Indigenous Clients Research Articles

Decolonise This Space

The 15 th April 2016 marked the 25-year anniversary since the Royal Commission into Aboriginal Deaths in Custody (RCIADIC) in Australia handed down its Final Report. The report signified a landmark in the relationships between Indigenous Australians and the post-colonial State and Federal governments. Established by the Hawke Labor Government in 1987, the Commission examined 99 Indigenous deaths. Most significant was the finding that the deaths were due to the combination of police and prisons failing their duty of care, and the high numbers of Indigenous people being arrested and incarcerated.
 In the wake of the RCIADIC, cross-cultural sessions and cultural competency workshops have become ubiquitous for public servants, therapists, and legal and welfare employees, in attempts to bridge gaps in cultural knowledge between agents of the welfare state and Indigenous clients. Using Indigenous Knowledges theory, this chapter assesses how cultural misalignments between Indigenous clients and those who work with them in the name of therapies designed to improve Indigenous lives, dominate cross-cultural interactions. In so doing the questions are posed: how do good intentions become part of the discourses and practices of on-going colonialism for Indigenous Australians, and what can be done to change the balance of power in favour of therapies of relevance to Indigenous people?

Seeds of Decolonial Practice: An Autoethnographic Study of Settlers Working in Indigenous Communities

This autoethnographic study explores the process of cultivating a culturally safe and critically reflexive counselling practice in Indigenous contexts, an orientation that is imperative for settlers to work ethically with Indigenous clients, families, and communities. Any other approach risks recreating experiences of colonial violence in subtle or overt ways and eroding the therapeutic relationship. Research data generation included reflexive writing and interactive interviews with one female counselling therapists (aged 28) who, as a settler, has worked in multiple Indigenous communities. The analysis involved triangulation and using critical reflection and an understanding of cultural safety to interpret and learn from the data. Becoming unsettled is an emotionally evocative experience, but reflecting critically on discomforting emotions, reactions, and experiences is an essential component of personal transformation. Settlers cannot engage theoretically in decolonizing but rather must experience it first as individuals and then as ethically responsible citizens willing to challenge dominant cultural narratives and to help foster a more just society.

Reflecting on culturally responsive goal achievement with indigenous clients using the Australian Therapy Outcome Measure for Indigenous Clients (ATOMIC)

Appropriate evaluation of health services for First Australians demands culturally responsive goal setting tools that can be used by inter-professional teams. The Australian Therapy Outcome Measure for Indigenous Clients (ATOMIC) is a purpose-designed tool for measuring therapy outcomes for First Australians. The aim of this study was to establish the clinical utility of the ATOMIC by investigating its alignment with the practice perspectives of an inter-professional First Australian health service. Using action research cycles, 12 occupational therapists and 8 speech pathologists applied two successive versions of the ATOMIC in practice. Focus group feedback after use of the first version (ATOMICv1) prompted adaptations to the tool (ATOMICv2). Therapists participated in four focus groups, two after using ATOMICv1 and two after using ATOMICv2. Focus group transcripts were analysed inductively using a qualitative description approach. Challenges in setting SMART goals early in therapy and defining specific measurement increments in ATOMICv1 led to therapists favouring skill-based goals that were easier to measure rather than broader daily life goals, thereby impacting on occupation- and client-centred practice. ATOMICv2 allowed goal setting at any point in therapy, evaluated goals using visual analogue scales, and gathered evidence for rating goal achievement throughout the therapy process. Therapists found the ATOMICv2 to be a culturally responsive tool that aligned with practice perspectives by foregrounding relationship building, facilitating clinical reasoning, documenting daily life changes, and providing integrated inter-professional care. The ATOMIC demonstrated good clinical utility in an inter-professional service for First Australian children. It aligned with a culturally responsive practice perspective and captured goal achievement in daily life contexts. Further research is needed to gain client perspectives across the lifespan and to investigate its application by other health professions.

A systematic review of evidence-based psychological interventions and Aboriginal and Torres Strait Islander people

ABSTRACT Objective Limited empirical literature exists examining the application of evidenced-based psychotherapies when working with Aboriginal and Torres Strait Islander people. Further, Australian Aboriginal and Torres Strait Islander people’s view of Social and Emotional Wellbeing (SEWB) differs to Western ideologies of mental health. In the present study, a qualitative systematic review explored evidenced-based psychological therapies with Indigenous clients. Method A systematic review was conducted using the PRISMA framework. A total of 12 articles that met criteria for inclusion in the review were extracted through hand- and database searching. Therapies identified in the articles included Narrative Therapy (NT), Cognitive-Behaviour Therapy (CBT), Acceptance-based Therapies (ACT) and Multisystemic Therapy (MST). Results CBT was the most commonly reported therapy in the review. Three articles, rated lower in quality, also identified NT. Although limited in quantity, acceptance-based and strength-based therapies and MST were also identified as having cross-cultural applications. Conclusions While, CBT, ACT and MST have been used when working at the cultural interface with Indigenous people, further empirical evidence with outcome data is required. Such evidence is required to assess acceptability and suitability of such psychotherapies and for clinicians to provide culturally responsive practice when working with Indigenous people.

Preliminary Recommendations for Assessing Adverse Childhood Experiences in Clinical Practice With Indigenous Clients

Preliminary Recommendations for Assessing Adverse Childhood Experiences in Clinical Practice With Indigenous Clients

Evaluation of the B.strong Queensland Indigenous Health Worker Brief Intervention Training Program for Multiple Health Risk Behaviours.

Queensland’s B.strong brief intervention training program was a complex intervention developed for Aboriginal and Torres Strait Islander health workers to assist clients address multiple health risks of smoking, poor nutrition and physical inactivity. This study evaluates program effectiveness by applying the Kirkpatrick four-level evaluation model: (1) Reaction, participants’ satisfaction; (2) Learning, changes in participants’ knowledge, confidence, attitudes, skills and usual practice; (3) Behaviour, application of learning to practice; and (4) Results, outcomes resulting from training. A retrospective analysis was conducted on data for respondents completing pre-training, post-workshop and follow-up surveys. Changes in domains such as training participant knowledge, confidence, attitudes, and practices between survey times were assessed using paired-samples t-tests. From 2017–2019, B.strong trained 1150 health professionals, reaching targets for workshop and online training. Findings showed statistically significant improvements from baseline to follow-up in: participants’ knowledge, confidence, and some attitudes to conducting brief interventions in each domain of smoking cessation, nutrition and physical activity; and in the frequency of participants providing client brief interventions in each of the three domains. There was a statistically significant improvement in frequency of participants providing brief interventions for multiple health behaviours at the same time from pre-workshop to follow-up. Indigenous Queenslander telephone counselling referrals for smoking cessation increased during the program period. B.strong improved practitioners’ capacity to deliver brief interventions addressing multiple health risks with Indigenous clients.

Indigenous Psychotherapy, COVID-19, and the Online Space: Yarning About Challenges and Opportunities

This article is a transcript of a yarn, or, kōrero, about Indigenous psychotherapy in Australia and Aotearoa New Zealand during the period of COVID-19. The authors discuss the challenges and opportunities presented to Indigenous psychotherapists and clients following the shift to online therapy as a result of government restrictions on social contact and travel.

The The Violence of Colonization and the Importance of Decolonizing Therapeutic Relationship: The Role of Helper in Centring Indigenous Wisdom


 
 
 Engaging existing literature and current mainstream frontline health and mental health practice, this article expands research on the impact of colonization and mainstream mental health practices on Indigenous clients. Through this process, it creates new ground on which decolonizing therapeutic responses to ongoing attempted genocide are introduced, described, and developed. I identify the brutality of historical and contemporary colonization as one of the major influences in undermining Indigenous clients’ health and wellbeing—a perspective that decentres and resists individualistic pathologizing that is the focal point of mainstream psychiatric diagnoses and treatment. I also illustrate the negative impacts of psychiatric assessment for Indigenous clients and demonstrate how mainstream mental health practices, in not acknowledging colonization as the context for Indigenous clients’ suffering, are implicated in ongoing enactments of colonial oppression. The mainstream assessment of Indigenous clients’ suicidality as an individualized mental health disorder is also problematized. I conclude by centring Indigenous ways of knowing and culture in the promotion of health and wellbeing for Indigenous clients.
 
 

Arts-Based Compassion Skills Training (ABCST): Channelling Compassion Focused Therapy Through Visual Arts for Australia's Indigenous Peoples.

The last 20 years have seen the development of a new form of therapy, compassion focused therapy (CFT). Although CFT has a growing evidence base, there have been few studies of CFT outside of an Anglo-European cultural context. In this paper, we ask: Might a CFT-based approach be of value for Indigenous Australians? If so, what kind of cultural adaptations might be needed? We report the findings from a pilot study of an arts-based compassion skills training (ABCST) group, in which usual CFT group processes were significantly adapted to meet the needs of Indigenous Australians. At face value, CFT appeared to be a promising approach to enhancing the social and emotional wellbeing of Australia’s Indigenous peoples. However, despite initial consultations with Indigenous health professionals, the first attempts to offer a more conventional group-based CFT to Indigenous clients were largely unsuccessful. Following a review and advice from two Indigenous clients, we combined elements of CFT with visual arts to develop a new approach, “arts-based compassion skills training” (ABCST). This paper reports an evaluation of this pilot ABCST group. The group had 6 × 4 h sessions of ABCST, facilitated by two psychologists (1 Indigenous, 1 non-Indigenous) and two artists (1 Indigenous, 1 non-Indigenous). There were 10 participants, who attended between 2 and 6 sessions: five were clients, five were health professionals. Between 1 and 3 months later, six of the participants (2 clients, 4 health professionals) were interviewed. Qualitative analysis of interview data identified that two key processes—creating a positive group atmosphere and channeling compassion skills training through the medium of visual arts—led to four positive outcomes for participants: planting the seeds of new understandings, embodying the skills of compassion, strengthening relationships with others, and evolving a more self-compassionate relationship. We suggest that the preliminary results are sufficiently encouraging to warrant further development of ABCST in Indigenous communities.

Resisting the “Attachment Disruption” of Colonisation Through Decolonising Therapeutic Praxis: Finding Our Way Back to the Homelands Within

This article provides a theoretical framework and practical applications for an Indigenous-centred decolonising therapeutic practice. I define and critique the concept of the “attachment disruption” of colonisation and its impacts on Indigenous Peoples and, specifically, Indigenous clients. I discern and differentiate colonial forms of power, which are based in domination and violence, from Indigenous forms of power rooted in cultural traditions and connections to ancestral territories. Case examples illustrate ways of working therapeutically with the “attachment disruption” of colonisation as it concerns “residential school trauma,” “lateral violence,” and “addictions”. The importance of externalising the impacts of colonial violence and centring Indigenous cultural and relational imprints is the foundation of this decolonising therapeutic praxis.

Conceptualising cultural safety at an Indigenous-focused midwifery practice in Toronto, Canada: qualitative interviews with Indigenous and non-Indigenous clients.

ObjectiveCultural safety is an Indigenous concept that can improve how healthcare services are delivered to both Indigenous and non-Indigenous peoples in Canada. This study explored how Indigenous and non-Indigenous clients at an urban, Indigenous-focused midwifery practice in Toronto, Canada (Seventh Generation Midwives Toronto, SGMT) conceptualised and experienced culturally safe care.Design and settingInterviews were conducted with former clients of SGMT as a part of a larger evaluation of the practice. Participants were purposefully recruited. Interviews were transcribed and analysed thematically using an iterative, consensus-based approach and a critical, naturalistic, and decolonising lens.ParticipantsSaturation was reached after 20 interviews (n=9 Indigenous participants, n=11 non-Indigenous participants).ResultsThree domains of cultural safety emerged. Each domain included several themes: Relationships and Communication (respect and support for choices; personalised and continuous relationships with midwives; and being different from past experiences); Sharing Knowledge and Practice (feeling informed about the basics of pregnancy, birth, and the postpartum period; and having access to Indigenous knowledge and protocols), and Culturally Safe Spaces (feeling at home in practice; and having relationships interconnected with the physical space). While some ideas were shared across groups, the distinctions between the Indigenous and non-Indigenous participants were prominent.ConclusionThe Indigenous participants conceptualised cultural safety in ways that highlight the survival and resurgence of Indigenous values, understandings, and approaches in cities like Toronto, and affirm the need for Indigenous midwives. The non-Indigenous participants conceptualised cultural safety with both congruence, illuminating Black-Indigenous community solidarities in cultural safety, and divergence, demonstrating the potential of Indigenous spaces and Indigenous-focused midwifery care to also benefit midwifery clients of white European descent. We hope that the positive impacts documented here motivate evaluators and healthcare providers to work towards a future where ‘cultural safety’ becomes a standard of care.

Real gains: development of a tool to measure outcomes for urban First Australian children accessing culturally responsive interprofessional therapy

ABSTRACT Healthcare services are accountable to their clients, communities, governments and funding sources to clearly demonstrate the effectiveness of interventions. A First Australian children’s therapy service delivering culturally responsive, interprofessional collaborative practice aimed to evaluate their service. However, this process was constrained by available outcome measures which lacked the flexibility necessary for meaningful use within the dynamic and relational nature of their service delivery. This paper outlines an action research process in three cycles which was used to develop the Australian Therapies Outcome Measure for Indigenous Clients (ATOMIC) with the aim of evaluating therapy outcomes for urban First Australian children engaged in culturally responsive interprofessional therapy. Interrater reliability values of 0.995 and 0.982 were established for ATOMIC pre- and post-therapy measures, respectively, during a pilot phase involving 16 participants. Participants in the main study were 80 First Australian children aged two to 16 years who attended between two and nine interprofessional therapy sessions with occupational therapists and speech pathologists. Pre- and post-therapy ATOMIC scores confirmed progress on pre-determined functional goals across a range of skill domains. Outcomes of this study demonstrated that real gains are being made in urban First Australian children’s lives following interprofessional collaborative service provision.

Situating Race in Cultural Competency Training: A Site of Self-Revelation

Indigenous cross-cultural training has been around since the 1980s. It is often seen as a way to increase the skills and competency of staff engaged in providing service to Indigenous clients and customers, teaching Indigenous students within universities and schools, or working with Indigenous communities (Fredericks and Bargallie, “Indigenous”; “Which Way”). In this article we demonstrate how such training often exposes power, whiteness, and concepts of an Indigenous “other”. We highlight how cross-cultural training programs can potentially provide a setting in which non-Indigenous participants can develop a deeper realisation of how their understandings of the “other” are formed and enacted within a “white” social setting. Revealing whiteness as a racial construct enables people to see race, and “know what racism is, what it is not and what it does” (Bargallie, 262). Training participants can use such revelations to develop their racial literacy and anti-racist praxis (Bargallie), which when implemented have the capacity to transform inequitable power differentials in their work with Indigenous peoples and organisations.

Use and uptake of web-based therapeutic interventions amongst Indigenous populations in Australia, New Zealand, the United States of America and Canada: a scoping review

BackgroundBarriers to receiving optimal healthcare exist for Indigenous populations globally for a range of reasons. To overcome such barriers and enable greater access to basic and specialist care, developments in information and communication technologies are being applied. The focus of this scoping review is on web-based therapeutic interventions (WBTI) that aim to provide guidance, support and treatment for health problems.ObjectivesThis review identifies and describes international scientific evidence on WBTI used by Indigenous peoples in Australia, New Zealand, Canada and USA for managing and treating a broad range of health conditions.Eligibility criteriaStudies assessing WBTI designed for Indigenous peoples in Australia, Canada, USA and New Zealand, that were published in English, in peer-reviewed literature, from 2006 to 2018 (inclusive), were considered for inclusion in the review. Studies were considered if more than 50% of participants were Indigenous, or if results were reported separately for Indigenous participants.Sources of evidenceFollowing a four-step search strategy in consultation with a research librarian, 12 databases were searched with a view to finding both published and unpublished studies.Charting methodsData was extracted, synthesised and reported under four main conceptual categories: (1) types of WBTI used, (2) community uptake of WBTI, (3) factors that impact on uptake and (4) conclusions and recommendations for practice.ResultsA total of 31 studies met the inclusion criteria. The WBTI used were interactive websites, screening and assessment tools, management and monitoring tools, gamified avatar-based psychological therapy and decision support tools. Other sources reported the use of mobile apps, multimedia messaging or a mixture of intervention tools. Most sources reported moderate uptake and improved health outcomes for Indigenous people. Suggestions to improve uptake included as follows: tailoring content and presentation formats to be culturally relevant and appropriate, customisable and easy to use.ConclusionsCulturally appropriate, evidence-based WBTI have the potential to improve health, overcome treatment barriers and reduce inequalities for Indigenous communities. Access to WBTI, alongside appropriate training, allows health care workers to better support their Indigenous clients. Developing WBTI in partnership with Indigenous communities ensures that these interventions are accepted and promoted by the communities.

An Indigenous American Conceptualization of Substance Abuse and Its Treatment

ABSTRACT Alcohol misuse has persisted in Indian country for generations. These disparities persist despite recent advances in services that often promote some combination of western-oriented conceptualizations of treatment with traditional healing and cultural practices. The intractability of alcohol and drug problems in many Indigenous communities suggests that current expressions of treatment are not sufficient to address substance misuse in these communities and effectively prepare clients for the post-treatment experiences of recovery. The focus of this paper is to generate hypotheses about what may be missing from the treatment today to improve treatment outcomes for Indigenous clients, and then propose ways for how treatment may be transformed from its current mostly western-oriented perspective to foundationally align with an Indigenous American worldview concerning well-being and health. Advancing treatment for American Indians and Alaska Natives includes consideration for how to address the consequences of colonialism that persist in ways that systematically harm the well-being and health of clients, how to align treatment models with Indigenous beliefs concerning an interdependent communalistic existence, and how to transform treatment to a holistic healing model that addresses alcohol and other substance misuse in the context of relationships.

Factors Impacting on Development and Implementation of Training Programs for Health Professionals to Deliver Brief Interventions, with a Focus on Programs Developed for Indigenous Clients: A Literature Review.

This paper reviews the literature on evaluations of brief intervention training programs for health professionals which address one or more lifestyle factors of chronic disease to identify factors impacting on development and implementation of programs. A search was conducted of the literature evaluating brief intervention training programs from 2000–2019 in the databases: Medline, CINAHL, Psychinfo, Academic Premier, Science Direct, Ovid (Including EMBASE and Healthstar), Web of Science and Informit. The content analysis and data extraction were aligned to the domains in the Consolidated Framework for Implementation Research (CFIR) to assist in the narrative synthesis. The search identified eight evaluations of programs targeting multiple risk factors, and 17 targeting single risk factors. The behavioural risk factor most commonly addressed was smoking, followed by alcohol and drug use. Programs consisted of face-to-face workshops and/or online or distance learning methods. Facilitators included availability of sustainable funding, adapting the program to suit the organisation’s structural characteristics and adoption of the intervention into routine client care. For Indigenous programs, the use of culturally appropriate images and language, consultation with Indigenous communities, and development of resources specific to the communities targeted were important considerations.

Evaluation of a home medicines review program at an Aboriginal Medical Service in the Northern Territory

AbstractBackgroundThe home medicines review (HMR) program aims to achieve quality use of medicines. In 2009, the model of HMR provision at Danila Dilba Health Service (DDHS) in Darwin was adjusted to include the services of a dedicated consultant pharmacist and an expanded role for an Aboriginal Health Worker (AHW) in the HMR process.AimThis study evaluated a unique program providing HMRs to Indigenous clients of DDHS.MethodsA retrospective review of HMRs was conducted for clients at DDHS between December 2009 and December 2010 to determine relevant time frames between HMR activities, reasons for referral, issues identified by the pharmacist, education provided, recommendations and uptake of recommendations. Awareness and attitudes to the program among general practitioners (GPs), AHWs, and pharmacists were also evaluated using a self‐administered questionnaire.ResultsSixty‐four HMRs were conducted. Thirty‐nine (61%) follow‐up appointments were documented and 30 Medicare claims made. The average time between referral and follow‐up was 66 days. For most HMRs, more than one reason for referral was identified. In all, 348 issues were identified, 256 educational activities undertaken and 379 recommendations made. Fifty‐two per cent of recommendations were implemented. Attitudes to the HMR program were positive. Common themes included the importance of cultural safety, particularly the inclusion of an AHW in HMR activities and difficulties associated with the follow‐up of patients.ConclusionUptake of recommendations for improvements in the quality of documentation, GP follow‐up and the referral system will enhance the HMR service at DDHS.

Establishing and sustaining a new interprofessional allied health student placement

Meeting the increasing demand for allied health (AH) clinical placements is challenging (McBride, Fitzgerald, Morrison, & Hulcombe, 2015), as is providing experience for AH students in authentic interprofessional practice (Copley et al., 2007). Furthermore, limited opportunities exist to develop AH students’ skills in working effectively with Indigenous clients (Hill, Nelson, Copley, Quinlan, & White, 2017), due to the low number of health professionals practising in Indigenous communities (Nelson, Shannon, & Carson, 2013; Whitford, Taylor, & Thomas, 2013). The need for paediatric AH services for developmentally-vulnerable children in the Inala Indigenous community was identified in 2014 by the Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care’s (CoE) visiting paediatrician. Children in the region are developmentally vulnerable in all domains, particularly in language and communication, where the average percentage of vulnerable children is twice that in the Queensland population and more than double the national figures (Commonwealth of Australia, 2015). In 2014, the demand for the local mainstream public child development service exceeded capacity, leading to lengthy waiting lists. With few nearby private AH practices offering paediatric services, many Inala paediatric patients were unable to access comprehensive AH assessments and care. At the time, no paediatric AH clinical services or training opportunities existed within the CoE.

Group antenatal care for Aboriginal and Torres Strait Islander women: An acceptability study

BackgroundGood quality antenatal care is essential to improve the perinatal outcomes of Aboriginal and Torres Strait Islander women in Australia. Group antenatal care (GAC) is an innovative model which places clinical assessment, education and social support into a group setting. Previous studies have found GAC to be associated with improved perinatal outcomes, particularly for vulnerable populations, and high satisfaction levels among group members. No implementations of GAC, or evaluations of its acceptability, for an Indigenous population in Australia have been previously conducted. AimTo explore the perceptions of a group of Indigenous health workers (n=5) in a health service in Far North Queensland, Australia, towards the prospective acceptability of GAC as an additional choice of model of care for their Indigenous women clients. MethodsThis qualitative acceptability study employed a descriptive/exploratory methodology. Data collection was by semi structured interview. Data analysis was guided by a theoretical framework of acceptability and conducted following a process of iterative categorisation. FindingsNo overall precluding factors were identified to render the model unacceptable for Indigenous women in this locality. Some features of the model would not suit all women. Indigenous health workers were interested in increased involvement with antenatal care and participation in a GAC model. ConclusionA foundation of acceptability exists upon which the implementation of a GAC model could offer benefits to Indigenous women in this health service. The positive response of the Indigenous health workers to the concept of GAC endorsed the potential of this model to contribute to the provision of culturally appropriate and effective antenatal care within mainstream services.

“Big Sister” Wisdom: How might non-Indigenous speech-language pathologists genuinely, and effectively, engage with Indigenous Australia?

Speech Pathology Australia, through its landmark project for the profession, “Speech Pathology 2030 - making futures happen” (SP 2030), calls for speech-language pathologists to “respond (to presenting clients) in ways that respect each person’s culture, language, life experiences, and preferences” (Speech Pathology Australia, 2016, p. viii). Such engagement, it holds, is central to successful practice. Meeting the needs of Aboriginal and/or Torres Strait Islander (Indigenous) clients and communities, however, requires a skilled response to client wholeness, to their indissoluble, and unique, immersion in their: indigeneity; lived cultural experience; and the social, geographical, economic and political realities that surround them. Equally, the achievement of a truly-effective engagement, one able to engender desired outcomes, is also dependent on the challenging achievement of culturally-safe practice. Given that the relevant literature is, historically, based on a privileging of western purviews, this article asserts the validity of incorporating (pan-)Indigenous epistemologies and perspectives. As well as the Indigenous health and cultural safety literature, then, this article draws on particular Indigenous professional experience as a locus of good-practice evidence, one capable of contributing additional insights to best address the question: “How might Non-Indigenous speech-language pathologists really engage, effectively, with Indigenous Australia?”. It introduces a guiding rubric, “Meet People in their Own Reality”, as a tool with which to examine how engagement, in the service of more-effective practice, can be optimised in four exemplar domains of SP 2030.