The Daalbirrwirr Gamambigu (Safe Children) Model: Embedding Cultural Safety in Child Protection Responses for Australian Aboriginal Children in Hospital Settings
Abstract
:1. Introduction
2. Materials and Methods
- 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
2.2. Phase 1: Developing Appropriate Governance and Oversight
2.3. Phase 2: Cultural Engagement Process and Mapping
2.4. Phase 3: Scoping Literature Review
2.5. Phase 4: Yarning Groups and In-Depth Interviews
2.6. Phase 5: Clinical Utility Testing
3. Results
3.1. Thematic Diagram and a Culturally Safe Patient Journey
- The child is at the centre of care and grows up supported by community, family, and Elders (following [2]).
- The many outer contextual factors are depicted as “yellow balls’” and are 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 [64].
- 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.
3.2. Clinical Yarning
3.3. Culturally Adapted ISBAR
3.4. Cultural Safety Checklist for Clinicians
3.5. Clinical Utility Testing of the Model
4. Discussion
4.1. The Daalbirrwirr Gamambigu (Safe Children) Model of Care
4.2. Appropriate Governance and Cultural Engagement
4.3. A Culturally Safe Patient Journey
4.4. Clinical Yarning
4.5. Culturally Adapted ISBAR
4.6. Daalbirrwirr Gamambigu at the Intersection of Public Health and Child Protection
- can be embedded in health professional accreditation [105];
- 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
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
- 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.
- 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 the 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 disadvantages 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. Career 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), and 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 a sponsoring organisation (the 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.
- Sydney Children’s Hospital Network Staff (SCHN): There were nine staff from the SCHN, including 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), and the Aboriginal health management advisor (MS, Aboriginal). Of the nine SCHN members, one is Aboriginal and ten are non-Aboriginal. Their roles and careers are in the fields of nursing, medicine, clinical, information technology, paediatrics, specialists, research, and management. 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 and MRC, the 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?
- The protocols for local community engagement were learned through oral communication with Aboriginal people, as cultural authority is learned and understood through the developing of 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 with respect to 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?
- 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.
- 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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Flemington, T.; Fraser, J.; Gibbs, C.; Shipp, J.; Bryant, J.; Ryan, A.; Wijetilaka, D.; Marks, S.; Scarcella, M.; Tzioumi, D.; et al. 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 2022, 19, 5381. https://doi.org/10.3390/ijerph19095381
Flemington T, Fraser J, Gibbs C, Shipp J, Bryant J, Ryan A, Wijetilaka D, Marks S, Scarcella M, Tzioumi D, et al. The Daalbirrwirr Gamambigu (Safe Children) Model: Embedding Cultural Safety in Child Protection Responses for Australian Aboriginal Children in Hospital Settings. International Journal of Environmental Research and Public Health. 2022; 19(9):5381. https://doi.org/10.3390/ijerph19095381
Chicago/Turabian StyleFlemington, Tara, Jennifer Fraser, Clinton Gibbs, Joanne Shipp, Joe Bryant, Amanda Ryan, Devika Wijetilaka, Susan Marks, Mick Scarcella, Dimitra Tzioumi, and et al. 2022. "The Daalbirrwirr Gamambigu (Safe Children) Model: Embedding Cultural Safety in Child Protection Responses for Australian Aboriginal Children in Hospital Settings" International Journal of Environmental Research and Public Health 19, no. 9: 5381. https://doi.org/10.3390/ijerph19095381