The Daalbirrwirr Gamambigu (Safe Children) Model: Embedding Cultural Safety in Child Protection Responses for Australian Aboriginal Children in Hospital Settings

Abstract

The aim of this paper is to describe the development of a model of care to embed cultural safety for Aboriginal children into paediatric hospital settings. The Daalbirrwirr Gamambigu (pronounced “Dahl-beer-weer gum-um-be-goo” in the Gumbaynggirr language means ‘safe children’) model encompasses child protection responses at clinical, managerial and organisational levels of health services. A review of scholarly articles and grey literature followed by qualitative interviews with Aboriginal health professionals formed the evidence base for the model, which then underwent rounds of consultation for cultural suitability and clinical utility. Culturally appropriate communication with children and their families using clinical yarning and a culturally adapted version of ISBAR (a mnemonic for Identify, Situation, Background, Assessment and Recommendation) for interprofessional communication is recommended. The model guides the development of a critical consciousness about cultural safety in health care settings, and privileges the cultural voices of many diverse Aboriginal peoples. When adapted appropriately for local clinical and cultural contexts, it will contribute to a patient journey experience of respect, dignity and empowerment.

Full text

Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 1 of 30
Original research article
The Daalbirrwirr Gamambigu (Safe Children) Model:
Embedding cultural safety in child protection
responses for Australian Aboriginal children in
hospital settings
Tara Flemington1,2, Jennifer Fraser* 2,4, Clinton Gibbs3, Joanne Shipp3, Joe Bryant1, Amanda Ryan3,
Devika Wijetilaka1, Susan Marks4, Michele (Mick) Scarcella4, Dimitra Tzioumi5, Shanthi
Ramanathan6,7, Liesa Clague8, Donna Hartz7, Bob Lonne9, Mark Lock (Ngiyampaa)10
Affiliation 1; Mid North Coast Local Health District, Coffs Harbour,
2450, New South Wales, Australia
Affiliation 2; University of Sydney, Camperdown, 2006, New South
Wales, Australia
Affiliation 3; Mid North Coast Local Health District, Port Macquarie,
2444, New South Wales, Australia
Affiliation 4; The Sydney Children’s Hospitals Network, Westmead,
2145, New South Wales, Australia
Affiliation 5; The Sydney Children’s Hospitals Network, Randwick,
New South Wales, 2031
Affiliation 6; Hunter Medical Research Institute, New Lambton
Heights, 2305, New South Wales, Australia
Affiliation 7; University of Newcastle, Callaghan, 2308, New South
Wales, Australia
Affiliation 8; University of Notre Dame, Chippendale, 2007, New
South Wales, Australia
Affiliation 9; Queensland University of Technology, Kelvin Grove,
4059, Queensland, Australia
Affiliation 10; University of Technology Sydney, Ultimo, 2007, New
South Wales, Australia
* Correspondence: Jennifer.Fraser@sydney.edu.au; Tel.: (+61) 2 9114
4063
Abstract: The aim of this paper is to describe the development of a model
of care to embed cultural safety for Aboriginal children into paediatric
hospital settings. The Daalbirrwirr Gamambigu (pr. Dahl-beer-weer
gum-um-be-goo in the Gumbaynggirr language means ‘safe children’)
model encompasses child protection responses at clinical, managerial and
organisational levels of health services. A review of scholarly articles and
grey literature followed by qualitative interviews with Aboriginal health
professionals formed the evidence base for the model, which then
underwent rounds of consultation for cultural suitability and clinical
utility. Culturally appropriate communication with children and their
families using clinical yarning and a culturally adapted version of ISBAR
(a mnemonic for Identify, Situation, Background, Assessment and
Recommendation) for interprofessional communication is
recommended. The model guides the development of a critical
consciousness about cultural safety in health care settings, and privileges
the cultural voices of many diverse Aboriginal peoples. When adapted
Citation: xx The Daalbirrwirr
Gamambigu (Safe Children)
Model: Embedding cultural safety
in child protection responses for
Australian Aboriginal children in
hospital settings. Int. J.
Environ. Res. Public Health
2021, 18, x.
https://doi.org/10.3390/
xxxxx
Academic Editor:
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Published: date
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Copyright: © 2021 by the
authors. Submitted for
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(https://creativecommon
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Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 2 of 30
appropriately for local clinical and cultural contexts, it will contribute to a
patient journey experience of respect, dignity and empowerment.
Keywords: child protection, healthcare, Aboriginal, cultural safety, critical
consciousness, interprofessional collaboration, translational research, Australia,
model of care, hospital, paediatric, emergency department
1. Introduction
The cultural strengths of Aboriginal and Torres Strait Islander
(hereafter and with respect, Aboriginal Australians) families resonate
from 60,000 year-old cultures [1]. Aboriginal cultural practices help
children to: a) contribute to family, community and society; b) develop
independence, problem solving ability and decision-making; c)
understand relationships within the family and with Elders; d) imbue a
strong sense of cultural identity; and e) contribute to stable and
supportive environments [2,3]. This in turn promotes good physical
health, as well as social, cultural, and emotional wellbeing [4].
For Australian health professionals, culturally safe practice may be
defined as ‘the ongoing critical reflection of health practitioner
knowledge, skills, attitudes, practising behaviours and power
differentials in delivering safe, accessible and responsive healthcare free
of racism’ [38]. Against this background, stakeholders in hospital settings
challenged us to answer the question: What does cultural safety look like
and how do we do it in practice?
In 1997 the Bringing Them Home Report chronicled the policies and
practices of Australian governments that led to the ‘Stolen Generation’;
the widespread removal of Aboriginal children from their families, and
its profound impacts on many children, families and communities. The
impacts include the physical, sexual and emotional maltreatment of
children who were placed into institutional and foster care, and the
resultant inter-generational trauma that resulted for many people,
including stolen cultural identity. The policy framework driving these
removals reflected the systemic racism that was longstanding within the
society and its political and social institutions, and was so pervasive the
Report found, as to constitute ‘genocide’. Since 2000, the numbers of
children in out of home care have been increasing rapidly, with the rates
for Aboriginal children leading the way. A recent report on Aboriginal
children in the out-of-home care system identified a range of historical
and contemporary issues including non-compliance with the Aboriginal
Child Placement Principle (prioritising placements of children with kin),
an increasing propensity to remove children at birth, inadequate use of
preventive strategies and earlier intervention aimed at working with
families, and placement instability and lack of suitable care providers due
to existing procedures. In 2008, the Australian Prime Minister and all
state and federal governments gave public apologies which led to the
Closing the Gap initiatives to redress the now-recognised gross
inequalities in health, economic and social outcomes for Aboriginal
Australians.
The extraordinary resilience of Aboriginal Australians—people
belonging to communities with a deeply emotional history of cultural
destruction—continutes to be tested, resulting in intergenerational
trauma and widespread disadvantage [5]. Since the first days of
European occupation of Australia in the late 18th century, Aboriginal
children have been forcibly removed from their families and
communities, and hospitals have played a key part [6,7]. Initially, these
practices were not based on an assessment of risk to the child and there
was no requirement to provide evidence of maltreatment to justify the
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separation of children from families [8]. Indeed, child welfare laws
(which required evidence of maltreatment to justify removal) did not
apply to Aboriginal children until the 1940s. Since the introduction of
these laws it has been necessary for child removal authorities to prove
neglect and/or abuse—a somewhat arbitrary presentation in
disadvantaged communities where poverty can present as neglect,
particularly in the eyes of someone from outside the community, and
someone who is not in a position to fully appreciate the social and
emotional support network surrounding a child. Stereotyping and
disapproval of Aboriginal Australians’ parenting practices have led to
disastrous child protection responses—even when applied in good faith
[8].
While the associations between social inequalities and health
outcomes have long been recognised, research on the links that social
inequalities and health outcomes have on child protection contact and
interventions has not been the subject of detailed examination until
relatively recently [9-11]. Perhaps unsurprisingly, in child protection
systems around the globe, there is over-representation of children and
families who are of colour, who are First Nations and who live in poverty
[12-14]. Intersectionality occurs across a variety of factors, but what is
clear is that historical policies including removal of First Nations children
and their placement away from their kin, culture and communities has
resulted in longstanding and widespread fear of engagement with child
protection authorities [15,16]. Despite system reforms and policy
changes, these disproportionalities remain and as a result movements are
increasing around the globe toward public health approaches that
prioritise earlier intervention and prevention strategies through universal
services, including hospitals and health services [17-19]. This may be in
response to the increasing recognition that public health approaches aim
to address the underlying inequities that contribute to child maltreatment
[18].
A public health approach to child protection has been promoted in
Australia [18], but remains aspirational. This approach holds promise to
addressing the rates of removal for Aboriginal children, which remain
extraordinarily high. At June 2020, there were 18,900 Aboriginal children
in out-of-home-care, at a rate of 56 per 1,000 children [20]. This is 11 times
the rate for non-Aboriginal children, and while admissions of non-
Aboriginal children to out-of-home-care remain stable, the rate for
Aboriginal children is increasing [20]. Over-representation of Australian
Aboriginal children in child protection notifications and out-of-home care
services have prevailed despite policy aimed at addressing this issue
[21,22]. Furthermore, reports for neglect dominate [23], reflecting the long
history of economic and social disadvantage experienced by Aboriginal
Australians.
This is coupled with poor health outcomes for children in out-of-
home care in general [24,25], and also for Aboriginal children [26,27]. For
example, a Victorian health service reported widespread mental health
problems (66%), hearing problems (37%), vision problems (34%), dental
caries (40%) and developmental delays (46%) in a cohort of 103
Aboriginal children in out-of-home-care [28]. Medical and health
personnel are the third highest source of notifications for potential neglect
(12.5%) compared to school personnel (18.9%) and police (21.7%) [29].
Disproportionalities in child protection substantiations and admissions
to care exacerbate existing health inequalities and, therefore, a public
health approach to child protection calls for ‘interagency collaboration to
address poor health and social outcomes of children’ [14,30].
Descriptions of the significance of culture in this field are evident in
research findings in general hospital care [31,32], child protection services
delivery [33], child protection interprofessional relationships [34], the
broader service delivery environment [35], in hospitals generally [36],
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and in emergency departments [37]. In child protection, it is
acknowledged ‘that patient safety includes the inextricably linked
elements of clinical and cultural safety’ [38], although this has not been
empirically investigated. In fact, few studies have examined how to
successfully implement the necessary elements of cultural safety at the
point of care [32].
Our primary goal was to produce a practical guide for clinicians that
would be supported by an overarching and integrated organisational
framework with measurable indicators of success. This paper describes
the formative research processes and procedures for methodological and
cultural rigour to develop a model that would address these inequalities
in child protection and health outcomes for Aboriginal children.
2. Materials and Methods
We firstly present the settings and context of this project. This is
followed by detailing the five project phases and the measures
undertaken to ensure cultural leadership and cultural safety. These
phases of the Model of Care (the model) development are:
Developing appropriate governance and oversight;
Cultural engagement process and mapping;
Scoping literature review;
Yarning groups and in-depth interviews; and
Clinical utility testing.
2.1 Settings and Context
This formative research project was undertaken in the rural Mid
North Coast and metropolitan Sydney of New South Wales, Australia,
extending earlier translational child protection research in their rural and
metropolitan hospitals. The translational research project, Maam-
darrundaygam Daalbirrwirrr Gamambigu (Embedding Cultural Safety
in Health Professional Child Protection Responses for Aboriginal
Children), arose from Aboriginal health staff alerting the non-Aboriginal
research team to the urgent need for clinical and organisational resources
to improve health professional child protection responses for at-risk
Aboriginal children.
There are approximately 265,685 Aboriginal people residing in New
South Wales, representing 3.4% of the total population [40]. Aboriginal
children represent 11.8% of all children in the Mid North Coast Local
Health District, and between 0.6 and 5.1% of children across Sydney [41].
While emergency department presentations for Aboriginal children in
the Sydney Children’s Hospitals Network are proportionate with the
population figures (2.2%), they are substantially higher in rural areas [41].
The project took place on the Birpai, Dunghutti, Gumbaynggirr and
Nganyaywana Nations/language groups (Mid North Coast Local Health
District), the Gadigal and Bidjigal peoples who traditionally occupied the
Sydney coast at Randwick, the Burramattagal peoples at Westmead, the
Gayamaygal people of Manly and the Dharug people at Bankstown. We
acknowledge that the Aboriginal participants in this project, while
residing on these lands, are from many First Nations in Australia. We also
acknowledge Aboriginal people as the traditional custodians of the lands
on which this project took place, and their ongoing spiritual and cultural
connections to Country.
2.2 Phase 1: Developing Appropriate Governance and Oversight
Aboriginal Australians’ voices infused the methodology, which was
framed by key documents that are significant in the institutional
discourse of research, policy and practice with Aboriginal Australians.
Firstly, the ethical principles of spirit and integrity, cultural continuity,
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equity, reciprocity, respect, and responsibility [42] guided the study
design and ethics application through the NSW Aboriginal Health and
Medical Research Council [43] (Aboriginal Health and Medical Research
Council HREC: Ref 1369/18; Sydney Children’s Hospitals Network
HREC: Ref LNR/17/SCHN/318). This protocol and the subsequent
processes were then layered with the domains of the Cultural Respect
Framework for Aboriginal and Torres Strait Islander Health [44]; the
Ngaa-bi-nya Aboriginal and Torres Strait Program Evaluation
Framework (hereafter, Ngaa-bi-nya Framework) [45]; the integrated
Promoting Action on Research Implementation in Health Services (i-
PARIHS) Framework [46]; and the building blocks of the Family Matters
Roadmap (a national strategy to reduce the number of Aboriginal
children removed from families) [47].
A culturally safe [48,49] research process was developed through the
perspective of the cultural interface [50] by weaving [51] together a
Wiradjuri worldview embedded in the Ngaa-bi-nya framework [45] and
the Western world view embedded in the i-PARIHS framework [46]. The
Ngaa-bi-nya framework (pr. naa-bi-nya, means to examine, try, and
evaluate in the language of the Wiradjuri peoples) is one of few tools
developed with Aboriginal worldviews of health [52], and it accounts for
many of the factors that are relevant to Aboriginal people. It focusses on
four domains—landscape factors, resources, ways of working and
learnings. They in turn complement the i-PARIHS Framework domains
of facilitation, innovation, recipients and context, as detailed elsewhere
[32].
The project was led by a research team of seven Aboriginal and six
non-Aboriginal investigators and supported by Aboriginal investigators
with expertise in the field, aligned with cultural governance in research
[53]. Operationally, the project team comprised of a non-Aboriginal post-
doctoral project lead with qualifications in paediatric nursing, public
health and child protection, and Aboriginal project officers with
qualifications in health promotion/public health and allied
health/Indigenous studies. Organisational governance was maintained
by a project steering committee, of whom six members were Aboriginal,
and represented disciplines of clinical governance, paediatric medicine,
emergency medicine, child protection, social work, violence prevention,
nursing, and midwifery, with executive representation from nursing,
clinical governance and Aboriginal health (Appendix A).
2.3 Phase 2: Cultural Engagement Process and Mapping
The project team’s approach was further shaped by principles of
research practice based on recognizing the cultural world views of
Aboriginal Australians [45,54], improving the cultural competency of
non-Aboriginal peoples [55], promoting cultural safety in research
processes [56], and ‘fostering cultural and emotional safety’ [57] of
Aboriginal research participants. This team ethic is evident in our
consideration of reflexivity (Appendix A) and the team’s cultural
diversity with Aboriginal (ML, JS, CG, JB, DH, MS and LC) and non-
Aboriginal Australians (JF, TF, SR, BL, DT, SM) working together in the
spirit of shared learning [48]. Additionally, Aboriginal people led the
project’s governance, participated in clinical workshops, led workshops,
conducted interviews, were involved in all aspects of data analysis, and
wrote the reports and papers.
The team members developed a stakeholder cultural engagement
map to ensure all relevant people were contacted, invited for a yarn about
the project, and formally invited to participate in accord with their own
priorities. Feedback was invited on all aspects of the model, including
visual presentation and design, evaluation measures, and clinical and
cultural content. Stakeholders could provide feedback through a variety
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of channels (email, telephone or in-person) and to their choice of an
Aboriginal or non-Aboriginal researcher.
The Daalbirrwirr Gamambigu Aboriginal Consultation Diagram
(Figure 1) illustrates the range of stakeholders involved at the intersection
of child protection and healthcare services. It presents consultation as a
constant process instead of one-off engagement, creating wrap-around
discourse between all the stakeholders (dotted circular line with arrows).
Aboriginal families are located as the central focus of the model and
service provision.
Figure 1: Daalbirrwirr Gamambigu Aboriginal consultation diagram
A key component of Aboriginal stakeholder testing took place at a
public conference hosted by AbSec (the New South Wales Child, Family
and Community Peak Aboriginal Corporation) [58]. The research team
developed a workshop format that began with an opening presentation
followed by three breakout sessions. Each group of 20 participants was
guided by an Aboriginal team member to workshop one of three model
components: the model thematic diagram; culturally appropriate
approaches to interprofessional communication; and clinical yarning
with families. The results of the one-hour long workshop were collated
and analysed by the project team, then distributed to workshop
participants afterwards for feedback and to demonstrate transparency
(the workshop report is available on request).
Broader rounds of consultation and testing with Aboriginal
stakeholders occurred throughout the model’s development with
members of community organisations, nationally recognized peak
Aboriginal professional organisations, professional networks and
personal connections (Figure 1).
The Thematic Diagram (Figure 2) was developed in discussion with
a Dunghutti artist and members of the project team. The team reflected
on: the policy, strategic and research base for the project; findings from
the literature review and yarning groups; and their own experiences and
knowledges working with Aboriginal communities. These reflections
were sketched onto large sheets of paper, organised into categories, and
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mapped back to the core artwork. After four iterations of this process, the
artist converted the design into the diagram for further consultation.
2.4 Phase 3: Scoping Literature Review
Our scoping review [6] found three central intersectional themes to
embedding cultural safety in health professional child protection
responses for Aboriginal children in hospital settings. These themes were:
relationships; organisational processes; and culture. Safe cultural
governance lay over the intersection of these three themes. The scoping
review search was unable to identify any published articles that
specifically addressed the intersection of Aboriginal identity, cultural
safety, cultural competence and child protection in the hospital setting.
Nor was there any specific translational framework available to guide
practitioners to develop competence in delivering culturally safe
responses in this intersecting context. These findings went on to inform
the approach to qualitative data collection and the generation of original
evidence.
2.5 Phase 4: Yarning Groups and In-depth Interviews
A summary of the qualitative component of this project is presented
below, with detailed description of the qualitative data collection,
analysis and findings to be published elsewhere. A cultural strengths-
based approach requires genuine and safe cultural governance processes
[32,53] and respect for oral traditions of yarning [59-62]. Respecting the
cultural diversity of Aboriginal Australians meant the development and
utilisation of a culturally safe yarning group protocol. This informed
selection of male or female facilitators known (or not known) to the
participants, the gender composition of the yarning groups, and the
Aboriginality of the facilitator.
Yarns were conducted with a convenience sample of 27 Aboriginal
health professionals and community members with linkages to
Aboriginal nations from around Australia. The professional backgrounds
of participants included child protection, nursing, medicine, allied health,
executive management, health promotion, and early childhood
education. The yarns explored how health professionals work together,
and with families, to care for at-risk Aboriginal children. Five themes
emerged from the yarning groups that aligned with evidence from the
literature review and the experiences of Aboriginal peoples when
accessing health services. These were genuine engagement and
understanding; racism; historical bias; equity; and culture.
2.6 Phase 5: Clinical utility testing
Nine in-service sessions were delivered to present the proposed
model and evaluate the clinical utility with 96 staff members across the
four participating hospitals. The project team designed a paper-based
survey (available on request) to evaluate the model utility and
appropriateness, and to identify potential barriers and enablers to model
uptake from the perspective of clinicians in the field.
The survey comprised six multiple choice items for participants to
rate the usefulness of the model, and the anticipated ease of
implementing the principles into practice on a Likert scale from one to
five. The participant’s confidence in applying the principles to practice
was measured on a Likert scale from one to four. The five short answer
response questions invited respondents to identify potential barriers and
enablers to implementation, and potential benefits to both health services
and Aboriginal families.
The clinical utility survey was completed by 60 respondents: 57
clinicians who attended one of the in-service sessions and three others
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who were Aboriginal members of the project steering committee. The
quantitative data were summarised as descriptive statistics, and
qualitative findings were analysed for recurring themes and
incorporation into the final model design implementation plan.
3. Results
The results of the five project phases of Daalbirrwirr Gamambigu
and its components are described here. The model is a practical, 25-page
document designed for use by frontline clinicians, their managers and
hospital executives to guide the delivery of culturally safe child
protection responses for Aboriginal families in hospital settings. The
visual elements of the model document design reflect the value of
Aboriginal Australian artwork in promoting patient engagement in the
design of healthcare settings [63], and accords with health policy for
creating welcoming hospital environments [64].
The model is designed in such a way that it presents all the elements
of a culturally safe patient journey. These elements are: i) the thematic
diagram of the model; ii) the use of clinical yarning as a tool for
communication with families; and iii) a culturally adapted version of
ISBAR for inter-professional communication. A real-world example of
these elements is provided in ‘Latrell’s Story’, a fictional scenario to guide
clinicians in the practical application of the model. Supplementary
materials include: a cultural safety checklist for clinicians; an index of
resources for Aboriginal families; and the Daalbirrwirr Gamambigu
Aboriginal Consultation Diagram (Figure 1). A guide to organisational
model implementation and monitoring is provided in an accompanying
document.
3.1. Thematic Diagram and a Culturally Safe Patient Journey
The thematic diagram (Figure 2) forms the foundation of the model,
is rooted in strong Aboriginal cultures, and one that has thorough
community engagement embedded in all health service organisational
processes. The child is of primary importance, and grows up supported
by community, family, and Elders. When applied to clinical practice with
clinical yarning and a culturally adapted ISBAR, it reflects the aim of the
model for Aboriginal Australian families; and that is to ensure these
families experience respect, dignity and empowerment in their patient
journey (Figure 3). The culturally safe patient journey illustrates the
points and pathways of the hospital journey where Aboriginal families
can exert influence, and where hospital staff can acknowledge their roles
in listening and learning with respect, and their roles in advocating for
Aboriginal families.
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Figure 2: Daalbirrwirr Gamambigu thematic diagram
The Daalbirrwirr Gamambigu thematic diagram (Figure 2) shows:
The child is at the centre of care and grows up supported by
community, family, and Elders (following [2]).
The many outer contextual factors as ‘yellow balls’ inspired by the
flowers of the Australian tree Acacia Jennerae.
A ‘tree of life’ inspired by the trauma-informed perspective of the
collective healing tree for Stolen Generations members and their
descendants [65].
Thematic nests from yarning groups such as family, community and
Elders, reflecting the strengths in the cultural roots of life.
The critical success factors (following [45]) of cultural safety are
shown as building on a foundation of community engagement,
strong Aboriginal cultures and safe health services.
In phase 5 (clinical utility testing), 72% of the 57 in-service
participants felt the approach would be very to extremely useful and 95%
thought it could be easily or moderately challenging to apply in practice.
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Figure 3: Culturally safe patient journey
3.2. Clinical Yarning
The clinical yarning model (Figure 4) was adapted from the work of
Lin, Green and Bessarab (2016) and illustrates the key elements to
effective communication between health professionals and Australian
Aboriginal families.
Figure 4: Keys to clinical yarning (adapted from Lin, Green and Bessarab (2016))
For the Clinical Yarn, a process was adopted based on extant
research [66] where clinicians, stakeholders, and patients came together
to yarn through the relevance of the Lin et al. (2016) model. The ‘key
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elements of clinical yarning’ were slightly adapted in response to
stakeholder feedback and redrawn to fit within the artistic design of the
model document.
Clinical yarning guides clinicians to find common ground or
connection with families through two-way exchange and sharing of
experiences in a Social Yarn. Following this, conversation transitions to a
Diagnostic Yarn, in which open-ended questions and long silences are
used to hear the patient’s health story, which is then interpreted through
a biomedical (or child safety) lens. In the Management Yarn the clinician
provides ‘straight-up’ health information and critically, cocreates a plan
for care. When tested for clinical utility, almost three quarters (73%) of 57
in-service participants thought clinical yarning would be very or extremely
useful.
3.3 Culturally adapted ISBAR
Study site clinicians routinely conduct clinical handover following
the ISBAR mnemonic [67], where ISBAR is a tool that standardises this
routine process while leaving room for situational variation. When a
health professional suspects an Aboriginal child is at risk of harm, the
model provides a culturally adapted version of this approach that follows
the standardised process of ISBAR, while incorporating knowledge of
Aboriginal strengths and family culture (Figure 5).
The culturally adapted ISBAR template is a concise, stepwise guide
to presenting timely and relevant medical and cultural information in
routine professional communications. In clinical utility testing, almost
three quarters (71%) of 57 in-service participants thought the modified
ISBAR would be very or extremely useful.
Figure 5: Culturally adapted ISBAR
3.4. Cultural Safety Checklist for Clinicians
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Clinical stakeholders and participants in the clinical utility testing
identified the need for a self-assessment checklist to guide (but not
dominate) their practice with Aboriginal families. In response, the
Cultural Safety Checklist for Clinicians was developed for use as a wallet-
sized prompt card for attachment to staff identification badges, as large-
scale posters for display in clinical areas, and in staff education inductions
(Figure 6). The checklist prompts clinicians to reflect on use of core model
elements in clinical yarning with families; incorporation of relationships;
and considerations in the use of ISBAR.
Figure 6: Cultural safety checklist for clinicians
3.6 Clinical Utility Testing of the Model
The model was rated as very to extremely useful by 72% (n=43) of
respondents (Mean 3.8/5), 73% (n=44) rated clinical yarning as very to
extremely useful (Mean 4/5), and 72% (n=43) rated the culturally adapted
ISBAR as very to extremely useful (Mean 3.9/5).
Of the 100% (n=60) of respondents who felt that the model could be
implemented into clinical practice (Mean 3.3/4), 33% (n=20) thought it
could be easily implemented, 62% (n=37) thought it could be
implemented but would be moderately challenging, and 5% (n=3)
thought it could be implemented by would be very challenging.
Perceived confidence levels varied with 30% (n=18) of respondents very
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or extremely confident to apply the model, and 70% (n=42) somewhat or
slightly confident to apply the model.
4. Discussion
The aim of Maam-darrundaygam Daalbirrwirr Gamambigu is to
guide clinical and organisational approaches to a culturally safe patient
journey. It does this through: a detailed framework with its core elements
of clinical yarning with Aboriginal families; a culturally adapted ISBAR
for professional communication; clinician checklist; and culturally
designed resources. Rigorous community and clinician consultation
attests to the potential of Maam-darrundaygam Daalbirrwirr
Gamambigu to be successfully implementated and integrated into
existing health and child protection services, including policy directions.
Thus far, we have tested its clinical utility, and so the next step is to use
implementation science to evaluate impact and outcomes. To date, there
has been a void in this space which has led to at-risk Aboriginal families
becoming engaged with child protection services receiving
inappropriate/insufficient healthcare. The model is one tool that may
serve to turn around the reluctance of a non-Aboriginal health workforce
to engage with cultural awareness and respect because it provides a
practical guide for clinicians to follow. Differentiating the response to
child protection concerns in settings such as hospital emergency
departments that interface with child protection services, may not only
result in improved referral to support services but also reduce the impact
of serious longer-term outcomes of referral to child protection services for
neglect in particular [68].
4.1 The Daalbirrwirr Gamambigu (Safe Children) Model of Care
Cultural safety is relevant at every ‘level’ of care [26,34,35,48], and
the model thematically interconnects organisational types and levels of
cultural safety (Figure 2). The culturally adapted tools prioritise honesty
and authenticity in health professional practice and contribute to
dismantling institutional racism with safe organisational processes. This
aligns with the concept of ‘cultural support’ [69], a key concept in child
protection policy.
4.2 Appropriate Governance and Cultural Engagement
Phases 1 and 2 of the project involved the establishment of cultural
governance, project oversight, cultural engagement processes and
mapping. Positive cultural factors are present in each level of intervention
(child and/or family) and the service system itself [70], and
acknowledged in related models, for example the Koorliny Mort and
Wadja New Models of Care [71,72]. Respecting the diversity of the more
than 500 Aboriginal nations in Australia is key to safe cultural governance
and implementation [73]. While the model demonstrated strong cultural
acceptance among Aboriginal stakeholders in the study sites and
participating organisations, consideration of cultural diversity will need
to be continued in implementation through strengthening and extending
these relationships.
The five project phases and quality appraisal (Appendix A; [74])
demonstrate the degree of cultural rigour [39] in the model development.
In the absence of detailed explorations of cultural rigour in Australian
research ethics, our approach aligns with international ethics processes
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[75] so that Aboriginal Australians were involved in the design,
governance, management, implementation and analysis of the research.
This culturally respectful research process, an enabling policy context,
and enthusiastic clinician engagement in the topic of cultural safety,
meant the project process and relational methodology was decidedly
non-linear. This is a reflection of the importance of building relationships
as the foundation for practice [34], and locates the model as a point of
reference for intersectoral approaches to care. The model bridges the gaps
between child maltreatment policy, research and practice [76] and serves
as an aide to overcoming the fragmentation in service provision to
Aboriginal families [35].
4.3 A Culturally Safe Patient Journey
Health professionals who want to ‘step-up’ [77], and build a critical
consciousness [78] beyond that of cultural awareness training [79], can
draw on the model to restructure their practice to embed Aboriginal
world views [80]. The graphic of the culturally safe patient journey
(Figure 3) is an original concept by an Aboriginal project officer, and
culturally connects the visual, cognitive, social and pedagogic systems
[81]. In that journey, Aboriginal yarning enables honest, respectful and
clear communication with families, which is key to the provision of safe
and effective clinical care [32]. Implementation of the model throughout
the patient journey puts the importance of taking time [34,35,82] to build
trust [59,83] in forming meaningful therapeutic relationships [84,85] with
Aboriginal Australians into a practical format.
4.4 Clinical Yarning
A key clinical resource in the model was the adaptation of clinical
yarning as a method for building relationships of trust [66]. The
Daalbirrwirr Gamambigu thematic diagram (Figure 2) and the yarning
group data analysis acknowledge the importance of power (a key
dimension of cultural safety) in spaces where healthcare and child
protection services intersect. Language builds meaning [86], and
communication between clinicians and Aboriginal children and families
defines the way we think about the child and the family.
A key policy lever challenging institutional power is the embedding
of cultural safety in Australian healthcare standards [87] which may
influence a shift within the dominant discourse in health and child
protection services from that of the clinician to that of the Aboriginal
child, family and community [8]. The project was also supported by
cultural plans local to the study sites [41,88]; locating the model as a
ground level clinical strategy to remove the culturally blind [89] filter that
is placed over Aboriginal families’ culture and experiences. As we have
argued elsewhere [32], embedding cultural safety means: the patient has
the power to determine what is culturally safe practice; professionals
reflect on their personal and professional power in care; and services
respond to cultural differences.
The language used by clinicians in hospital settings shapes the
interactions they have with Aboriginal families [90]. That is, institutional
discourse occurs in an organisational setting where the clinician is the
expert driving the discourse. Communication is a key factor in creating
safe environments for Aboriginal patients [91]. Tanner argued that
‘communication difficulties exacerbate knowledge and power
differentials for many families’ [31] and Jennings emphasised that ‘talk’
played a pivotal role in ‘mediating the power differentials between health
professionals and Indigenous clients’ [90]. Communication between
clinicians and non-Aboriginal and Aboriginal people defines the way
clinicians think about the child and family. We aime to remove the filter
placed over culture and experiences, and to shift the dominant discourse
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in health and child protection services from that of the clinician to that of
the Aboriginal child, family and community.
4.5 Culturally Adapted ISBAR
The model aligns with policy that calls for culturally safe care to be
delivered in regard to cultural identity [92,93] and in response to peoples’
cultural uniqueness [94-96]. The culturally adapted ISBAR tool [67]
prompts communication of the cultural diversity and strengths of
Australian Aboriginal families and culture (Figure 4). The mediation of
power differentials—evident in clinical yarning—is also central to the
content of the culturally adapted ISBAR. This approach advances
culturally responsive communication research [91] by demonstrating
how communication between two worlds can be practically integrated in
interprofessional communication through an enabling workplace [97].
Such processes are critical to address the widespread inadequacies in
communications between health organisations and with Aboriginal
families, and the subsequent impacts on engagement, service
coordination, and continuity of care [114]f). In going beyond the
communication skills developed in standard cultural awareness training
[98,99], health and child protection professionals may utilise these
techniques as common points of reference for quality care.
4.6 Daalbirrwirr Gamambigu at the Intersection of Public Health and Child
Protection
In the child protection sector, numerous reports, policies and
strategies call for reforms. For example, the national level Fourth Action
Plan of the National Framework for Protecting Australia’s Children [100]
has a priority to improve outcomes for Aboriginal children and
improving the application of the Aboriginal and Torres Strait Islander
Child Placement Principle [101]. The Family Matters Report 2020 calls for
a dedicated national strategy to implement national standards of practice
for child protection [47] and the Australian Government’s ‘National
Agreement on Closing the Gap’ includes an outcome to reduce
overrepresentation in the child protection system [102]. The potential
significance of the model lies at the intersection of healthcare and child
protection systems because both systems have enabling policy
environments that emphasise cultural safety where the cultures of
Aboriginal peoples:
matter in health and wellbeing policy [52,103,104];
can be embedded in health professional accreditation [105];
are a priority in child safe organisations [106,107];
can enhance culturally respectful and appropriate emergency
department team skills [108];
influence emergency department care [109];
inform interdisciplinary approaches to child care [110];
are a foundation for cultural training for health professionals [111];
lead to the provision of care that is judged to be culturally safe [112];
and
can help improve the effectiveness of communication with
Australian Aboriginal families [113].
4.7 Strengths and Limitations
The Daalbirrwirr Gamambigu Model is the first empirical resource
to support clinicians and organisations to engage with at-risk Aboriginal
families in Australian hospitals and improve outcomes through referral
to appropriately targeted early intervention services. It is the first
Australian translational action research project to clearly articulate how
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to create cultural safety in research and in practice since the definition
was noted as an emerging policy concept in hospital care in early 2000
[36].
There is a major gap in our knowledge of how Aboriginal families
use hospital and other mainstream health services, and how this
utilisation and engagement is impacted by better health professional
communication and innovative models of care. For example, some
Aboriginal families do not identify as such on presentation to hospital for
personal or historical experiences of racism and trauma from government
institutions. The extrapolation of findings from the qualitative study was
limited to some extent by recruiting a convenience sample to the yarning
groups. A broad and more diverse representation from Aboriginal
nations throughout New South Wales is recommended for future
research.
The project gave rigorous attention to cultural forms of engagement
and communication by providing a practical guide for interprofessional
collaboration in hospitals. The project also contributed to reframing the
nature of interaction that is currently determined by western institutional
discourse.
Known barriers to translation of research findings into practice were
addressed through early and ongoing engagement with community
stakeholders and ministerial policy makers. Study limitations and
potential barriers to implementation identified in clinical utility testing
will be addressed in the feasibility stage of translation. This approach will
support clinicians and organisations with required learnings and
processes, engaging with a broader range of Aboriginal stakeholders and
use of patient experience measures as a key domain of evaluation.
5. Conclusions
The Daalbirrwirr Gamambigu Model of Care is a practical link
between policy and daily practice that shows how staff systems in
mainstream organisations can be disrupted to decolonise professional
power and institutional racism. In doing so, the model can be used as a
tool to support and advocate for culturally safe health services for
Aboriginal Australian families. If cultural safety can be successfully
embedded using our model within these systems and integrated into
routine healthcare practice, significant improvements in Aboriginal child
and family outcomes, including child protection outcomes are possible.
Supplementary Materials: The following are available online at
www.mdpi.com/xxx/s1, Figure S1: Daalbirrwirr Gamambigu Aboriginal
consultation diagram, Figure S2: Daalbirrwirr Gamambigu thematic diagram,
Figure S3: Culturally safe patient journey, Figure S4: Keys to clinical yarning,
Figure S5: Culturally adapted ISBAR, Figure S6: Cultural safety checklist for
clinicians.
Author Contributions: Conceptualisation, Tara Flemington, Jennifer Fraser, Bob
Lonne and Mark Lock; Data curation, Tara Flemington, Clinton Gibbs, Shanthi A.
Ramanathan, Liesa Clague and Donna Hartz; Formal analysis, Tara Flemington,
Jennifer Fraser, Shanthi A. Ramanathan, Liesa Clague and Mark Lock; Funding
acquisition, Tara Flemington, Jennifer Fraser, Amanda Ryan, Susan Marks,
Dimitra Tzioumi, Shanthi A. Ramanathan, Donna Hartz and Bob Lonne;
Investigation, Tara Flemington, Clinton Gibbs, Joe Bryant, Amanda Ryan, Devika
Wijetilaka, Susan Marks, Dimitra Tzioumi, Mick Scarcella and Liesa Clague;
Methodology, Tara Flemington, Jennifer Fraser, Clinton Gibbs, Shanthi A.
Ramanathan, Liesa Clague and Bob Lonne; Project administration, Tara
Flemington, Jennifer Fraser and Clinton Gibbs; Resources, Tara Flemington and
Jennifer Fraser; Supervision, Tara Flemington and Jennifer Fraser; Validation,
Jennifer Fraser, Joanne Shipp, Joe Bryant, Amanda Ryan, Mick Scarcella and Mark
Lock; Visualisation, Tara Flemington; Writing – original draft, Tara Flemington
and Mark Lock; Writing – review & editing, Tara Flemington, Jennifer Fraser,
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Clinton Gibbs, Joanne Shipp, Joe Bryant, Shanthi A. Ramanathan, Liesa Clague,
Donna Hartz, Bob Lonne and Mark Lock . All authors have read and agreed to the
published version of the manuscript.
Funding: This research was funded by NSW Regional Health Partners – MRFF
Rapid Applied Research Translation Grant – GA59722.
Institutional Review Board Statement: The study was conducted according to
the guidelines of the National Health and Medical Research Council’s National
Statement on Ethical Conduct in Human Research. It was approved by the NSW
Aboriginal Health and Medical Research Council HREC (Ref: 1369/18), and the
Sydney Children’s Hospitals Network HREC (Ref: LNR/17/SCHN/318).
Informed Consent Statement: Informed consent was obtained from all subjects
involved in the study.
Data Availability Statement: Not applicable.
Acknowledgments: We thank Jessica Morris for conceptualization of the
Culturally Safe Patient Journey diagram; and First Nations editor Angie Martin
(Kooma) for proofreading. We acknowledge the generosity and spirit with which
participants shared their cultural experiences in the yarning groups, interviews,
and workshops. We pay our respects to all First Nations Australians—Always
Was, Always Will Be, Aboriginal Land!
Conflicts of Interest: The authors declare no conflict of interest. The funders had
no role in the design of the study; in the collection, analyses, or interpretation of
data; in the writing of the manuscript, or in the decision to publish the results.
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Appendix A
Aboriginal and Torres Strait Islander Quality Appraisal Tool
Harfield S, Pearson O, Morey K, Kite E, Canuto K, Glover K, et al. Assessing the quality of
health research from an Indigenous perspective: the Aboriginal and Torres Strait Islander
quality appraisal tool. BMC Medical Research Methodology. 2020;20(1):79.
1. Did the research respond to a need or priority determined by the community?
Unmet need identified by research project steering committee. The Daalbirrwirr
Gamambigu Project developed from the SAFE-ED project where the steering
committee members recognised the unmet need of responding to Aboriginal children
at risk of harm who presented to emergency departments.
Testing relevance of idea with staff. JF and TF tested the relevance of this idea in
discussions with Aboriginal and non-Aboriginal colleagues in the Mid North Coast
Local Health District and the Sydney Children’s Hospital Network. JF and TF
received affirmation that there was an unmet need in emergency department
responses to Aboriginal children at risk of harm.
Finding research funding. JF and TF investigated opportunities for a Medical
Research Future Fund (MRFF) grant entitled ‘Embedding cultural safety in child
protection policies for Aboriginal families in NSW paediatric care settings’ with the
formal support of the Director of Aboriginal Health (Mid North Coast Local Health
District) and Executive Aboriginal Health Manager (Sydney Children’s Hospitals
Network).
Engaging with Aboriginal community in local areas. TF, a long-time community
member in the local area, discussed the grant idea further with Aboriginal staff
members, who provided TF with advice to contact Aboriginal community (not health
staff), such as the Coffs Harbour Aboriginal Community Care Centre Inc. (known as
Abcare) and the NSW Child, Family and Community Peak Aboriginal Corporation (
AbSec). This engagement involved genuine contact between TF/CG and AbSec staff
at many stages of the development of the Daalbirrwirr Gamambigu project. The
project team are now finalising endorsement of the Framework and MoC with the
AbSec CEO.
Engaging with Aboriginal Researchers. TF and JF had established the project
steering committee which included a number of Aboriginal advisors at the clinical,
managerial and executive level from two Local Health Districts. Furthermore, the
project team included three Aboriginal project officers at various stages of the project,
and Aboriginal members of the research team Associate Professor Donna Hartz, Dr
Mark J Lock, and Dr Liesa Clague.
Engaging with Aboriginal staff. The Aboriginal staff involved in the project are
listed in an Appendix of the Framework and Model of Care documents are Clinton
Gibbs, Joanne Shipp, Joseph Bryant, Robyn Martin, Amanda Ryan, Mick Scarcella,
Jessica Morris, and Brenna Bernardino.
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Testing the idea with reference to policy, strategy, and research. There were
numerous formal published sources of information where the needs of Aboriginal
families and children were noted in regards to hospital care and child protection
systems. The scoping literature review demonstrates the depth of investigation that
the team went to so that the project aligned with the needs of Aboriginal families as
described in formal literature.
Occurs within a broader policy context. The idea for the project occurred within an
enabling policy context where the Mid North Coast Local Health District and the
Sydney Children’s Hospital Network had strategies to Close the Gaps in Aboriginal
health outcomes. These organisations operated in accord with NSW Government
policy to reduce disadvantage experienced by Aboriginal people. In practice, an
enabling organisational environment and policy context allows engagement and
consultation activities to occur with Aboriginal people.
2. Was community consultation and engagement appropriately inclusive?
The consultation diagram shows the key points of engagement with stakeholders
appropriate to researching the intersection between healthcare and child protection
systems.
Project Staff are listed in the Framework and Model. There were two staff from the
University of Sydney (lead academic organisation, one non-Aboriginal person and
one Aboriginal person); five staff from the Mid North Coast Local Health District
(sponsoring organisation, government health agency, four Aboriginal people and
one non-Aboriginal person); three staff from the Sydney Children’s Hospitals
Network (participating organisation, government health agency, one Aboriginal
person and two non-Aboriginal people) and three independent staff, two Aboriginal
and one non-Aboriginal. Of the ten project staff, seven were Aboriginal and three
were non-Aboriginal peoples. Careers spans show that six Aboriginal staff (CG, ML,
LC, JS, JB, JM) combined had careers in Aboriginal affairs. Career spans for the two
non-Aboriginal staff (JF and TF) were developed in paediatric/midwifery nursing
practice, child protection and research with a high awareness of Aboriginal peoples’
needs in healthcare.
AbSec Conference Workshop Participants: There were over 50 participants in the
workshop that took place in Coffs Harbour on Gumbaynggirr Country in November
2019. This was a culturally appropriate event because of: the conference theme
(Strong Communities Strong Kids), it was hosted by the AbSec (the NSW Child and
Family Peak Aboriginal Corporation), the conference provided participants with an
opportunity to strengthen their skills and knowledge in supporting Aboriginal
children, young people and families. The location (Coffs Harbour) was also the site of
sponsoring organisation (Mid North Coast Local Health District); and the
participants were Aboriginal stakeholders with professional and personal interests in
the Daalbirrwirr Gamambigu project. The structure of the workshop was designed
around circles of yarning, with three roundtable topics (clinical yarning, model of
care, and ISBAR). The workshop comments and suggestions informed the
implementation of the project.
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Sydney Children’s Hospital Network Staff (SCHN): There were nine staff from the
SCHN. The Chief Investigator (JF, non-Aboriginal), child protection unit director
(SM, non-Aboriginal), executive medical director (MM, non-Aboriginal), staff
specialist (DT, non-Aboriginal), diversity health coordinator (JC, non-Aboriginal),
senior nursing research fellow (SSL, non-Aboriginal), director of nursing and
midwifery education (SW, non-Aboriginal), director of clinical integration (MD, non-
Aboriginal), Aboriginal health management advisor (MS, Aboriginal). Of the nine
SCHN members, one is Aboriginal and ten are non-Aboriginal. Their roles and
careers are nursing, medical, clinical, information technology, paediatricians,
specialists, researchers, and executives. The SCHN members were active in health
and child protection areas.
Aboriginal organisations. Five Aboriginal organisations participated in this project.
The Aboriginal Health and Medical Research Council (AH&MRC, peak advocacy
body and Human Research Ethics Committee for Aboriginal community controlled
health organisations in NSW); AbSec the NSW Child and Family Peak Aboriginal
Corporation (lead advocacy organisation for Aboriginal child protection in NSW);
AbCare (Aboriginal Children/Young People in Out of Home Care, Coffs Harbour,
NSW) is the lead organisation in the Mid North Coast Local Health District that
provides services for Aboriginal people in out of home care to Aboriginal
communities in Coffs Harbour, Bellingen and Clarence Valley areas, the Secretariat
National Aboriginal and Torres Strait Islander Child Care (SNAICC, is the national
peak body for Aboriginal child protection, of which AbSec is a member); the
Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM
) is the national peak professional association for Aboriginal and Torres Strait
Islander Nurses. These organisations represent Aboriginal communities and
professionals in child protection and health care, from the local level (AbCare), to
state level (AbSec, AH&MRC), to the national level (SNAICC, CATSINaM).
3. Did the research have Aboriginal and Torres Strait Islander research leadership?
The research was not led by Aboriginal researchers. However, Aboriginal researchers
were integral to its evolution and development through the governance committee,
research assistance, research advice, and in technical aspects of the project such as
ethics applications, yarning groups, interviews, conference presentations, data
analysis and writing (ML, LC, CG, JS, JB, MS).
4. Did the research have Aboriginal and Torres Strait Islander governance?
The Daalbirrwirr Gamambigu project had a Steering Committee of 21 members
representing the three stakeholder organisations, the University of Sydney, the Mid
North Coast Local Health District, and the Sydney Children’s Hospital Network. The
steering committee had Aboriginal (n=6) and non-Aboriginal (n=15) members and
was chaired by a non-Aboriginal Executive chairperson.
5. Were local community protocols respected and followed?
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The protocols for local community engagement were learnt through oral
communication with Aboriginal people, as cultural authority is learnt and
understand through developing trusting relationships. In this project, the local
communities were not only Australian Aboriginal communities but also the
communities of practice established around child protection in healthcare settings.
Some examples will explain. The Aboriginal staff of the MNCLHD (e.g., RM, AR, CG,
JS, and JB) have 75 years of living and working with Aboriginal people throughout
the Mid North Coast Local Health District. Key stakeholders in each of the Aboriginal
organisations (SNAICC, AbSec, and AbCare) provided direction on community
engagement within their respective networks to TF. The degree and extent of
engagement, as aligned with local community protocols, was not systematically
documented in respect of cultural protocols or yarning and oral knowledge transfer.
6. Did the researchers negotiate agreements in regards to rights of access to Aboriginal and
Torres Strait Islander peoples’ existing intellectual and cultural property?
This was not explicitly negotiated but will be considered in the evaluation phase.
7. Did the researchers negotiate agreements to protect Aboriginal and Torres Strait Islander
peoples' ownership of intellectual and cultural property created through the research?
This was not explicitly negotiated.
8. Did Aboriginal and Torres Strait Islander peoples and communities have control over the
collection and management of research materials?
The data collection and materials are owned and managed by the University of
Sydney, and stored in a secure digitally encrypted location. The control and
management of these materials was overseen by the steering committee and
administered by the research team. Data collection, analysis and publication was
undertaken by Aboriginal and non-Aboriginal staff.
9. Was the research guided by an Australian Aboriginal research paradigm?
The methodology was founded on the combination of the Wiradjuri developed
Ngaa-bi-nya program evaluation framework and the Western i-PARIHS framework,
in keeping with the Australian ethic of cultural safety being a shared learning
experience.
The methodology was intersectional in acknowledgement of the cultural interface
(following Nakata) between Aboriginal and Western world views as this is reflected
in the empirical methodology of data collection such as the scoping literature review
and yarning groups.
The ethic of the project was founded on enabling cultural safety in every point and
pathway of healthcare governance which is stated in the Mid North Coast Aboriginal
Health Authority endorsed Aboriginal Cultural Safety and Security Framework.
10. Does the research take a strengths-based approach, acknowledging and moving beyond
practices that have harmed Aboriginal and Torres Strait peoples in the past?
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The Daalbirrwirr Gamambigu project privileged the cultural strengths and cultural
voices of Aboriginal peoples. This is evidenced in the philosophy informing the
project (cultural safety), the methodology (Ngaa-bi-nya, i-PARIHS, Cultural Respect
Framework for Aboriginal and Torres Strait Islander Health, and the Family Matters
Roadmap), the consultation process which involved many Aboriginal people and
Aboriginal organisations (who then formally endorsed the Daalbirrwirr Gamambigu
materials), the governance committee, feedback to stakeholders and broader
audiences, all aspects of the data analysis and writing, commissioning of the artwork
from a local Aboriginal artist, and the use of an Aboriginal language through
engagement with an Muurrbay Aboriginal Language and Culture Co-operative.
11. Did the researchers plan to and translate the findings into sustainable changes in policy
and/or practice?
The methodology, informed by both Ngaa-bi-nya and i-PARIHS, was directed
towards translational research that benefits Aboriginal families and the professionals
who work with them. The Daalbirrwirr Gamambigu Framework and Model will be
cited in policy documents (e.g. NSW Aboriginal Health Plan) as direct evidence of
cultural safety research. It will be referenced in peer reviewed journal articles in line
with the need to produce a high quality evidence for policy and practice. It was
developed into the training resources (the Framework and Model) after extensive
stakeholder consultation and practitioner workshops. In 2022, the Daalbirrwirr
Gamambigu Model will be trialled and evaluated in both the Sydney Children’s
Hospital Network (metropolitan) and the Mid North Coast Local Health District
(regional).
12. Did the research benefit the participants and Aboriginal and Torres Strait Islander
communities?
The benefit is formally demonstrated in the Aboriginal organisational endorsement
of the Daalbirrwirr Gamambigu project. This endorsement underscores the
determination of the research team to ensure meaningful consultation with
Aboriginal stakeholders as a key way to determine if the benefit is seen by Aboriginal
people.
13. Did the research demonstrate capacity strengthening for Aboriginal and Torres Strait
Islander individuals?
There were many Aboriginal people involved in this project from clinical experts,
executive officers, project workers, researchers, staff members, and from Aboriginal
community organisations. The strengthening is about participation in a formal
research translation activity, paid employment as project officers, paid employment
as researchers, inclusion in data analysis, inclusion in publications, and inclusion in
conference and workshop activities. That is capacity building was evident in
employment, research participation, formal publication, and communication and
engagement activities. Three Aboriginal project officers employed across the project
duration have since gone on to permanent roles in positions of seniority in
government health organisations.
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14. Did everyone involved in the research have opportunities to learn from each other?
We learned from each other as members of the governance committee (how to
translate research into practice and Aboriginal community benefit); in
communication and engagement activities (workshop design and conduct); in data
analysis and writing (collecting data, interpreting data, and writing in formal reports
and journal articles); and in routine meetings between non-Aboriginal and
Aboriginal researchers.
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