INDIVIDUAL COMMUNITY YARNING
Four Aboriginal research assistants (ARAs), two male and two female, have been employed and trained to facilitate yarning sessions with Aboriginal mums and dads. All training by Prof Dawn Bessarab and Jayne Kotz. They have since commenced the 'yarning sessions' in late 2014. At this point, the research assistants have held Yarning sessions with 23 Aboriginal women and men.
What is a Yarning Circle?
Aboriginal men and women are telling their own stories to one of the KM Aboriginal research assistants. These women and men are yarning about their experiences of becoming mums and dads, what they found rewarding and challenging, their experiences of the health care system during this time, and being screened for depression and anxiety. These are their own stories about what happened, what they liked, and what they would have liked during the perinatal period.
All stories are completely confidential and are being de-identified for analysis.
Once we have reached a point in the analysis where no new themes are emerging from these stories, we will stop collecting stories. Until then, please let us know if you would like to tell us your story....
What is a Yarning Circle?
Aboriginal men and women are telling their own stories to one of the KM Aboriginal research assistants. These women and men are yarning about their experiences of becoming mums and dads, what they found rewarding and challenging, their experiences of the health care system during this time, and being screened for depression and anxiety. These are their own stories about what happened, what they liked, and what they would have liked during the perinatal period.
All stories are completely confidential and are being de-identified for analysis.
Once we have reached a point in the analysis where no new themes are emerging from these stories, we will stop collecting stories. Until then, please let us know if you would like to tell us your story....
From July until October 2015
(Expert) Advisory Group (AG):
The (expert) AG, has been established to provide broad project support and guidance to Kalyakool Moort and in particular to support research translation. The expert Advisory Group membership has high level commitment from: Department of Health (DoH) Office of Nursing and Midwifery (ONM), the Centre of Perinatal Excellence (COPE), DoH Aboriginal Health Division, North Metropolitan Health Service, South Metropolitan Health Service, KEMH-Women’s Health Clinical Support Unit, KEMH-Dept. Psychological Medicine, Aboriginal Mental Health Service (SAMHS), AMSSU, Aboriginal Maternity Group Practice- Moort Boodjari Mia, Telethon Kids Institute, Murdoch University, Ngala, and a highly respected Aboriginal Elder.
The Elders Group
Elders Membership includes 10 committed Elders who ensure the project’s cultural security. This has been critical in safeguarding success of the research project. Meetings have been facilitated at key points in the progress and direction of Kalyakool Moort.
The (expert) Aboriginal Community Focus Groups (CFGs)
The men’s and the women’s CFGs have been established and provide a critical role in this research. Membership was invited from among highly regarded, respected and experienced people were werein their fields of work. They come as midwives, child health nurses, carers, Aboriginal liaison officers, health workers and mental health workers, social workers, psychologists, grandmothers, mothers,and fathers working in a multiplicity of organisations throughout they region.
Through workshops and meetings they have:
(Expert) Advisory Group (AG):
The (expert) AG, has been established to provide broad project support and guidance to Kalyakool Moort and in particular to support research translation. The expert Advisory Group membership has high level commitment from: Department of Health (DoH) Office of Nursing and Midwifery (ONM), the Centre of Perinatal Excellence (COPE), DoH Aboriginal Health Division, North Metropolitan Health Service, South Metropolitan Health Service, KEMH-Women’s Health Clinical Support Unit, KEMH-Dept. Psychological Medicine, Aboriginal Mental Health Service (SAMHS), AMSSU, Aboriginal Maternity Group Practice- Moort Boodjari Mia, Telethon Kids Institute, Murdoch University, Ngala, and a highly respected Aboriginal Elder.
The Elders Group
Elders Membership includes 10 committed Elders who ensure the project’s cultural security. This has been critical in safeguarding success of the research project. Meetings have been facilitated at key points in the progress and direction of Kalyakool Moort.
The (expert) Aboriginal Community Focus Groups (CFGs)
The men’s and the women’s CFGs have been established and provide a critical role in this research. Membership was invited from among highly regarded, respected and experienced people were werein their fields of work. They come as midwives, child health nurses, carers, Aboriginal liaison officers, health workers and mental health workers, social workers, psychologists, grandmothers, mothers,and fathers working in a multiplicity of organisations throughout they region.
Through workshops and meetings they have:
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DATA COLLECTION 2014- 2016:
October 2015 - November 2015
The online health professional survey
This has concluded with 153 respondents. 89% reported working in hospital based or community health services as midwives of child health nurses.
Focus groups (CFGs)
These were facilitated with 31 Aboriginal men and women. Issues pertaining to perinatal mental health of Aboriginal women and men, factors that strengthen Aboriginal mothers and fathers, barriers and enablers to mental health screening were all explored.
The Screening Tool Working Party
This group emerged as a subgroup of men and women of the original CFGs. The tools originally identified for exploration were the EPDS, the KEMH Perinatal Anxiety Screen Scale (PASS) tool, K10, K7 and K5, DASS 21, Kimberley Mums Mood Scale (KMMS), the UWA Here And Now Aboriginal Assessment (HANNA), the Menzies AimHi screening tool, Kica-d, aPHQ9, Postpartum Distressed Measure (PDM), Strong Souls and the Edinburgh Well-Being Scale.
This initial assessment resulted in a detailed analysis of the following screening tools: the PDM, Strong Souls, Kica-d, aPHQ9 and the psychosocial content of the AimHi, the KMMS and the HANNA.
This detailed analysis involved assessment of each tool based on the following:
Data has been collected from 175 service providers: midwives from the Aboriginal Maternity Group Practices and King Edward Memorial Hospital; ALOs and AHWs attached to maternity services at Armadale and Rockingham; Social Workers from the Perth Family Court.
Individual yarning sessions
Individual and small group Yarning Circles have been facilitated with 68 Aboriginal men and women participating in individual yarning sessions from the Nyoongar, Balladong, Bardi, Kokotha, Ngarrindjeri, Yngabani, Yorta Yorta, Ngarinyin, Nyul Nyul, Bardi, Wajak and Yamatji and Kauralaig clans and Nations.
Individual semi-structured interviews with midwives, child health nurses and Aboriginal health workers have concluded.
The online health professional survey
This has concluded with 153 respondents. 89% reported working in hospital based or community health services as midwives of child health nurses.
Focus groups (CFGs)
These were facilitated with 31 Aboriginal men and women. Issues pertaining to perinatal mental health of Aboriginal women and men, factors that strengthen Aboriginal mothers and fathers, barriers and enablers to mental health screening were all explored.
The Screening Tool Working Party
This group emerged as a subgroup of men and women of the original CFGs. The tools originally identified for exploration were the EPDS, the KEMH Perinatal Anxiety Screen Scale (PASS) tool, K10, K7 and K5, DASS 21, Kimberley Mums Mood Scale (KMMS), the UWA Here And Now Aboriginal Assessment (HANNA), the Menzies AimHi screening tool, Kica-d, aPHQ9, Postpartum Distressed Measure (PDM), Strong Souls and the Edinburgh Well-Being Scale.
This initial assessment resulted in a detailed analysis of the following screening tools: the PDM, Strong Souls, Kica-d, aPHQ9 and the psychosocial content of the AimHi, the KMMS and the HANNA.
This detailed analysis involved assessment of each tool based on the following:
- Psychometric properties
- Consideration DSM V1 criteria for anxiety, depression & post-traumatic stress disorder (PTSD). PTSD was recognised as being frequently present at a low level as a normal function for many Aboriginal people.
- Language Appropriateness
- Cultural relevance
- Relevance of somatic versus emotional symptoms
- What would be useful in an alternative screening tool and process, and why
- Screening in context
- Relative usability
Data has been collected from 175 service providers: midwives from the Aboriginal Maternity Group Practices and King Edward Memorial Hospital; ALOs and AHWs attached to maternity services at Armadale and Rockingham; Social Workers from the Perth Family Court.
Individual yarning sessions
Individual and small group Yarning Circles have been facilitated with 68 Aboriginal men and women participating in individual yarning sessions from the Nyoongar, Balladong, Bardi, Kokotha, Ngarrindjeri, Yngabani, Yorta Yorta, Ngarinyin, Nyul Nyul, Bardi, Wajak and Yamatji and Kauralaig clans and Nations.
Individual semi-structured interviews with midwives, child health nurses and Aboriginal health workers have concluded.
RESULTS & EMERGENT OUTCOME
'Baby Coming - You Ready?'
The emergent Social & Emotional Wellbeing
ASSESSMENT Rubric
November 2015 - April 2016
After completion of the Kalyakool Moort data coding, analysis and triangulation of results, a number of 'where to from here' workshops have resulted in the development of the 'Baby Coming-You Ready?' rubric for change.
This mental health and wellbeing assessment rubric was designed by the Aboriginal men and women from the CFG. Its development has drawn upon all results from Kalyakool Moort data and the Screening Tool Analysis Workshops.
The 'Baby Coming-You Ready?' assessment rubric:
Is a web-based interactive, digital app that facilitates an engaging, strength-based individual social and emotional wellbeing screen and assessment process, finally concluding with the development of a personalized management plan.
Initiated during pregnancy it follows throughout pregnancy and the year after baby is born.
It is accessed via a specific 'Baby Coming-You Ready?' Aboriginal Parenting website where it is downloaded onto any touchscreen device such as an iPad for joint use by the parent-to-be and her/his midwife/support worker.
Uniquely it is designed to support trust & engagement between the care-provider and the mother and/or father-to-be for their joint perinatal journey ahead.
Thus The 'Baby Coming-You Ready?' rubric:
After completion of the Kalyakool Moort data coding, analysis and triangulation of results, a number of 'where to from here' workshops have resulted in the development of the 'Baby Coming-You Ready?' rubric for change.
This mental health and wellbeing assessment rubric was designed by the Aboriginal men and women from the CFG. Its development has drawn upon all results from Kalyakool Moort data and the Screening Tool Analysis Workshops.
The 'Baby Coming-You Ready?' assessment rubric:
Is a web-based interactive, digital app that facilitates an engaging, strength-based individual social and emotional wellbeing screen and assessment process, finally concluding with the development of a personalized management plan.
Initiated during pregnancy it follows throughout pregnancy and the year after baby is born.
It is accessed via a specific 'Baby Coming-You Ready?' Aboriginal Parenting website where it is downloaded onto any touchscreen device such as an iPad for joint use by the parent-to-be and her/his midwife/support worker.
Uniquely it is designed to support trust & engagement between the care-provider and the mother and/or father-to-be for their joint perinatal journey ahead.
Thus The 'Baby Coming-You Ready?' rubric:
- Supports Trust & Engagement
- Gives control back to the mother (or father)-to-be in their perinatal journey
- Identifies strengths to be built upon
- Identifies accumulative stressors & degree of resultant distress
- Screens for psycho-social vulnerabilities
- Provides a strong framework for a jointly developed strength-based and family-centered management plan
- Identifies strong a Aboriginal family/community member to act as 'champion' for the mother/father-to-be throughout her/his pregnancy and journey as a new parent.
- Provides a direct link between clinicians, the parent-to-be and Aboriginal Elders through its 'Gangster Grannies' program.
If a referral is jointly agreed upon, then a direct personalized or ‘warm’ referral process is undertaken.
‘Baby Coming-You Ready?’ is designed to be facilitated through the use of technology by incorporating visual prompters that support the yarning or story gathering against specific domains.
These visual prompters when clicked, automatically populate the a basic framework for the later development of a personalized (visual) and strength-based management plan. The 'Baby Coming-You Ready?' rubric creates a story and picture ultimately resulting in the joint development of a family-centered management plan. It does not rely on a numerical score which determines the referral response. Rather it creates a framework whereby the parent-to-be and the worker jointly identify how soon follow-up of the management plan should be i.e:
‘Baby Coming-You Ready?’ is designed to be facilitated through the use of technology by incorporating visual prompters that support the yarning or story gathering against specific domains.
These visual prompters when clicked, automatically populate the a basic framework for the later development of a personalized (visual) and strength-based management plan. The 'Baby Coming-You Ready?' rubric creates a story and picture ultimately resulting in the joint development of a family-centered management plan. It does not rely on a numerical score which determines the referral response. Rather it creates a framework whereby the parent-to-be and the worker jointly identify how soon follow-up of the management plan should be i.e:
- Immediate Followup (an imminent safety risk)
- Short Term Followup (1-5 days)
- Medium Term Followup (6-14 days)
- Longer Term Followup (2-3 weeks)
- Routine Followup (4 weeks)
Piloting 'Baby Coming ......You Ready?'
With funding from the Ian Potter Foundation, the Department of Health Office of Nursing and Midwifery and Western Austrian Primary Health care Alliance, the 'Baby Coming-You Ready?' rubric is being digitalized and piloted in an Aboriginal Controlled Medical Service (Derbarl Yerrigan Health Services), antenatal facilities in both government (Fiona Stanley Hospital, Armadale Hospital) and non-government (St John of God) sectors throughout North South and East Metropolitan Health areas, Ngala Family Services and Western Australian Child and Adolescent Health Services.
The pilot will be implemented early 2018, to evaluate the impact of the 'Baby Coming- You Ready?' and it's digital assessment/screening interface from the points of view of the:
- Aboriginal parents
- Care providers
- Agency