About the project

Our research and project approach is participatory and collaborative. It involves Aboriginal and Torres Strait Islander people in all stages of the research, including:

  • funding submissions
  • governance
  • project leadership
  • data collection
  • analysis
  • distribution.

Community leaders, service providers, policy makers and families are involved in the co-design process, working with investigators from 12 institutions.

Conceptual framework

We have developed a Conceptual framework drawing on holistic Aboriginal constructs of social and emotional wellbeing to illustrate the aims and values of the project.

The conceptual framework incorporates two main elements:

1. Four main domains of recognition, assessment, awareness and support 

The four main domains were developed during the initial consultation stages of the project which revealed concerns about the use of language such as ‘screening’ and ‘intervention’. The domains of ‘recognition’ and ‘assessment’ more accurately articulate ‘screening’ strategies that incorporate a feasible two-tiered process for care providers to recognise parents who may require more in-depth assessment for complex trauma; and ‘intervention’ approaches to improve trauma-informed perinatal care and minimise the risks of re-traumatising parents (awareness), and provide trauma-specific support.

2. Eight core values with related principles and questions

We identified seven frameworks that included trauma-informed values and principles using online searches and team members’ knowledge. Further values and principles relating to cultural and emotional safety were identified in the first key stakeholder workshop. These were mapped and consensus reached by the project team. This process resulted in identification of eight core values: safety, trustworthiness, empowerment, collaboration, culture, holism, compassion and reciprocity. Each contains action-oriented principles that enable the core values to be realised, and are accompanied by questions developed to aid reflection on whether the activity under consideration is consistent with the core value. See HPNF conceptual framework values, principles and reflective questions – Table 1 [PDF 158.66KB]

Research plan

The research plan is designed in accordance with:

  • Intervention mapping, [external link] [1] using “theory and evidence as foundations for taking an ecological approach to assessing and intervening in health problems and engendering community participation”. This research addresses steps one to four. Steps five and six (implementation and evaluation) will form the basis of a subsequent project.
  • Power threat meaning framework [external link] (PTMF), [2] “an over-arching structure for identifying patterns in emotional distress, unusual experiences and troubling behaviour, as an alternative to psychiatric diagnosis and classification”. We will incorporate the PTMF by reframing behaviours related to complex trauma as normal self- protective responses to threatening situations rather than pathological deficits.
  • Principles for population-based screening [external link] [3] to assess the benefits, risks, costs, acceptability, accuracy and harms of recognising and assessing parents' experiencing complex trauma.
  • Indigenous research methodologies [4] that involve privileging Aboriginal worldviews, self-determination and Aboriginal community control.

References

  1. Bartholomew Eldrigde LK, Markham CM, Ruiter RAC, et al. Planning health promotion programs: An Intervention Mapping approach. 4 ed. Hoboken, NJ: Wiley 2016.
  2. Johnstone L, Boyle M, Cromby J, et al. The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society, 2018.
  3. Australian Health Ministers' Advisory Council. Population based screening framework. Barton: Commonwealth of Australia, 2008.
  4. Rigney L. Indigenous Australian views on knowledge production and Indigenist research. In: Runnie J, Goduka N, eds. Indigenous peoples' wisdom and power: Affirming our knowledge. Burlington, USA: Ashgate Publishing 2006:32-48.

Ethics phase

Applications for ethical approval are being submitted in three phases.

Phase One (2018)

Focus: scoping and fostering a culturally and emotionally safe project environment.

In this phase, key stakeholders will be identified, including:

  • community members
  • service providers
  • clinicians
  • academics

Activities during this planning phase and first two CBPAR cycles include:

  • conducting a scoping review of perinatal research involving parents who have experienced maltreatment in their own childhood
  • hosting the first key stakeholder workshop to present scoping review evidence, refine project aims, develop safety protocols and discuss current strategies
  • piloting qualitative research with community leaders/Elders
  • conducting a full systematic review of qualitative studies of perinatal experiences among parents with a history of maltreatment in their own childhoods
  • scoping relevant complex trauma screening tools
  • hosting the second key stakeholder workshop to reflect on gain consensus on assessment tool domains, reflect on findings from Elder discussion groups, share information about current ‘exemplar’ programs, and refining protocols for working with parents in Phase Two.

Phase Two (2019)

Focus: preliminary discussions with families.

This phase and third CBPAR cycle will include:

  • conducting in-depth qualitative interviews and focus (discussion) groups with prospective and new Aboriginal parents who have experienced complex trauma to ask about wording in draft assessment tool questions and what support strategies might be helpful
  • Indigenous psychologist training to refine a ‘gold standard’ comparison for assessing Aboriginal parents experiencing complex trauma
  • hosting the third key stakeholder workshop to reflect on the findings from the qualitative research with parents and refine draft assessment process and possible support strategies.

Phase Three (2020)

Focus: psychometric evaluation of assessment approach.

This third ethics phase and fourth CBPAR cycle will include:

  • psychometric testing of the proposed assessment approach.
  • a teleconference to refine the assessment process for field testing.
  • interviewing and holding focus groups with service providers to assess the feasibility of using the proposed recognition and assessment approach and support strategies
  • conducting interviews and discussion groups with prospective and new Aboriginal parents to assess the acceptability of the proposed assessment process and support strategies

Image credit: Cultures Child, Ink on paper, 2018, Shawana Andrews
A father, mother and child wearing possum skin cloaks sitting by a myrnong daisy, the feather holds the stem and looks to the daisy as it holds history and knowledge of the ancestors, this gives him strength. The mother holds a newborn and rests against the stem, it supports her. Mother and father are on different sides of the stem representing their different paths and roles in caring and nurturing for children. The daisy is in flower but also has a new bud and speaks of future generations and continuity. The stones below represent a strong foundation of many generations and the stitching on the cloaks represent the relational connectedness of Aboriginal people and worldview. The mother's hair blows in the wind, representing change.