Healing the Past by Nurturing the Future: Aboriginal parents' views of what helps support recovery from complex trauma

Revitalising strong cultural connections and resilience: Co-designing a pilot Elder-led mentorship program for Indigenous mothers in a remote northern community in Alberta, Canada

Connecting with traditional knowledge and culture promotes the well-being of Indigenous parents and creates healthy environments for child development. Community Elders in a remote northern community in Alberta, Canada, collaborated with researchers to design a pilot Elders Mentoring Program. The programme aims to support young Indigenous mothers(-to-be), bringing back cultural traditions and teachings. Twelve workshops for Indigenous mothers(-to-be) focused on cultural activities and passing down traditional knowledge from Elders. Nine mothers(-to-be) completed a survey about their perinatal and postpartum experiences and care needs. Sharing circles with Elders and individual debriefings with mothers were conducted to understand their experiences in the workshops. Survey responses showed limited childcare services and transportation availability as barriers to accessing perinatal and postpartum support. Four themes emerged from qualitative data analysis: (1) the meaningful role of Elder mentorship for Indigenous mothers(-to-be); (2) Weekly workshops provided a safe space to share and develop relationships; (3) Participation in workshop activities fostered positive coping and improved self-esteem; (4) Elder-led workshops encouraged cultural connection and transference of traditional knowledge to younger generations. Cultural workshops led by Elders enhanced the connection to culture and resilience for Indigenous mothers and expectant mothers in a remote northern community.

Winanga-Li (I Hear You): Privileging Voices and Experiences of Aboriginal Parents' Journey with Their Gaaynggal (Baby) Through a Neonatal Intensive Care Unit

Aboriginal parents experience neonatal intensive care settings at a higher rate than non-Indigenous parents. We sought to explore Aboriginal parents' experiences of having a gaaynggal (baby) admitted to a neonatal intensive care unit (NICU) in order to improve culturally safe neonatal care environments. The yarning method was used to collect the qualitative data of 15 Aboriginal parents' stories. Thematic analysis and collaborative yarning were used to determine themes. The themes emerging from the stories included Trauma and its triggers in the NICU; Aboriginal cultural caring practices are not upheld in the NICU; Covert racism and biases impact culturally safe experiences; Health provider communication can obstruct parents' experience of cultural safety; and Recommendations to uphold culturally safe care in NICU. Culturally safe care practices have been identified as needed, to improve cultural safety in neonatal settings. Through further education and training, the facilitation of Aboriginal family connections and support groups, culturally inclusive spaces for parents and their kinship systems, and increasing Aboriginal staff representations across all levels of health professional experience, cultural safety for Aboriginal parents and gaaynggal can be increased.

The Impact of Caregivers' Experiences of Child Sexual Abuse on Parenting Practices: Examination of the Moderating Role of Connection to Culture and Social Support

This study drew on the resilience perspective to investigate whether connection to culture and social support moderated the relationship between Indigenous caregivers' history of child sexual abuse (CSA) victimization and outcomes critical to child development (i.e. caregivers' parenting practices). Participants were 119 Indigenous caregivers in the Northern Great Plains region in the U.S. The study found that social support was associated with aspects of parenting practices and that connection to culture was a significant moderator. These findings highlight the protective role of connection to culture in mitigating potentially negative effects of CSA on parenting practices, particularly within Indigenous communities. The results also underscore the importance of recognizing and drawing on cultural strengths in interventions designed to support survivors of CSA.

'They got my back': Thematic analysis of relationship building in nurse home visiting in Aboriginal communities

OBJECTIVE

The client-practitioner relationship is the cornerstone of nurse home-visiting programs. Little is understood about how relationship-based maternal and early childhood health care is perceived by women in remote Aboriginal communities. As part of an evaluation of nurse home-visiting in the Northern Territory, this research examines how relationships are established with clients, and what elements are valued most by women.

SETTING

Maternal Early Childhood Sustained Home-visiting (MECSH) is an Australian model of nurse-led home-visiting targeted at women facing adversity who need extra support. The model provides parenting information, health education and psychosocial support during pregnancy and the first 3 years of children's development.

PARTICIPANTS

Interviews were conducted with 92 Aboriginal women and 11 practitioners including nurses, social workers and community workers.

DESIGN

Qualitative semi-structured interviews were conducted with convenience samples of MECSH clients and practitioners. Data were analysed using a two-step process of structural coding and thematic analysis.

RESULTS

Trust was the foundation of clients' positive perception of the relationship with their MECSH provider. Relationships took time to develop, often beginning with practical support to meet clients' basic needs. Practitioner dependability and flexibility to client priorities, communication, confidentiality and being helpful to the woman and her family was important. Clients emphasised emotional support and friendship.

CONCLUSION

The relationship-based approach was valued and consistent with culturally safe and trauma informed ways of working with Aboriginal families. Effort is required to commit to the model to address ongoing healthcare engagement and health outcomes in remote Northern Territory communities.

Music Across Generations: Exploring Intergenerational First Nations Musical Practices as Cultural Determinants of Health

This article reports on promising pilot research which indicates that intergenerational musical practices in diverse First Nations families and communities in Vanuatu and Australia can shape cultural determinants of health (CDoH). We contend that such strength- and culture-based approaches to health promotion may help to disrupt colonial and deficit constructions of First Nations People and our health and wellbeing. The pilot study used Indigenist yarning which prioritized First Nations ideas, concepts, and knowledges during informal and relational semi-structured interviews with 9 diverse First Nations musicians in Australia and Vanuatu. The pilot study underpins an ongoing international 3-year research project examining First Nations music as a determinant of health led by Griffith University, The University of the Sunshine Coast, The University of Queensland, and Edith Cowan University. Yarning interviews were analyzed using collaborative thematic analysis and Indigenous visual art responses. Major themes emerging from the data related to intergenerational music activity and transmission. Themes include Music as an intergenerational medium of cultures; Music as a bond between older and younger generations; Intergenerational musical activism and advocacy; and Musical lineages and strengths. Intergenerational musical practices in diverse First Nations families may provide protective cultural, social, economic, educative, and professional determinants of health. The study indicates that more research and new theory may unlock the potential of First Nations musical activities as protective and agentic cultural practices in our families and communities.

Music as a determinant of health among First Nations people in Australia: A scoping narrative review

ISSUE ADDRESSED

While social determinants frameworks are still popular in research about First Nations health in Australia, a growing body of research prefers cultural determinants of health models. Cultural determinants models provide a holistic, strength-based framework to explain connections between health and contextual factors, including the potential role of music and its impact on social and emotional well-being. Given the growing international recognition of links between music, health, and wellbeing through bodies such as the World Health Organisation, this article examines whether and how music practices are acknowledged in First Nations determinants of health literature.

METHODS

We conducted a scoping narrative review of literature from five databases: Scopus, PsycInfo, CINAHL, PubMed and ProQuest Central. The search returned 60 articles published since 2017, which we analysed in NVivo for common themes.

RESULTS

Music was only explicitly identified as a determinant of health in two studies. Yet, participants in five studies identified music and song as directly impacting their social and emotional well-being. When we broadened our frame of analysis to include other forms of expressive cultural practice, one quarter of included studies empirically acknowledged the role of expressive cultural practice for social and emotional well-being.

CONCLUSION

While many recent studies identify the impact of First Nations' expressive practices broadly, they miss important features of First Nations music as a potentially unique cultural, social, political and ecological determinant of health. SO WHAT?: There is an opportunity for future research and health determinant modelling to explicitly examine the role of First Nations music and other creative practices for social and emotional well-being.

Healing the Past by Nurturing the Future: trauma-aware, healing-informed care to improve support for Aboriginal and Torres Strait Islander families - implementation and evaluation study protocol

INTRODUCTION

Complex trauma can have serious impacts on the health and well-being of Aboriginal and Torres Strait Islander families. The perinatal period represents a 'critical window' for recovery and transforming cycles of trauma into cycles of healing. The Healing the Past by Nurturing the Future (HPNF) project aims to implement and evaluate a programme of strategies to improve support for Aboriginal and Torres Strait islander families experiencing complex trauma.

METHOD

The HPNF programme was codesigned over 4 years to improve awareness, support, recognition and assessment of trauma. Components include (1) a trauma-aware, healing-informed training and resource package for service providers; (2) trauma-awareness resources for parents; (3) organisational readiness assessment; (4) a database for parents and service providers to identify accessible and appropriate additional support and (5) piloting safe recognition and assessment processes. The programme will be implemented in a large rural health service in Victoria, Australia, over 12 months. Evaluation using a mixed-methods approach will assess feasibility, acceptability, cost, effectiveness and sustainability. This will include service user and provider interviews; service usage and cost auditing; and an administrative linked data study of parent and infant outcomes.

ANALYSIS

Qualitative data will be analysed using reflexive thematic analysis. Quantitative and service usage outcomes will be described as counts and proportions. Evaluation of health outcomes will use interrupted time series analyses. Triangulation of data will be conducted and mapped to the Consolidated Framework for Implementation Research and Reach, Effectiveness, Adoption, Implementation and Maintenance frameworks to understand factors influencing feasibility, acceptability, effectiveness, cost and sustainability.

ETHICS AND DISSEMINATION

Approval granted from St Vincent's Melbourne Ethics Committee (approval no. 239/22). Data will be disseminated according to the strategy outlined in the codesign study protocol, in-line with the National Health and Medical Research Council Aboriginal and Torres Strait Islander Research Excellence criteria.

Indigenous approaches to perinatal mental health: a systematic review with critical interpretive synthesis

Indigenous mothers and birthing parents experience significant inequities during the perinatal period, with mental health distress causing adverse outcomes for mothers/birthing parents and their infants. Limited literature is available to inform our understanding of solutions to these issues, with research primarily focusing on inequities. Our aim was to conduct a systematic review of Indigenous approaches to treatment of perinatal mental health illness. Following the PRISMA guidelines for systematic literature reviews, an electronic search of CINAHL, Medline, PubMed, Embase, APA PsycInfo, OVID Nursing, Scopus, Web of Science, and Google Scholar databases was conducted in January and February 2022 and repeated in June 2022. Twenty-seven studies were included in the final review. A critical interpretive synthesis informed our approach to the systematic review. The work of (Yamane and Helm J Prev 43:167-190, 2022) was drawn upon to differentiate studies and place within a cultural continuum framework. Across the 27 studies, the majority of participants were healthcare workers and other staff. Mothers, birthing parents, and their families were represented in small numbers. Outcomes of interest included a reduction in symptoms, a reduction in high-risk behaviours, and parental engagement/attachment of mothers/birthing parents with their babies. Interventions infrequently reported significant reductions in mental health symptoms, and many included studies focused on qualitative assessments of intervention acceptability or utility. Many studies focused on describing approaches to perinatal mental health distress or considered the perspectives and priorities of families and healthcare workers. More research and evaluation of Indigenous interventions for perinatal mental health illness is required. Future research should be designed to privilege the voices, perspectives, and experiences of Indigenous mothers, birthing parents, and their families. Researchers should ensure that any future studies should arise from the priorities of the Indigenous population being studied and be Indigenous-led and designed.

Corporal punishment of children in Australia: The evidence-based case for legislative reform

OBJECTIVE

Across all of Australia's states and territories, it is legal for a parent or carer to hit their child. In this paper, we outline the legal context for corporal punishment in Australia and the argument for its reform.

METHODS

We review the laws that allow corporal punishment, the international agreements on children's rights, the evidence on the effects of corporal punishment, and outcomes of legislative reform in countries that have changed their laws to prohibit corporal punishment.

RESULTS

Legislative reform typically precedes attitude changes and reductions in the use of corporal punishment. Countries with the most ideal outcomes have instigated public health campaigns educating the population about law reform while also providing access to alternative non-violent discipline strategies.

CONCLUSIONS

Extensive evidence exists demonstrating the adverse effects of corporal punishment. When countries change legislation, educate the public about these effects, and provide alternative strategies for parents, rates of corporal punishment decrease.

IMPLICATIONS FOR PUBLIC HEALTH

We recommend law reform in Australia to prohibit corporal punishment, a public health campaign to increase awareness of corporal punishment and its effects, provision of access for parents to alternative evidence-based strategies to assist in parenting, and a national parenting survey to monitor outcomes.

Aspects of Wellbeing for Indigenous Youth in CANZUS Countries: A Systematic Review

Indigenous children and young people (hereafter youth) across CANZUS nations embody a rich diversity of cultures and traditions. Despite the immense challenges facing these youth, many harness cultural and personal strengths to protect and promote their wellbeing. To support this for all youth, it is critical to understand what contributes to their wellbeing. This review aims to identify components contributing to wellbeing for Indigenous youth in CANZUS nations. Five databases were searched from inception to August 2022. Papers were eligible if they: focused on Indigenous youth in CANZUS nations; included views of youth or proxies; and focused on at least one aspect of wellbeing. We identified 105 articles for inclusion (Canada n = 42, Australia n = 27, Aotearoa New Zealand n = 8, USA n = 28) and our analysis revealed a range of thematic areas within each nation that impact wellbeing for Indigenous youth. Findings highlight the unique challenges facing Indigenous youth, as well as their immense capacity to harness cultural and personal strengths to navigate into an uncertain future. The commonalities of Indigenous youth wellbeing across these nations provide valuable insights into how information and approaches can be shared across borders to the benefit of all Indigenous youth and future generations.