Meaningful Involvement Research Articles

Is inclusive more elusive? An impact assessment analysis on designating environmental justice communities in the US

As a policy objective, environmental justice (EJ) aims to promote the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to environmental laws and regulations. At the current stage of EJ policy, federal and state regulators have attempted to prioritize populations for receiving federal and state grants and other benefits or to incentivize private investment. Using mapping and screening tools, policymakers have identified communities as “environmental justice communities”, “disadvantaged”, or “overburdened” based on selected social, economic, environmental, and health indicators. The overarching goal of the study is to understand the impacts of the environmental justice policy at the federal and state level, the extent to which the designation of EJ communities is a representative illustration of the populations experiencing environmental burdens, and their link to systemic racism, i.e., redlining.A methodology for assessing the implications of EJ definitions is proposed through a data-driven approach using socioeconomic and environmental indicators and examining previous land use discriminatory decision-making. The findings of the study have direct implications on the distribution of federal and state resources towards underserved and overburdened communities, but also in the methodologies utilized for environmental impact assessments (EIAs). The approach is demonstrated as a showcase study for the State of Connecticut, but the proposed methodology is of significance for future research on environmental impact assessments and policymakers nationwide. Our analysis points to four main key conclusions: a) a sole indicator to designate EJ communities, although it might seem more inclusive, is not representative of the disproportionate burdens communities are experiencing, b) race is a factor that cannot be neglected to identify injustices as is the parameter most correlated with environmental burdens, c) sophisticated tools that combine both social and environmental criteria in the designation provide a more accurate description of the environmentally challenged populations, and d) formerly redlined areas are highly associated with present inequalities, which indicates the value of the historical context in the identification of today's EJ communities, and the value of integrating redlining maps as a screening factor to designate EJ populations.

Young people’s involvement in migration research – opportunities for (re)shaping research priorities and practices

Young people are frequently involved in research about their own lives and their contributions to the shaping of research priorities increasingly valued. Recently, young people’s participation in research has been extended to advisory group roles including supporting the planning, design and delivery of projects. Such involvement marks an important shift towards valuing young people’s views on how research should be conducted and is often required as part of research funding processes. In this article, we explore the value and contribution of young people’s involvement in a research project focusing on the livelihoods of young migrants in Ghana and the related possibilities for empowerment. Our collaborations remind us of the pitfalls of working from an adult centric lens, and how this may inadvertently contribute to the reproduction of adult ways of understanding young lives. Here, our project Young Person Advisory Group members share their experiences of being youth advisors – highlighting both challenges and opportunities for young people’s meaningful involvement in research.

Violence, responsibility and best interests: children rights in Elizabeth Harrower’s A Few Days in the Country and Other Stories

Abstract In her short story collection of A Few Days in the Country and Other Stories (2015), contemporary Australian novelist Elizabeth Harrower skillfully portrays a cohort of children who have come of age in diverse fractured family settings since the 1960s. This article delves into the realm of child welfare and best interests in Australia, elucidating the intricate web of family laws that govern these principles. It casts a revealing light on the myriad challenges children confront in contexts marked by family violence, parental separation, and child custody and adoption. This analysis exposes the unfortunate reality where children’s rights are frequently subverted by guardians, effectively preventing their meaningful involvement in familial decision-making. In instances of family violence, children are relegated to the role of silent victims, rendered voiceless by their inability to resist. During divorce proceedings, children are relegated to the sidelines, unable to actively participate in the decision-making process, resulting in the neglect or outright harm of their best interests. Children who find themselves in foster care or adoption situations often respond with unprecedented rebellion, asserting their independence and self-determination beneath the facade of silent victimhood. Tragically, their fundamental rights consistently remain inadequately protected. By undertaking a critical examination of the dynamic between adults and children within the framework of family law and by juxtaposing it with the contemporary portrayal of marginalized children in Australia, as exemplified in Harrower’s works, this article offers multifaceted insights that can guide efforts to safeguard children’s rights and enhance the development and implementation of legislation pertaining to children.

Community Health Impacts From Natural Gas Pipeline Compressor Stations.

Compressor stations maintain pressure along natural gas pipelines to sustain gas flow. Unfortunately, they present human health concerns as they release chemical pollutants into the air, sometimes at levels higher than national air quality standards. Further, compressor stations are often placed in rural areas with higher levels of poverty and/or minority populations, contributing to environmental justice concerns. In this paper we investigate what chemical pollutants are emitted by compressor stations, the impacts of emitted pollutants on human health, and local community impacts. Based on the information gained from these examinations, we provide the following policy recommendations with the goal of minimizing harm to those affected by natural gas compressor stations: the Environmental Protection Agency (EPA) and relevant state agencies must increase air quality monitoring and data transparency; the EPA should direct more resources to monitoring programs specifically at compressor stations; the EPA should provide free indoor air quality monitoring to homes near compressor stations; the EPA needs to adjust its National Ambient Air Quality Standards to better protect communities and assess cumulative impacts; and decision-makers at all levels must pursue meaningful involvement from potentially affected communities. We find there is substantial evidence of negative impacts to strongly support these recommendations.

Keeping isolation and loneliness at bay: how community centres can support belonging as we age

ABSTRACT Experiencing a sense of belonging is helpful for warding off loneliness and social isolation. With social isolation and loneliness among older adults increasingly recognized as a societal concern, it is important to understand the conditions that enhance belonging. The purpose of this paper is to share findings of a study that examined the role of a community centre in contributing to belonging for older adults. Forty-nine community centre members participated in a focus group or individual interview that explored their personal meanings and experiences of belonging. Findings suggest the community centre supports belonging by creating a welcoming environment, offering opportunities for meaningful involvement, and offering leisure programmes and services that meet diverse needs and interests. This paper responds to calls for research highlighting the benefits of community centres for older adults by suggesting their prospective benefit lies in their efforts to become spaces of belonging.

“Nothing About Us Without Us”: Analyzing the Potential Contributions of Lived Experience to Penological Pedagogy

This paper explores the necessity and considerations of integrating Lived Experience Criminology (LEC) into penological pedagogy. It critically analyses the underutilized, yet transformative, potential of lived experience of the CJS to enrich academic curricula and further inform student understanding, particularly in Australia. Drawing on initiatives such as the Inside-Out Prison Exchange Program, Learning Together, and Walls to Bridges, the paper highlights how such programs operationalize LEC’s dimensions—particularly Persistent Experiential Narratives (PEN) and Common Experiential Narratives (CEN)—to build criminological knowledge. However, the need for cautious and ethical expansion of these programs is emphasized, considering potential objectification of people with lived experience of the CJS. The paper advocates for greater inclusion of lived experience perspectives in criminology curricula, underscoring the value they could bring to the preparation of future practitioners, the design of robust research, and the advancement of penological epistemology. Additionally, it stresses the importance of context, locality, and specialization within LEC, and the ethical considerations inherent to these pedagogical approaches. The paper concludes by calling for a stronger commitment from academia towards inclusion and empowerment of individuals with lived experience of the CJS, echoing the maxim “Nothing About Us Without Us” from the disability rights movement. The paper posits that significant strides in the CJS and academic discipline are achievable only through meaningful and sustained involvement of these individuals.

Regulating Online Hate Speech through the Prism of Human Rights Law: The Potential of Localised Content Moderation

Abstract This article explores whether international human rights standards can provide insights into the following questions: who can and should define what constitutes ‘hate speech’ for online moderation, and how can hate speech be detected and moderated on social media platforms? Regarding who should moderate hateful content, the article underscores the responsibility of social media companies, in reference to international human rights law and principles on business and human rights. This paper advocates for a multistakeholder approach where companies work in partnership with and under the monitoring of state actors, civil society and other relevant stakeholders. Given the complexity of what constitutes hate speech, the article proposes the localisation of terms of service and guidelines of social media companies. This approach, in line with human rights standards, enables the meaningful involvement of local experts and civil society groups in formulating, implementing and monitoring online community rules. Addressing the question of how social media companies can detect and moderate hate speech, the article argues that a globally standardised approach reliant on AI content moderation is limited in detecting contextual nuances of hate speech. Drawing from international human rights tools like the Rabat Plan of Action, the article suggests that social media companies should consider diverse local contexts for better interpretation and effective detection, with qualified human moderators with local knowledge and oversight boards with local expertise. By taking a human-centered, localised approach to content moderation and collaborating with relevant stakeholders, businesses can contribute to creating a digital space that upholds fundamental rights, prevents harm, and encourages inclusivity and diversity.

Stakeholder perspectives on co-designing a post-registration mental health nursing curriculum: A case study.

Globally, healthcare regulatory bodies require providers of academic programs to involve service users in the design and delivery of education, yet concrete and tested directions for operationalising this are lacking. Service users' involvement in education is often passive, ad-hoc and tokenistic, with limited input at the program development level. To explore the co-design processes and outcomes of a collaborative revision of an Australian post-registration mental health nursing curriculum. Using qualitative case study design, the experiences and collaborative practices of five stakeholders (one mental health service user, two carers and two academics) co-designing a post-registration mental health nursing curriculum were explored. Commonly identified barriers to meaningful involvement were overcome through planning and collaborative execution of the group's work. Participants reported a strong sense of successful collaboration in reviewing the curriculum, trusting relationships and mutual respect. While it was possible to support and augment stakeholder knowledge in the context of post-registration education, co-design processes were ultimately bound by the university's relatively inflexible bureaucratic context. To ensure effective stakeholder collaboration beyond classroom teaching, mental health nurse academics must prepare service users for the role, explaining the language and practices of the tertiary health education and nursing context. As part of co-design processes, organisational mandates must be explored and negotiated, and mutual clarity regarding expectations and roles must be established. A Design Thinking approach can support meaningful engagement of stakeholders in curriculum development.

Climate change and cancer: the Environmental Justice perspective.

Despite advances in cancer control-prevention, screening, diagnosis, treatment, and survivorship-racial disparities in cancer incidence and survival persist and, in some cases, are widening in the United States. Since 2020, there's been growing recognition of the role of structural racism, including structurally racist policies and practices, as the main factor contributing to historical and contemporary disparities. Structurally racist policies and practices have been present since the genesis of the United States and are also at the root of environmental injustices, which result in disproportionately high exposure to environmental hazards among communities targeted for marginalization, increased cancer risk, disruptions in access to care, and worsening health outcomes. In addition to widening cancer disparities, environmental injustices enable the development of polluting infrastructure, which contribute to detrimental health outcomes in the entire population, and to climate change, the most pressing public health challenge of our time. In this commentary, we describe the connections between climate change and cancer through an Environmental Justice perspective (defined as the fair treatment and meaningful involvement of people of all racialized groups, nationalities, or income, in all aspects, including development, implementation, and enforcement, of policies and practices that affect the environment and public health), highlighting how the expertise developed in communities targeted for marginalization is crucial for addressing health disparities, tackling climate change, and advancing cancer control efforts for the entire population.

Participatory research approaches to studying social capital in youth mentoring: Not the panacea we hoped for

Participatory approaches have gained broad interest among researchers as a vehicle for allowing participants’ experiences and voices to inform research, beyond simply being a source of data. However, participants in mentoring programs, particularly young people, often are not included in research partnerships in a meaningful way. Additionally, practitioners often struggle to translate research findings into program improvements. This paper examines the experiences of a research team collaborating with two user groups: mentoring practitioners, and youth with migrant and refugee backgrounds participating in mentoring programs. With ambitions for meaningful user involvement, our aim was to develop and test a digital intervention for supporting social capital in mentoring. The paper draws primarily upon participant observation and qualitative data from a focus group and panel discussions. While youth voices did inform and shape the research, we also experienced challenges related to youth understanding and engagement. The adult practitioners participated actively but encountered tensions due to their dual roles as co-researchers and mentoring professionals, and resource constraints. Ultimately, a close collaboration enabled the co-creation of adaptations to our research approaches, allowing meaningful participation for some of the youth, and facilitating program changes. This paper offers lessons for researchers wishing to conduct participatory research in the context of youth mentoring, as well as specific suggestions for those studying social capital. It contributes to the discussion on participatory approaches with multicultural youth, presenting critical reflections on our experiences within this mentoring context.

Setting the research agenda: involving parents in research on children who are HIV-free.

There is growing interest in health, developmental and survival outcomes of children who are born HIV-free to women living with HIV (children born HIV-free). To date, the research agenda has been largely determined by researchers, funders and policy makers, with limited involvement of parents, who are key stakeholders. Researchers at UCL Great Ormond Street Institute of Child Health in partnership with community-based organisation 4M Network of Mentor Mothers conducted two workshops with parents in March 2022 to establish research priorities for children born HIV-free, and key considerations for methodological approaches both to research and engagement with the affected communities. When exploring research on children born HIV-free, we consider the following: what aspects of current research are aligned with women and parents' priorities, what is missing and what approaches would be preferred. A holistic approach to research on children born HIV-free should be prioritised, focussing on a breadth of outcomes and how they intersect. Secondary use of existing data sources should be maximised to facilitate this, with a view of monitoring the long-term effects of fetal antiretroviral drug exposure alongside other key health and developmental outcomes. Involving and engaging with parents, and children where possible, must be at the heart of research design to maximise relevance and impact of findings for the affected communities. Potential barriers to engaging with individuals who were children born HIV-free include parental disclosure and individuals not identifying as a child born HIV-free to a mother living with HIV. Stigma-free language must be incorporated into the vocabulary of researchers and other stakeholders, avoiding reference to exposure; we propose the term "children born HIV-free." Mothers and parents living with HIV should be involved in research about their children born HIV-free and are key in identifying research priorities so that findings may translate into an impact on their children's health and wellbeing. Meaningful involvement of women living with HIV through trusted community partners is an effective mechanism by which to elicit views on research about their children.

What is known about what works in community-involved decision-making relating to urban green and blue spaces? A realist review protocol

BackgroundThere is now a relatively well-established evidence base suggesting that greener living environments and time spent in urban green and blue spaces (UGBS) can be beneficial for human health and wellbeing. However, benefits are not universal and there remain widespread social inequalities in access to such resources and experiences, particularly along axes of class, race, ethnicity, age and disability, and in relation to efforts to increase the availability and accessibility of such spaces. These injustices often relate to distributive, procedural and recognition-based processes. There is growing interest in how to ensure that efforts to increase access to or use of UGBS (whether through infrastructural or social programmes) result in equitable outcomes whilst minimising potential for exacerbating existing inequalities and injustices. Community engagement is considered an important step towards more inclusive UGBS decision-making, from planning and design to management and maintenance processes. It is thought to contribute to better and more widely trusted decisions, enhanced democracy, community satisfaction, civic interest and feelings of green space ownership, and greater longevity of UGBS projects. However, uneven representation and barriers to participation can create imbalances and undermine these benefits.MethodsAn iterative, multi-stage realist-inspired review will be conducted to ask what works, in what context and in what ways relating to the meaningful involvement of communities in UGBS decision-making, focusing on the skills, capacities and capabilities of different stakeholders and the role of contexts and processes. ‘Effectiveness’ (or what works) will be understood as a multifaceted outcome, encompassing both the processes and results of community engagement efforts.Following a scoping stage to identify initial programme theory, inclusion/exclusion criteria and derive search terms, relevant databases and grey literature will be searched to identify interdisciplinary literature in two phases. The first phase will be used to further develop programme theories, which will be articulated as ‘if then’ statements. The second phase searches will be used to identify sources to further explore and evidence the programme and formal theory. We will assess all includable evidence for conceptual richness, prioritising more conceptually rich sources if needed.DiscussionThe realist synthesis will explore the key context, mechanism and outcome configurations that appear to explain if and how different approaches to community-involved UGBS decision-making are or are not effective. We will consider factors such as different conceptualisations of community, and if and how they have been involved in UGBS decision-making; the types of tools and approaches used; and the socio-cultural and political or governance structures within which decision-making takes place.

Making a difference for the future: the views of Educators by experience about their involvement in social work education

ABSTRACT The involvement of people with lived experience of social work intervention is a crucial aspect of social work education and is firmly embedded in social work programmes within the UK. The benefit of such involvement by ‘Educators by Experience’ for students is well documented. For example, learning directly from people with lived experience can help students to develop their knowledge and skills. However, the benefit and impact of involvement for Educators by Experience is less well explored. This qualitative project aimed to understand why people with lived experience choose to become involved in social work education and how they felt about their involvement. 12 semi structured interviews were undertaken and analyzed using thematic analysis. The findings revealed the motivations for people’s involvement as well as a range of benefits that people experience as a result of this work. The paper highlights the support and ongoing work that is required in order to support the meaningful involvement of Educators by Experience in social work education.

Developing a Patient and Public Involvement Training Course for People with Intellectual Disabilities: The Leicestershire Experience

There is a lack of meaningful involvement of people with intellectual disability in research, outside of the context of study participation. There is a need to develop adapted means of facilitating Patient and Public Involvement when working with people with intellectual disability, that takes account for their level of neurodevelopmental functioning. In this article we describe a Patient and Public Involvement course developed for people with intellectual disability, developed by professionals working with this group, which was subsequently piloted in Leicestershire UK. Different versions of the course were developed for student participants with different levels of neurodevelopmental functioning and communication impairment. For Part 1 of the course (‘What is Research?’), students from Pathway 1 (mild intellectual disability) and Pathway 2 (moderate intellectual disability) both had significantly increased (p ≤ 0.05) mean knowledge test scores post-course relative to pre-course, with non-significant increases in mean confidence test scores for both pathway groups. For Part 2 of the course (‘Your Involvement in Research’), most participants agreed or strongly agreed with the statement ‘I found this interesting’ (Pathway 1: 8 of 9 students [89%]; Pathway 2: 8 of 10 students [80%]), but less students provided equivalent responses to the statement ‘I want to be involved in research in the future’ (Pathway 1: 2 of 9 students [22%]; Pathway 2: 8 of 10 students [80%]). This training course provides a template to provide basic training for people with intellectual disability with respect to research involvement, but requires further evaluation in larger student samples of diverse demographic and neurodevelopmental characteristics.

205 Exploring stakeholder experiences of Comprehensive Geriatric Assessment in community and out-patient settings: a qualitative evidence synthesis

Abstract Background Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary process that addresses an older adult’s bio-psycho-social capabilities to create an integrated and co-ordinated plan of care. While there is established quantitative evidence that demonstrates the positive impacts of CGA on clinical and process outcomes, less is known about how older adults and service providers experience CGA. This study aimed to systematically review and synthesise qualitative studies reporting the experiences of CGA of community-dwelling older adults, caregivers and healthcare professionals in the community and Out-Patient Department (OPD) setting. Methods This qualitative evidence synthesis involved a systematic search across 5 databases targeting qualitative or mixed methods studies that reported qualitative findings on stakeholder experiences of CGA. The protocol was registered with the PROSPERO database (Registration: CRD42021283167). The methodological quality of the included studies was appraised using the Critical Appraisal Skills Programme checklist for qualitative research. Results were synthesised according to Noblit and Hare’s seven-step approach to meta-ethnography. Results Fourteen studies were included where CGA was completed in the home, general practice, out-patient setting in acute hospitals and in hybrid models across the community and acute OPD settings. Synthesis identified four key themes: (1) CGA is experienced as a holistic process (2) The home environment enhances CGA (3) Time, the prevailing healthcare model and interprofessional communication influenced the success of CGA in the community (4) Conflicting perspectives on the meaningful involvement of older adults, carers and family in the CGA process. Conclusion The findings demonstrate that CGA in a home-based setting allows for a more holistic approach to care while increasing patient satisfaction and accessibility to healthcare. Although potential barriers to the delivery of CGA include current fragmented health service structures and a lack of understanding of CGA, factors such as enhanced communication, carer and older adult involvement in the CGA process are potential facilitators to its implementation.

Standard Involvement Is Not Enough: A Mixed Method Study of Enablers and Barriers in Research Meetings with Forced Migrants

Abstract Although participatory approaches in health research are increasingly used, critical voices are being raised around lack of diversity among the public contributors involved. This article explores enabling and hindering factors in participatory meetings with forced migrants involved as public contributors in health research, using a convergent parallel mixed methods design including behavioural observations and questionnaires, with the aim of contributing to practices of meaningful and inclusive involvement in research. Our findings indicated that relationship-building and adapting to team development over time were key. Additionally, researcher responsivity and transparency enabled relevant contributions, but few decisions were taken. Although linguistic barriers existed and were rated higher by the researchers, engaging interpreters as co-facilitators of the meetings enabled nuanced discussions. In addition to following PPI recommendations, involving public contributors with experience of forced migration requires considering relationship-focused factors; inclusive communication, relationships and trust, and process-focused factors: where and how decisions are taken.

Optimism and eternal vigilance: Gathering disease, responsible subjects and the hope of elimination in the new hepatitis C treatment era.

The advent of direct-acting antiviral hepatitis C medications has reshaped experiences of hepatitis C treatment and cure. Positioned as a treatment revolution, the new medications mean a world without hepatitis C has become imaginable, and this optimism is reflected in Australia's commitment to the WHO's target of 'eliminating' the virus as a public health threat by 2030. Alongside optimism about new treatments, Australia's current National Hepatitis C Strategy also emphasises the importance of partnerships with, and the 'meaningful involvement' of, priority populations for elimination to be achieved. We draw on Fraser and Seear's (2011) work on hepatitis C as a 'gathering' to examine these developments, and to approach hepatitis C as a disease in-the-making. Analysing 50 interviews conducted with people affected by the virus, we identify three key articulations that combine to trouble the distinction between old and new treatments: (1) the new treatment constitutes the disease as readily curable; (2) nevertheless, those who have been cured are responsibilised against acquiring it again by managing and monitoring their conduct; and (3) in the process, hepatitis C becomes re-constituted as an ongoing threat requiring continual post-cure medical and other monitoring. We argue that while treatment experiences have dramatically improved, responsibilising people affected by hepatitis C to attain cure in the context of an elimination agenda constitutes cure as valuable as much for the greater good as for self-care. This raises pressing ethical and political questions. Overall, we shed light on how, even in a context shaped by the availability of highly effective treatment, the hepatitis C-free body is never hepatitis C-free, but must be continually reproduced through regulatory practices.

The development of the People with Aphasia and Other Layperson Involvement (PAOLI) framework for guiding patient and public involvement (PPI) in aphasia research

BackgroundPatient and Public Involvement (PPI) in aphasia research requires researchers to include people with aphasia as research partners from the beginning of the study. Yet the quality of reporting on the level and type of involvement is poorly documented in the absence of a framework to guide PPI in aphasia research. This study aimed to extract the items and statements relevant for the development of the People with Aphasia and Other Layperson Involvement (PAOLI) framework for designing and implementing PPI in aphasia research, in collaboration with people with aphasia.MethodThe method recommended by the EQUATOR network was followed. This involved: (1) evidence from a scoping review, (2) a thematic analysis of the in-depth interviews, of people with stroke and aphasia, on the topics to be included in the pilot draft, (3) a two round Delphi survey for item/statement selection and (4) an experts’ consensus meeting. The research team involved two PPI partners with chronic stroke-induced aphasia. The research process involved co-design and was informed by the Dialogue model.ResultsTwenty-three panellists, from 13 countries, voted in round one with 87% (20/23) responding in round two. The final PAOLI framework includes the following 17 items (with 66 descriptive statements): establish collaborations, recruit patients, gain informed consent, organize induction meetings, train patient partners, create communication links, engage communication partners, conceptualize topics, establish research priorities, reach consensus, work with co-design methods, develop proposals, assist with dissemination of results, promote implementation of the outcomes, support patient partners and promote self-evaluation, monitor progress and assess impact of the patient involvement. These items were considered by the panellists as the most relevant for the involvement of people with aphasia as research partners.ConclusionThe PAOLI is the first international consensus framework for guiding patient involvement in aphasia research. Researchers are encouraged to adopt the framework to improve the quality of their research by promoting the meaningful involvement of people with aphasia within the research team from the start.

What Is Wellbeing, and What Is Important for Wellbeing? Indigenous Voices from across Canada.

Indigenous peoples' perceptions of wellbeing differ from non-Indigenous constructs. Thus, it is imperative to recognize that Indigenous peoples will conceptualize wellbeing from their perspectives and set their own wellbeing priorities. In keeping with this viewpoint, the aims of the present study were to conceptualize wellbeing and determine what was (and is) important for wellbeing from Canadian Indigenous peoples' perspectives. In this paper, we take a partnership approach based on the elements of respect, equity, and empowerment. One primary data source and two existing data sources were examined and analyzed thematically utilizing a combination approach of deductive and inductive coding. Indigenous leadership and organizations viewed wellbeing holistically and conceptualized wellbeing multidimensionally. From across Canada, wellbeing was communicated as physical, economic, political, social, and cultural. The scaling of wellbeing represented a collectivist perspective, and land was the connecting thread between all types of wellbeing, being a place to practice cultural traditions, reassert one's Indigenous identity, find solace, and pass on Indigenous knowledge and languages. Although wellbeing was discussed in the context of the individual, family, community, and nation, wellbeing was most often discussed at the cultural level by regional and national Indigenous leadership and organizations. Even in acknowledging the great cultural diversity among Canadian Indigenous nations, four concordant themes were identified regionally and nationally, with respect to what was important for cultural wellbeing: land and water, sustainability, and inherent obligations; being on the land, and indigenous languages and knowledge systems; sustainable development; and meaningful involvement in decision-making, and free, prior, and informed consent. Taking into account these themes is foundational for any interaction with Indigenous peoples, especially in the context of land, culture, and development. There needs to be a new beginning on the journey to reconciliation with land and cultural wellbeing at the forefront.

Development of expert consensus to guide physical rehabilitation in children and adolescents with acquired brain injury during the subacute phase.

To develop consensus among experts to guide physical rehabilitation in children and adolescents with acquired brain injury during the subacute phase. International Delphi study. A 3-round online Delphi study was conducted with 11 international experts in rehabilitation for children and adolescents with acquired brain injury. The first round consisted of open-ended questions; the second and third round consisted of ranking 139 statements on a 5-point Likert scale. The panel reached consensus on 116/139 statements. Consensus was reached on the importance of age, pre-injury developmental stage and the clinical presentation of the child when determining content and focus of physical rehabilitation. In addition, consensus was reached on the importance of participation-focused interventions, and involvement of family members in goal-setting and therapeutic activities. Although dosage was deemed very important, no consensus was reached for determination of dose-response variables to suit and influence the child's needs. This study provides a framework for clinicians to design physical rehabilitation interventions in children with acquired brain injury in the sub-acute recovery phase. The promotion of physical activity in meaningful contexts and involvement of family members are considered as important components to optimize recovery.