for which the panel had rated 166 helping statements and had endorsed 52. These re-developed guidelines can be used to inform Indigenous suicide gatekeeper training courses.

 

Dickson, M.J., Cruise, K., McCall, A.C., & Taylor, J.P. (2019). A systematic review of the antecedents and prevalence of suicide, self-harm and suicide ideation in Australian Aboriginal and Torres Strait Islander youth. International Journal of Environmental Research and Public Health, 16(17).

Suicide and self-harm represent serious global health problems and appear to be especially elevated amongst indigenous (sic) minority groups, and particularly amongst young people (aged 24 years or younger). This systematic review investigates for the first time the antecedents and prevalence of suicide, self-harm and suicide ideation among Australian Aboriginal and Torres Strait Islander youth. Web of Science, PubMed, PsychINFO, CINAHL databases and grey literature were searched from earliest records to April 2019 for eligible articles. Twenty-two empirical articles met the inclusion criteria. The data confirmed that indigenous (sic) youth in Australia have elevated rates of suicide, self-harm and suicidal ideation relative to the non indigenous (sic) population. Risk factors included being incarcerated, substance use and greater social and emotional distress. Notably, though, information on predictors of suicide and self-harm remains scarce. The findings support and justify the increasing implementation of public health programs specifically aimed at tackling this crisis. Based on the review findings, we argued that Aboriginal communities are best positioned to identify and understand the antecedents of youth self-harm, suicide ideation and suicide, and to take the lead in the development of more effective mental health preventive strategies and public policies within their communities.

 

Dudgeon, P., & Holland, C. (2018). Recent developments in suicide prevention among the Indigenous peoples of Australia. Australasian Psychiatry, 26(2), 166-169.

Objectives: Suicide is an Aboriginal and Torres Strait Islander (hereafter ‘Indigenous’) population health issue. Over 2015–2016, the Aboriginal and Torres Strait Islander Suicide Prevention Project (ATSISPEP) aimed to identify success factors in Indigenous suicide prevention. Conclusions: For non-Indigenous practitioners working with indigenous clients at risk of suicide, ATSISPEP identified important considerations to make treatment more effective. The start is acknowledging the differences in the historical, cultural, political, social and economic experiences of Indigenous peoples, and their greater exposure to trauma, psychological distress and risks to mental health. These mental health difficulties are specific and more prevalent amongst Indigenous peoples and communities due to the ongoing impacts of colonisation in Australia including a range of social determinants impacting on the well-being of Indigenous peoples today. Working effectively with Indigenous clients also includes being able to establish culturally safe work environments, and the ability of non-Indigenous practitioners to work in a culturally competent and trauma-informed manner. There are also considerations regarding time protocols and client follow-up. Further, postvention responses might be required. Supporting selective suicide prevention activity among younger people (and other groups at increased risk) and community-level work is an important complement to working with Indigenous individuals at risk of suicide.

 

Hearn, S., Wanganeen, G., Sutton, K., & Isaacs, A. (2016). The Jekkora group: An Aboriginal model of early identification, and support of persons with psychological distress and suicidal ideation in rural communitiesAdvances in Mental Health, 14(2), 96-105.

Objective: To describe a community developed Aboriginal model for early identification and referral of people with psychological distress and suicidal ideation.

Method: A description of an Aboriginal mental health service model is presented, as established at the Njernda Aboriginal Corporation, Echuca, Victoria.

Results: The model is presented under five headings: Setting; Recruitment and appointment of Voluntary Trained Support Persons; Identifying persons at risk; Follow-up and referral by Voluntary Trained Support Persons; Expansion and Sustainability.

Conclusions: The Jekkora group model is in its early stages of implementation and no evaluation data are available on its outcomes. However, the model has potential to enable early identification, treatment and follow-up support for Aboriginal people in distress that is undisclosed. Factors that support its acceptability in the community are that the model was developed by Aboriginal people for their community. The network of voluntary trained and untrained support persons might help strengthen bonds and build resilience in the community. 

Implications: The principles used in this model can be used to develop models for suicide prevention in other settings.

 

Isaacs, A. N., & Dudgeon, P. (2016). Ground realities in building effective Aboriginal suicide prevention strategiesAdvances in Mental Health, 14(2), 79-81.

 

Lopez-Carmen, V., McCalman, J., Benveniste, T., Askew, D., Spurling, G., Langham, E., & Bainbridge, R. (2019). Working together to improve the mental health of Indigenous children: A systematic review. Children and Youth Services Review104, 104408.

This systematic review analyses research measuring or evaluating primary health care interventions that focused on improving the mental health of Indigenous children via intersectoral service integration processes and tools.  Of the eleven studies included five were conducted with Indigenous children (aged 4 to 17 years) in Australia, the remaining studies included New Zealand, Canada, Norway and/or the United States. Among the nine key strategies adopted by service integration interventions of note were: Engaging the members of the Indigenous community; Empowerment of families; Adapting interventions and care to the specific socio-cultural circumstances; and Cultural strengthening and empowerment of Indigenous children’s identity.  Six factors enabling effective implementation of service integration included: Including and involving the community and stakeholders, Sensitivity to culture, including to historical background and inter-generational trauma, Multi-disciplinary and collaborative health services and Resourcing factors (e.g. funding, costs, time availability, staff/organisation capacity). The authors conclude that while the research evidence for interventions focused on improving the mental health of Indigenous children via intersectoral service integration is preliminary the findings hold potential. Importantly, the main outcomes where strategies focused on intersectoral integration were: Improvements in children’s psychosocial functioning, stress management, and individual empowerment; Improvements in health service access and use; Empowerment of both families and communities; and Increased links and collaboration between the community and health services. The authors identify the need for further research, particularly to incorporate Indigenous voices in evaluation, help clarify impact, and to evaluate costs.

 

Nasir, B., Hides, L., Kisely, S., Ranmuthugala, G., Nicholson G., Black, E., Gill, N., Kondalsamy-Chennakesavan, S., & Toombs, M. (2016). The need for a culturally-tailored gatekeeper training intervention program in preventing suicide among Indigenous peoples: A systematic reviewBMC Psychiatry, 16(1), 357. 

Background: Suicide is a leading cause of death among Indigenous youth worldwide. The aim of this literature review was to determine the cultural appropriateness and identify evidence for the effectiveness of current gatekeeper suicide prevention training programs within the international Indigenous community. 

Method: Using a systematic strategy, relevant databases and targeted resources were searched using the following terms: ‘suicide’, ‘gatekeeper’, ‘training’, ‘suicide prevention training’, ‘suicide intervention training’ and ‘Indigenous’. Other internationally relevant descriptors for the keyword “Indigenous” (e.g. “Maori”, “First Nations”, “Native American”, “Inuit”, “Metis” and “Aboriginal”) were also used. 

Results: Six articles, comprising five studies, met criteria for inclusion; two Australian, two from USA and one Canadian. While pre and post follow up studies reported positive outcomes, this was not confirmed in the single randomised controlled trial identified. However, the randomised controlled trial may have been underpowered and contained participants who were at higher risk of suicide pre-training. 

Conclusion: Uncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population. Further RCT evidence is required.

 

Nasir B., Kisely, S., Hides, L., Ranmuthugala, G., Brennan-Olsen, S., Nicholson, G., Gill, N.,  Hayman, N., Kondalsamy-Chennakesavan, S., & Toombs, M. (2017) An Australian Indigenous community-led suicide intervention skills training program: Community consultation findings.  BMC Psychiatry, 17(1), 219.

Background: Little is known of the appropriateness of existing gatekeeper suicide prevention programs for Indigenous communities. Despite the high rates of Indigenous suicide in Australia, especially among Indigenous youth, it is unclear how effective existing suicide prevention programs are in providing appropriate management of Indigenous people at risk of suicide. 

Methods: In-depth, semi-structured interviews and focus groups were conducted with Indigenous communities in rural and regional areas of Southern Queensland. Thematic analysis was performed on the gathered information. 

Results: Existing programs were time-intensive and included content irrelevant to Indigenous people. There was inconsistency in the content and delivery of gatekeeper training. Programs were also not sustainable for rural and regional Indigenous communities. 

Conclusions: Appropriate programs should be practical, relevant, and sustainable across all Indigenous communities, with a focus on the social, emotional, cultural and spiritual underpinnings of community wellbeing. Programs need to be developed in thorough consultation with Indigenous communities. Indigenous-led suicide intervention training programs are needed to mitigate the increasing rates of suicide experienced by Indigenous peoples living in rural and remote locations.

 

Rouen, C., Clough, A., & West, C. (2019). Non-fatal deliberate self-harm in three remote Indigenous communities in far north Queensland, AustraliaCrisis: The Journal of Crisis Intervention and Suicide Prevention, 1–7.

Background: Indigenous Australians experience a suicide rate over twice that of the general population. With nonfatal deliberate self-harm (DSH) being the single most important risk factor for suicide, characterizing the incidence and repetition of DSH in this population is essential. 

Aims: To investigate the incidence and repetition of DSH in three remote Indigenous communities in Far North Queensland, Australia. 

Method: DSH presentation data at a primary health-care center in each community were analyzed over a 6-year period from January 1, 2006 to December 31, 2011. Results: A DSH presentation rate of 1,638 per 100,000 population was found within the communities. Rates were higher in age groups 15–24 and 25–34, varied between communities, and were not significantly different between genders; 60% of DSH repetitions occurred within 6 months of an earlier episode. Of the 227 DSH presentations, 32% involved hanging. Limitations: This study was based on a subset of a larger dataset not specifically designed for DSH data collection and assesses the subset of the communities that presented to the primary health-care centers. 

Conclusion: A dedicated DSH monitoring study is required to provide a better understanding of DSH in these communities and to inform early intervention strategies.

 

Shand, F., Mackinnon, A., O’Moore, K., Ridani, R., Reda, B., Hoy, M., Heard, T., Duffy, L., Shanahan, M., Jackson Pulver, L., & Christensen, H. (2019). The iBobbly Aboriginal and Torres Strait Islander app project: study protocol for a randomised controlled trialTrials, 20, 198-208.

Background: Suicide amongst Australian Aboriginal and Torres Strait Islander communities occurs at twice the rate of the general population and, with significant barriers to treatment, help-seeking prior to a suicide attempt is low. This trial aims to test the effectiveness of an app (iBobbly) designed with Aboriginal and Torres Strait Islander people for reducing suicidal ideation. Methods/Design: This is a two-arm randomised controlled trial that will compare iBobbly to a wait-list control condition. The trial aims to recruit Aboriginal and Torres Strait Islander participants aged 16 years and over to test iBobbly, which is a self-help app delivering content based on acceptance and commitment therapy. The primary outcome for the study is suicidal ideation, and secondary outcomes include depression, hopelessness, distress tolerance, perceived burdensomeness and thwarted belonging, and help-seeking intentions. Data will be collected for both groups at baseline, post-intervention (after 6 weeks of app use), and at 6 months post-baseline (with a final 12-month follow-up for the iBobbly group). Primary analysis will compare changes in suicidal ideation for the intervention condition relative to the wait-list control condition using mixed models. An examination of the cost-effectiveness of the intervention compared to the control condition will be conducted. Discussion: If effective, iBobbly could overcome many barriers to help-seeking amongst a group of people who are at increased risk of suicide. It may provide a low-cost, accessible intervention that can reach more people. This trial will add to a sparse literature on indigenous suicide prevention and will increase our knowledge about the effectiveness of e-health interventions for suicide prevention.

 

Shand, F., Torok, M., Cockayne, N., Batterham, P. J., Calear, A. L., Mackinnon, A., Martin, D., Zbukvic, I., Mok, K., Chen, N., McGillivray, L., Phillips, M., Cutler, H., Draper, B., Sara, G., & Christensen, H. (2020). Protocol for a stepped-wedge, cluster randomized controlled trial of the LifeSpan suicide prevention trial in four communities in New South Wales, AustraliaTrials 21, 332.

Background:Despite increasing investment in suicide prevention, Australian suicide rates have increased steadily in the past decade. In response to growing evidence for multicomponent intervention models for reducing suicide, the LifeSpan model has been developed as the first multicomponent, evidence-based, system-wide approach to suicide prevention in Australia. The LifeSpan model consists of nine evidence-based strategies. These include indicated, selective and universal interventions which are delivered simultaneously to community and healthcare systems over a 2-year implementation period. This study will evaluate the effectiveness of the LifeSpan model in reducing suicide attempts and suicide deaths in four geographically defined regions in New South Wales, Australia. 

Methods:We outline the protocol for a stepped-wedge, cluster randomized controlled trial. Following a 6-month transition phase, the trial sites will move to the 2-year active implementation phase in 4-monthly intervals with evaluation extending a minimum of 24 months after establishment of the full active period. Analysis will be undertaken of the change attributable to the invention across the four sites. The primary outcome for the study is the rate of attempted suicide in the regions involved. Rate of suicide deaths within each site is a secondary outcome. 

Discussion:If proven effective, the LifeSpan model for suicide prevention could be more widely delivered in Australian communities, providing a valuable new approach to tackle rising suicide rates. LifeSpan has the potential to significantly contribute to the mental health of Australians by improving help-seeking for suicide, facilitating early detection, and improving aftercare to reduce re-attempts. The findings from this research should also contribute to the evidence base for multilevel suicide prevention programs internationally.

 

Tait, G., Carpenter, B., & Jowett, S. (2018). Coronial practice, Indigeneity and suicideInternational Journal of Environmental Research and Public Health, 15(4).

All available data suggest that, like many other indigenous peoples, Australian Aborigines (sic) are significantly more likely to kill themselves than are non-Aboriginal Australians. This statistical disparity is normally positioned an objective, ontological and undeniable social fact, a fact best explained as a function of endemic community disadvantage and disenfranchisement. This research explores the possibility that higher-than-normal Aboriginal suicide rates may also be a function of coronial decision-making practices. Based upon in-depth interviews with 32 coroners from across Australia, the following conclusions emerged from the data. First, coroners have differing perceptions of Indigenous capacity, and are less likely to have concerns about intent when the suicide is committed by an Indigenous person. Second, coroners have identified divergent scripts of Indigenous suicide, particularly its spontaneity and public location, and this supports rather than challenges, a finding of suicide. Third, the coronial perception of Indigenous life is a factor which influences a suicide determination for Indigenous deaths. Finally, the low level of Indigenous engagement with the coronial system, and the unlikelihood of a challenge to the finding of suicide by Indigenous families, means that a coronial determination of suicide is more likely.

Dudgeon, P., Milroy, J., Calma, T., Luxford, Y., Ring, I., Walker, R., Cox, A., Georgatos, G., & Holland, C. (2016). Solutions that work: What the evidence and our people tell us. Aboriginal and Torres Strait Islander suicide prevention evaluation project reportUniversity of Western Australia.

Leske, S., Crompton, D., & Kõlves, K. Suicide in Queensland: 2019 annual report. Australian Institute for Suicide Research and Prevention, Griffith University.

The Suicide in Queensland Annual Report 2019 (Suicide in Queensland) provides recent suicide trends in Queensland to help target and inform suicide prevention activities in Queensland by understanding the circumstances in which suicides occurred. This report focuses on information from the years 2013 to 2018. The information comes from a public health surveillance system — the Queensland Suicide Register (QSR) and the interim Queensland Suicide Register (iQSR). Surveillance systems play an important role in many areas of public health. Public health surveillance is the ongoing capture, analysis and interpretation of health data (World Health Organization, 2014). This information is used to plan, implement and evaluate public health practice and share timely information with those who need to know to take prompt action to prevent further suicides (Centers for Disease Control, 1986).

Lowitja Institute. (2020). We nurture our culture for our future, and our culture nurtures us. Lowitja Institute for the Close the Gap Steering Committee. 

This year’s Close the Gap report sets out a blueprint for systemic reform, presenting 14 recommendations (see p.6-7 of the report) for Australian governments that must be urgently implemented to avoid further preventable deaths and protect Indigenous health, wellbeing, culture and Country. The report takes a strengths-based approach, featuring case studies of Aboriginal and Torres Strait Islander-led programs and initiatives that prove how the recognition of Aboriginal and Torres Strait Islander empowerment is vital to wellbeing. However, a strengths-based approach does not overlook the relationship of power and inequality on health outcomes or the responsibility of governments in leading systems reform. We cannot continue to create solutions inside a system that has not been designed for our needs.

The Healing Foundation. (2016). Talking family healing: East Kimberley gathering report. 

This report outlines discussions held at the family healing gathering Woorrb Yarrenkoo Ninggooneng Ngoodengig Woonjoo-gerring in Kununurra, Western Australia in November 2014. The gathering included more than 100 community members and agencies from the East Kimberley communities of Kununurra, Wyndham, Kalumburu, Warmun, Halls Creek, Fitzroy, Derby and Broome. Topics discussed include: family violence, child abuse and neglect, intergenerational trauma, and grief, loss and suicide. The report includes five recommendations of ways forward for the future.The gathering and report was a partnership between The Healing Foundation and Gawooleng Yawoodeng Aboriginal Corporation.

Dudgeon, P., Milroy, J., Calma, T., Luxford, Y., Ring, I., Walker, R., Cox, A., Georgatos, G., & Holland, C. (2016). Solutions that work: What the evidence and our people tell us. Aboriginal and Torres Strait Islander suicide prevention evaluation project reportUniversity of Western Australia.

 

Leske, S., Crompton, D., & Kõlves, K. Suicide in Queensland: 2019 annual report. Australian Institute for Suicide Research and Prevention, Griffith University.

The Suicide in Queensland Annual Report 2019 (Suicide in Queensland) provides recent suicide trends in Queensland to help target and inform suicide prevention activities in Queensland by understanding the circumstances in which suicides occurred. This report focuses on information from the years 2013 to 2018. The information comes from a public health surveillance system — the Queensland Suicide Register (QSR) and the interim Queensland Suicide Register (iQSR). Surveillance systems play an important role in many areas of public health. Public health surveillance is the ongoing capture, analysis and interpretation of health data (World Health Organization, 2014). This information is used to plan, implement and evaluate public health practice and share timely information with those who need to know to take prompt action to prevent further suicides (Centers for Disease Control, 1986).

 

Lowitja Institute. (2020). We nurture our culture for our future, and our culture nurtures us. Lowitja Institute for the Close the Gap Steering Committee. 

This year’s Close the Gap report sets out a blueprint for systemic reform, presenting 14 recommendations (see p.6-7 of the report) for Australian governments that must be urgently implemented to avoid further preventable deaths and protect Indigenous health, wellbeing, culture and Country. The report takes a strengths-based approach, featuring case studies of Aboriginal and Torres Strait Islander-led programs and initiatives that prove how the recognition of Aboriginal and Torres Strait Islander empowerment is vital to wellbeing. However, a strengths-based approach does not overlook the relationship of power and inequality on health outcomes or the responsibility of governments in leading systems reform. We cannot continue to create solutions inside a system that has not been designed for our needs.

 

The Healing Foundation. (2016). Talking family healing: East Kimberley gathering report. 

This report outlines discussions held at the family healing gathering Woorrb Yarrenkoo Ninggooneng Ngoodengig Woonjoo-gerring in Kununurra, Western Australia in November 2014. The gathering included more than 100 community members and agencies from the East Kimberley communities of Kununurra, Wyndham, Kalumburu, Warmun, Halls Creek, Fitzroy, Derby and Broome. Topics discussed include: family violence, child abuse and neglect, intergenerational trauma, and grief, loss and suicide. The report includes five recommendations of ways forward for the future.The gathering and report was a partnership between The Healing Foundation and Gawooleng Yawoodeng Aboriginal Corporation.

Dudgeon, P., & Bray, A., & Walker, R. (2020). Self-determination and strengths-based Aboriginal and Torres Strait Islander suicide prevention: an emerging evidence-based approach. In A. C. Page & W. G.K. Stritzke (Eds.), Alternatives to suicide: Beyond risk and toward a life worth living(pp. 237 – 256). Elsevier.

Ansloos, J. (2018). Rethinking Indigenous suicideInternational Journal of Indigenous Health13(2), 8–28.

While the last three decades have seen substantial investments in suicidology research within the Canadian context, rates of Indigenous deaths by suicide have remained relatively stable, and little remains known about effective means to reduce Indigenous deaths by suicide. A movement of critical suicidology scholars across health and social sciences is beginning to challenge the mainstream approach of suicidology research and suicide prevention, citing concerns about the ideological and epistemic foundations. In this article, the author highlights how these critiques are relevant to Indigenous contexts. Challenging a range of assumptions, the author considers the need to rethink the ideological foundations of research on Indigenous suicide. Finally, the author considers two methodological projects that are integral to forming a critical approach to Indigenous suicidology research and Indigenous suicide prevention praxis–culturally grounded research and decolonizing research.

Baird, M. (2020) Perspectives of my lived experiences for addressing suicides among aboriginal communities in the North Queensland tropicsAlterNative – An International Journal of Indigenous Peoples, Vol. 16(3) 211 – 219

This article contextualises my perspectives of Indigenous knowledge within a cultural cosmology, used to address the suicide epidemic in an Indigenous community in the Far North Queensland Tropics of Australia. I use my personal narrative from the philosophical standpoint theory of an Indigenous female with first-hand experience of living under the residues of the Queensland Government Act (1897).

Baker, M., Sewell, T., Morris, T., McClintock, K., & Elkington, A. (2017). Waka Hourua, Ko Au, Ko Koe, Ko Tātou Māori suicide prevention community programme. Journal of Indigenous Wellbeing Te Mauri – Pimatisiwin, 3(2), 32-40.

In 2014, the first dedicated National Māori Suicide Prevention Programme: Waka Hourua was launched by Te Rau Matatini. One of its five streams was the operation of a National Coordination Centre for Māori Community Suicide Prevention. The major programme championed by the Centre included fostering Māori leadership, and building their capacity and capability to lead the development of whole of community plans. In drawing on what differentiates Waka Hourua from other programmes, it is the distinction of being privileged to work as informed insiders to Māori communities. This article provides an account of the Ko Au, Ko Koe, Ko Tātou Māori Suicide Prevention Community Programme and Māori Champions working in communities – the Pou Ārahi role.

Black, E.B., & Kisely, S. (2018). A systematic review: Non-suicidal self-injury in Australia and New Zealand’s Indigenous populationsAustralian Psychologist53(1), 3-12.

Objective: To undertake a systematic review of non‐suicidal self‐injury (NSSI) prevalence, patterns, functions, and behavioural correlates for the Indigenous populations of Australia (Aboriginal and Torres Strait Islanders) and New Zealand (NZ; Maori). 

Method: We searched the following electronic databases: PubMed, MedLine, Scopus, Web of Science, ScienceDirect, PsycInfo, and PsycArticles, CINAHL, and the Informit Health and Indigenous Peoples collections. Studies were included for review if they were published within the last 25 years and reported on NSSI in Australia and NZ’s Indigenous populations. 

Results: Seven studies were included, six of which came from Australia. The prevalence of NSSI in Australia ranged from 0.9% up to 22.50%; statistics varied by the different samples, types of prevalence, and relationship to alcohol. Several studies found that Aboriginal and Torres Strait Islander peoples had higher rates of NSSI than other Australians, but that this was not significantly higher. Two studies indicated that NSSI was linked to alcohol use, incarceration, and a younger age. The one NZ study was of injury and not specifically NSSI. 

Conclusions: Findings are limited due to a small pool of literature. Cultural variations in NSSI presentation should be considered when working with Indigenous populations. Further research is required to help determine what cultural variations may exist.

Bloch-Elkouby, S., Gorman, B., Schuck, A., Barzilay, S., Calati, R., Cohen, L. J., Begum, F., & Galynker, I. (2020). The suicide crisis syndrome: A network analysisJournal of Counseling Psychology. 

Recent studies introduced the suicide crisis syndrome (SCS), a condition associated with imminent suicidal behavior and characterized by (a) a pervasive feeling of entrapment in which the escape from an unbearable life situation is perceived as both urgent and impossible (Criterion A) and (b) affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal (Criterion B). The goal of the present study was to use some of the analytic tools provided by network analyses to further the understanding of the psychological, emotional, cognitive, behavioral, and physiological processes involved in the SCS by testing (a) whether the different symptoms of the proposed syndrome are related to each other, (b) whether symptoms form meaningful clusters, and (c) whether certain symptoms are more central than others. The study included 500 outpatient and 223 inpatient participants. A network analysis of the participants’ scores on the various symptoms of the SCS was conducted. The network analysis suggested that most SCS symptoms are linked by strong connections and that entrapment and ruminative flooding are highly correlated with the other SCS symptoms. Three clusters of symptoms were identified, suggesting the existence of several interdependent psychological processes potentially involved in SCS phenomenology. Our findings support both the suggested symptoms of the SCS and the central role of entrapment in the proposed criteria for the syndrome. Emotional pain appears to be closely linked to entrapment and may belong in Criterion A.

Dallas-Katoa, W., Varona, G., Kipa, M., Dallas, R., & Leahy, H. (2019). Summary findings of an exploratory data gathering exercise on Māori suicide in Te Waipounamu. Journal of Indigenous Wellbeing, 4(1), 49-60.

This paper presents the findings of a recently completed exploratory data gathering exercise on Māori suicide in Te Waipounamu (South Island of New Zealand). The data gathering exercise was conducted through Te Pūtahitanga o Te Waipounamu, the Whānau Ora commissioning agency in the South Island. Data from the Coronial Services of New Zealand and relevant information from the District Health Boards were explored for the South Island. In-depth interviews with whānau (families) and a pilot survey on mental wellbeing were also conducted. Results from the exercise indicate that whānau access suicide intervention health services only after a suicide incident or suicide attempt. On the whole, these health services generally use a clinical/health-based approach. Whānau, however, pointed out that a culturally grounded whole-of-whānau approach is required to address issues around mental health and suicide, particularly among young whānau. Strengthening and maintaining cultural relational ties, networks, and whānau connections have been consistently identified by whānau in Te Waipounamu as important not only for Māori mental and emotional wellbeing more generally, but also for preventing suicide.

Eskin, M., Tran, U. S., Carta, M. G., Poyrazli, S., Flood, C., Mechri, A., Shaheen, A., Janghorbani, M., Khader, Y., Yoshimasu, K., Sun, J., Kujan, O., Abuidhail, J., Aidoudi, K., Bakhshi., Harlak, H., Moro, M. F., Phillips, L., Hamdan M., Abuderman, A., Tsuno, K., & Voracek, M. (2020). Is individualism suicidogenic? Findings from a multinational study of young adults from 12 countriesFront Psychiatry, 11, 259.

The associations of individualistic versus collectivistic value orientations with suicidal ideation and attempts, attitudes towards suicide and towards suicidal individuals, and psychological distress were investigated across 12 nations (N = 5572 university students). We expected differential associations of value orientations with suicidal behavior and moderating effects of the prevailing value orientations in the various countries. Findings showed that intermediate levels of individualism appeared protective against suicide attempts across all investigated nations, but that, otherwise, there seemingly are no universal associations of individualism and collectivism with suicidal behaviors. High collectivism was associated with less suicidal ideation only in individualistic countries. Low individualism appeared to be a risk factor for suicidal ideation specifically in Muslim collectivistic cultures, whereas high individualism in Asian collectivistic cultures. Collectivistic values are uniformly associated with less permissive attitudes to suicide, whereas individualistic values with a more stigmatized view of suicidal behavior. Both individualistic and collectivistic values were associated with socially accepting attitudes to a suicidal peer, helping a suicidal friend, and emotional involvement. The associations of individualistic and collectivistic values with disapproving attitudes to suicidal disclosure were complex. Beliefs in punishment after death for suicide, seeing suicide as mental illness, and emotional involvement with a suicidal friend were lower in high-suicide-rate countries. These evidence patterns are discussed in the light of related research evidence, along with directions for future research in this area.

Kral, M. J. (2012). Postcolonial suicide among Inuit in Arctic CanadaCulture, Medicine, and Psychiatry, 36,306-325.

Indigenous youth suicide incidence is high globally, and mostly involves young males. However, the Inuit of Arctic Canada have a suicide rate that is among the highest in the world (and ten times that for the rest of Canada). The author suggests that suicide increase has emerged because of changes stemming in part from the Canadian government era in the Arctic in the 1950s and 1960s. The effects of government intervention dramatically affected kin relations, roles, and responsibilities, and affinal/romantic relationships. Suicide is embedded in these relationships. The author also discusses the polarization between psychiatric and indigenous/community methods of healing, demonstrating that government-based intervention approaches to mental health are not working well, and traditional cultural healing practices often take place outside of the mainstream clinics in these communities. The main questions of the paper are: Who should control suicide prevention? What is the best knowledge base for suicide prevention?

Pollock, N. J., Naicker, K., Loro, A., Milary, S., & Colman, I. (2018). Global incidence of suicide among Indigenous peoples: A systematic reviewBMC Medicine, 16, 145.

Background: Suicide is the second leading cause of death among adolescents worldwide, and is a major driver of health inequity among Indigenous people in high-income countries. However, little is known about the burden of suicide among Indigenous populations in low- and middle-income nations, and no synthesis of the global data is currently available. Our objective was to examine the global incidence of suicide among Indigenous peoples and assess disparities through comparisons with non-Indigenous populations. 

Methods: We conducted a systematic review of suicide rates among Indigenous peoples worldwide and assessed disparities between Indigenous and non-Indigenous populations. We performed text word and Medical Subject Headings searches in PubMed, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), PsycINFO, Latin American and Caribbean Health Sciences Literature (LILACS), and Scientific Electronic Library Online (SciELO) for observational studies in any language, indexed from database inception until June 1, 2017. Eligible studies examined crude or standardized suicide rates in Indigenous populations at national, regional, or local levels, and examined rate ratios for comparisons to non-Indigenous populations. 

Results: The search identified 13,736 papers and we included 99. Eligible studies examined suicide rates among Indigenous peoples in 30 countries and territories, though the majority focused on populations in high-income nations. Results showed that suicide rates are elevated in many Indigenous populations worldwide, though rate variation is common, and suicide incidence ranges from 0 to 187.5 suicide deaths per 100,000 population. We found evidence of suicide rate parity between Indigenous and non-Indigenous populations in some contexts, while elsewhere rates were more than 20 times higher among Indigenous peoples. 

Conclusions: This review showed that suicide rates in Indigenous populations vary globally, and that suicide rate disparities between Indigenous and non-Indigenous populations are substantial in some settings but not universal. Including Indigenous identifiers and disaggregating national suicide mortality data by geography and ethnicity will improve the quality and relevance of evidence that informs community, clinical, and public health practice in Indigenous suicide prevention.

Inuit Tapiriit Kanatami. (2019). Promising practices in suicide prevention across Inuit Nunangat: NISPS research and data collection project.

In the National Inuit Suicide Prevention Strategy (NISPS), suicide is identified as “the most urgent challenge facing our people” (Inuit Tapiriit Kanatami 2016, 4). Given the seriousness of the issue, and recognizing that more work is needed to mobilize Inuit knowledge for resilience and suicide prevention across Inuit Nunangat (one of the NISPS’s six priority areas), Inuit Tapiriit Kanatami (ITK) and the NISPS Working Group have a shared interest in:
• Developing a more complete picture of the actions and interventions currently in place to address the elevated rate of suicide across Inuit Nunangat;
• Gathering and sharing information about actions and interventions that appear to be effective/showing promise in addressing elevated rates of suicide among Inuit;
• Identifying opportunities to improve outcomes concerning suicide rates in Inuit Nunangat; and
• Identifying opportunities to effectively mobilize knowledge across the six areas noted above.
This report presents findings from an environmental scan that was undertaken to support these objectives. The scan involved a review of both grey and academic literature, and a series of key informant interviews with individuals who have experience working on suicide prevention and related initiatives across Inuit Nunangat. The literature review and interviews were organized around the following six topic areas:
1. Links between childhood adversity and suicide;
2. Promising practices with respect to addressing child sexual abuse across Inuit Nunangat;
3. Promising practices with respect to social emotional development in Inuit Nunangat;
4. Promising practices with respect to safe shelters focusing on children and youth within Inuit Nunangat;
5. Promising practices with respect to current supports for Inuit within the justice system with a specific focus addressing child sexual abuse; and
6. Promising practices with respect to parenting and family support programs.
Key informants were identified by ITK staff and the NISPS Working Group. 20 people were interviewed in total.

 

Ministry of Health. (2017). A strategy to prevent suicide in New Zealand: Draft for public consultation.

Wellbeing & Healing

Balaratnasingam, S., Chapman, M., Chong, D., Hunter, E., Lee, J., Little, C., Mulholland, K., Parker, R., Watson, M., & Janca, A. (2019). Advancing social and emotional well-being in Aboriginal and Torres Strait Islander Australians: clinicians’ reflectionsAustralasian Psychiatry27(4), 348-351.

Objective: An expert reference group met on four occasions to consider ways forward in terms of Indigenous mental health. This paper summarises the discussion and recommendations. 

Conclusion: While the negative effects of colonisation and trans-generational trauma continue, we propose renewed emphasis on improving access, cultural orientation and trauma-informed care, and a focus on the needs of young Indigenous Australians.

 

Butler, T.L., Anderson, K., Garvey, G., Cunningham, J., Ratcliffe, J., Tong, A., Whop, L.J., Cass, A., Dickson, M., & Howard, K. (2019). Aboriginal and Torres Strait Islander people’s domains of wellbeing: A comprehensive literature reviewSocial Science and Medicine233, 138-157.

There are significant health and social disparities between the world’s Indigenous and non-Indigenous people on factors likely to influence quality of life (QOL) and wellbeing. However, these disparities in wellbeing are not captured in conventional QOL instruments, as they often do not include dimensions that are likely to be relevant to Indigenous people. The objective of this comprehensive literature review was to identify these wellbeing domains for Aboriginal and Torres Strait Islander people in Australia (hereafter, respectfully referred to collectively as Indigenous Australians). We searched PsycINFO, MEDLINE, Econlit, CINAHL, and Embase (from inception to June 2017, and updated in March 2019), and grey literature sources using keywords relating to adult Indigenous Australians’ QOL and wellbeing. From 278 full-text articles assessed for eligibility, 95 were included in a thematic analysis. This synthesis revealed nine broad interconnected wellbeing dimensions: autonomy, empowerment and recognition; family and community; culture, spirituality and identity; Country; basic needs; work, roles and responsibilities; education; physical health; and mental health. The findings suggest domains of wellbeing relevant to and valued by Indigenous Australians that may not be included in existing QOL and wellbeing instruments, domains that may be shared with Indigenous populations globally. This indicates the need for a tailored wellbeing instrument that includes factors relevant to Indigenous Australians. Developing such an instrument will ensure meaningful, culturally-relevant measurement of Indigenous Australians’ wellbeing.

 

Cairney, S., Abbott, T., Quinn, S., Yamaguchi, J., Wilson, B., & Wakerman, J. (2017). Interplay wellbeing framework: A collaborative methodology ‘bringing together stories and numbers’ to quantify Aboriginal cultural values in remote AustraliaInternational Journal for Equity in Health 16(68), 1-13.

Background: Wellbeing has been difficult to understand, measure and strengthen for Aboriginal people in remote Australia. Part of the challenge has been genuinely involving community members and incorporating their values and priorities into assessment and policy. Taking a ‘shared space’ collaborative approach between remote Aboriginal communities, governments and scientists, we merged Aboriginal knowledge with western science – by bringing together stories and numbers. This research aims to statistically validate the holistic Interplay Wellbeing Framework and Survey that bring together Aboriginal-identified priorities of culture, empowerment and community with government priorities including education, employment and health. 

Method: Quantitative survey data were collected from a cohort of 842 Aboriginal people aged 15-34 years, recruited from four different Aboriginal communities in remote Australia. Aboriginal community researchers designed and administered the survey. 

Results: Structural equation modeling showed good fit statistics (χ/df = 2.69, CFI = 0.95 and RMSEA = 0.045) confirming the holistic nature of the Interplay Wellbeing Framework. The strongest direct impacts on wellbeing were ‘social and emotional wellbeing’ (r = 0.23; p < 0.001), ‘English literacy and numeracy’ (r = 0.15; p < 0.001), ‘Aboriginal literacy’ (r = 0.14; p < 0.001), ‘substances’ (lack thereof; r = 0.13; p = 0.003), ‘work’ (r = 0.12; p = 0.02) and ‘community’ (r = 0.08; p = 0.05). Correlation analyses suggested cultural factors have indirect impacts on wellbeing, such as through Aboriginal literacy. All cultural variables correlated highly with each other, and with empowerment and community. Empowerment also correlated highly with all education and work variables. ‘Substances’ (lack thereof) was linked with positive outcomes across culture, education and work. Specific interrelationships will be explored in detail separately. 

Conclusion: The Interplay Wellbeing Framework and Survey were statistically validated as a collaborative approach to assessing wellbeing that is inclusive of other cultural worldviews, values and practices. New community-derived social and cultural indicators were established, contributing valuable insight to psychometric assessment across cultures. These analyses confirm that culture, empowerment and community play key roles in the interplay with education, employment and health, as part of a holistic and quantifiable system of wellbeing. This research supports the holistic concept of wellbeing confirming that everything is interrelated and needs to be considered at the ‘whole of system’ level in policy approaches.

 

Clark, Y., Augoustinos, M., & Malin, M. (2017). Coping and prevention of lateral violence in the Aboriginal community in Adelaide. The Australian Community Psychologist, 28 (2), 105-123.

Lateral violence describes how members of oppressed groups direct their dissatisfaction inward. This inward deflection has been associated with the Aboriginal community in Adelaide, South Australia and has shown to be destructive. Interviews with 30 Aboriginal participants examining their ways of dealing with and strategising to prevent lateral violence in the community have been presented in a thematic analysis. Overall seven major interpretive themes emerged from these interviews: education is central; support provides unity; champions and role models are essential; culture and identity are empowering; avoidance of Aboriginal spaces by Aboriginal people can be protective; lateral violence can be challenged; and positively reinterpreted. Given that many participants drew on a number of coping strategies to deal with lateral violence, it is hoped that such information will benefit individuals, community, governments and funding agencies to support future research, education and services within communities in order for Aboriginal people to heal and prevent lateral violence.

 

Hill, N., & Murrary, K. (2020). Psychological sense of community and values: Understanding attitudes towards people seeking asylum and Australia’s First Nations peopleAustralian Psychologist, 1-14.

Objective: Discrimination and prejudice have significant implications for individuals and communities and are prevalent throughout the world towards marginalised groups. This study investigated the role of psychological sense of community (PSOC), values of self‐transcendence and openness‐to‐change, and demographic variables, with attitudes towards two different groups in Australia. 

Method: A convenience sample of adults living in Australia (N = 396) was randomly assigned to complete one of two online surveys; reporting on their attitudes towards Australia’s First Nations People (N = 198), or towards people seeking asylum (N = 198). The study assessed the extent to which a PSOC (in reference to local, national, and global communities), self‐transcendence, and openness‐to‐change, predicted attitudes towards the two groups.

Results: Self‐transcendence and psychological sense of global community consistently predicted attitudes towards both groups, with psychological sense of global community partially mediating the relationship between self‐transcendence and attitudes. Bivariately, those holding a stronger local psychological sense of community reported more positive attitudes towards people seeking asylum, whereas those holding a stronger psychological sense of national community reported more positive attitudes towards Australia’s First Nations People. However, in multivariable regression models with self‐transcendence and demographic characteristics, only a higher psychological sense of national community significantly predicted more negative attitudes towards people seeking asylum. 

Conclusions: This research suggests that where people have a strong sense they are part of a global community they hold more positive attitudes towards people from various cultures both near and far. The research has implications for social cohesion and social policy.

 

Hunter, E. (2020). Indigenous mental health: The limits of medicalised solutionsAustralasian Psychiatry, 28(1), 55-57.

Objective: The excess burden of mental disorders experienced by Indigenous Australians is complexly overdetermined. Social and political factors contributing to the intransigence of vulnerability are reviewed, and the wider arena of neoliberal political change considered. 

Conclusions: The dynamic relationship between disadvantage and mental health vulnerability requires that practitioners should be attuned to both the ‘big picture’ and ‘modest and practical ways’ to contribute to reducing the developmental embedding of social disadvantage and transgenerational vulnerability.

 

Jones, R. , Thurber, K.A. , Chapman, J. , D’Este, C. , Dunbar, T. , Wenitong, M., Eades, S.J. , Strelein, L. , Davey, M. , Du, W. , Olsen, A. , Smylie, J.K., Banks, E., & Lovett, R. (2018). Study protocol: Our cultures count, the Mayi Kuwayu study, a national longitudinal study of Aboriginal and Torres Strait Islander wellbeingBMJ Open, 8(6).

Aboriginal and Torres Strait Islander peoples are Australia’s first peoples and have been connected to the land for ≥65 000 years. Their enduring cultures and values are considered critical to health and wellbeing, alongside physical, psychological and social factors. We currently lack large-scale data that adequately represent the experiences of Aboriginal and Torres Strait Islander people; the absence of evidence on cultural practice and expression is particularly striking, given its foundational importance to wellbeing.

 

Kilcullen, M., Swinbourne, A., & Cadet‐James, Y. (2018). Aboriginal and Torres Strait Islander health and wellbeing: Social emotional wellbeing and strengths‐based psychology. Clinical Psychologist22(1), 16–26.

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 well-being that will support culturally appropriate service delivery.

 

Macedo, D., Smithers, L., Roberts, R., Haag, D., Paradies, Y., & Jamieson, L. (2019). Does ethnic-racial identity modify the effects of racism on the social and emotional wellbeing of Aboriginal Australian children? PLoS ONE14(8), e0220744.

Objectives: This study investigates the protective role of ethnic-racial identity (ERI) affirmation on the longitudinal association between racism and Aboriginal Australian children’s social and emotional well-being (SEWB). 

Methods: 408 children from the K-Cohort of the Longitudinal Study of Indigenous Children were included in the analysis. Data were collected through questionnaire-guided interviews at 7–10 and 9–12 years of age. Children’s racism experience, SEWB (Strengths and Difficulties Questionnaire), and confounding were reported by caregivers. ERI was reported by children and dichotomized into high versus low. Generalized linear models with log-Poisson links and robust errors were used to estimate adjusted Risk Ratios (RR) for the effect of racism on SEWB domains. Effect-measure modification analysis was used to verify differences on effect sizes per strata of ERI affirmation. The presence of modification was indicated by the Relative Excess Risk due to Interaction (RERI). 

Results: Slightly above half (51.4%) of the children presented high ERI affirmation. Children exposed to racism and with low ERI affirmation were at increased risk of hyperactive behavior (RR 2.53, 95% CI 1.17, 5.48), conduct problems (RR 2.35, 95% CI 1.07, 5.15), and total difficulties (RR 1.73, 95% CI 0.84, 3.55). Positive RERIs indicated the joint effects of racism and low ERI affirmation surpassed the sum of their separate effects in these domains. Children with high ERI affirmation were at increased risk of peer problems (RR 1.66, 95% CI 0.78, 3.52). 

Conclusions: These findings suggest that ERI may mitigate the risk of poor SEWB due to racism. Fostering affirmative ERI can be an important strategy in promoting resilience in Aboriginal Australian children.

 

Macedo, D., Smithers, L., Roberts, R., Paradies, Y., & Jamieson, L. (2019). Effects of racism on the socio-emotional wellbeing of Aboriginal Australian children. International Journal for Equity in Health18(1), 132.

Background: Racism is a pervasive experience in the life of Aboriginal Australians that begins in childhood. As a psychosocial stressor, racism compromises wellbeing and impacts developmental trajectories. The purpose of the present study was to estimate the effect of racism on indicators of Australian Aboriginal child socio-emotional wellbeing (SEWB) at one to two years after exposure. Age-related differences in the onset of symptoms were explored. Methods: Data from the B- and K-cohorts of the Longitudinal Study of Indigenous Children were used (aged 6 to 12 years). Racism, confounding variables, and the Strengths and Difficulties Questionnaire (a measure of SEWB) were collected by questionnaires and guided interviews with each child’s main caregiver. Adjusted Poisson regression was used to estimate the relative risk (RR) effects of racism on SEWB for both cohorts separately. RR were pooled in a random effects meta-analysis. 

Results: Exposure to racism was associated with an adjusted point estimate indicating a 41% increased risk for total emotional and behavioural difficulties, although the confidence intervals were wide (pooled RR 1.41, 95% CI 0.75, 2.07). Analyses by cohort showed younger children had higher RR for total difficulties (RR 1.72, 95% CI 1.16, 2.54), whilst older children had higher RR for hyperactive behaviour (RR 1.66, 95% CI 1.01, 2.73). 

Conclusions: The effects observed contributes to our understanding of the impact of racism on Aboriginal Australian children. Support for emotional and behavioural difficulties, and hyperactive behaviour, for Aboriginal children might help counteract the effects of racism. Future longitudinal research and policies aimed at reducing racism in Australian society are necessary.

 

Brown, N., & Brown, A. (2019). “Language breathes life”—Barngarla Community perspectives on the wellbeing impacts of reclaiming a dormant Australian Aboriginal languageInternational Journal of Environmental Research and Public Health, 16(20).

Traditional languages are a key element of Indigenous peoples’ identity, cultural expression, autonomy, spiritual and intellectual sovereignty, and wellbeing. While the links between Indigenous language loss and poor mental health have been demonstrated in several settings, little research has sought to identify the potential psychological benefits that may derive from language reclamation. The revival of the Barngarla language on the Eyre Peninsula, South Australia, offers a unique opportunity to examine whether improvements in mental health and social and emotional wellbeing can occur during and following the language reclamation process. This paper presents findings from 16 semi-structured interviews conducted with Barngarla community members describing their own experienced or observed mental health and wellbeing impacts of language reclamation activities. Aligning with a social and emotional wellbeing framework from an Aboriginal and Torres Strait Islander perspective, key themes included connection to spirituality and ancestors; connection to Country; connection to culture; connection to community; connection to family and kinship; connection to mind and emotions; and impacts upon identity and cultural pride at an individual level. These themes will form the foundation of assessment of the impacts of language reclamation in future stages of the project.

 

Sutherland, S., Adams, M. (2019). Building on the definition of social and emotional wellbeing: An Indigenous (Australian, Canadian, and New Zealand) viewpointab-Original3(1), 48-72.

This article will build on the definition of social and emotional wellbeing (SEWB) used within an Indigenous health framework. We intend to distance it from its current discipline of mental health, the Eurocentric term commonly used in social science literature. This is to emphasize that, within Aboriginal (Rudder and Grant, 2005) and Torres Strait Islander, Maori, and First Nations (Canadian) languages, there is no specific word for “health.” Indigenous peoples from within these countries have a holistic view of health that encompasses the physical, mental, emotional, and environmental spectrum of wellbeing. This article therefore uses “social and emotional wellbeing” rather than the generic Eurocentric terms of “health” or “mental health” to give this a stronger Indigenous voice. The elements of social and emotional wellbeing are discussed from an Indigenous viewpoint and from extracts compiled in work undertaken by Sutherland (2017). The elements explored may offer new perspectives to others. Similarly, this article offers an explanation as to why elements are siloed within the context of mental and physical health. This has led to some parts of SEWB gaining advantages over others within policy and funding models.

 

Wynne-Jones, M., Hillin, A., Byers, D., Stanley, D., Edwige, V., Brideson, T. (2016). Aboriginal grief and loss: a review of the literatureAustralian Indigenous HealthBulletin, 16(3).

This article is based on a literature review that was conducted in 2013 as part of the NSW Aboriginal Grief and Loss Training Project funded by the NSW Ministry of Health and delivered by the NSW Institute of Psychiatry (see Appendix, 1.). A series of workshops and resources in Aboriginal grief and loss has been developed and delivered for Aboriginal Mental Health and Wellbeing Workers across NSW, to support them with working with grief and loss in their communities. The aim of the review was to examine the existing literature, training and resources on Australian Aboriginal grief and loss, identifying areas for further research, and to confirm the need for the project. Other Indigenous literature on grief and loss was not reviewed, due to limited resources.

Dudgeon, P., Milroy, H., & Walker, R. (2014). Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice (2nd edition). Canberra: Commonwealth of Australia.

 

Whiteside, M., Tsey, K., Cadet-James, Y., McCalman, J. (2014). Promoting Aboriginal health: The family wellbeing empowerment approach. New York, NY: Springer Briefs in Public Health.

This book highlights the health gap that exists between Indigenous and other Australians and proposes that one solution is to empower Indigenous Australians to take control of their own health and wellbeing. In particular, the book describes an Aboriginal family wellbeing model of empowerment which has been used successfully in programs across Australia. The book provides evidence for what can happen when communities accept change, and acknowledges the importance of future resourcing for empowerment programs which do make a difference in the lives of Indigenous Australians.

Australian Indigenous HealthInfoNet. (2020). Overview of Aboriginal and Torres Strait Islander health status, 2019.

Australian Primary Health Care Research Institute. (2015). A ‘Wellbeing Framework’ for Aboriginal and Torres Strait Islander peoples living with chronic disease. Kanyini Vascular Collaboration.

This report presents a wellbeing framework designed to assist healthcare services to improve the quality of life and quality of care, as well as the health outcomes, for Aboriginal and Torres Strait Islander peoples living with chronic disease. Guided by a national reference group, the framework incorporates physical and social, emotional, cultural and spiritual aspects of health and wellbeing.

Dudgeon, P., Bray, A., Darlaston-Jones, D., & Walker, R.,(2020) Aboriginal Participatory Action Research: an Indigenous research methodology strengthening decolonisation and social and emotional wellbeing was published by the Lowitja Institute as part of its respected Discussion Papers series.

Dudgeon, P., Bray, A., Smallwood, G., Walker, R., & Dalton, T. (2020). Wellbeing and Healing Through Connection and Culture. Lifeline.

Dudgeon, P., Walker, R., Scrine, C., Shepherd, C., Calma, T., & Ring, I. (2014). Closing the gap clearinghouse: Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people.

Fogarty, W., Lovell, M., Langenberg, J., & Heron, M. (2018). Deficit discourse and strengths-based approaches: Changing the narrative of Aboriginal and Torres Strait Islander health and wellbeing. National Centre for Indigenous Studies, The Australian National University.

McKendrick, J., Brooks, R., Hudson, J., Thorpe, M., Bennett, P. (2013). Aboriginal and Torres Strait Islander healing programs: a literature review. The Healing Foundation.

This review summarises existing research on healing internationally and nationally, highlighting what constitutes an effective Aboriginal and Torres Strait Islander healing process. This evidence enables the identification of what constitutes an effective healing program and the gaps in our knowledge that can inform future evaluation and research priorities. The literature revealed that to be successful, a healing program needs to be created within the local context; respond to needs identified by local community members and be supported by the local community. Sustainability needs to be multi-level and include development and transfer of knowledge and resources. This includes strong evaluation frameworks that are consistent with an Aboriginal and Torres Strait Islander world view.  The literature review has provided an inter-country context for healing that clearly demonstrates what constitutes an effective healing program; the interface between healing and health and the need for quality evaluations that incorporate Aboriginal knowledge systems. The depth of this material enables the Healing Foundation to identify a clear pathway to building and developing the evidence of healing into the future.

Monson-Wilbraham, L. (2015). Watering the garden of family wellbeing: Empowering Aboriginal and Torres Strait Islander people to bloom and grow. The Lowitja Institute.

This report presents the recommendations and outcomes from the national roundtable Empowering Aboriginal and Torres Strait Islander people through the Family Wellbeing Program. The Family Wellbeing Program is an effective social and emotional wellbeing program originally developed and delivered by and for Aboriginal people. The objective of the program is to develop people’s skills and capacity to move from a position of disempowerment to empowerment. It aims to empower Aboriginal and Torres Strait Islander people with a way to control and change their lives.

National Mental Health Commission. (2019). Monitoring mental health and suicide prevention reform: National report 2019. Australian National Mental Health Commission.

The mental health system in Australia is undergoing significant change. Reforms such as the National Disability Insurance Scheme (NDIS), the Fifth National Mental Health and Suicide Prevention Plan (Fifth Plan), Primary Health Networks (PHNs) and activities in suicide prevention are all occurring simultaneously. These reforms are ambitious in their scope. They are also interrelated which adds to the complexity of their implementation, and it will take time before their implementation leads to sustained change for consumers and carers.

The Healing Foundation. (2016). Restoring our spirits – reshaping our futures. The Healing Foundation.

In response to the Royal Commission into Institutional Responses to Child Sexual Abuse this report sets out a culturally based healing framework for understanding and responding to trauma experienced by Aboriginal and Torres Strait Islander people who as children were sexually abused within public or private institutions. The report draws on the views of Aboriginal and Torres Strait Islander survivors and service providers involved in healing work, the work of the Healing Foundation and the broader literature on trauma and healing. It provides a cultural perspective on the incidence of child sexual abuse in this context, the nature and impact of trauma, healing strategies and practices, and healing responses.

Gone, J. P. (2019). “The thing happened as he wished”: Recovering an American Indian cultural psychologyAmerican Journal of Community Psychology, 64(1-2), 172-184.

 

Theodore, R., Ratima, M., Edwards, W., Sporle, A., Te Morenga, L., Kiro, C., & Ruakere, H. (2019). How a lifecourse approach can promote long-term health and wellbeing outcomes for MāoriJournal of Indigenous Wellbeing Te Mauri – Pimatisiwin, 4(1), 15-25.

Lifecourse studies examine ways to prevent ill-health, by determining how issues develop and when there are good periods in the lifecourse to intervene. For this reason, lifecourse findings and longitudinal data are increasingly being used to inform government policies and practice, regarding for whom, when, and how prevention and intervention programmes are implemented. Māori and Indigenous peoples experience wide and enduring ethnic inequalities across a broad range of outcomes throughout the lifecourse. There has been limited Māori lifecourse research to date. In this paper, we describe current lifecourse approaches being used by Māori researchers and discuss the value of a taking a lifecourse approach for Māori health and wellbeing. We address issues around longitudinal data. In particular, the need for Māori leadership in the collection, analysis, management, and governance of longitudinal data that can be used to inform health and social policy to guide programmes and interventions that support positive Māori outcomes throughout life.

 

Webber, M., & O’Connor, K. (2019). A fire in the belly of hineāmaru: Using whakapapa as a pedagogical tool in educationGenealogy, 3(3), 41.

The numerous iwi (tribes) and hapū (subtribes) of Te Tai Tokerau (Northland) have a long whakapapa (genealogy) of influential leaders that have made a significant impact on the Māori world and beyond. However, ruinous media narratives that focus without relent on poverty, low employment, inadequate housing, and lagging educational outcomes—particularly among Māori—continue to negatively impact the ways students from this region define their identity. This paper presents a number of strengths-based narratives—focusing on tūpuna (ancestors) from Te Tai Tokerau whakapapa—that act as counter-narratives to this rhetoric. The paper discusses how these narratives can be used as powerful pedagogical tools that enhance Te Tai Tokerau Māori students’ self-efficacy, aspiration, optimism, and cultural pride, presenting them as powerful agents of their own destiny. This paper draws on data produced from a Marsden-funded study—led by Te Tai Tokerau descendents—that has collected and re-presented multifaceted hapū/iwi-based narratives that celebrate Te Tai Tokerau distinctiveness, success, history, and identity. This wider study has examined, contextualised, and celebrated diverse characteristics recurring in Te Tai Tokerau pūrākau (genealogical stories), pepeha (tribal sayings), waiata (songs), karakia (incantations), televisual materials, and written histories.

Screening & Assessment

Several recent articles listed below have reviewed tools that have been culturally validated, or adapted for use with Aboriginal and Torres Strait Islander people and tools being used without specific adaptation. These screening and assessment tools include structured or semi structured diagnostic interviews, survey and self-report questionnaires, measures of treatment outcome, and qualitative approaches.

Black, E. B., Toombs, M. R., & Kisely, S. (2018)The cultural validity of diagnostic psychiatric measures for Indigenous Australians. Australian Psychologist53(5), 383–393.

Objective: There is limited research available regarding the prevalence rates of psychiatric illness in Indigenous Australians, and the available literature varies widely in terms of methods and findings. Culturally valid and appropriate tools are needed to ensure accurate outcomes. The purpose of this review is to examine the methods used to diagnose psychiatric disorders in Indigenous Australians and identify whether these are culturally appropriate or valid. 

Method: A systematic search of available literature was undertaken in electronic databases (PubMed, Scopus, PsycInfo, PsycArticles, Web of Science, Medline, and Informit Health Indigenous Australians Peoples Collections). Narrative synthesis was used to analyse the data obtained, with a quantitative evaluations of study quality and cultural validity. 

Results: Twelve articles were included for review. Six studies were of diagnostic tools and none had been validated for use with Indigenous Australians. Another six used practitioner assessment. Some studies indirectly referenced cultural competence on behalf of the practitioner, but again on the whole this was lacking. 

Conclusions: Further validation of the use of diagnostic instruments in Indigenous Australians is needed so that the prevalence of psychiatric disorders in this population can be accurately determined. In addition, practitioners working with Indigenous Australians should have some training in cultural awareness or competence, and consider the cultural appropriateness of diagnostic tools when applied to this population.

 

Carlin, E., Atkinson, D., & Marley, J. (2019)  ‘Having a quiet word’: Yarning with Aboriginal women in the Pilbara region of Western Australia about mental health and mental health screening during the perinatal periodInternational Journal of Environmental Research and Public Health, 16(21), 4253.

Despite high rates of perinatal depression and anxiety, little is known about how Aboriginal women in Australia experience these disorders and the acceptability of current clinical screening tools. In a 2014 study, the Kimberley Mum’s Mood Scale (KMMS) was validated as an acceptable perinatal depression and anxiety screening tool for Aboriginal women in the Kimberley region of Western Australia. In the current study, we explored if it was appropriate to trial and validate the KMMS with Aboriginal women in the Pilbara. Yarning as a methodology was used to guide interviews with 15 Aboriginal women in the Pilbara who had received maternal and child health care within the last three years. Data were analysed thematically, the results revealing that this cohort of participants shared similar experiences of stress and hardship during the perinatal period. Participants valued the KMMS for its narrative-based approach to screening that explored the individual’s risk and protective factors. While support for the KMMS was apparent, particular qualities of the administering health care professional were viewed as critical to the tool being well received and culturally safe. Building on these findings, we will work with our partner health services in the Pilbara to validate the KMMS with Pilbara Aboriginal women.

 

Chan, A.W., Skerrington, P., Reid, C., & Marriott, R. (2018). Research protocol for the exploration of experiences of Aboriginal Australian mothers and healthcare professionals when using the Edinburgh Postnatal Depression Scale: A process-oriented validation study using triangulated participatory mixed methodsBMJ Open, 8, e022273.

Adopting a process-oriented framework for test validation can help to establish whether this tool has the potential to be an acceptable, valid and reliable indicator of depression for mothers and mothers-to-be. This mixed-methods research protocol seeks to explore the views and experiences of Aboriginal mothers and healthcare professionals in relation to the Edinburgh Postnatal Depression Scale (EPDS), and is intended to highlight potential barriers in perinatal mental health conceptualisation, engagement and response style.

 

Farnbach, S., Gee, G., Eades, A-M., Evans, J. R., Fernando, J., Hammond, B., Simms, M., DeMasi, K., Glozier, N., Brown, A., & Hackett, M. L. (2019). Process evaluation of the getting it right study and acceptability and feasibility of screening for depression with the aPHQ-9. BMC Public Health, 19, 1270.

Background: The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9. 

Methods: Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9. 

Results: Primary healthcare staff (n = 36) and community members (n = 4) from nine of the ten participating Getting it Right services and Indigenous participants (n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%). 

Conclusion: Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use.

 

Hackett, M. L., Farnbach, S., Glozier, N., Skinner, T., Teixeira-Pinto, A., Askew, D., Gee, G., Cass, A., & Brown, A. (2016)Getting it right: Study protocol to determine the diagnostic accuracy of a culturally-specific measure to screen for depression in Aboriginal and/or Torres Strait Islander people. BMJ Open, 6, e015009.

Introduction: A freely available, culturally valid depression screening tool is required for use by primary care services across Australia to screen for depression in Aboriginal and/or Torres Strait Islander populations. This is the protocol for a study aiming to determine the validity, sensitivity and specificity of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9). 

Methods and analysis: Cross-sectional validation study. A total of 500 people who self-identify as Aboriginal and/or Torres Strait Islander, are ≥18 years of age, attending 1 of 10 primary healthcare services or service events across Australia and able to communicate sufficiently to answer study questions will be recruited. All participants will complete the aPHQ-9 and the criterion standard MINI International Neuropsychiatric Interview (MINI) 6.0.0. The primary outcome is the criterion validity of the aPHQ-9. Process outcomes related to acceptability and feasibility of the aPHQ-9 will be analysed only if the measure is found to be valid. 

Ethics and dissemination: Lead ethical approval was obtained jointly from the University of Sydney Human Research Ethics Committee (project 2014/361) and the Aboriginal Health and Medical Research Council of New South Wales (project 1044/14). Results will be disseminated via the usual scientific forums, including peer-reviewed publications and presentations at international conferences following presentation to, discussion with and approval by participating primary healthcare service staff and community.

 

Jongen, C., Langham, E., Bainbridge, R., & McCalman, J. (2019). Instruments for measuring the resilience of Indigenous adolescents: An exploratory reviewFrontiers in Public Health, 7(194).

Introduction: Resilience is enabled by internal, individual assets as well as the resources available in a person’s environment to support healthy development. For Indigenous people, these resources and assets can include those which enhance cultural resilience. Measurement instruments which capture these core resilience constructs are needed, yet there is a lack of evidence about which instruments are most appropriate and valid for use with Indigenous adolescents. The current study reviews instruments which have been used to measure the resilience of Indigenous adolescents in Canada, Australia, New Zealand, and the United States (the CANZUS nations). The aim is to provide guidance for the future use of instruments to measure resilience among Indigenous adolescents and provide recommendations for research to strengthen evidence in this area. 

Method: Instruments were identified through a systematic search of resilience intervention and indicator studies targeting Indigenous youth from CANZUS nations. The studies were analyzed for information on the constructs of resilience measured in the instruments, their use with the targeted groups, and their psychometric properties. A second search was conducted to fill in any gaps in information. Instruments were included if they measured at least one construct of resilience reflecting individual assets, environmental resources, and/or cultural resilience.  

Results: A total of 20 instruments were identified that measured constructs of resilience and had been administered to Indigenous adolescents in the CANZUS nations. Instruments which measured both individual assets and environmental resources (n = 7), or only environmental resources (n = 6) were most common. Several instruments (n = 5) also measured constructs of cultural resilience, and two instruments included items addressing all three constructs of individual assets, environmental resources, and cultural resilience. The majority of the reviewed studies tested the reliability (75%) and content or face validity (80%) of instruments with the target population. 

Conclusion: There are several validated instruments available to appropriately measure constructs of resilience with Indigenous adolescents from CANZUS nations. Further work is needed on developing a consistent framework of resilience constructs to guide research efforts. Future instrument development and testing ought to focus on measures which include elements of all three core constructs critical to Indigenous adolescent resilience.

 

Kickett-Tucker, C., Christensen, D., Lawrence, D., Zubrick, S., Johnson, D., & Stanley, F. Development and validation of the Australian Aboriginal racial identity and self-esteem survey for 8–12 year old children (IRISE_C). International Journal for Equity in Health, 14, 103. 

Abstract: Introduction: In Australia, there is little empirical research of the racial identity of Indigenous children and youth as the majority of the current literature focuses on adults. Furthermore, there are no instruments developed with cultural appropriateness when exploring the identity and self-esteem of the Australian Aboriginal population, especially children. The IRISE_C (Racial Identity and Self-Esteem of children) inventory was developed to explore the elements of racial identity and self-esteem of urban, rural and regional Aboriginal children. This paper describes the development and validation of the IRISE_C instrument with over 250 Aboriginal children aged 8 to 12 years. 

Methods: A pilot of the IRISE C instrument was combined with individual interviews and was undertaken with 35 urban Aboriginal children aged 8–12 years. An exploratory factor analysis was performed to refine the survey and reduce redundant items in readiness for the main study. In the main study, the IRISE C was employed to 229 Aboriginal children aged 6–13 years across three sites (rural, regional and urban) in Western Australia. An exploratory factor analysis using Principal axis factoring was used to assess the fit of items and survey structure. A confirmatory factor analysis was then employed using LISREL (diagonally weighted least squares) to assess factor structures across domains. Internal consistency and reliability of subscales were assessed using Cronbach’s coefficient alpha. 

Results: The pilot testing identified two key concepts – children’s knowledge of issues related to their racial identity, and the importance, or salience, that they attach to these issues. In the main study, factor analyses showed two clear factors relating to: Aboriginal culture and traditions; and a sense of belonging to an Aboriginal community. Principal Axis Factoring of the Knowledge items supported a 2-factor solution, which explained 38.7 % of variance. Factor One (Aboriginal culture) had a Cronbach’s alpha of 0.835; Factor 2 (racial identity) had a Cronbach’s alpha of 0.800, thus demonstrating high internal reliability of the scales. 

Conclusion: The IRISE_C has been shown to be a valid instrument useful of exploring the development of racial identity of Australian Aboriginal children across the 8–12 year old age range and across urban, rural and regional geographical locations.

 

Kotz, J., & Robinson, M. (2018).‘Baby coming – you ready?’ An audacious innovation to perinatal social and emotional wellbeing assessment screening and supportive management for vulnerable parents-to-be. Women and Birth, 31, 1, S3.
Introduction: ‘Baby Coming – You Ready?’ is an audacious innovation to perinatal social and emotional wellbeing assessment screening and supportive management for vulnerable parents-to-be. This digitalised screening rubric, called ‘Baby Coming-You Ready?’, uses touch screen images to provide an engaging culturally safe solution to the many barriers to effective screening and primary prevention currently faced by both non-Indigenous service providers and Indigenous women. It has been developed through a strong collaboration between Aboriginal Australians, midwives, child health nurses and researchers through the participatory action research (PAR) called Kalyakool Moort- Always Family. Indigenous Australians are historically cautious, acute observers and frequently over-ridden in research and health care processes. Embarking on PAR and adopting an Aboriginal world view in the research process has seen a curious interface of cultures that is both complex and challenging. However, it has been critical to its success. 

Aim: This paper describes this process which resulted in a solid effective research structure, a commitment to working from the Aboriginal world view and a strong research translational pathway. It will explain the significance of strong community commitment and the extensive organisational and community collaboration. 

Method: A desire based approach to narrative inquiry through an Indigenous lens is a key feature of this process. Through analysis of the current context of perinatal mental health screening among Indigenous mothers and fathers, the perspectives of three separate target groups has been included: that of Indigenous women, Indigenous fathers and health professionals involved in routine perinatal care. Data triangulation of results included a state-wide online questionnaires and thematic analysis of semi-structured interviews with health professionals, ‘yarning’ sessions with Indigenous women and fathers, extensive analysis of current screening surveillance data through a cultural lens and metasynthesis of current literature. 

Findings: Emergent from this process is the touch screen image driven screening and assessment ‘rubric’ called ‘Baby Coming-You Ready?’. It embodies four key elements: good engagement, a sense of safety, a trusting relationship, and the capacity to embrace the strengths in the Aboriginal and Torres Strait peoples cultural viewpoint which is central to family/community centred-care. This goes far beyond current woman/family-centred care. Culture is fluid, traditional roles/expectations are changing and many Indigenous Australian fathers are becoming increasingly vulnerable as a result. Therefore developing a parallel version of the ‘Baby Coming-You Ready? rubric for fathers was considered vital. 

Conclusion: Widespread community acceptance to this innovative approach to perinatal mental health screening and primary prevention is now possible as the ‘Baby Coming-You Ready?’ rubric is being piloted across the health care sector.

 

Lavrencic, L., Bennett, H., Daylight, G., Draper, B., Cumming, R., Mack, H., Garvey, G., Lasschuit, D., Hill, T. Y., Chalkley, S.,  Delbaere, K., Broe, G. A., & Radford, K. (2019). Cognitive test norms and comparison between healthy ageing, mild cognitive impairment, and dementia: A population‐based study of older Aboriginal Australians. Australian Journal of Psychology, 71(3), 249-260.
The prevalence of dementia and cognitive impairment is higher in Aboriginal Australians compared to the national population, increasing the need to understand cognitive impairment in this at‐risk population. This article reports normative data for a range of commonly used cognitive tests, in a population‐based small normative sample of older Aboriginal Australians living in urban/regional New South Wales.

 

Le Grande, M., Ski, C.F., Thompson, D.R., Scuffham, P., Kularatna, S., Jackson, A.C., &  Brown, A. (2017)Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review. Social Science & Medicine, 187, 164-173. 

Rationale: There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that “standard” wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health. 

Objective: The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community. 

Method: The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used. 

Results: Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied. 

Conclusion: It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a diverse range of research and clinical settings

 

Marley, J. V., Kotz, J., Engelke, C., Williams, M., Stephen, D., Coutinho, S., & Trust, S. K. (2017). Validity and acceptability of Kimberley mum’s mood scale to screen for perinatal anxiety and depression in remote aboriginal health care settingsPLoS ONE, 12(1), e0168969.

Background: The Edinburgh Postnatal Depression Scale (EPDS) is widely recommended for perinatal anxiety and depression screening. However, many Aboriginal women find EPDS language complex and confusing, and providers find using it with Aboriginal women challenging. The two part Kimberley Mum’s Mood Scale (KMMS) was developed to improve screening: Part 1 is a Kimberley version of EPDS; Part 2 is a psychosocial tool that enables contextualisation of Part 1 scores. We aimed to determine if KMMS is a valid and acceptable method of identifying Kimberley Aboriginal perinatal women at risk of anxiety or depressive disorders compared to a semi-structured clinical interview. 

Methods: Across 15 sites in the Kimberley, Western Australia, 97 Aboriginal women aged 16 years and older who intended to continue with their pregnancy or had a baby within the previous 12 months were administered the KMMS by trained healthcare providers who provided an overall assessment of no, low, moderate or high risk; 91 participants were then independently assessed by a blinded clinical expert using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. A qualitative approach was used to determine KMMS’ acceptability. 

Results: Part 1 had high internal consistency (Cronbach’s alpha, 0.89), and overall KMMS risk equivalence for screening for anxiety or depressive disorders was moderate (sensitivity, 83%; specificity, 87%; positive predictive value, 68%). Participants found the process easy and useful, and healthcare providers found KMMS more useful than EPDS. Part 2 allowed healthcare providers to ask questions that gave participants an opportunity to express themselves, resulting in a deeper understanding between them. 

Conclusion: KMMS is an effective tool for identifying Kimberley Aboriginal perinatal women at risk of anxiety and depressive disorders. Adoption of KMMS with culturally safe training and support is likely to improve screening processes, and with further validation may have broader applicability across remote Australia.

 

Nasir, B.F., Toombs, M., Kondalsamy-Chennakesavan, S., Kisely, S., Gill, N., Black, E., Hayman, N., Ranmuthugala, G., Beccaria, G., Ostini, R., & Nicholson, G. (2018) Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study. BMJ Open8(6), e020196.

To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists’ diagnoses. Cross-sectional study July 2014-November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78). Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales.

 

Newton, D. , Day, A. , Gillies, C., & Fernandez, E. (2015). The assessment of social and emotional well‐being in Indigenous patients. Australian Psychologist, 50, 40-50.

Addressing low levels of social and emotional well‐being (SEWB) in Indigenous communities has been a national strategic priority for over 10 years and yet progress in assessing the impact of interventions has been slow. One of the key factors limiting the development of evidence‐based practice has been the lack of well‐validated instruments to assess SEWB and how it changes over time as a result of intervention. This article systematically reviews available measures, classifying them in terms of the evidence base that exists to support their use. It is concluded that there is an ongoing need to develop psychometrically sound, comprehensive, culturally appropriate measures to operationalise Indigenous SEWB at a population health, programme evaluation, and clinical level. It is suggested that seven pathways be followed to achieve this goal, including the need to recognise that the gold standard status for Indigenous measurement tools cannot be ascribed based on evidence‐based assessment criteria alone.

 

Smith, K., Gilchrist, L., Taylor, K., Clinch, C., LoGiudice, D., Edgill, P., Ratcliffe, J., Flicker, L., Douglas, H., Bradley, K., & Bessarab, D. (2019). Good spirit, good life: A quality of life tool and framework for older Aboriginal peoples. Gerontologist, XX(X), 1-10. 

Background and Objectives: The lack of appropriate quality of life (QoL) measures is a major barrier to planning and delivering health and aged care services for older Indigenous peoples worldwide. QoL is dependent on cultural values and priorities may vary between age groups. This project aims to develop a QoL tool for older Aboriginal Australians. 

Research Design and Methods: The study was completed with Aboriginal Australians aged over 45 years living in Perth and Melbourne, Australia. Participatory Action Research methods were applied with an Indigenous research paradigm. Semi-structured interviews were undertaken to identify the factors important to having a good life. Factors were further explored in yarning groups with older Aboriginal peoples to develop the draft QoL tool questions. Face validity of the tool was completed in two regions. 

Results: The participants preferred the term “a good life” to QoL. Having a good spirit is at the core of having a good life. The protective factors for a good life were family and friends, health, culture, Elder role, respect, Country, spirituality, services and supports, community, future plans, safety and security, and basic needs. 

Discussion and Implications: Twelve factors were identified and developed into key questions for the Good Spirit, Good Life tool. The draft tool will undergo quantitative validity testing, prior to embedding in service provision to inform care for older Aboriginal peoples. With local adaptation, the tool, accompanying framework, and participatory methods for development may have wider applicability to other Indigenous populations worldwide

 

Stephens, A., Bohanna, I., & Graham, D. (2017). Expert consensus to examine the cross-cultural utility of substance use and mental health assessment instruments for use with Indigenous clients. Evaluation Journal of Australasia, 17(3), 14-22.

Evaluation of minority-culture specific treatment centres for substance use and mental health is challenging. The challenge is compounded by a paucity of validated instruments for assessing substance use and mental ill health. In the field of Australian Indigenous alcohol and other drug service provision there are few guidelines to determine which instruments should be targets for validation for use with Indigenous clients. As such, reliable, validated, evaluable data on the client population is limited, posing multifaceted concerns for clinicians and service providers as well as evaluators. The aim of this study was to pilot the use of a participatory expert consensus approach to evaluate, rate and select suitable majority-culture substance use and mental health assessment instruments for use with their clients. Eight practitioners of an Indigenous-specific substance misuse residential treatment centre participated. The findings reinforce the value of consensus approaches for stakeholder engagement and to provide a sense of ownership of the results. In this setting, consensus on the implementation of an agreed set of Indigenous-specific and non-Indigenous specific instruments improved the ownership of the instruments by clinicians allowing for the use of valid and/or reliable instruments that also had good face validity. This makes it more probable that reliable client wellbeing data will be collected. This is crucial to program evaluation at a later point in time. This study was a novel approach to generating evidence to inform practice in the absence of normative practice guidelines.

 

The Getting it Right Collaborative Group. (2019). Getting it right: Validating a culturally specific screening tool for depression (aPHQ-9) in Aboriginal and Torres Strait Islander Australians. The Medical Journal of Australia, 211(1), 24-30.

Objectives: To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander people. 

Design: Prospective observational validation study, 25 March 2015 – 2 November 2016. Setting, participants: 500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions. 

Main outcome measures: Criterion validity of the aPHQ-9, with the depression module of the Mini-International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard. 

Results: 108 of 500 participants (22%; 95% CI, 18–25%) had a current episode of major depression according to the MINI criterion. The sensitivity of the aPHQ-9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40–68%), its specificity was 91% (95% CI, 88–94%), with a positive predictive value of 64%. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85–0.92); with a cut-point of 10 points its sensitivity was 84% (95% CI, 74–91%) and its specificity 77% (95% CI, 71–83%). The aPHQ-9 was deemed acceptable by more than 80% of participants. 

Conclusions: Indigenous Australians found the aPHQ-9 acceptable as a screening tool for depression. Applying a cut-point of 10 points, the performance characteristics of the aPHQ were good.

 

Toombs, M., Nasir, B., Kisely, S., Ranmuthugala, G., Gill, Neeraj S., Beccaria, G., Hayman, N., Kondalsamy-Chennakesavan, S., & Nicholson, G. C. (2019) Cultural validation of the structured clinical interview for diagnostic and statistical manual of mental disorders in Indigenous Australians. Australasian Psychiatry27(4), 362-365.

Black, E. B., Toombs, M. R., & Kisely, S. (2018)The cultural validity of diagnostic psychiatric measures for Indigenous Australians. Australian Psychologist53(5), 383–393.

Objective: There is limited research available regarding the prevalence rates of psychiatric illness in Indigenous Australians, and the available literature varies widely in terms of methods and findings. Culturally valid and appropriate tools are needed to ensure accurate outcomes. The purpose of this review is to examine the methods used to diagnose psychiatric disorders in Indigenous Australians and identify whether these are culturally appropriate or valid. 

Method: A systematic search of available literature was undertaken in electronic databases (PubMed, Scopus, PsycInfo, PsycArticles, Web of Science, Medline, and Informit Health Indigenous Australians Peoples Collections). Narrative synthesis was used to analyse the data obtained, with a quantitative evaluations of study quality and cultural validity. 

Results: Twelve articles were included for review. Six studies were of diagnostic tools and none had been validated for use with Indigenous Australians. Another six used practitioner assessment. Some studies indirectly referenced cultural competence on behalf of the practitioner, but again on the whole this was lacking. 

Conclusions: Further validation of the use of diagnostic instruments in Indigenous Australians is needed so that the prevalence of psychiatric disorders in this population can be accurately determined. In addition, practitioners working with Indigenous Australians should have some training in cultural awareness or competence, and consider the cultural appropriateness of diagnostic tools when applied to this population.

 

Carlin, E., Atkinson, D., & Marley, J. (2019)  ‘Having a quiet word’: Yarning with Aboriginal women in the Pilbara region of Western Australia about mental health and mental health screening during the perinatal periodInternational Journal of Environmental Research and Public Health, 16(21), 4253.

Despite high rates of perinatal depression and anxiety, little is known about how Aboriginal women in Australia experience these disorders and the acceptability of current clinical screening tools. In a 2014 study, the Kimberley Mum’s Mood Scale (KMMS) was validated as an acceptable perinatal depression and anxiety screening tool for Aboriginal women in the Kimberley region of Western Australia. In the current study, we explored if it was appropriate to trial and validate the KMMS with Aboriginal women in the Pilbara. Yarning as a methodology was used to guide interviews with 15 Aboriginal women in the Pilbara who had received maternal and child health care within the last three years. Data were analysed thematically, the results revealing that this cohort of participants shared similar experiences of stress and hardship during the perinatal period. Participants valued the KMMS for its narrative-based approach to screening that explored the individual’s risk and protective factors. While support for the KMMS was apparent, particular qualities of the administering health care professional were viewed as critical to the tool being well received and culturally safe. Building on these findings, we will work with our partner health services in the Pilbara to validate the KMMS with Pilbara Aboriginal women.

 

Chan, A.W., Skerrington, P., Reid, C., & Marriott, R. (2018). Research protocol for the exploration of experiences of Aboriginal Australian mothers and healthcare professionals when using the Edinburgh Postnatal Depression Scale: A process-oriented validation study using triangulated participatory mixed methodsBMJ Open, 8, e022273.

Adopting a process-oriented framework for test validation can help to establish whether this tool has the potential to be an acceptable, valid and reliable indicator of depression for mothers and mothers-to-be. This mixed-methods research protocol seeks to explore the views and experiences of Aboriginal mothers and healthcare professionals in relation to the Edinburgh Postnatal Depression Scale (EPDS), and is intended to highlight potential barriers in perinatal mental health conceptualisation, engagement and response style.

 

Farnbach, S., Gee, G., Eades, A-M., Evans, J. R., Fernando, J., Hammond, B., Simms, M., DeMasi, K., Glozier, N., Brown, A., & Hackett, M. L. (2019). Process evaluation of the getting it right study and acceptability and feasibility of screening for depression with the aPHQ-9. BMC Public Health, 19, 1270.

Background: The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9. 

Methods: Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9. 

Results: Primary healthcare staff (n = 36) and community members (n = 4) from nine of the ten participating Getting it Right services and Indigenous participants (n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%). 

Conclusion: Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use.

 

Hackett, M. L., Farnbach, S., Glozier, N., Skinner, T., Teixeira-Pinto, A., Askew, D., Gee, G., Cass, A., & Brown, A. (2016)Getting it right: Study protocol to determine the diagnostic accuracy of a culturally-specific measure to screen for depression in Aboriginal and/or Torres Strait Islander people. BMJ Open, 6, e015009.

Introduction: A freely available, culturally valid depression screening tool is required for use by primary care services across Australia to screen for depression in Aboriginal and/or Torres Strait Islander populations. This is the protocol for a study aiming to determine the validity, sensitivity and specificity of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9). 

Methods and analysis: Cross-sectional validation study. A total of 500 people who self-identify as Aboriginal and/or Torres Strait Islander, are ≥18 years of age, attending 1 of 10 primary healthcare services or service events across Australia and able to communicate sufficiently to answer study questions will be recruited. All participants will complete the aPHQ-9 and the criterion standard MINI International Neuropsychiatric Interview (MINI) 6.0.0. The primary outcome is the criterion validity of the aPHQ-9. Process outcomes related to acceptability and feasibility of the aPHQ-9 will be analysed only if the measure is found to be valid. 

Ethics and dissemination: Lead ethical approval was obtained jointly from the University of Sydney Human Research Ethics Committee (project 2014/361) and the Aboriginal Health and Medical Research Council of New South Wales (project 1044/14). Results will be disseminated via the usual scientific forums, including peer-reviewed publications and presentations at international conferences following presentation to, discussion with and approval by participating primary healthcare service staff and community.

 

Jongen, C., Langham, E., Bainbridge, R., & McCalman, J. (2019). Instruments for measuring the resilience of Indigenous adolescents: An exploratory reviewFrontiers in Public Health, 7(194).

Introduction: Resilience is enabled by internal, individual assets as well as the resources available in a person’s environment to support healthy development. For Indigenous people, these resources and assets can include those which enhance cultural resilience. Measurement instruments which capture these core resilience constructs are needed, yet there is a lack of evidence about which instruments are most appropriate and valid for use with Indigenous adolescents. The current study reviews instruments which have been used to measure the resilience of Indigenous adolescents in Canada, Australia, New Zealand, and the United States (the CANZUS nations). The aim is to provide guidance for the future use of instruments to measure resilience among Indigenous adolescents and provide recommendations for research to strengthen evidence in this area. 

Method: Instruments were identified through a systematic search of resilience intervention and indicator studies targeting Indigenous youth from CANZUS nations. The studies were analyzed for information on the constructs of resilience measured in the instruments, their use with the targeted groups, and their psychometric properties. A second search was conducted to fill in any gaps in information. Instruments were included if they measured at least one construct of resilience reflecting individual assets, environmental resources, and/or cultural resilience.  

Results: A total of 20 instruments were identified that measured constructs of resilience and had been administered to Indigenous adolescents in the CANZUS nations. Instruments which measured both individual assets and environmental resources (n = 7), or only environmental resources (n = 6) were most common. Several instruments (n = 5) also measured constructs of cultural resilience, and two instruments included items addressing all three constructs of individual assets, environmental resources, and cultural resilience. The majority of the reviewed studies tested the reliability (75%) and content or face validity (80%) of instruments with the target population. 

Conclusion: There are several validated instruments available to appropriately measure constructs of resilience with Indigenous adolescents from CANZUS nations. Further work is needed on developing a consistent framework of resilience constructs to guide research efforts. Future instrument development and testing ought to focus on measures which include elements of all three core constructs critical to Indigenous adolescent resilience.

 

Kickett-Tucker, C., Christensen, D., Lawrence, D., Zubrick, S., Johnson, D., & Stanley, F. Development and validation of the Australian Aboriginal racial identity and self-esteem survey for 8–12 year old children (IRISE_C). International Journal for Equity in Health, 14, 103. 

Abstract: Introduction: In Australia, there is little empirical research of the racial identity of Indigenous children and youth as the majority of the current literature focuses on adults. Furthermore, there are no instruments developed with cultural appropriateness when exploring the identity and self-esteem of the Australian Aboriginal population, especially children. The IRISE_C (Racial Identity and Self-Esteem of children) inventory was developed to explore the elements of racial identity and self-esteem of urban, rural and regional Aboriginal children. This paper describes the development and validation of the IRISE_C instrument with over 250 Aboriginal children aged 8 to 12 years. 

Methods: A pilot of the IRISE C instrument was combined with individual interviews and was undertaken with 35 urban Aboriginal children aged 8–12 years. An exploratory factor analysis was performed to refine the survey and reduce redundant items in readiness for the main study. In the main study, the IRISE C was employed to 229 Aboriginal children aged 6–13 years across three sites (rural, regional and urban) in Western Australia. An exploratory factor analysis using Principal axis factoring was used to assess the fit of items and survey structure. A confirmatory factor analysis was then employed using LISREL (diagonally weighted least squares) to assess factor structures across domains. Internal consistency and reliability of subscales were assessed using Cronbach’s coefficient alpha. 

Results: The pilot testing identified two key concepts – children’s knowledge of issues related to their racial identity, and the importance, or salience, that they attach to these issues. In the main study, factor analyses showed two clear factors relating to: Aboriginal culture and traditions; and a sense of belonging to an Aboriginal community. Principal Axis Factoring of the Knowledge items supported a 2-factor solution, which explained 38.7 % of variance. Factor One (Aboriginal culture) had a Cronbach’s alpha of 0.835; Factor 2 (racial identity) had a Cronbach’s alpha of 0.800, thus demonstrating high internal reliability of the scales. 

Conclusion: The IRISE_C has been shown to be a valid instrument useful of exploring the development of racial identity of Australian Aboriginal children across the 8–12 year old age range and across urban, rural and regional geographical locations.

 

Kotz, J., & Robinson, M. (2018).‘Baby coming – you ready?’ An audacious innovation to perinatal social and emotional wellbeing assessment screening and supportive management for vulnerable parents-to-be. Women and Birth, 31, 1, S3.
Introduction: ‘Baby Coming – You Ready?’ is an audacious innovation to perinatal social and emotional wellbeing assessment screening and supportive management for vulnerable parents-to-be. This digitalised screening rubric, called ‘Baby Coming-You Ready?’, uses touch screen images to provide an engaging culturally safe solution to the many barriers to effective screening and primary prevention currently faced by both non-Indigenous service providers and Indigenous women. It has been developed through a strong collaboration between Aboriginal Australians, midwives, child health nurses and researchers through the participatory action research (PAR) called Kalyakool Moort- Always Family. Indigenous Australians are historically cautious, acute observers and frequently over-ridden in research and health care processes. Embarking on PAR and adopting an Aboriginal world view in the research process has seen a curious interface of cultures that is both complex and challenging. However, it has been critical to its success. 

Aim: This paper describes this process which resulted in a solid effective research structure, a commitment to working from the Aboriginal world view and a strong research translational pathway. It will explain the significance of strong community commitment and the extensive organisational and community collaboration. 

Method: A desire based approach to narrative inquiry through an Indigenous lens is a key feature of this process. Through analysis of the current context of perinatal mental health screening among Indigenous mothers and fathers, the perspectives of three separate target groups has been included: that of Indigenous women, Indigenous fathers and health professionals involved in routine perinatal care. Data triangulation of results included a state-wide online questionnaires and thematic analysis of semi-structured interviews with health professionals, ‘yarning’ sessions with Indigenous women and fathers, extensive analysis of current screening surveillance data through a cultural lens and metasynthesis of current literature. 

Findings: Emergent from this process is the touch screen image driven screening and assessment ‘rubric’ called ‘Baby Coming-You Ready?’. It embodies four key elements: good engagement, a sense of safety, a trusting relationship, and the capacity to embrace the strengths in the Aboriginal and Torres Strait peoples cultural viewpoint which is central to family/community centred-care. This goes far beyond current woman/family-centred care. Culture is fluid, traditional roles/expectations are changing and many Indigenous Australian fathers are becoming increasingly vulnerable as a result. Therefore developing a parallel version of the ‘Baby Coming-You Ready? rubric for fathers was considered vital. 

Conclusion: Widespread community acceptance to this innovative approach to perinatal mental health screening and primary prevention is now possible as the ‘Baby Coming-You Ready?’ rubric is being piloted across the health care sector.

 

Lavrencic, L., Bennett, H., Daylight, G., Draper, B., Cumming, R., Mack, H., Garvey, G., Lasschuit, D., Hill, T. Y., Chalkley, S.,  Delbaere, K., Broe, G. A., & Radford, K. (2019). Cognitive test norms and comparison between healthy ageing, mild cognitive impairment, and dementia: A population‐based study of older Aboriginal Australians. Australian Journal of Psychology, 71(3), 249-260.
The prevalence of dementia and cognitive impairment is higher in Aboriginal Australians compared to the national population, increasing the need to understand cognitive impairment in this at‐risk population. This article reports normative data for a range of commonly used cognitive tests, in a population‐based small normative sample of older Aboriginal Australians living in urban/regional New South Wales.

 

Le Grande, M., Ski, C.F., Thompson, D.R., Scuffham, P., Kularatna, S., Jackson, A.C., &  Brown, A. (2017)Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review. Social Science & Medicine, 187, 164-173. 

Rationale: There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that “standard” wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health. 

Objective: The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community. 

Method: The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used. 

Results: Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied. 

Conclusion: It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a diverse range of research and clinical settings

 

Marley, J. V., Kotz, J., Engelke, C., Williams, M., Stephen, D., Coutinho, S., & Trust, S. K. (2017). Validity and acceptability of Kimberley mum’s mood scale to screen for perinatal anxiety and depression in remote aboriginal health care settingsPLoS ONE, 12(1), e0168969.

Background: The Edinburgh Postnatal Depression Scale (EPDS) is widely recommended for perinatal anxiety and depression screening. However, many Aboriginal women find EPDS language complex and confusing, and providers find using it with Aboriginal women challenging. The two part Kimberley Mum’s Mood Scale (KMMS) was developed to improve screening: Part 1 is a Kimberley version of EPDS; Part 2 is a psychosocial tool that enables contextualisation of Part 1 scores. We aimed to determine if KMMS is a valid and acceptable method of identifying Kimberley Aboriginal perinatal women at risk of anxiety or depressive disorders compared to a semi-structured clinical interview. 

Methods: Across 15 sites in the Kimberley, Western Australia, 97 Aboriginal women aged 16 years and older who intended to continue with their pregnancy or had a baby within the previous 12 months were administered the KMMS by trained healthcare providers who provided an overall assessment of no, low, moderate or high risk; 91 participants were then independently assessed by a blinded clinical expert using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. A qualitative approach was used to determine KMMS’ acceptability. 

Results: Part 1 had high internal consistency (Cronbach’s alpha, 0.89), and overall KMMS risk equivalence for screening for anxiety or depressive disorders was moderate (sensitivity, 83%; specificity, 87%; positive predictive value, 68%). Participants found the process easy and useful, and healthcare providers found KMMS more useful than EPDS. Part 2 allowed healthcare providers to ask questions that gave participants an opportunity to express themselves, resulting in a deeper understanding between them. 

Conclusion: KMMS is an effective tool for identifying Kimberley Aboriginal perinatal women at risk of anxiety and depressive disorders. Adoption of KMMS with culturally safe training and support is likely to improve screening processes, and with further validation may have broader applicability across remote Australia.

 

Nasir, B.F., Toombs, M., Kondalsamy-Chennakesavan, S., Kisely, S., Gill, N., Black, E., Hayman, N., Ranmuthugala, G., Beccaria, G., Ostini, R., & Nicholson, G. (2018) Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study. BMJ Open8(6), e020196.

To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists’ diagnoses. Cross-sectional study July 2014-November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78). Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales.

 

Newton, D. , Day, A. , Gillies, C., & Fernandez, E. (2015). The assessment of social and emotional well‐being in Indigenous patients. Australian Psychologist, 50, 40-50.

Addressing low levels of social and emotional well‐being (SEWB) in Indigenous communities has been a national strategic priority for over 10 years and yet progress in assessing the impact of interventions has been slow. One of the key factors limiting the development of evidence‐based practice has been the lack of well‐validated instruments to assess SEWB and how it changes over time as a result of intervention. This article systematically reviews available measures, classifying them in terms of the evidence base that exists to support their use. It is concluded that there is an ongoing need to develop psychometrically sound, comprehensive, culturally appropriate measures to operationalise Indigenous SEWB at a population health, programme evaluation, and clinical level. It is suggested that seven pathways be followed to achieve this goal, including the need to recognise that the gold standard status for Indigenous measurement tools cannot be ascribed based on evidence‐based assessment criteria alone.

 

Smith, K., Gilchrist, L., Taylor, K., Clinch, C., LoGiudice, D., Edgill, P., Ratcliffe, J., Flicker, L., Douglas, H., Bradley, K., & Bessarab, D. (2019). Good spirit, good life: A quality of life tool and framework for older Aboriginal peoples. Gerontologist, XX(X), 1-10. 

Background and Objectives: The lack of appropriate quality of life (QoL) measures is a major barrier to planning and delivering health and aged care services for older Indigenous peoples worldwide. QoL is dependent on cultural values and priorities may vary between age groups. This project aims to develop a QoL tool for older Aboriginal Australians. 

Research Design and Methods: The study was completed with Aboriginal Australians aged over 45 years living in Perth and Melbourne, Australia. Participatory Action Research methods were applied with an Indigenous research paradigm. Semi-structured interviews were undertaken to identify the factors important to having a good life. Factors were further explored in yarning groups with older Aboriginal peoples to develop the draft QoL tool questions. Face validity of the tool was completed in two regions. 

Results: The participants preferred the term “a good life” to QoL. Having a good spirit is at the core of having a good life. The protective factors for a good life were family and friends, health, culture, Elder role, respect, Country, spirituality, services and supports, community, future plans, safety and security, and basic needs. 

Discussion and Implications: Twelve factors were identified and developed into key questions for the Good Spirit, Good Life tool. The draft tool will undergo quantitative validity testing, prior to embedding in service provision to inform care for older Aboriginal peoples. With local adaptation, the tool, accompanying framework, and participatory methods for development may have wider applicability to other Indigenous populations worldwide

 

Stephens, A., Bohanna, I., & Graham, D. (2017). Expert consensus to examine the cross-cultural utility of substance use and mental health assessment instruments for use with Indigenous clients. Evaluation Journal of Australasia, 17(3), 14-22.

Evaluation of minority-culture specific treatment centres for substance use and mental health is challenging. The challenge is compounded by a paucity of validated instruments for assessing substance use and mental ill health. In the field of Australian Indigenous alcohol and other drug service provision there are few guidelines to determine which instruments should be targets for validation for use with Indigenous clients. As such, reliable, validated, evaluable data on the client population is limited, posing multifaceted concerns for clinicians and service providers as well as evaluators. The aim of this study was to pilot the use of a participatory expert consensus approach to evaluate, rate and select suitable majority-culture substance use and mental health assessment instruments for use with their clients. Eight practitioners of an Indigenous-specific substance misuse residential treatment centre participated. The findings reinforce the value of consensus approaches for stakeholder engagement and to provide a sense of ownership of the results. In this setting, consensus on the implementation of an agreed set of Indigenous-specific and non-Indigenous specific instruments improved the ownership of the instruments by clinicians allowing for the use of valid and/or reliable instruments that also had good face validity. This makes it more probable that reliable client wellbeing data will be collected. This is crucial to program evaluation at a later point in time. This study was a novel approach to generating evidence to inform practice in the absence of normative practice guidelines.

 

The Getting it Right Collaborative Group. (2019). Getting it right: Validating a culturally specific screening tool for depression (aPHQ-9) in Aboriginal and Torres Strait Islander Australians. The Medical Journal of Australia, 211(1), 24-30.

Objectives: To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander people. 

Design: Prospective observational validation study, 25 March 2015 – 2 November 2016. Setting, participants: 500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions. 

Main outcome measures: Criterion validity of the aPHQ-9, with the depression module of the Mini-International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard. 

Results: 108 of 500 participants (22%; 95% CI, 18–25%) had a current episode of major depression according to the MINI criterion. The sensitivity of the aPHQ-9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40–68%), its specificity was 91% (95% CI, 88–94%), with a positive predictive value of 64%. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85–0.92); with a cut-point of 10 points its sensitivity was 84% (95% CI, 74–91%) and its specificity 77% (95% CI, 71–83%). The aPHQ-9 was deemed acceptable by more than 80% of participants. 

Conclusions: Indigenous Australians found the aPHQ-9 acceptable as a screening tool for depression. Applying a cut-point of 10 points, the performance characteristics of the aPHQ were good.

 

Toombs, M., Nasir, B., Kisely, S., Ranmuthugala, G., Gill, Neeraj S., Beccaria, G., Hayman, N., Kondalsamy-Chennakesavan, S., & Nicholson, G. C. (2019) Cultural validation of the structured clinical interview for diagnostic and statistical manual of mental disorders in Indigenous Australians. Australasian Psychiatry27(4), 362-365.

Black, E. B., Toombs, M. R., & Kisely, S. (2018)The cultural validity of diagnostic psychiatric measures for Indigenous Australians. Australian Psychologist53(5), 383–393.

Objective: There is limited research available regarding the prevalence rates of psychiatric illness in Indigenous Australians, and the available literature varies widely in terms of methods and findings. Culturally valid and appropriate tools are needed to ensure accurate outcomes. The purpose of this review is to examine the methods used to diagnose psychiatric disorders in Indigenous Australians and identify whether these are culturally appropriate or valid. 

Method: A systematic search of available literature was undertaken in electronic databases (PubMed, Scopus, PsycInfo, PsycArticles, Web of Science, Medline, and Informit Health Indigenous Australians Peoples Collections). Narrative synthesis was used to analyse the data obtained, with a quantitative evaluations of study quality and cultural validity. 

Results: Twelve articles were included for review. Six studies were of diagnostic tools and none had been validated for use with Indigenous Australians. Another six used practitioner assessment. Some studies indirectly referenced cultural competence on behalf of the practitioner, but again on the whole this was lacking. 

Conclusions: Further validation of the use of diagnostic instruments in Indigenous Australians is needed so that the prevalence of psychiatric disorders in this population can be accurately determined. In addition, practitioners working with Indigenous Australians should have some training in cultural awareness or competence, and consider the cultural appropriateness of diagnostic tools when applied to this population.

Carlin, E., Atkinson, D., & Marley, J. (2019)  ‘Having a quiet word’: Yarning with Aboriginal women in the Pilbara region of Western Australia about mental health and mental health screening during the perinatal periodInternational Journal of Environmental Research and Public Health, 16(21), 4253.

Despite high rates of perinatal depression and anxiety, little is known about how Aboriginal women in Australia experience these disorders and the acceptability of current clinical screening tools. In a 2014 study, the Kimberley Mum’s Mood Scale (KMMS) was validated as an acceptable perinatal depression and anxiety screening tool for Aboriginal women in the Kimberley region of Western Australia. In the current study, we explored if it was appropriate to trial and validate the KMMS with Aboriginal women in the Pilbara. Yarning as a methodology was used to guide interviews with 15 Aboriginal women in the Pilbara who had received maternal and child health care within the last three years. Data were analysed thematically, the results revealing that this cohort of participants shared similar experiences of stress and hardship during the perinatal period. Participants valued the KMMS for its narrative-based approach to screening that explored the individual’s risk and protective factors. While support for the KMMS was apparent, particular qualities of the administering health care professional were viewed as critical to the tool being well received and culturally safe. Building on these findings, we will work with our partner health services in the Pilbara to validate the KMMS with Pilbara Aboriginal women.

Chan, A.W., Skerrington, P., Reid, C., & Marriott, R. (2018). Research protocol for the exploration of experiences of Aboriginal Australian mothers and healthcare professionals when using the Edinburgh Postnatal Depression Scale: A process-oriented validation study using triangulated participatory mixed methodsBMJ Open, 8, e022273.

Adopting a process-oriented framework for test validation can help to establish whether this tool has the potential to be an acceptable, valid and reliable indicator of depression for mothers and mothers-to-be. This mixed-methods research protocol seeks to explore the views and experiences of Aboriginal mothers and healthcare professionals in relation to the Edinburgh Postnatal Depression Scale (EPDS), and is intended to highlight potential barriers in perinatal mental health conceptualisation, engagement and response style.

Farnbach, S., Gee, G., Eades, A-M., Evans, J. R., Fernando, J., Hammond, B., Simms, M., DeMasi, K., Glozier, N., Brown, A., & Hackett, M. L. (2019). Process evaluation of the getting it right study and acceptability and feasibility of screening for depression with the aPHQ-9. BMC Public Health, 19, 1270.

Background: The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9. 

Methods: Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9. 

Results: Primary healthcare staff (n = 36) and community members (n = 4) from nine of the ten participating Getting it Right services and Indigenous participants (n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%). 

Conclusion: Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use.

Hackett, M. L., Farnbach, S., Glozier, N., Skinner, T., Teixeira-Pinto, A., Askew, D., Gee, G., Cass, A., & Brown, A. (2016)Getting it right: Study protocol to determine the diagnostic accuracy of a culturally-specific measure to screen for depression in Aboriginal and/or Torres Strait Islander people. BMJ Open, 6, e015009.

Introduction: A freely available, culturally valid depression screening tool is required for use by primary care services across Australia to screen for depression in Aboriginal and/or Torres Strait Islander populations. This is the protocol for a study aiming to determine the validity, sensitivity and specificity of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9). 

Methods and analysis: Cross-sectional validation study. A total of 500 people who self-identify as Aboriginal and/or Torres Strait Islander, are ≥18 years of age, attending 1 of 10 primary healthcare services or service events across Australia and able to communicate sufficiently to answer study questions will be recruited. All participants will complete the aPHQ-9 and the criterion standard MINI International Neuropsychiatric Interview (MINI) 6.0.0. The primary outcome is the criterion validity of the aPHQ-9. Process outcomes related to acceptability and feasibility of the aPHQ-9 will be analysed only if the measure is found to be valid. 

Ethics and dissemination: Lead ethical approval was obtained jointly from the University of Sydney Human Research Ethics Committee (project 2014/361) and the Aboriginal Health and Medical Research Council of New South Wales (project 1044/14). Results will be disseminated via the usual scientific forums, including peer-reviewed publications and presentations at international conferences following presentation to, discussion with and approval by participating primary healthcare service staff and community.

Jongen, C., Langham, E., Bainbridge, R., & McCalman, J. (2019). Instruments for measuring the resilience of Indigenous adolescents: An exploratory reviewFrontiers in Public Health, 7(194).

Introduction: Resilience is enabled by internal, individual assets as well as the resources available in a person’s environment to support healthy development. For Indigenous people, these resources and assets can include those which enhance cultural resilience. Measurement instruments which capture these core resilience constructs are needed, yet there is a lack of evidence about which instruments are most appropriate and valid for use with Indigenous adolescents. The current study reviews instruments which have been used to measure the resilience of Indigenous adolescents in Canada, Australia, New Zealand, and the United States (the CANZUS nations). The aim is to provide guidance for the future use of instruments to measure resilience among Indigenous adolescents and provide recommendations for research to strengthen evidence in this area. 

Method: Instruments were identified through a systematic search of resilience intervention and indicator studies targeting Indigenous youth from CANZUS nations. The studies were analyzed for information on the constructs of resilience measured in the instruments, their use with the targeted groups, and their psychometric properties. A second search was conducted to fill in any gaps in information. Instruments were included if they measured at least one construct of resilience reflecting individual assets, environmental resources, and/or cultural resilience.  

Results: A total of 20 instruments were identified that measured constructs of resilience and had been administered to Indigenous adolescents in the CANZUS nations. Instruments which measured both individual assets and environmental resources (n = 7), or only environmental resources (n = 6) were most common. Several instruments (n = 5) also measured constructs of cultural resilience, and two instruments included items addressing all three constructs of individual assets, environmental resources, and cultural resilience. The majority of the reviewed studies tested the reliability (75%) and content or face validity (80%) of instruments with the target population. 

Conclusion: There are several validated instruments available to appropriately measure constructs of resilience with Indigenous adolescents from CANZUS nations. Further work is needed on developing a consistent framework of resilience constructs to guide research efforts. Future instrument development and testing ought to focus on measures which include elements of all three core constructs critical to Indigenous adolescent resilience.

Kickett-Tucker, C., Christensen, D., Lawrence, D., Zubrick, S., Johnson, D., & Stanley, F. Development and validation of the Australian Aboriginal racial identity and self-esteem survey for 8–12 year old children (IRISE_C). International Journal for Equity in Health, 14, 103. 

Abstract: Introduction: In Australia, there is little empirical research of the racial identity of Indigenous children and youth as the majority of the current literature focuses on adults. Furthermore, there are no instruments developed with cultural appropriateness when exploring the identity and self-esteem of the Australian Aboriginal population, especially children. The IRISE_C (Racial Identity and Self-Esteem of children) inventory was developed to explore the elements of racial identity and self-esteem of urban, rural and regional Aboriginal children. This paper describes the development and validation of the IRISE_C instrument with over 250 Aboriginal children aged 8 to 12 years. 

Methods: A pilot of the IRISE C instrument was combined with individual interviews and was undertaken with 35 urban Aboriginal children aged 8–12 years. An exploratory factor analysis was performed to refine the survey and reduce redundant items in readiness for the main study. In the main study, the IRISE C was employed to 229 Aboriginal children aged 6–13 years across three sites (rural, regional and urban) in Western Australia. An exploratory factor analysis using Principal axis factoring was used to assess the fit of items and survey structure. A confirmatory factor analysis was then employed using LISREL (diagonally weighted least squares) to assess factor structures across domains. Internal consistency and reliability of subscales were assessed using Cronbach’s coefficient alpha. 

Results: The pilot testing identified two key concepts – children’s knowledge of issues related to their racial identity, and the importance, or salience, that they attach to these issues. In the main study, factor analyses showed two clear factors relating to: Aboriginal culture and traditions; and a sense of belonging to an Aboriginal community. Principal Axis Factoring of the Knowledge items supported a 2-factor solution, which explained 38.7 % of variance. Factor One (Aboriginal culture) had a Cronbach’s alpha of 0.835; Factor 2 (racial identity) had a Cronbach’s alpha of 0.800, thus demonstrating high internal reliability of the scales. 

Conclusion: The IRISE_C has been shown to be a valid instrument useful of exploring the development of racial identity of Australian Aboriginal children across the 8–12 year old age range and across urban, rural and regional geographical locations.

Kotz, J., & Robinson, M. (2018).‘Baby coming – you ready?’ An audacious innovation to perinatal social and emotional wellbeing assessment screening and supportive management for vulnerable parents-to-be. Women and Birth, 31, 1, S3.
Introduction: ‘Baby Coming – You Ready?’ is an audacious innovation to perinatal social and emotional wellbeing assessment screening and supportive management for vulnerable parents-to-be. This digitalised screening rubric, called ‘Baby Coming-You Ready?’, uses touch screen images to provide an engaging culturally safe solution to the many barriers to effective screening and primary prevention currently faced by both non-Indigenous service providers and Indigenous women. It has been developed through a strong collaboration between Aboriginal Australians, midwives, child health nurses and researchers through the participatory action research (PAR) called Kalyakool Moort- Always Family. Indigenous Australians are historically cautious, acute observers and frequently over-ridden in research and health care processes. Embarking on PAR and adopting an Aboriginal world view in the research process has seen a curious interface of cultures that is both complex and challenging. However, it has been critical to its success. 

Aim: This paper describes this process which resulted in a solid effective research structure, a commitment to working from the Aboriginal world view and a strong research translational pathway. It will explain the significance of strong community commitment and the extensive organisational and community collaboration. 

Method: A desire based approach to narrative inquiry through an Indigenous lens is a key feature of this process. Through analysis of the current context of perinatal mental health screening among Indigenous mothers and fathers, the perspectives of three separate target groups has been included: that of Indigenous women, Indigenous fathers and health professionals involved in routine perinatal care. Data triangulation of results included a state-wide online questionnaires and thematic analysis of semi-structured interviews with health professionals, ‘yarning’ sessions with Indigenous women and fathers, extensive analysis of current screening surveillance data through a cultural lens and metasynthesis of current literature. 

Findings: Emergent from this process is the touch screen image driven screening and assessment ‘rubric’ called ‘Baby Coming-You Ready?’. It embodies four key elements: good engagement, a sense of safety, a trusting relationship, and the capacity to embrace the strengths in the Aboriginal and Torres Strait peoples cultural viewpoint which is central to family/community centred-care. This goes far beyond current woman/family-centred care. Culture is fluid, traditional roles/expectations are changing and many Indigenous Australian fathers are becoming increasingly vulnerable as a result. Therefore developing a parallel version of the ‘Baby Coming-You Ready? rubric for fathers was considered vital. 

Conclusion: Widespread community acceptance to this innovative approach to perinatal mental health screening and primary prevention is now possible as the ‘Baby Coming-You Ready?’ rubric is being piloted across the health care sector.

Lavrencic, L., Bennett, H., Daylight, G., Draper, B., Cumming, R., Mack, H., Garvey, G., Lasschuit, D., Hill, T. Y., Chalkley, S.,  Delbaere, K., Broe, G. A., & Radford, K. (2019). Cognitive test norms and comparison between healthy ageing, mild cognitive impairment, and dementia: A population‐based study of older Aboriginal Australians. Australian Journal of Psychology, 71(3), 249-260.
The prevalence of dementia and cognitive impairment is higher in Aboriginal Australians compared to the national population, increasing the need to understand cognitive impairment in this at‐risk population. This article reports normative data for a range of commonly used cognitive tests, in a population‐based small normative sample of older Aboriginal Australians living in urban/regional New South Wales.

Le Grande, M., Ski, C.F., Thompson, D.R., Scuffham, P., Kularatna, S., Jackson, A.C., &  Brown, A. (2017)Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review. Social Science & Medicine, 187, 164-173. 

Rationale: There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that “standard” wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health. 

Objective: The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community. 

Method: The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used. 

Results: Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied. 

Conclusion: It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a diverse range of research and clinical settings

Marley, J. V., Kotz, J., Engelke, C., Williams, M., Stephen, D., Coutinho, S., & Trust, S. K. (2017). Validity and acceptability of Kimberley mum’s mood scale to screen for perinatal anxiety and depression in remote aboriginal health care settingsPLoS ONE, 12(1), e0168969.

Background: The Edinburgh Postnatal Depression Scale (EPDS) is widely recommended for perinatal anxiety and depression screening. However, many Aboriginal women find EPDS language complex and confusing, and providers find using it with Aboriginal women challenging. The two part Kimberley Mum’s Mood Scale (KMMS) was developed to improve screening: Part 1 is a Kimberley version of EPDS; Part 2 is a psychosocial tool that enables contextualisation of Part 1 scores. We aimed to determine if KMMS is a valid and acceptable method of identifying Kimberley Aboriginal perinatal women at risk of anxiety or depressive disorders compared to a semi-structured clinical interview. 

Methods: Across 15 sites in the Kimberley, Western Australia, 97 Aboriginal women aged 16 years and older who intended to continue with their pregnancy or had a baby within the previous 12 months were administered the KMMS by trained healthcare providers who provided an overall assessment of no, low, moderate or high risk; 91 participants were then independently assessed by a blinded clinical expert using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. A qualitative approach was used to determine KMMS’ acceptability. 

Results: Part 1 had high internal consistency (Cronbach’s alpha, 0.89), and overall KMMS risk equivalence for screening for anxiety or depressive disorders was moderate (sensitivity, 83%; specificity, 87%; positive predictive value, 68%). Participants found the process easy and useful, and healthcare providers found KMMS more useful than EPDS. Part 2 allowed healthcare providers to ask questions that gave participants an opportunity to express themselves, resulting in a deeper understanding between them. 

Conclusion: KMMS is an effective tool for identifying Kimberley Aboriginal perinatal women at risk of anxiety and depressive disorders. Adoption of KMMS with culturally safe training and support is likely to improve screening processes, and with further validation may have broader applicability across remote Australia.

Nasir, B.F., Toombs, M., Kondalsamy-Chennakesavan, S., Kisely, S., Gill, N., Black, E., Hayman, N., Ranmuthugala, G., Beccaria, G., Ostini, R., & Nicholson, G. (2018) Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study. BMJ Open8(6), e020196.

To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists’ diagnoses. Cross-sectional study July 2014-November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78). Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales.

Newton, D. , Day, A. , Gillies, C., & Fernandez, E. (2015). The assessment of social and emotional well‐being in Indigenous patients. Australian Psychologist, 50, 40-50.

Addressing low levels of social and emotional well‐being (SEWB) in Indigenous communities has been a national strategic priority for over 10 years and yet progress in assessing the impact of interventions has been slow. One of the key factors limiting the development of evidence‐based practice has been the lack of well‐validated instruments to assess SEWB and how it changes over time as a result of intervention. This article systematically reviews available measures, classifying them in terms of the evidence base that exists to support their use. It is concluded that there is an ongoing need to develop psychometrically sound, comprehensive, culturally appropriate measures to operationalise Indigenous SEWB at a population health, programme evaluation, and clinical level. It is suggested that seven pathways be followed to achieve this goal, including the need to recognise that the gold standard status for Indigenous measurement tools cannot be ascribed based on evidence‐based assessment criteria alone.

Smith, K., Gilchrist, L., Taylor, K., Clinch, C., LoGiudice, D., Edgill, P., Ratcliffe, J., Flicker, L., Douglas, H., Bradley, K., & Bessarab, D. (2019). Good spirit, good life: A quality of life tool and framework for older Aboriginal peoples. Gerontologist, XX(X), 1-10. 

Background and Objectives: The lack of appropriate quality of life (QoL) measures is a major barrier to planning and delivering health and aged care services for older Indigenous peoples worldwide. QoL is dependent on cultural values and priorities may vary between age groups. This project aims to develop a QoL tool for older Aboriginal Australians. 

Research Design and Methods: The study was completed with Aboriginal Australians aged over 45 years living in Perth and Melbourne, Australia. Participatory Action Research methods were applied with an Indigenous research paradigm. Semi-structured interviews were undertaken to identify the factors important to having a good life. Factors were further explored in yarning groups with older Aboriginal peoples to develop the draft QoL tool questions. Face validity of the tool was completed in two regions. 

Results: The participants preferred the term “a good life” to QoL. Having a good spirit is at the core of having a good life. The protective factors for a good life were family and friends, health, culture, Elder role, respect, Country, spirituality, services and supports, community, future plans, safety and security, and basic needs. 

Discussion and Implications: Twelve factors were identified and developed into key questions for the Good Spirit, Good Life tool. The draft tool will undergo quantitative validity testing, prior to embedding in service provision to inform care for older Aboriginal peoples. With local adaptation, the tool, accompanying framework, and participatory methods for development may have wider applicability to other Indigenous populations worldwide

Stephens, A., Bohanna, I., & Graham, D. (2017). Expert consensus to examine the cross-cultural utility of substance use and mental health assessment instruments for use with Indigenous clients. Evaluation Journal of Australasia, 17(3), 14-22.

Evaluation of minority-culture specific treatment centres for substance use and mental health is challenging. The challenge is compounded by a paucity of validated instruments for assessing substance use and mental ill health. In the field of Australian Indigenous alcohol and other drug service provision there are few guidelines to determine which instruments should be targets for validation for use with Indigenous clients. As such, reliable, validated, evaluable data on the client population is limited, posing multifaceted concerns for clinicians and service providers as well as evaluators. The aim of this study was to pilot the use of a participatory expert consensus approach to evaluate, rate and select suitable majority-culture substance use and mental health assessment instruments for use with their clients. Eight practitioners of an Indigenous-specific substance misuse residential treatment centre participated. The findings reinforce the value of consensus approaches for stakeholder engagement and to provide a sense of ownership of the results. In this setting, consensus on the implementation of an agreed set of Indigenous-specific and non-Indigenous specific instruments improved the ownership of the instruments by clinicians allowing for the use of valid and/or reliable instruments that also had good face validity. This makes it more probable that reliable client wellbeing data will be collected. This is crucial to program evaluation at a later point in time. This study was a novel approach to generating evidence to inform practice in the absence of normative practice guidelines.

The Getting it Right Collaborative Group. (2019). Getting it right: Validating a culturally specific screening tool for depression (aPHQ-9) in Aboriginal and Torres Strait Islander Australians. The Medical Journal of Australia, 211(1), 24-30.

Objectives: To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander people. 

Design: Prospective observational validation study, 25 March 2015 – 2 November 2016. Setting, participants: 500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions. 

Main outcome measures: Criterion validity of the aPHQ-9, with the depression module of the Mini-International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard. 

Results: 108 of 500 participants (22%; 95% CI, 18–25%) had a current episode of major depression according to the MINI criterion. The sensitivity of the aPHQ-9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40–68%), its specificity was 91% (95% CI, 88–94%), with a positive predictive value of 64%. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85–0.92); with a cut-point of 10 points its sensitivity was 84% (95% CI, 74–91%) and its specificity 77% (95% CI, 71–83%). The aPHQ-9 was deemed acceptable by more than 80% of participants. 

Conclusions: Indigenous Australians found the aPHQ-9 acceptable as a screening tool for depression. Applying a cut-point of 10 points, the performance characteristics of the aPHQ were good.

Toombs, M., Nasir, B., Kisely, S., Ranmuthugala, G., Gill, Neeraj S., Beccaria, G., Hayman, N., Kondalsamy-Chennakesavan, S., & Nicholson, G. C. (2019) Cultural validation of the structured clinical interview for diagnostic and statistical manual of mental disorders in Indigenous Australians. Australasian Psychiatry27(4), 362-365.

Adams, Y., Drew, N., & Walker, R. (2014).  Principles of practice in mental health assessment with Aboriginal Australians. In P. Dudgeon, H. Milroy & R. Walker (Eds). Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (2nd ed.),(Ch. 16) (pp. 271-288). Commonwealth of Australia.

In this chapter, concepts and history of assessment and testing in the context of Aboriginal and Torres Strait Islander social and emotional wellbeing and mental health are discussed. Importantly, recently revised diagnostic guidelines and the National Practice Standards for the Mental Health Workforce 20131 and their appropriateness for meeting the distinctive needs of Aboriginal people are reviewed. Various assessment tools and measures that have been validated or proved appropriate for use with particular Aboriginal populations, i.e. youth, women and older people, are described. We conclude that practitioners need to be critically reflective in their role in assessment, and position themselves to play an important transformative role in conducting assessment. This extends to acknowledging and enacting culturally responsive principles, procedures and practices to ensure that Aboriginal people have access to effective, culturally secure mental health care.

Choo, Carol C., Harris, Keith M., Chew, Peter K.H., & Ho, Roger C. (2019). Clinical assessment of suicide risk and suicide attempters’ self-reported suicide intent: A cross sectional study. PLoS One, 14(7), e0217613. 

This study explored medical doctors’ clinical assessment of suicide risk and suicide attempters’ self-reported suicide intent. Three years of archival assessment records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to analysis. Records related to 460 suicide attempters (70.4% females; 28.6% males) were analysed using logistic regressions. Their ages ranged from 12 to 85 (M = 29.08, SD = 12.86). The strongest predictor of suicide intent was habitual poor coping, followed by serious financial problems, and expressed regret. The strongest predictor of suicide risk was hiding the attempt followed by prior planning. The findings were discussed in regards to implications in clinical assessments and suicide prevention efforts.

Social Determinants

Isbister-Bear, O., Hatala, A. R., & Sjoblom, E. (2017). Strengthening Âhkamêyimo among Indigenous youth: The social determinants of health, justice, and resilience in Canada’s northJournal of Indigenous Wellbeing Te Mauri – Pimatisiwin, 2(3), 76-89.

The wellbeing of Indigenous youth living in Canada’s northern communities continues to lag behind the rest of the Canadian population. To a large extent, these health inequities are perpetuated by processes of colonisation that significantly impact the social determinants of health in Canada’s Indigenous north. The purpose of this article is to review the history of colonisation and its impacts on the wellbeing of Indigenous youth in Canada’s north, as well as processes of resilience that have helped Indigenous youth live healthy lives despite social challenges. Academic articles published between 2000 and 2016 outlining resilience from Indigenous perspectives are reviewed in the contexts of Canada’s Indigenous north. Analysis focuses on what insights about resilience emerge from Indigenous communities, particularly as they related to the health inequities of circumpolar regions. The concept of Âhkamêyimo is discussed and how systems of Indigenous knowledge offer important insights into resilience in general, and can be utilised in health promotion, education, and prevention programs targeting Indigenous youth in northern Canada. We conclude that attention should be turned toward issues of social justice and health equity that are desperately needed in order to create healthy environments whereby Indigenous youth within northern Canadian communities can be assisted to flourish.

 

Trout, L., Mceachern, D., Mullany, A., White, L., Wexler, L., & Trout, L. (2018). Decoloniality as a Framework for Indigenous Youth Suicide Prevention Pedagogy: Promoting Community Conversations About Research to End Suicide. American Journal of Community Psychology62(3-4), 396–405.

Indigenous youth suicide remains a substantial health disparity in circumpolar communities, despite prevention efforts through primary health care, public health campaigns, school systems, and social services. Innovations in prevention practice move away from expert‐driven approaches to emphasize local control through processes that utilize research evidence, but privilege self‐ determined action based on local and personal contexts, meanings, and frameworks for action. “Promoting Community Conversations About Research to End Suicide” is a community health intervention that draws on networks of Indigenous health educators in rural Alaska, who host learning circles in which research evidence is used to spark conversations and empower community members to consider individual and collective action to support vulnerable people and create health‐promoting conditions that reduce suicide risk. The first of nine learning circles focuses on narratives of local people who link the contemporary youth suicide epidemic to 20th century American colonialism, and situates prevention within this context. We describe the theoretical framework and feasibility and acceptability outcomes for this learning circle, and elucidate how the educational model engages community members in decolonial approaches to suicide prevention education and practice, thus serving as a bridge between Western and Indigenous traditions to generate collective knowledge and catalyze community healing.

Systems Approaches

Coming Soon.

Diverse Groups

Youth

Dickson, M.J., Cruise, K., McCall, A.C., Taylor, J.P. (2019). A systematic review of the antecedents and prevalence of suicide, self-harm and suicide ideation in Australian Aboriginal and Torres Strait Islander youth. International Journal of Environmental Research and Public Health, 16(17).

Suicide and self-harm represent serious global health problems and appear to be especially elevated amongst indigenous minority groups, and particularly amongst young people (aged 24 years or younger). This systematic review investigates for the first time the antecedents and prevalence of suicide, self-harm and suicide ideation among Australian Aboriginal and Torres Strait Islander youth. Web of Science, PubMed, PsychINFO, CINAHL databases and grey literature were searched from earliest records to April 2019 for eligible articles. Twenty-two empirical articles met the inclusion criteria. The data confirmed that indigenous youth in Australia have elevated rates of suicide, self-harm and suicidal ideation relative to the nonindigenous population. Risk factors included being incarcerated, substance use and greater social and emotional distress. Notably, though, information on predictors of suicide and self-harm remains scarce. The findings support and justify the increasing implementation of public health programs specifically aimed at tackling this crisis. Based on the review findings, we argued that Aboriginal communities are best positioned to identify and understand the antecedents of youth self-harm, suicide ideation and suicide, and to take the lead in the development of more effective mental health preventive strategies and public policies within their communities.

 

Isaacs, A., & Sutton, K. (2016). An Aboriginal youth suicide prevention project in rural VictoriaAdvances in Mental Health, 14(2), 118-125.

Objective:To describe an Aboriginal youth suicide prevention project developed by Njernda Aboriginal Corporation. Method: This is a descriptive study of an Aboriginal youth suicide prevention project developed by Njernda Aboriginal Corporation based in Echuca, Victoria. Information about the program was obtained from interviewing the project worker and the social and emotional wellbeing worker. Further information was obtained about the program by examining activity registers, program flyers and posters. 

Results: The Aboriginal youth suicide prevention project was designed and implemented by Njernda Aboriginal Corporation over a period of three years. The main components of the project were building resilience, early intervention response and immediate postvention support. Resilience was built through the Bullroarer program, the Red Dust Healing program and community awareness programs. Another program, the Jekkora group was developed and implemented as an early intervention response. A postvention service is in the planning stage. 

Conclusions:During a three-year period Njernda Aboriginal Corporation established community resilience building and early intervention programs. Developing and implementing a comprehensive suicide prevention plan at the community level requires adequate time as well as support from mainstream services. These findings therefore have implications for future planning of Aboriginal suicide prevention projects.

 

Lopez-Carmen, V., McCalman, J., Benveniste, T., Askew, D., Spurling, G., Langham, E., & Bainbridge, R. (2019). Working together to improve the mental health of Indigenous children: A systematic review. Children and Youth Services Review104, 104408.

This systematic review analyses research measuring or evaluating primary health care interventions that focused on improving the mental health of Indigenous children via intersectoral service integration processes and tools.  Of the eleven studies included five were conducted with Indigenous children (aged 4 to 17 years) in Australia, the remaining studies included New Zealand, Canada, Norway and/or the United States. Among thenine key strategies adopted by service integration interventions of note were: Engaging the members of the Indigenous community; Empowerment of families; Adapting interventions and care to the specific socio-cultural circumstances; and Cultural strengthening and empowerment of Indigenous children’s identity.  Six factors enabling effective implementation of service integration included: Including and involving the community and stakeholders, Sensitivity to culture, including to historical background and inter-generational trauma, Multi-disciplinary and collaborative health services and Resourcing factors (e.g. funding, costs, time availability, staff/organisation capacity). The authors conclude that while the research evidence for interventions focused on improving the mental health of Indigenous children via intersectoral service integration is preliminary the findings hold potential. Importantly, the main outcomes where strategies focused on intersectoral integration were: Improvements in children’s psychosocial functioning, stress management, and individual empowerment; Improvements in health service access and use; Empowerment of both families and communities; and Increased links and collaboration between the community and health services. The authors identify the need for further research, particularly to incorporate Indigenous voices in evaluation, help clarify impact, and to evaluate costs.

 

Macedo, D., Smithers, L., Roberts, R., Haag, D., Paradies, Y., & Jamieson, L. (2019). Does ethnic-racial identity modify the effects of racism on the social and emotional wellbeing of Aboriginal Australian children? PLoS ONE14(8), e0220744.

Objectives: This study investigates the protective role of ethnic-racial identity (ERI) affirmation on the longitudinal association between racism and Aboriginal Australian children’s social and emotional well-being (SEWB). Methods: 408 children from the K-Cohort of the Longitudinal Study of Indigenous Children were included in the analysis. Data were collected through questionnaire-guided interviews at 7–10 and 9–12 years of age. Children’s racism experience, SEWB (Strengths and Difficulties Questionnaire), and confounding were reported by caregivers. ERI was reported by children and dichotomized into high versus low. Generalized linear models with log-Poisson links and robust errors were used to estimate adjusted Risk Ratios (RR) for the effect of racism on SEWB domains. Effect-measure modification analysis was used to verify differences on effect sizes per strata of ERI affirmation. The presence of modification was indicated by the Relative Excess Risk due to Interaction (RERI). 

Results: Slightly above half (51.4%) of the children presented high ERI affirmation. Children exposed to racism and with low ERI affirmation were at increased risk of hyperactive behavior (RR 2.53, 95% CI 1.17, 5.48), conduct problems (RR 2.35, 95% CI 1.07, 5.15), and total difficulties (RR 1.73, 95% CI 0.84, 3.55). Positive RERIs indicated the joint effects of racism and low ERI affirmation surpassed the sum of their separate effects in these domains. Children with high ERI affirmation were at increased risk of peer problems (RR 1.66, 95% CI 0.78, 3.52). 

Conclusions: These findings suggest that ERI may mitigate the risk of poor SEWB due to racism. Fostering affirmative ERI can be an important strategy in promoting resilience in Aboriginal Australian children.

 

Macedo, D., Smithers, L., Roberts, R., Paradies, Y., & Jamieson, L. (2019). Effects of racism on the socio-emotional wellbeing of Aboriginal Australian children. International Journal for Equity in Health18(1), 132.

Background: Racism is a pervasive experience in the life of Aboriginal Australians that begins in childhood. As a psychosocial stressor, racism compromises wellbeing and impacts developmental trajectories. The purpose of the present study was to estimate the effect of racism on indicators of Australian Aboriginal child socio-emotional wellbeing (SEWB) at one to two years after exposure. Age-related differences in the onset of symptoms were explored. Methods: Data from the B- and K-cohorts of the Longitudinal Study of Indigenous Children were used (aged 6 to 12 years). Racism, confounding variables, and the Strengths and Difficulties Questionnaire (a measure of SEWB) were collected by questionnaires and guided interviews with each child’s main caregiver. Adjusted Poisson regression was used to estimate the relative risk (RR) effects of racism on SEWB for both cohorts separately. RR were pooled in a random effects meta-analysis. 

Results: Exposure to racism was associated with an adjusted point estimate indicating a 41% increased risk for total emotional and behavioural difficulties, although the confidence intervals were wide (pooled RR 1.41, 95% CI 0.75, 2.07). Analyses by cohort showed younger children had higher RR for total difficulties (RR 1.72, 95% CI 1.16, 2.54), whilst older children had higher RR for hyperactive behaviour (RR 1.66, 95% CI 1.01, 2.73). 

Conclusions: The effects observed contributes to our understanding of the impact of racism on Aboriginal Australian children. Support for emotional and behavioural difficulties, and hyperactive behaviour, for Aboriginal children might help counteract the effects of racism. Future longitudinal research and policies aimed at reducing racism in Australian society are necessary.

 

Moss, M. & Duwun Lee, A. (2019). TeaH (turn ‘em around healing): A therapeutic model for working with traumatised children on Aboriginal communitiesChildren Australia, 44(2), 55-59.

Aboriginal children in Australia are over-represented in both the child protection and juvenile justice systems. Using Western therapeutic models of practice with Aboriginal people who live in remote communities can be highly problematic. Moreover, the historical legacy of past and present legislation, government interventions and racist service provision needs to be acknowledged and addressed prior to any service implementation. This paper presents a therapeutic model of practice that incorporates Aboriginal concepts of healing and spirit within a creative therapeutic framework. It will demonstrate how the model works through principles of community engagement and capacity building, enabling the provision of a culturally derived therapeutic intervention that involves a synergy of both Aboriginal- and Western-based healing practices. The findings from the implementation of the TeaH model affirm the need to incorporate Aboriginal concepts of healing, spirit and creative therapies into mainstream practice with Aboriginal people.

 

Skerrett, D. M. Gibson, M., Darwin, L., Lewis, S., Rallah, R., & Diego, D. L. (2017). Closing the gap in Aboriginal and Torres Strait Islander youth suicide: A social–emotional wellbeing service innovation project. Australian Psychologist, 53(1), 13-22.

Objective: The suicide rate for Queensland’s Aboriginal and Torres Strait Islander young people is over four times that of their non- Indigenous counterparts, with Aboriginal and Torres Strait Islander children (under 15) dying by suicide at 12 times the non-Indigenous rate. There is a need for interventions that are culturally validated and community-endorsed. The aim of this article is to describe the design and implementation of a group-based intervention, as well to report the results of the various qualitative and quantitative measures. 

Method: Sixty-one Aboriginal and Torres Strait Islander persons aged 11–21 years completed a social–emotional wellbeing (SEWB) program at headspace Inala. Data were available through to 2-month follow-up for 49 participants. The program was designed and delivered in collaboration with the local Aboriginal and Torres Strait Islander community. 

Results: There was a statistically significant decrease in suicidal ideation experienced by the participants after completing the program. Qualitative measures indicated that participants experienced improved understanding of holistic health and an increased number of coping skills. 

Conclusions: Not only was this the first evaluated intervention in Aboriginal and Torres Strait Islander youth to ever report a decrease in individual suicidality, the program was carefully designed and implemented in consultation with community in a culturally sensitive manner and thus provides an invaluable framework for future SEWB work.

 

Wright, M., Culbong, T., Crisp, N., Biedermann, B., & Lin, A. (2019). “If you don’t speak from the heart, the young mob aren’t going to listen at all”: An invitation for youth mental health services to engage in new ways of working. Early Intervention in Psychiatry, 1-7.

Aim: Aboriginal and Torres Strait Islander young people are more likely to experience mental health issues or end their life by suicide than non-Aboriginal youth, but are less likely to access mental health services for support. Systemic change is required if mainstream youth mental health services are to be relevant and culturally secure for Aboriginal and Torres Strait Islander young people. 

Methods: Building Bridges (2017-2019) is a three-year participatory action research project being conducted in partnership with the Nyoongar community and three main-stream youth mental health services in Perth, Western Australia. The project involves Nyoongar Elders and Aboriginal and Torres Strait Islander young people working directly with senior management and key staff of youth mental health services to co-design, implement and evaluate a framework for systems change. The aim of the project is to increase Aboriginal and Torres Strait Islander young people’s engagement with services and improve mental health outcomes for young people and their families. 

Results: This paper outlines the engagement process that underpinned the first phase of the project. Our research methods are premised by an investment in establishing safe spaces for the Elders, young people and service staff to engage in open, honest dialogue. We present two key activities that illustrate this process of building trust and deepening understanding, namely: spending time “On Country” and engaging in a “storying” process. 

Conclusions: Building Bridges demonstrates the centrality of trusting relationships for systemic change and the way in which meaningful engagement is at the core of both the process and the outcome.

Aarnja Ltd (2019).2019 Kimberley empowered young leaders reportKimberley Aboriginal Suicide Prevention Trial, Alice and Kicking Goals, Headspace Broome, Kimberley Aboriginal Medial Service, Primary Health Network Country WA, WA Primary Health Alliance.

 

Dudgeon, P., Walker, R., Scrine, C., Shepherd, C.C., Calma, T., & Ring, I. (2014). Effective strategies to strengthen Aboriginal and Torres Strait Islander mental health and wellbeing.Issues paper no. 12. Closing the Gap Clearinghouse, Australian Institute of Health and Welfare, Australian Institute of Family Studies.

 

Fogliani, R.V.C.. (2019). Inquest into the deaths of thirteen children and young persons in the Kimberley region, Western Australia. Coroner’s Court of Western Australia.

The State Coroner conducted an inquest hearing into the deaths of thirteen children and young persons in the Kimberley Region of Western Australia. These deaths were investigated during one Inquest because there were similar circumstances, life events, developmental experiences and behaviours that appear to have contributed to making them vulnerable to suicide. As part of the Inquest process, the State Coroner made forty-two recommendations across a range of areas including:

  • Fetal alcohol spectrum disorder (FASD)
  • Alcohol restrictions
  • Housing
  • Mental health support
  • Employment
  • Cultural healing

 

Hall, S., Fildes, J., Perrens, B., Plummer, J.,Carlisle, E., Cockayne, N., & Werner-Seidler, A. (2019). Can we talk? Seven year youth mental health report – 2012-2018. Mission Australia.

The Can we talk? Seven year youth mental health report – 2012-2018 Youth Survey findings of the past seven years – is co-authored with Black Dog Institute experts – to ascertain and investigate rates of psychological distress experienced by young people in Australia who are aged 15-19. The report further examines the concerns, general wellbeing and help-seeking behaviours of the close to 27,000 participants of the 2018 Youth Survey aged 15-19, including those who are experiencing psychological distress – highlighting the vital role that friends, parents, services, schools and the internet play as sources of help for young people who are struggling with their mental health. Part 2 is about meeting the diversity of young people’s need  : Dedicated focus on Aboriginal and Torres Strait Islander young people.

 

SNAICC: National Voice for our Children. (2020). SNAICC submission to the productivity commission’s draft report into expenditure on children in the Northern Territory.

Douglas, J. (2015). Kin and knowledge: the meaning and acquisition of Indigenous ecological knowledge in the lives of young Aboriginal people in Central Australia. Charles Darwin University, Darwin.

This is an ethnographic study about young Aboriginal people in Central Australia. The voices and opinions of more than 150 Aboriginal youth were analysed. My findings show that Indigenous Ecological Knowledge (IEK) is an active part of their lives. This knowledge and practice contributes to the identity and pride of youth from Central Australia. Young Aboriginal people are commonly portrayed in the media as problems. Negative stereotypes and deficit narratives imply they occupy a failed space within and between Aboriginal and non-Aboriginal worlds. Youth are said to be lacking in culture and disinterested in cultural practices. My findings contradict such stereotypes and deficiencies. The lived experiences of Aboriginal people are often invisible to mainstream Australian society. Rarely do we hear from young Aboriginal people themselves. Their role as players in a system of knowledge is simultaneously ignored and assumed. IEK is characterised as the domain of the older generation but not younger generations. This thesis goes beyond academic attention to IEK in environmental programs, developmental theories or the nexus between Indigenous and Western or scientific knowledge. The study explores the social lives of young Aboriginal adults. Mixed methods were used to examine the learning practices, learning contexts and cultural acquisition processes that underpin IEK. Qualitative results from interviews, surveys and observations are presented. I look at how IEK is made to happen, how knowledge and practice is realised in contemporary contexts. The study shows that people’s everyday lived experience integrates IEK. Cultural knowledge is vulnerable to the stresses and forces of modern life; yet it persists. Factors that enable IEK to persevere are examined. I have found that hunting, bush food and medicine harvesting, and natural resource use contribute to IEK. Practices and beliefs are enriched through ceremonial life, health and healing, and in observances in bereavement and funerals. Amongst younger people there is an ongoing belief in the sentience of country. This research revealed that IEK is a vital part of youth values and beliefs. Beliefs inform youth practice. IEK is expressed through relationship to families and people’s connections to each other. Young people demonstrate their care for older and younger generations through the collection, preparation and use of natural resources. ‘Relatedness’ continues to be the currency of knowledge transmission. Feelings of love, duty and care motivate young people to listen, learn and do things for their older and younger loved ones. Deep and powerful feelings for family members call young people to action. Young people are integral to the future of Indigenous Ecological Knowledge and practice in Central Australia.

Anang, P., Naujaat Elder, E. H., Gordon, E., Gottlieb, N., & Bronson, M. (2019). Building on strengths in Naujaat: The process of engaging Inuit youth in suicide preventionInternational Journal of Circumpolar Health78(2), 1508321.

Death by suicide and attempted suicide among Inuit youth is now considered a public health emergency of epidemic proportion, with rates among the highest worldwide. A strong sense of cultural identity and pride, as well as social capital, has been identified as being protective against suicide. The Canadian Institute for Health Research (CIHR) Guidelines for Health Research Involving Aboriginal People call for communities to be included in the conception, planning and implementation of research. The authors took first steps towards sharing the responsibility of designing a community initiative with the youth of Naujaat, Nunavut, a community located directly on the Arctic Circle. With the objectives of promoting open listening and exploration of community needs and enhancing self-determination and sustainability, we postulated a youth resiliency project that will be co-authored by the community. This paper describes the joint work process. We recount how Inuit youth take ownership of the project with the guidance of Ms. Elizabeth Haqpi, a Naujaat Elder. The article will particularly reflect on the process of balancing the different perspectives and expectations while enjoying the richness of mutual learning through keeping each other accountable.

 

Hibbert, A., Fletcher, F., Hammer, B. (2018). Life skills journey: Measuring the impact of a resilience-based intervention for Métis children in Alberta. Journal of Indigenous Wellbeing Te Mauri – Pimatisiwin, 3(1), 18-29.

Métis peoples are descendants of unions between French or Scottish fur traders and First Nations women in Canada. Alberta is the only province in Canada with land-based Métis who live in self-governing communities known as Métis Settlements. University of Alberta’s Faculty of Extension and four Métis Settlements partnered in a community based participatory research project aimed at increasing children’s resilience through inner strength and support from peers and mentors. While working with community members, the learning needs of children were identified, prioritised, and included in a summer day-camp program for children (7 – 14 years). Pre- and post-program surveys with children used an adaption of the Youth Resiliency: Assessing Developmental Strengths Questionnaire. Results are presented using descriptive statistics and were tested for significance using the non-parametric Wilcoxon rank sum test. Positive change occurred in several areas of internal strength, including self-esteem, drug resistance, and planning and decision making. Risk factors also saw positive change, as did the area of external family support. Significant areas of positive change are encouraging given that they demonstrate success in major goals of the summer camp program. Significant areas of negative change require further analysis in order to understand the complexity of Métis youth resiliency.

 

Isbister-Bear, O., Hatala, A. R., & Sjoblom, E. (2017). Strengthening Âhkamêyimo among Indigenous youth: The social determinants of health, justice, and resilience in Canada’s northJournal of Indigenous Wellbeing Te Mauri – Pimatisiwin, 2(3), 76-89.

The wellbeing of Indigenous youth living in Canada’s northern communities continues to lag behind the rest of the Canadian population. To a large extent, these health inequities are perpetuated by processes of colonisation that significantly impact the social determinants of health in Canada’s Indigenous north. The purpose of this article is to review the history of colonisation and its impacts on the wellbeing of Indigenous youth in Canada’s north, as well as processes of resilience that have helped Indigenous youth live healthy lives despite social challenges. Academic articles published between 2000 and 2016 outlining resilience from Indigenous perspectives are reviewed in the contexts of Canada’s Indigenous north. Analysis focuses on what insights about resilience emerge from Indigenous communities, particularly as they related to the health inequities of circumpolar regions. The concept of Âhkamêyimo is discussed and how systems of Indigenous knowledge offer important insights into resilience in general, and can be utilised in health promotion, education, and prevention programs targeting Indigenous youth in northern Canada. We conclude that attention should be turned toward issues of social justice and health equity that are desperately needed in order to create healthy environments whereby Indigenous youth within northern Canadian communities can be assisted to flourish.

 

Kral, M. J. (2016). Suicide and suicide prevention among Inuit in CanadaCanadian Journal of Psychiatry. Revue canadienne de psychiatrie61(11), 688–695.

Inuit in Canada have among the highest suicide rates in the world, and it is primarily among their youth. Risk factors include known ones such as depression, substance use, a history of abuse, and knowing others who have made attempts or have killed themselves, however of importance are the negative effects of colonialism. This took place for Inuit primarily during the government era starting in the 1950s, when Inuit were moved from their family-based land camps to crowded settlements run by white men, and children were removed from their parents and placed into residential or day schools. This caused more disorganization than reorganization. The most negative effect of this colonialism/imperialism for Inuit has been on their family and sexual relationships. Many Inuit youth feel alone and rejected. Suicide prevention has been taking place, the most successful being community-driven programs developed and run by Inuit. Mental health factors for Indigenous peoples are often cultural. It is recommended that practitioners work with the community and with Inuit organizations. Empowered communities can be healing.

 

Slesnick, N., Zhang, J., & Walsh, L. (2020). Youth experiencing homelessness with suicidal ideation: Understanding risk associated with peer and family social networksCommunity Mental Health Journal.

Suicide is the leading cause of death among youth experiencing homelessness, and these youth report high rates of suicide attempts. Research suggests that the interpersonal factors of perceived burdensomeness and thwarted belongingness are proximal causes of suicide, but little is known about factors associated with these risks. The current study examined the relationship of social network characteristics, perceived social network support, and interpersonal risks for suicide among a sample of 150 youth experiencing homelessness who reported severe suicide ideation. Findings indicate that characteristics of the social network, including engagement in crime and alcohol use, interrupted the potentially protective effects of high perceived social network support for interpersonal risk factors of suicide. Findings imply that increasing perceived social network support as a protection against suicide will not be uniformly successful, and consideration of the social network characteristics is necessary. Future work needs to continue to uncover the complexity of modifiable intervention targets to prevent future suicide attempts among this high-risk group.

 

Trout, L., Mceachern, D., Mullany, A., White, L., Wexler, L., & Trout, L. (2018). Decoloniality as a framework for Indigenous youth suicide prevention pedagogy: Promoting community conversations about research to end suicide. American Journal of Community Psychology62(3-4), 396–405.

Indigenous youth suicide remains a substantial health disparity in circumpolar communities, despite prevention efforts through primary health care, public health campaigns, school systems, and social services. Innovations in prevention practice move away from expert‐driven approaches to emphasize local control through processes that utilize research evidence, but privilege self‐ determined action based on local and personal contexts, meanings, and frameworks for action. “Promoting Community Conversations About Research to End Suicide” is a community health intervention that draws on networks of Indigenous health educators in rural Alaska, who host learning circles in which research evidence is used to spark conversations and empower community members to consider individual and collective action to support vulnerable people and create health‐promoting conditions that reduce suicide risk. The first of nine learning circles focuses on narratives of local people who link the contemporary youth suicide epidemic to 20th century American colonialism, and situates prevention within this context. We describe the theoretical framework and feasibility and acceptability outcomes for this learning circle, and elucidate how the educational model engages community members in decolonial approaches to suicide prevention education and practice, thus serving as a bridge between Western and Indigenous traditions to generate collective knowledge and catalyze community healing.

Elders

Armstrong, G., Spittal, M.J., & Jorm, A.F. (2018). Are we underestimating the suicide rate of middle and older‐aged Indigenous Australians? An interaction between ‘unknown’ Indigenous status and ageAustralian and New Zealand Journal of Public Health42(4), 412-413.

High rates of Indigenous suicide are a distressing phenomenon that plague several postcolonial countries. In Australia, suicide is a leading cause of mortality for Aboriginal and Torres Strait Islander people. In the period 2012 to 2016, the suicide rate for Indigenous Australians was estimated to be 23.7 per 100,000, twice the rate (11.6 per 100,000) for non-Indigenous Australians. Data presented by the National Coronial Information System highlights a major disparity in suicide rates between Indigenous and non-Indigenous Australians in younger age groups; the Indigenous suicide rate was 31.5 per 100,000 among those aged 15–44 years, compared to 11.1 per 100,000 for non-Indigenous people. Meanwhile, among those aged 45 years and older, there appeared to be no or minimal disparity in suicide rates by Indigenous identification. This paper explores the interaction between age and ‘unknown’ Indigenous status in regards to deaths by suicide.

 

Gibson, C., Crockett, J., Dudgeon, P., Bernoth, M., & Lincoln, M. (2018). Sharing and valuing older Aboriginal people’s voices about social and emotional wellbeing services: A strength-based approach for service providersAging and Mental Health24(3), 481–488.

Objective: Over the last decade, the literature relating to older Aboriginal and Torres Strait Islander people’s preferences for social and emotional wellbeing services has grown. However, little evidence exists in relation to older Aboriginal and Torres Strait Islander people’s experiences of services relating to social and emotional wellbeing. This paper highlights older Aboriginal and Torres Strait Islander people’s experiences of social and emotional wellbeing services in Australia and then uses these key findings of the research, along with the literature, to develop a strength-based approach for service providers. 

Methods: Yarning was the preferred research method for the older Aboriginal community. In total, 16 older Aboriginal people, including eight women and eight men participated in the research yarning sessions. A modified version of an existing thematic analysis process supported yarning members to participate in each stage of the research, including data analysis. 

Results: The themes emerging from the voices of the yarning members are they couldn’t give a damn about themYou’ve got to get the right one and ticking the box. The themes focus on negative, positive and preferred experiences of social and emotional wellbeing service provision. 

Conclusion: The key findings and related literature contribute to the development of a strength-based approach, which supports the implementation of responsive and effective services that address Elders, older peoples and their communities’ social and emotional wellbeing issues and aspirations.

 

Love, P., Moore, M., & Warburton, J. (2017). Nurturing spiritual well-being among older people in Australia: Drawing on Indigenous and non-Indigenous way of knowingAustralasian Journal on Ageing36(3), 179-185.

Aim: The meaning of spiritual well‐being as a health dimension is often contested and neglected in policy and practice. This paper explores spiritual well‐being from both an Indigenous and a non‐Indigenous perspective. 

Method: We drew on Indigenous and non‐Indigenous methodologies to explore the existing knowledge around spiritual well‐being and its relationship with health. 

Results: The Indigenous perspective proposed that spiritual well‐being is founded in The Dreaming, informs everyday relationships and can impact on health. The non‐Indigenous perspective suggested that spiritual well‐being is shaped by culture and religion, is of increased importance as one ages, and can improve coping and resilience stressors. 

Conclusions: Situating these perspectives side by side allows us to learn from both, and understand the importance of spirituality in people’s lives. Further research is required to better address the spiritual well‐being/health connection in policy and practice.

 

Shen, Y.T., Radford, K. , Daylight, G. , Cumming, R. , Broe, T.G.A. , Draper, B. (2018). Depression, suicidal behaviour, and mental disorders in older Aboriginal Australians. International Journal of Environmental Research and Public Health15(3), 1-14.

Aboriginal Australians experience higher levels of psychological distress, which may develop from the long-term sequelae of social determinants and adversities in early and mid-life. There is little evidence available on the impact of these on the mental health of older Aboriginal Australians. This study enrolled 336 Aboriginal Australian participants over 60 years from 5 major urban and regional areas in NSW, utilizing a structured interview on social determinants, and life-time history of physical and mental conditions; current psychosocial determinants and mental health. Univariate and multivariate analyses were utilized to examine the link between these determinants and current depressive scores and suicidality. There was a high rate of life-time depression (33.3%), current late-life depression (18.1%), and suicidal ideation (11.1%). Risk factors strongly associated with late-life depression included sleep disturbances, a history of suicidal behaviour, suicidal ideation in late-life and living in a regional location. This study supports certain historical and psychosocial factors predicting later depression in old age, and highlights areas to target for prevention strategies.

Niu, L., Ma, Z., Jia, C., & Zhou, L. (2020). Gender-specific risk for late-life suicide in rural China: A case-control psychological autopsy studyAge and Ageing, 1-5.

Background:despite unique gender patterns of suicide among older people in rural China, research addressing this issue is scarce.  is study aims to clarify the gender-specific risk factors of late-life suicide in rural China. 

Methods:the study included 242 persons (51% male) aged 60 and above who had committed suicide between June 2014 and September 2015 in the rural areas of three provinces of China. Using 1:1 matched case-control design, 242 living controls matched in age, gender and neighbourhood were randomly selected. Psychological autopsy interviews and psychological assessments were conducted with two informants for each suicide and living control, respectively. 

Results:men used alcohol before suicide more than women (12.6 versus 4.7%, P < 0.05).  ere was no gender difference in suicide method, suicide intent and previous attempts. Univariate analysis showed that married status, mental disorder, depressive symptoms, hopelessness, impulsivity, loneliness, social support, family function and quality of life were associated with suicide in both genders. For men, other risk factors were chronic physical illness and functions of daily living. Variables remaining in the multivariable model for both men and women were depressive symptoms and hopelessness. 

Discussion: depression and hopelessness are the two major risk factors for suicide among both older men and woman in rural China. Suicide prevention programmes focusing on depression and hopelessness in this population are indicated. Also needed are continued efforts to develop and refined gender-specialised strategies to identify high-risk individuals or groups and to enhance targeted support in the rural community.

 

Yip, P. S. F., Cheung, Y. T., Chau, P. H., & Law, Y. W. (2010). The impact of epidemic outbreak the case of severe acute respiratory syndrome (SARS) and suicide among older adults in Hong KongCrisis, 31(2), 86–92.

Background: Previous studies revealed that there was a significant increase in suicide deaths among those aged 65 and over in 2003. The peak coincided with the majority of SARS cases being reported in April 2003. 

Aims: In this paper we examine the mechanism of how the SARS outbreak resulted in a higher completed suicide rate especially among older adults in Hong Kong. 

Methods: We used Qualitative data analysis to uncover the association between the occurrence of SARS and older adult suicide. Furthermore, we used a qualitative study based on the Coroner Court reports to provide empirical evidence about the relationship between SARS and the excessive number of suicide deaths among the elderly. Results: SARS-related older adult suicide victims were more likely to be afraid of contracting the disease and had fears of disconnection. The suicide motives among SARS-related suicide deaths were more closely associated with stress over fears of being a burden to their families during the negative impact of the epidemic. Social disengagement, mental stress, and anxiety at the time of the SARS epidemic among a certain group of older adults resulted in an exceptionally high rate of suicide deaths. 

Conclusions: We recommend that the mental and psychological well-being of the community, in particular older adults, be taken into careful account when developing epidemic control measures to combat the future outbreak of diseases in the community. In addition, it is important to alert family members to vulnerable individuals who are at potential risk because of their illnesses or anxieties.

People Involved in the Justice System

Johnson, J. E., Jones, R., Miller, T., Miller, I., Stanley, B., Brown, G., Arias, S. A., Cerbo, L., Rexroth, J., Fitting, H., Russell, D., Kubiak, S., Stein, M., Matkovic, C., Yen, S., Gaudiano, B., & Weinstock, L. M. (2020). Study protocol: A randomized controlled trial of suicide risk reduction in the year following jail release (the SPIRIT trial)Contemporary Clinical Trials94, 106003.

Purpose: This article describes the protocol for a randomized effectiveness and cost-effectiveness trial of Stanley and Brown’s Safety Planning Intervention (SPI) during pretrial jail detention to reduce post-release suicide events (suicide attempts, suicide behaviours, and suicide-related hospitalizations). 

Background: With 10 million admissions per year and short stays (often days), U.S. jails touch many individuals at risk for suicide, providing an important opportunity for suicide prevention that is currently being missed. This study (N = 800) is the first randomized evaluation of an intervention to reduce suicide risk in the vulnerable year after jail release. Given that roughly 10% of all suicides in the U.S. with known circumstances occur in the context of a criminal legal stressor, reducing suicide risk in the year after arrest and jail detention could have a noticeable impact on national suicide rates. 

Design: Pretrial jail detainees at risk for suicide were randomized to SPI during jail detention plus post-release phone follow-up or to enhanced Standard Care. Outcomes assessed through 12 months post-release include suicide events, suicide attempts, weeks of active suicide ideation, severity of suicide ideation, time to first event, psychiatric symptoms, functioning, and cost-effectiveness. Methods accommodate short jail stays and maximize trial safety and follow-up in a large sample with severe suicide risk, access to lethal means including substances and firearms, high rates of psychiatric illness, and unstable circumstances. 

Conclusion: Adequate funding was important to create the infrastructure needed to run this large trial cleanly. We encourage funders to provide adequate resources to ensure clean, well-run trials.

 

Lau, P., Marion, C., Blow, R., & Thomson, Z. (2012). Healing for Aboriginal and Torres Strait Islander Australians at risk with the justice system: A programme with wider implications? Criminal Behaviour and Mental Health22(5), 297-302.

 

Malvaso, C., Day, A., Casey, S., Corrado, R. (2017). Young offenders, maltreatment, and trauma: A pilot studyPsychiatry, Psychology and Law24(3), 458-469.

Although a large number of studies offer consistent and persuasive evidence that exposure to childhood maltreatment and subsequent juvenile offending behaviours are related, relatively few studies have investigated the mechanisms by which maltreatment might increase risk in young offender populations. The aim of this pilot study was to collate data on the key areas of need from 28 young male offenders in secure care in an Australian jurisdiction, with a specific focus on the inter-relationship between scores on self-report measures of maltreatment, trauma, and mental health. The findings provide preliminary evidence that these key constructs are linked to other proximal risk factors for juvenile offending, such as poor anger regulation and antisocial thinking patterns. They offer a rationale for considering the sequelae of maltreatment in the development of service delivery frameworks for young offenders.

 

Shepherd, S.M., Spivak, B., Arabena, K., Paradies, Y. (2018). Identifying the prevalence and predictors of suicidal behaviours for Indigenous males in custodyBMC Public Health, 18, 1159.

Background: High rates of suicidal behaviours among Indigenous Australians have been documented. Justice- involved individuals are also at a higher risk for engaging in suicidal behaviours. This study sought to ascertain the prevalence and correlates of suicidal behaviours for 107 Indigenous adult males in custody in Victoria, Australia. 

Methods: Participants undertook a structured interview comprising a psychiatric assessment. Information on suicidal behaviours (ideation and attempts), socio-demographics, environmental stressors, negative life events and mental health was obtained. 

Results: A high proportion of Indigenous males in custody experienced lifetime suicidal ideation (63.7%) and over one- half had attempted suicide (54.5%). A smaller, yet significant number of participants experienced ideation over the past 12 months (27.9%). Having a loved one pass away within the past 12 months predicted recent ideation; lifetime ideation and a diagnosis of Post-Traumatic Stress Disorder predicted a lifetime suicide attempt. 

Conclusions: The prevalence of suicidal behaviours among Indigenous people in custody is remarkably high. Correlates of suicidal behaviours for Indigenous people in custody in this study likely manifest in the community, denoting an urgent public health response. Prevention must begin in communities at-risk for suicidal behaviours. The development of low intensity mental health service infrastructure in communities to promote awareness and provide accessible, least restrictive support and treatment is necessary. Correctional institutions must also continue to improve custodial suicide prevention and management initiatives.

 

Stewart, A.C., Cossar, R., Dietze, P., Armstrong, G., Curtis, M., Kinner, S.A., Ogloff, J.R.P., Kirwan, A., Stoove, M. (2018). Lifetime prevalence and correlates of self-harm and suicide attempts among male prisoners with histories of injecting drug useHealth and Justice, 6(19).

Background: Histories of self-harm and suicide attempts are common among people in prison in Australia, and substance dependence is an established risk factor for these lifetime experiences. We describe the prevalence of self-reported history of non-suicidal self-injury (NSSI) and suicide attempts in a cohort of men with recent histories of injecting drug use (IDU) imprisoned in Victoria, Australia. Baseline interviews from the Prison and Transition Health (PATH) prospective cohort study were conducted in the weeks prior to release from prison among 400 incarcerated men who reported regular IDU in the six months prior to incarceration. 

Results: Participants completed a researcher-administered structured questionnaire that collected information on socio-demographics, substance use patterns, and physical and mental health indicators. More than one third (37%) reported a history of NSSI and almost half of participants (47%) reported a history of suicide attempts. In multivariable Poisson regression models, a history of NSSI was associated with: being aged 30–39 years; moving accommodation three or more times in the year prior to current sentence; self-reporting a history of mental illness diagnosis; current poor psychiatric well-being; and self-reporting three or more previous drug overdoses. History of suicide attempts was significantly associated with: self-reporting a history of mental illness diagnosis; current poor psychiatric well-being; and self-reporting a history of 1–2 and > 3 drug overdoses. 

Conclusion: We observed a disconcertingly high lifetime prevalence of non-suicidal self-injury and suicide attempts among incarcerated males with a history of recent regular injecting drug use. Significant associations with indicators of mental illness and drug related harms support the need to prioritise in-prison screening and early intervention to reduce the risk of future harms for this population.

Women

Carlin, E.; Atkinson, D.; Marley, J.V. ‘Having a quiet word’: Yarning with Aboriginal women in the Pilbara region of Western Australia about mental health and mental health screening during the perinatal periodInternational Journal of Environmental Research and Public Health16(21), 4253.

Despite high rates of perinatal depression and anxiety, little is known about how Aboriginal women in Australia experience these disorders and the acceptability of current clinical screening tools. In a 2014 study, the Kimberley Mum’s Mood Scale (KMMS) was validated as an acceptable perinatal depression and anxiety screening tool for Aboriginal women in the Kimberley region of Western Australia. In the current study, we explored if it was appropriate to trial and validate the KMMS with Aboriginal women in the Pilbara. Yarning as a methodology was used to guide interviews with 15 Aboriginal women in the Pilbara who had received maternal and child health care within the last three years. Data were analysed thematically, the results revealing that this cohort of participants shared similar experiences of stress and hardship during the perinatal period. Participants valued the KMMS for its narrative-based approach to screening that explored the individual’s risk and protective factors. While support for the KMMS was apparent, particular qualities of the administering health care professional were viewed as critical to the tool being well received and culturally safe. Building on these findings, we will work with our partner health services in the Pilbara to validate the KMMS with Pilbara Aboriginal women.

 

Dudgeon, P., Bray, A. (2017). Indigenous healing practices in AustraliaWomen & Therapy41(1-2), 97-113.

Indigenous Australian women are among the most disadvantaged women in the world. Over two centuries of colonization have had a damaging impact on perceptions of their gender roles and status as well as many other consequential oppressions. These experiences have affected the social and emotional wellbeing of Indigenous women of all ages, resulting in socio-economic ghettoization, higher suicide rates, psycho- logical distress, illness, and poverty. Generations of women have experienced the forced removal of their children, resulting in complex forms of historical trauma. Despite this, Indigenous women have also maintained strong leadership roles and have kept families and communities intact. In the last few decades, the Australian Indigenous mental health movement has emerged within the context of a broader self-determination movement, restoring and strengthening women’s traditional therapeutic practices. This article offers an overview of the social and emotional wellbeing of Indigenous women within neocolonial Australia and explores women’s relationship to traditional therapeutic practices. Future directions and key issues for the capacity building of Indigenous women’s healing are explored.

Saunders, M.A.E.E. (2014). Yarning with Minjungbal women: testimonial narratives of transgenerational trauma and healing explored through relationships with country and culture, community and family. University of Sydney.

 Yarning with Minjungbal women incorporates the testimonial narratives of five women from the Minjungbal community of Tweed Heads in far northern New South Wales. Our combined metanarrative explores how we have been able to interrupt transgenerational trauma, which is the process that explains how the impacts of historical suffering are inherited by successive generations. Minjungbal women’s experiences of transgenerational trauma are discussed firstly through our ties to country and culture, secondly within the relationships in our community, and finally inside the dynamics of our families. Minjungbal women explain how we have experienced transgressions, resisted oppression, engendered healing and spread strength within each of these spheres. Minjungbal women’s relationships to country and culture, community and family have been influenced by the legacies of the past, and Minjungbal women still experience ongoing injustices from government policies and the attitudes of the dominant society. Nevertheless, this thesis contends that Minjungbal women have always been actors in resisting oppression, agents in interrupting the cycle of transgenerational trauma and instrumental in facilitating positive changes. Yarning with Minjungbal Women proposes that the key to resistance, resilience and healing lies within the teaching and learning that occurs within the context of relationships. Yarning with Minjungbal Women is therefore an embodiment of activism research as it is informed by the sharing of stories and the strengthening of relationships. Yarning with Minjungbal Women is a contribution to the field of research about the history of Minjungbal country. It contributes to existing research that explains the mechanisms by which the transgenerational transfer of trauma is inherited and passed on. This research is focussed though an Indigenous feminist heuristic perspective as the most culturally appropriate and immersive methodology for me to employ as a Minjungbal woman who has been shaped by transgenerational trauma, as I am perfectly suited to elucidate sensitive information from women in my community. The testimonial narratives were recorded using yarning as a communication method. Yarning facilitated the release of information in a way that Minjungbal women were comfortable with, giving them agency in the research process, as well as retaining the integrity of Minjungbal communication practises.

McGuire-Adams, T. (2017). Anishinaabeg women’s stories of wellbeing: Physical activity, restoring wellbeing, and confronting the settler colonial deficit analysis. Journal of Indigenous Wellbeing Te Mauri – Pimatisiwin, 2(3), 90-104.

The settler colonial lens deficit approach to Indigenous peoples’ health constructs us as ill, which sets the stage for our eventual erasure. In contrast to this deficit-based approach, in this paper I employed an Anishinaabeg research paradigm and followed Anishinaabeg protocols to understand how Anishinaabeg women are creating wellbeing for themselves, their families, and communities through engaging in physical activity. Based on seven interviews with Anishinaabeg women who are engaged in decolonized physicality, the Anishinaabeg women participants promote gwesayjitodoon indo bimaadiziiwin, which means to transform oneself into a better life. The participants showed how if one can apply the concept of gwesayjitodoon indo bimaadiziiwin to his or her physical activity, it has potential to enact broader community wellbeing that can confront the settler colonial deficit lens that requires Indigenous peoples’ erasure, and through which Aboriginal health research has for too long been examined.

Indigenous Governance & Cultural Safety

Hunter, E. (2020). Indigenous mental health: The limits of medicalised solutionsAustralasian Psychiatry, 28(1), 55-57.

Objective: The excess burden of mental disorders experienced by Indigenous Australians is complexly overdetermined. Social and political factors contributing to the intransigence of vulnerability are reviewed, and the wider arena of neoliberal political change considered. 

Conclusions: The dynamic relationship between disadvantage and mental health vulnerability requires that practitioners should be attuned to both the ‘big picture’ and ‘modest and practical ways’ to contribute to reducing the developmental embedding of social disadvantage and transgenerational vulnerability.

 

Moss, M., & Duwun Lee, A. (2019). TeaH (turn ‘em around healing): A therapeutic model for working with traumatised children on Aboriginal communitiesChildren Australia, 44(2), 55-59.

Aboriginal children in Australia are over-represented in both the child protection and juvenile justice systems. Using Western therapeutic models of practice with Aboriginal people who live in remote communities can be highly problematic. Moreover, the historical legacy of past and present legislation, government interventions and racist service provision needs to be acknowledged and addressed prior to any service implementation. This paper presents a therapeutic model of practice that incorporates Aboriginal concepts of healing and spirit within a creative therapeutic framework. It will demonstrate how the model works through principles of community engagement and capacity building, enabling the provision of a culturally derived therapeutic intervention that involves a synergy of both Aboriginal- and Western-based healing practices. The findings from the implementation of the TeaH model affirm the need to incorporate Aboriginal concepts of healing, spirit and creative therapies into mainstream practice with Aboriginal people.

 

Murrup-Stewart, C., Searle, A.K., Jobson, L., & Adams, K. (2019). Aboriginal perceptions of social and emotional wellbeing programs: a systematic review of literature assessing social and emotional wellbeing programs for Aboriginal and Torres Strait Islander Australians perspectivesAustralian Psychologist54(3), 171-186.

Australian Aboriginal and Torres Strait Islander communities have been targets of social and emotional wellbeing programs for many years. However, the few health‐care programs and services that are evaluated rarely provide insight into the participants’ perspectives of program success or failure. This systematic review assessed 33 social and emotional wellbeing programs across Australia to better understand what Aboriginal community members think about the programs and how they could be improved. Results highlighted the interesting and valuable insights provided by Aboriginal participants, including what kinds of program activities and approaches are most suitable, what program characteristics are successful or desired, and their experiences of wellbeing change before and after program participation. They likewise voiced opinions about poorly received programs, culturally inappropriate services and negative experiences. This review highlighted how health and wellbeing programs must better engage Aboriginal and Torres Strait Islander clients to ensure that services are culturally safe, holistic, integrate appropriate staffing, include culturally relevant activities and value patient/participant experiences. These findings have significant implications for the health and wellbeing sector; specifically, research, policy, program design and implementation, evaluation methods, and self‐determination.

 

Nasir, B. F., Hides, L., Kisely, S., Ranmuthugala, G., Nicholson, G. C., Black, E., Gill, N., Kondalsamy-Chennakesavan, S., & Toombs, M. (2016). The need for a culturally-tailored gatekeeper training intervention program in preventing suicide among Indigenous peoples: A systematic reviewBMC Psychiatry16(1), 357-363.

Background: Suicide is a leading cause of death among Indigenous youth worldwide. The aim of this literature review was to determine the cultural appropriateness and identify evidence for the effectiveness of current gatekeeper suicide prevention training programs within the international Indigenous community. 

Method:Using a systematic strategy, relevant databases and targeted resources were searched using the following terms: ‘suicide’, ‘gatekeeper’, ‘training’, ‘suicide prevention training’, ‘suicide intervention training’ and ‘Indigenous’. Other internationally relevant descriptors for the keyword “Indigenous” (e.g. “Maori”, “First Nations”, “Native American”, “Inuit”, “Metis” and “Aboriginal”) were also used. 

Results:Six articles, comprising five studies, met criteria for inclusion; two Australian, two from USA and one Canadian. While pre and post follow up studies reported positive outcomes, this was not confirmed in the single randomised controlled trial identified. However, the randomised controlled trial may have been underpowered and contained participants who were at higher risk of suicide pre-training. 

Conclusion:Uncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population. Further RCT evidence is required.

Monchalin, R., & Monchalin, L. (2018). Closing the health service gap: Métis women and solutions for culturally- safe health servicesJournal of Indigenous Wellbeing Te Mauri – Pimatisiwin, 3(1), 18-29.

Métis peoples, while comprising over a third of the total Indigenous population in Canada, experience major gaps in health services that are culturally-safe. This is problematic given Métis peoples experience severe disparities in health determinants and outcomes compared to the non-Indigenous Canadian population. At the same time, Métis are unlikely to engage in health services that do not value their cultural identities, often utilising mainstream options. Traditionally, Métis women were central to the health and well-being of their communities. However, due to decades of colonial legislation and land displacement, female narratives have been silenced, and Métis identities have been fractured. This has resulted in having direct implications on Métis peoples current health and access to health services. Solutions to filling the Métis health service gap may lie in the all too often unacknowledged or missing voices of Métis women.  Given these contexts, this commentary aims to generate critical discussion on the culturally-safe health care gap for Métis peoples in Canada. It does this by calling on policymakers, health care workers, and researchers alike to engage with Métis women regarding the health of Métis communities, and finding solutions towards identifying and implementing pathways to culturally-safe healthcare.

Evaluation

Clark, Y., Augoustinos, M., & Malin, M. (2017). Evaluation of the preventing lateral violence workshop in Adelaide, South Australia: Phase 1 survey responsesJournal of Indigenous Wellbeing: Te Mauri-Pimatisiwin, 2(3), 41-53.

Education and awareness workshops are important resources to the Indigenous community in Australia to tackle difficult issues and situations within communities. It is equally important that such workshops are appropriately evaluated to ensure that they are relevant, refined and continued within communities. This paper focuses on an evaluation of the one-day Preventing Lateral Violence workshop. A sample of six workshops were conducted predominately in Adelaide in 2014 using pre, post and three months post workshop measures to determine the impact on participants. Phase 1 measured participant changes in four areas which were awareness, understanding, knowledge as well as prevention strategies of lateral violence. Analysis of the quantitative data revealed the workshops’ success as an intervention tool both at completion and three months after the workshops. The results indicated that participants understood and resonated with the terminology and the impact on self and others, recognized their experiences of lateral violence, and had an awareness of and developed strategies to combat lateral violence. The qualitative response to open-ended questions suggested that various strategies of education and the challenging of behaviours were in place even after three months. The implications of these findings are discussed.

 

Clark, Y., Augoustinos, M., & Malin, M. (2017). Evaluation of the preventing lateral violence workshop in Adelaide, South Australia: Phase 2 qualitative aspectsJournal of Indigenous Wellbeing: Te Mauri-Pimatisiwin, 2(3), 54-66.

Lateral violence describes how members of oppressed groups direct their dissatisfaction toward each other. This inward deflection has been associated with Indigenous communities around the world and has shown to be destructive. The focus of this research concerns Aboriginal Strait Islander people in Adelaide, South Australia, as part of an evaluation of the preventing lateral violence workshops. The overall evaluation comprised both quantitative and qualitative components. This article reports on qualitative data, from interviews with seven Aboriginal participants, post workshop. These interviews, examined their ways of dealing with and strategizing to prevent lateral violence in various contexts as well as suggestions for improvements to the workshops. There were several interpretive themes that emerged from these interviews. This paper reports on the three main themes: improvements to workshops; participant support needs and their strategies to prevent lateral violence in their contexts. The information complemented and provided a deeper understanding of the phase one evaluation. It is hoped that such evaluation provides robust evidence for workshops to improve and be maintained as a useful resource for the Aboriginal and Torres Strait Islander communities to prevent lateral violence.

 

Guenther, J., & Galbraith, M. (2014) Learning from evaluations of school-family strengthening programs: lessons for all

For more than 10 years, a program called Families And Schools Together (FAST) has been run in schools across the Northern Territory. These programs have always had an evaluation component built in. However, over time, the evaluations have changed. Initially, they were summative, built around a quantitative psychometric tool (with a positivist research paradigm). The intent of the summative evaluation was to demonstrate the effectiveness of the program. However, as the program was rolled out in remote contexts, the need for adaptation was recognised. Changes were made but it was soon recognised that other outcomes, not captured or explored in the methodology, were emerging. After six years of working together, the evaluator and the program manager felt that it was time to explore effectiveness in a different way with a more qualitative evaluation process (based on naturalistic and pragmatic paradigms). The purpose of this paper is to share learnings from this experience with other program managers and evaluators. The presentation will be an opportunity for participants to engage in a discussion about monitoring and evaluation from a program evaluation perspective, particularly taking account of the complexities of the northern Australian context. This paper explores the six year learning journey through evaluation that the evaluator and program manager have undertaken. It describes tensions between the need for reliable and generalizable objective quantitative data and the need for authentic and credible data based on participant experience.

 

Maughan, C. (2012)  Monitoring and evaluating social impacts in Australia, Ninti One Limited

Abstract: Monitoring and evaluation (M&E) allows people to learn from past experiences, improve service delivery, plan and allocate resources and demonstrate results as part of accountability to stakeholders. M&E also assists in keeping projects on track, providing a basis for reassessing priorities and creating an evidence base for current and future projects There is a growing interest in the measurement of social impact across the business, government and nonprofit sectors. In recognising the role that non-profit organisations play in ‘enhancing the economic, social, cultural and environmental wellbeing of society’, the Australian Government has recently focused on improving the measurements of social impact This report describes the main monitoring and evaluating frameworks and methods used in Australia which include some assessment of social impact. Each of the following are discussed in terms of an overview of how it works (in terms of M&E), the benefits and limitations, examples of organisations using the technique and where to find further resources.

 

Murrup-Stewart, C., Searle, A.K., Jobson, L., Adams, K. (2019). Aboriginal perceptions of social and emotional wellbeing programs: a systematic review of literature assessing social and emotional wellbeing programs for Aboriginal and Torres Strait Islander Australians perspectivesAustralian Psychologist54(3), 171-186.

Australian Aboriginal and Torres Strait Islander communities have been targets of social and emotional wellbeing programs for many years. However, the few health‐care programs and services that are evaluated rarely provide insight into the participants’ perspectives of program success or failure. This systematic review assessed 33 social and emotional wellbeing programs across Australia to better understand what Aboriginal community members think about the programs and how they could be improved. Results highlighted the interesting and valuable insights provided by Aboriginal participants, including what kinds of program activities and approaches are most suitable, what program characteristics are successful or desired, and their experiences of wellbeing change before and after program participation. They likewise voiced opinions about poorly received programs, culturally inappropriate services and negative experiences. This review highlighted how health and wellbeing programs must better engage Aboriginal and Torres Strait Islander clients to ensure that services are culturally safe, holistic, integrate appropriate staffing, include culturally relevant activities and value patient/participant experiences. These findings have significant implications for the health and wellbeing sector; specifically, research, policy, program design and implementation, evaluation methods, and self‐determination.

 

Rogers, Alison, Harrison, Nea, Puruntatameri, Therese, Puruntatameri, Alberta, Meredith, Joan, Dunne, Rachel 2018, Participatory evaluation is the sea eagle looking “long way wide eyed” https://journals.sagepub.com/doi/abs/10.1177/1035719X18778712

 Abstract: Participatory evaluation can be embedded in programs to support good governance and facilitate informed decision making in Aboriginal communities in remote and urban contexts. An Aboriginal Elder from the Tiwi Islands in the Northern Territory of Australia described participatory evaluation as a sea eagle looking “long way wide eyed.” The metaphor refers to the long-term and broad approach undertaken when a complex community development program used participatory processes to build evaluation capacity and solve problems. The evaluation approach ensured the program was inclusive, responsive, empowering, and resulted in direct benefits for the communities. This article addresses the lack of literature on applying developmental and empowerment evaluation approaches in practice by describing the methods, tools, and use of evaluation findings. The value of participating for the community members and partner organizations is shared and the benefits and implications for participants and the evaluator are discussed. The authors hope this article inspires practitioners and evaluators to consider participatory ways of working with communities to support community directed action and social change.

Evaluation of Gathering Places: Inclusion, connection and empowerment – Victorian Government

In 2015 the Indigenous Health Equity Unit (IHEU) at The University of Melbourne was commissioned to undertake an evaluation of 13 identified Aboriginal and Torres Strait Islander gathering places across the state. The focus of the evaluation was to explore the extent to which gathering places in Victoria impact on the health and wellbeing of Aboriginal and Torres Strait Islander communities across the state.

Fisher, S. (2012) Monitoring and evaluation methodologies for remote settings: A literature review conducted in 2010 Report to the Office of Indigenous Policy Coordination, Department of Families, Housing, Community Services and Indigenous Affairs Working Paper  http://www.nintione.com.au/resource/NW001_MonitoringAndEvaluationMethodologiesForRemoteSettings.pdf

This report was undertaken by Ninti-One and provides useful material for staff working on new initiatives in monitoring and evaluation. Drawing on a review of the literature this report provide an overall analysis and recommendations regarding the conduct of monitoring and evaluation in Indigenous remote communities.

Hand, K. (2018). Gift of Gallang: Evaluation. Brisbane, QLD: Mission Australia.

In 2018 the Gift of Gallang was implemented in a local primary school in Inala for the first time. This represented the culmination of a three-year journey of ongoing community engagement and collaboration, which included the formation of the Committee of Hope and the development of community engagement activities such as cultural nights. The need for creating hope, resilience and wellbeing in the community of Inala was evident after a cluster of youth suicides occurred in 2016. Creating a community where children had a strong sense of culture and connection framed the Gift of Gallang activities with the long-term aim of reducing risk of suicide for Aboriginal and Torres Strait Islander children and young people. This work was supported by partnership between Mission Australia, and several other key stakeholders, including Inala Wangarra, local Elders, other Aboriginal Torres Strait Islander community and health organisations, and a local primary school. Mission Australia also funded evaluation of the processes involved throughout this work in order to document key learnings. Data was collected from members of the Committee of Hope, facilitators, educators, parents and carers. Before data collection Ethics approval was obtained through the Mission Australia research team as well as the Queensland Department of Education for data relating to school staff, children and families.

Skerrett, D.M., Gibson, M., Darwin, L., Lewis, S., Rallah, R., De Leo, D. (2017) Evaluating the  “United Health Education and Learning Program” (UHELP) program – Closing the Gap in Aboriginal and Torres Strait Islander Youth Suicide: A Social–Emotional Wellbeing Service Innovation Project. Australian Pyschological Society, Vol 53, Issue 1. doi.org/10.1111/ap.12277

The suicide rate for Queensland’s Aboriginal and Torres Strait Islander young people is over four times that of their non‐Indigenous counterparts, with Aboriginal and Torres Strait Islander children (under 15) dying by suicide at 12 times the non‐Indigenous rate. There is a need for interventions that are culturally validated and community‐endorsed. The aim of this article is to describe the design and implementation of a group‐based intervention, as well to report the results of the various qualitative and quantitative measures.

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