Lowitja Institute:: Browsing by Author "Armstrong E."

Browsing by Author "Armstrong E."

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A flow that comes when we're talking: water metaphors for exploring intercultural communication during early childhood assessment interactions in a Yolnu (First Nations Australian) community.
Armstrong E.; Maypilama L.; Bukulatjpi Y.; Gapany D.; Fasoli L.; Ireland S.; Baker R.D.; Hewat S.; Lowell A.; Yolnu
Culture mediates how all people think and communicate and intercultural communication skills are required for effective collaboration. This study (2017-2021) explored intercultural communication with 40 participants in one very remote First Nations Australian community in Northern Australia. We explored the perspectives of both Yolnu (First Nations Australian people from North-East Arnhem Land) and Balanda (non-Indigenous people, in this case Australian) on interactions during early childhood assessments of Yolnu children (0-6 years). Our intercultural research team used a culturally responsive form of video-reflexive ethnography, a Yolnu approach to in-depth discussion and collaborative analysis. In this article, we explore nine intercultural communication processes that were recognized and enacted by study participants. Each process is represented by a metaphor drawn from water traveling in North-East Arnhem Land. We share these processes so that others may consider exploring their relevance in other intercultural communication contexts. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
How do Yolnu recognise and understand their children's learning? Nhaltjan nuli ga yolnuy nhama ga marr-dharanan djamarrkuliw marngithinyawuy?
Armstrong E.; Maypilama L.; Fasoli L.; Guyula A.; Yunupinu M.; Garrutju J.; Gundjarranbuy R.; Gapany D.; Godwin-Thompson J.; Lowell A.; Yolnu
Indigenous families have culturally-specific strengths, priorities, and methods for assessing their children's development. Recognition and support of children's and families' strengths are important for identity, health and wellbeing. However, strengths can be missed in assessment processes developed in non-Indigenous contexts. Yolnu are First Nations Australian peoples from North-East Arnhem Land. This study was conducted to explore Yolnu early childhood development, assessment and support in response to concerns that Yolnu strengths and priorities are often not recognised. The cultural and linguistic expertise of Yolnu researchers was central in this qualitative study. Rich empirical data were collected through a form of video reflexive ethnography with six children and their extended families over seven years and through in-depth interviews with 38 other community members. An iterative process of data collection and analysis engaged Yolnu families and researchers in a collaborative, culturally responsive research process which drew on constructivist grounded theory methods. Findings illustrate how Yolnu children are immersed in complex layers of intertwined and continuous testing and teaching processes integrating holistic frameworks of cultural identity and connection, knowledge and practices. Yolnu families monitor and recognise a child's development through both direct and explicit testing and through observing children closely so that children can be supported to keep learning and growing into their knowledge, strengths and identity. Yolnu expressed concern that such learning is invisible when the child is viewed through non-Yolnu lenses and assessed with processes and tools from outside the community. Indigenous peoples have a right to culturally congruent assessment of their children. Those who share the child's culture and language have the expertise to ensure that cultural strengths and priorities are recognised and understood. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
Intercultural aphasia: new models of understanding for Indigenous populations.
(2017-03-16) Penn C.; Armstrong E.
Background: Indigenous health matters have largely been neglected in the speech-language pathology literature and have particular import for the aphasia clinician. The influence of culture on people's experiences and expectations after an event such as stroke can vary widely and there is a need to understand the impact of context on assessment and therapy. Standard approaches may not be adequate or relevant, nor always ethical to apply. Examination of aphasia in contexts with Indigenous populations provides an opportunity to explore methods and approaches with socially complex and marginalised communities and to expand our understanding of the lived experience of aphasia. Aim(s): The goal of this paper is to explore the role of culture in aphasia in Indigenous populations and drawing from a body of emerging research, highlight relevant dimensions of understanding and practice for the aphasia clinician. Main Contribution: A series of qualitative studies undertaken with Indigenous people with aphasia in two separate contexts-Australia and South Africa-will be described and their findings considered along several dimensions. A consideration of methods of approach and understanding will be provided, followed by discussion of some central constructs. A series of conceptual and clinical propositions for culturally safe research and practice in aphasia will be derived from this evidence. Models of collaboration are derived which are decolonising and potentially transformative and supplement models of knowledge and intervention in a local community. Particular attention is paid to temporal and spatial issues, the role of family, identity and community, the notion of resilience in such communities and addressing some of the specific challenges that may be involved such as working with cultural brokers. A series of recommendations is provided which allows for a critical engagement with interdisciplinary frameworks of understanding aphasia in context. Conclusion(s): As a reflective piece, this paper has enabled a collation of knowledge about aphasia in two Indigenous cultures and has helped consolidate some novel principles and insights and the need for expanded skills, attitudes, insights, explanations and methodologies-ones that acknowledge and accommodate diversity and difference, and that are relevant to Indigenous communities. Language difficulties are only one cause of social exclusion and issues such as poverty and identity make a huge impact on the lives of our clients and their families, and on the approach we adopt. A shift from the primary framework of our profession is required to accommodate the central role of culture in communication. Copyright © 2016 Informa UK Limited, trading as Taylor & Francis Group.
Study protocol: missing voices - communication difficulties after stroke and traumatic brain injury in Aboriginal Australians.
(2015-07-23) Armstrong E.; Hersh D.; Katzenellenbogen J.M.; Coffin J.; Thompson S.C.; Ciccone N.; Hayward C.; Flicker L.; Woods D.; McAllister M.
Background: Aboriginal and Torres Strait Islander Australians experience stroke and traumatic brain injury (TBI) with much greater frequency than non-Aboriginal Australians. Acquired communication disorders (ACD) can result from these conditions and can significantly impact everyday life. Yet few Aboriginal people access rehabilitation services and little is known about Aboriginal peoples' experiences of ACD. This paper describes the protocol surrounding a study that aims to explore the extent and impact of ACD in Western Australian Aboriginal populations following stroke or TBI and develop a culturally appropriate screening tool for ACD and accessible and culturally appropriate service delivery models. Method/Design: The 3-year, mixed methods study is being conducted in metropolitan Perth and five regional centres in Western Australia. Situated within an Aboriginal research framework, methods include an analysis of linked routine hospital admission data and retrospective file audits, development of a screening tool for ACD, interviews with people with ACD, their families, and health professionals, and drafting of alternative service delivery models. Discussion(s): This study will address the extent of ACD in Aboriginal populations and document challenges for Aboriginal people in accessing speech pathology services. Documenting the burden and impact of ACD within a culturally secure framework is a forerunner to developing better ways to address the problems faced by Aboriginal people with ACD and their families. This will in turn increase the likelihood that Aboriginal people with ACD will be diagnosed and referred to professional support to improve their communication, quality of life and functioning within the family and community context.Copyright © Australasian Society for the Study of Brain Impairment 2015.
The 'invisible homeless' - challenges faced by families bringing up their children in a remote Australian Aboriginal community.
(2019-02-20) Lowell A.; Maypilama L.; Fasoli L.; Guyula Y.; Guyula A.; Yunupiengu M.; Godwin-Thompson J.; Gundjarranbuy R.; Armstrong E.; Garrutju J.; McEldowney R.; Yolnu
Background: Insufficient and inadequate housing remain serious and enduring problems in remote Aboriginal communities in the Northern Territory (NT) of Australia. Housing is recognised as a key determinant of persisting inequities between Aboriginal and other Australians in health, as well as education and employment outcomes which in turn impact on health. In our qualitative study exploring strengths and challenges related to early childhood in a remote NT community, insufficient housing emerged as the greatest challenge families experience in 'growing up' their children. Methods: The "Growing up children in two worlds" study engaged Yolnu (Aboriginal) and other researchers in a culturally responsive qualitative research process. Methods included video ethnography and in-depth interviews with six case study families as well as participant observation and interviews with a wide range of other community members. Data collection and analysis occurred through an iterative and collaborative process and the findings related to housing are the focus of this article. Results: Concerns about crowded and insecure housing were pervasive in the study community where many families are, in effect, homeless. Most rely on extended family to provide accommodation and some never find a secure and stable space in which to bring up their children. Absence of control over their living conditions is a key element underlying many of the sources of distress associated with crowded housing. The lack of food security, sharing sickness and disturbances in the night affecting sleep are just some of the challenges that generate conflict between family members and impact on health, wellbeing, work and school attendance. Although interaction with other family members is highly valued, the ambition of most participants is for independent and secure accommodation in which they can safely 'grow up' their children. Conclusions: Yolnu who live with the consequences of crowded and insecure housing want their voices to be heard. They best understand the challenges they face and their perspectives must inform the solutions. Equitable access to housing through sufficient and sustained investment in an integrated approach, engaging all stakeholders, is needed. This is essential to address persisting inequities between Aboriginal and non-Aboriginal Australians in health and other outcomes.
The wangi (talking) project: a feasibility study of a rehabilitation model for Aboriginal people with acquired communication disorders after stroke.
(2020-09-24) Ciccone N.; Armstrong E.; Hersh D.; Adams M.; MCAllister M.
Purpose: Aboriginal Australians are under-represented in stroke rehabilitation services and rehabilitation practices that are sensitive to the needs of Aboriginal people are not currently available. This project tested the feasibility and acceptability of a rehabilitation model and approach to therapy with Aboriginal people with acquired communication disorders post-stroke. Method(s): Eight Aboriginal people with acquired communication disorders post-stroke were recruited to this study. Sixteen treatment sessions were provided twice weekly at the person's place of residence by a speech-language pathologist and Aboriginal co-worker. Feasibility was measured by analysing the number of sessions conducted jointly by the speech-language pathologist and Aboriginal co-worker and participant attendance. Participant acceptability was measured through the analysis of a post-therapy questionnaire. The Aboriginal co-worker's and speech-language pathologists' perceptions of the acceptability were collected through semi structured interviews. Result(s): Across all sessions 84.2% were attended by the Aboriginal co-worker and speech-language pathologist and seven of the eight participants completed all prescribed sessions. Positive feedback was provided by participants, the Aboriginal co-worker and speech-language pathologist on the key components of the programme. Conclusion(s): The rehabilitation model used within Wangi appears to be feasible and acceptable to participants and therapists. It provides direction to improve the quality of care for Aboriginal stroke survivors.
Yarning together: developing a culturally secure rehabilitation approach for Aboriginal Australians after brain injury.
(2020-01-31) Ciccone N.; Armstrong E.; Adams M.; Bessarab D.; Hersh D.; McAllister M.; Godecke E.; Coffin J.
Background and Objectives: Stroke and traumatic brain injury are more common in Aboriginal Australians than their non-Aboriginal counterparts, yet knowledge surrounding what constitutes a culturally secure and accessible rehabilitation service for Aboriginal Australians is sparse. This research (Lowitja Institute Funding 2018-2019) is working with Aboriginal people with an acquired communication disorder (ACD) following brain injury to (i) develop an understanding of the individual's perceptions of rehabilitation services and (ii) test the feasibility and acceptability of a culturally tailored model of speech pathology rehabilitation delivered via one of two modes: face to face or using telehealth technology. Method(s): Participants (n = 20) with an ACD after stroke or traumatic brain injury will be allocated to one of two groups: face-to-face therapy or therapy utilising telehealth technology and will receive 16 x 1 h treatment sessions provided twice weekly. Therapy utilises collaborative planning, integrates a yarning framework and is provided by a speech pathologist and Aboriginal co-worker. Improvement in participant communication skills is being measured through change in verbal output in discourse. The perspectives of the participants on the rehabilitation services accessed previously, the therapy provided through the study and change in everyday communication will be collected through semi-structured interviews. Result(s): This paper will present the therapy protocol, an explanation of the key elements involved in therapy implementation and some preliminary findings. Conclusion(s): The findings from this study will provide direction for rehabilitation therapists who provide services to Aboriginal brain injury survivors to improve quality of care.
Yarning together: incorporating telehealth into the provision of culturally secure speech pathology services for Aboriginal Australians after brain injury.
(2021-02-27) Ciccone N.; Armstrong E.; Adams M.; Hersh D.; McAllister M.; Bessarab D.; Godecke E.; Coffin J.; Walley M.
Background and objectives: Stroke and traumatic brain injury are more common in Aboriginal Australians than their non-Aboriginal counterparts, yet knowledge surrounding what Aboriginal Australians view as a culturally secure rehabilitation service is limited. Our previous research trialled a culturally secure model of rehabilitation which was feasible to deliver and acceptable to Aboriginal people who had an acquired communication disorder (ACD) following a stroke. The model involved the use of yarning principles and an Aboriginal co-worker (ACW) working in conjunction with the speech pathologist (SP). The current project (Lowitja Institute Funding 2018- 2019) extends this previous work by adding a telehealth component and again explores the feasibility and acceptability of the treatment delivered via one of two modes: face to face or using telehealth technology. Method(s): Participants (n = 11), Aboriginal adults with an ACD after stroke or traumatic brain injury (>1 year-18 years post-onset), were case-matched and allocated to one of two groups: face-to-face therapy or therapy utilising telehealth technology and received 16 x 1 h treatment sessions provided twice weekly. Therapy integrated a yarning framework and was provided jointly by a SP and ACW in the person's place of residence. Feasibility was measured by analysing the number of sessions conducted jointly by the SP and ACW and participant attendance. Improvement in the participants' communication skills were measured through change in verbal output within language samples collected at multiple time points. Semi-structured interviews were used to explore both the participants' perspectives and the ACW's and SP's perceptions on the acceptability of and change achieved through the therapy. All interviews were analysed through qualitative descriptive analysis. Result(s): Across all sessions, 235/258 (91.1%) were attended by the ACW and SP and 10 of the 11 participants completed all prescribed sessions. Positive feedback was provided by participants, the ACW and SPs on the key components of the programme including the use of telehealth technology. Conclusion(s): The findings from this study provide direction for rehabilitation therapists who provide services to Aboriginal people to improve quality of care and provide culturally secure services. This work demonstrates that therapy can be delivered remotely by a SP but that an ACW being physically present is an important part of this rehabilitation approach.
"You felt like a prisoner in your own self, trapped": the experiences of Aboriginal people with acquired communication disorders.
(2021-08-03) Armstrong E.; Coffin J.; Hersh D.; Katzenellenbogen J.M.; Thompson S.C.; Ciccone N.; Flicker L.; Woods D.; Hayward C.; Dowell C.; McAllister M.
PURPOSE: Aboriginal Australians are under-represented in brain injury rehabilitation services despite a high incidence of both stroke and traumatic brain injury in this population. This study aimed to explore the experiences of Aboriginal Australian adults with acquired communication disorders (ACDs) after brain injury for the first time to inform the development of accessible and culturally secure service delivery models. METHODS AND MATERIALS: Semi-structured interviews were undertaken with 32 Aboriginal people who had experienced a brain injury resulting in ACDs (aged 35-79 years) and 18 family members/carers across Western Australia. Thematic analysis identified common themes across participants. Results: Overall themes related to communication (both related to the communication disorder and general healthcare interactions), health and social contexts, recovery, and support, being away from family and country, knowledge and beliefs about brain injury, and follow-up. Conclusions: An increase in healthcare staff's appreciation of the health and social contexts of Aboriginal people after brain injury is needed in order to improve communication with Aboriginal patients and the ability to offer accessible rehabilitation services. Ongoing support is required, with cultural identity noted as key to ensuring cultural security and ultimately recovery. Involvement of family and other Aboriginal people in recovery processes, as well as access to relevant Aboriginal languages and proximity to ancestral lands is central.Implications for rehabilitationAcknowledgment of cultural identity and strengths through involvement of extended family and Aboriginal Hospital Liaison Officers, access to language and proximity to country all central to rehabilitation planning for Aboriginal people after brain injury.Cultural security training for rehabilitation staff is recommended focusing on clear two-way communication skills to make medical information accessible for Aboriginal patients and to listen to patients' concerns in a way that respects cultural context.Information regarding practical support and implications for ongoing management of life after brain injury (for the person and their family) is essential, and should supplement the medical-related information provided.Follow-up post discharge from hospital best facilitated through establishing contact with local Aboriginal community through Aboriginal community controlled health services, community elders, and Aboriginal health workers across organisations.

Browsing by Author "Armstrong E."

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