Browsing by Author "Gee G."
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Item Aboriginal and Torres Strait Islander complex trauma and strengths questionnaire: psychometric evaluation.Gee G.; Bright T.; Morgan A.; Atkinson C.; Andrews S.; Clark Y.; Glover K.; Hirvonen T.; Davis E.; Jones K.A.; Reilly R.; Mensah F.; Hudson-Buhagiar M.; Bennetts S.K.; Herrman H.; Milroy H.; Mackinnon A.; Chamberlain C.eObjective: Complex post-traumatic stress disorder (complex trauma) describes a cluster of symptoms frequently associated with prolonged exposure to inescapable threats or abuse. For Aboriginal and Torres Strait Islander peoples in Australia impacted by complex trauma, there may be compounding factors, such as experiences of historical trauma, loss and socio-economic deprivation stemming from colonisation. However, there is no culturally appropriate tool to assess complex trauma. This paper presents the psychometric evaluation of a preliminary version Aboriginal and Torres Strait Islander Complex Trauma and Strengths Questionnaire (ACTSQ). Methods: Following 2 years of rigorous Aboriginal-led co-design, participants were recruited through community networks and partner health services in South Australia, Victoria, and Northern Territory (October 2020-May 2022). A trained interviewer contacted Aboriginal (n = 109) and Torres Strait Islander (n = 1) parents aged > 16 years by phone to complete the ACTSQ. Underlying domain structures were investigated with exploratory factor analysis and reviewed by experts to refine. Reliability and inter-rater reliability were assessed using McDonald's Omega and Intraclass Correlation Coefficient (ICC). Results: Forty-four items on five factors were retained. Factors were labelled complex trauma symptoms (16 items), grief, loss and disconnection (6 items), support and relationships (9 items), sense of self and strengths (7 items), and Cultural connections and resources (6 items). There were moderate correlations between factors, with the exception of factor 5. Omega was > 0.75 for all factors. The inter-rater reliability for each factor was fair to good (ICC 0.5-0.7). Conclusions: This study conducted a comprehensive psychometric validation that provides initial evidence towards the cultural validity of the ACTSQ to support assessment of complex trauma and strengths among Aboriginal and Torres Strait Islander peoples. Future studies are required to replicate and further evaluate the psychometric properties of the ACTSQ using larger samples. (PsycInfo Database Record (c) 2024 APA, all rights reserved)Item Community perspectives of complex trauma assessment for Aboriginal parents: 'its important, but how these discussions are held is critical'.Chamberlain C.; Gee G.; Gartland D.; Mensah F.K; Mares S.; Clark Y.; Ralph N.; Atkinson C.; Hirvonen T.; McLachlan H.; Edwards T.; Herrman H.; Brown S.J.; Nicholson J.M.Background and Purpose: Becoming a parent can be an exciting and also challenging transition, particularly for parents who have experienced significant hurt in their own childhoods, and may be experiencing 'complex trauma.' Aboriginal and Torres Strait Islander (Aboriginal) people also experience historical trauma. While the parenting transition is an important time to offer support for parents, it is essential to ensure that the benefits of identifying parents experiencing complex trauma outweigh any risks (e.g., stigmatization). This paper describes views of predominantly Aboriginal stakeholders regarding (1) the relative importance of domains proposed for complex trauma assessment, and (2) how to conduct these sensitive discussions with Aboriginal parents. Setting and Methods: A co-design workshop was held in Alice Springs (Central Australia) as part of an Aboriginal-led community-based participatory action research project. Workshop participants were 57 predominantly Aboriginal stakeholders with expertise in community, clinical, policy and academic settings. Twelve domains of complex trauma-related distress had been identified in existing assessment tools and through community consultation. Using story-telling and strategies to create safety for discussing complex and sensitive issues, and delphi-style methods, stakeholders rated the level of importance of the 12 domains; and discussed why, by whom, where and how experiences of complex trauma should be explored. Main Findings: The majority of stakeholders supported the importance of assessing each of the proposed complex trauma domains with Aboriginal parents. However, strong concerns were expressed regarding where, by whom and how this should occur. There was greater emphasis and consistency regarding 'qualities' (e.g., caring), rather than specific 'attributes' (e.g., clinician). Six critical overarching themes emerged: ensuring emotional and cultural safety; establishing relationships and trust; having capacity to respond appropriately and access support; incorporating less direct cultural communication methods (e.g., yarning, dadirri); using strengths-based approaches and offering choices to empower parents; and showing respect, caring and compassion. Conclusion: Assessments to identify Aboriginal parents experiencing complex trauma should only be considered when the prerequisites of safety, trusting relationships, respect, compassion, adequate care, and capacity to respond are assured. Offering choices and cultural and strengths-based approaches are also critical. Without this assurance, there are serious concerns that harms may outweigh any benefits for Aboriginal parents. (PsycInfo Database Record (c) 2022 APA, all rights reserved)Item Community views on 'can perinatal services safely identify Aboriginal and Torres Strait Islander parents experiencing complex trauma?'Chamberlain C.; Gray P.; Herrman H.; Mensah F.; Andrews S.; Krakouer J.; McCalman P.; Elliott A.; Atkinson J.; O'Dea B.; Bhathal A.; Gee G.Family and extended kinship systems which nurture healthy, happy children are central to Aboriginal and Torres Strait Islander cultures. Since colonisation, Aboriginal and Torres Strait Islander communities have been impacted by intergenerational cycles of trauma, stemming from colonial violence, genocidal policies and discrimination, including the forced removal of children from their families. Becoming a parent offers a unique life-course opportunity for trauma recovery and preventing intergenerational trauma. However, identifying or 'recognising' complex trauma carries significant risk of harm for Aboriginal and Torres Strait Islander parents due to reactive prenatal child protection involvement potentially compounding experiences of trauma, and limited benefits due to lack of culturally appropriate support. The Aboriginal-led participatory Healing the Past by Nurturing the Future project aims to co-design safe, accessible and feasible perinatal awareness, recognition, assessment and support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma. This paper presents views of 38 workshop participants to determine prerequisites for ensuring benefits outweigh risks of assessment to safely recognise parents experiencing complex trauma, consistent with screening criteria. Six essential elements were identified from thematic analysis: high-quality holistic care; cultural, social and emotional safety; empowerment, choice and control; flexible person-centred approaches; trusting relationships; and sensitive, skilled communication. Key Practitioner Messages The impacts of colonisation and rates of Aboriginal and Torres Strait children in out-of-home care mean that there can be a myriad of issues facing Aboriginal and Torres Strait Islander parents with regard to perinatal child protection involvement. The benefits must outweigh the risks of identifying parents experiencing complex trauma. Assessment must be offered within foundations of supportive relationships and holistic care in culturally-safe, empowering settings, where choices are respected and skilled communication approaches are used. (PsycInfo Database Record (c) 2023 APA, all rights reserved)Item Healing the past by nurturing the future: a qualitative systematic review and metasynthesis of pregnancy, birth and early postpartum experiences and views of parents with a history of childhood maltreatment.(2020-04-08) Chamberlain C.; Ralph N.; Hokke S.; Clark Y.; Gee G.; Stansfield C.; Sutcliffe K.; Brown S.J.; Brennan S.Background Child maltreatment can have serious effects on development and physical, social and emotional wellbeing. Any long-lasting relational effects can impede the capacity to nurture children, potentially leading to 'intergenerational trauma'. Conversely, the transition to parenthood during pregnancy, birth and the early postpartum period offers a unique life-course opportunity for healing. This systematic review aims to understand the pregnancy, birth and early postpartum experiences of parents who reported maltreatment in their own childhood. Methods A protocol, based on the ENTREQ statement, was registered with PROSPERO. We searched Medline, PsycINFO, CINAHL, EMBASE, NHS Evidence and key Web of Science databases from date of inception to June 2018 to identify qualitative studies exploring perinatal experiences of parents who were maltreated in their own childhood. Two reviewers independently screened articles for inclusion and extracted data. Data were synthesised using grounded theory and thematic analysis approaches. Findings The search yielded 18329 articles, 568 full text articles were reviewed, and 50 studies (60 articles) met inclusion criteria for this review. Due to the large number of studies across the whole perinatal period (pregnancy to two years postpartum), this paper reports findings for experiences during pregnancy, birth and early postpartum (27 studies). Parents described positive experiences and strategies to help them achieve their hopes and dreams of providing safe, loving and nurturing care for their children. However, many parents experienced serious challenges. Seven core analytic themes encapsulated these diverse and dynamic experiences: New beginnings; Changing roles and identities; Feeling connected; Compassionate care; Empowerment; Creating safety; and Reweaving a future. Conclusions Pregnancy birth and the early postpartum period is a unique life-course healing opportunity for parents with a history of maltreatment. Understanding parent's experiences and views of perinatal care and early parenting is critical for informing the development of acceptable and effective support strategies.Copyright © 2019 Chamberlain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Item Healing the past by nurturing the future: trauma-aware, healing-informed care to improve support for Aboriginal and Torres Strait Islander families - implementation and evaluation study protocol.(2024-07-15) Jones K.A.; Henderson H.; Bright T.; Segal L.; Mauerhofer O.; Lake K.J.; Julian R.; Duncan J.; Raymond A.; Jones A.; Cameron D.; Fergie D.; Andrews S.; Stewart S.; Atkinson C.; Elliot A.; Crawford B.; Mohammed J.; Bundle G.; Hirvonen T.; Gnanamanickam E.; Davis E.; Gee G.; Herrman H.; Fisher J.; Lovett R.; Campbell S.; Forster D.A.; Clark Y.; Atkinson J.; Marriott R.; Chamberlain C.Introduction Complex trauma can have serious impacts on the health and well-being of Aboriginal and Torres Strait Islander families. The perinatal period represents a critical window for recovery and transforming cycles of trauma into cycles of healing. The Healing the Past by Nurturing the Future (HPNF) project aims to implement and evaluate a programme of strategies to improve support for Aboriginal and Torres Strait islander families experiencing complex trauma. Method The HPNF programme was codesigned over 4 years to improve awareness, support, recognition and assessment of trauma. Components include (1) a trauma-aware, healing-informed training and resource package for service providers; (2) trauma-awareness resources for parents; (3) organisational readiness assessment; (4) a database for parents and service providers to identify accessible and appropriate additional support and (5) piloting safe recognition and assessment processes. The programme will be implemented in a large rural health service in Victoria, Australia, over 12 months. Evaluation using a mixed-methods approach will assess feasibility, acceptability, cost, effectiveness and sustainability. This will include service user and provider interviews; service usage and cost auditing; and an administrative linked data study of parent and infant outcomes. Analysis Qualitative data will be analysed using reflexive thematic analysis. Quantitative and service usage outcomes will be described as counts and proportions. Evaluation of health outcomes will use interrupted time series analyses. Triangulation of data will be conducted and mapped to the Consolidated Framework for Implementation Research and Reach, Effectiveness, Adoption, Implementation and Maintenance frameworks to understand factors influencing feasibility, acceptability, effectiveness, cost and sustainability. Ethics and dissemination Approval granted from St Vincent's Melbourne Ethics Committee (approval no. 239/22). Data will be disseminated according to the strategy outlined in the codesign study protocol, in-line with the National Health and Medical Research Council Aboriginal and Torres Strait Islander Research Excellence criteria.Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.Item Parenting after a history of childhood maltreatment: a scoping review and map of evidence in the perinatal period.(2019-03-26) Chamberlain C.; Gee G.; Harfield S.; Campbell S.; Brennan S.; Clark Y.; Mensah F.; Arabena K.; Herrman H.; Brown S.; Atkinson J.; Nicholson J.; Gartland D.; Glover K.; Mitchell A.; Atkinson C.; McLachlan H.; Andrews S.; Hirvoven T.; Ralph N.; Dyall D.Background and aims Child maltreatment is a global health priority affecting up to half of all children worldwide, with profound and ongoing impacts on physical, social and emotional wellbeing. The perinatal period (pregnancy to two years postpartum) is critical for parents with a history of childhood maltreatment. Parents may experience 'triggering' of trauma responses during perinatal care or caring for their distressed infant. The long-lasting relational effects may impede the capacity of parents to nurture their children and lead to intergenerational cycles of trauma. Conversely, the perinatal period offers a unique life-course opportunity for parental healing and prevention of child maltreatment. This scoping review aims to map perinatal evidence regarding theories, intergenerational pathways, parents' views, interventions and measurement tools involving parents with a history of maltreatment in their own childhoods. Methods and results We searched Medline, Psychinfo, Cinahl and Embase to 30/11/2016. We screened 6701 articles and included 55 studies (74 articles) involving more than 20,000 parents. Most studies were conducted in the United States (42/55) and involved mothers only (43/55). Theoretical constructs include: attachment, social learning, relational-developmental systems, family-systems and anger theories; 'hidden trauma', resilience, post-traumatic growth; and 'Child Sexual Assault Healing' and socioecological models. Observational studies illustrate sociodemographic and mental health protective and risk factors that mediate/moderate intergenerational pathways to parental and child wellbeing. Qualitative studies provide rich descriptions of parental experiences and views about healing strategies and support. We found no specific perinatal interventions for parents with childhood maltreatment histories. However, several parenting interventions included elements which address parental history, and these reported positive effects on parent wellbeing. We found twenty-two assessment tools for identifying parental childhood maltreatment history or impact. Conclusions Perinatal evidence is available to inform development of strategies to support parents with a history of child maltreatment. However, there is a paucity of applied evidence and evidence involving fathers and Indigenous parents.Copyright © 2019 Chamberlain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Item The Her Tribe and His Tribe Aboriginal-designed empowerment programs.(2022-02-28) Gee G.; Sheridan S.; Charles L.; Dayne L.; Joyce L.; Stevens J.; Paradies Y.; Hulbert C.; Haslam N.; Thorpe R.; Thorpe L.; Thorpe A.; Stewart P.; Austin L.; Lyons L.; Belfrage M.; Warber R.; Paxton A.; Thompson L.This study documents evaluation of the Her Tribe and His Tribe Aboriginal-designed empowerment pilot programs. The programs were designed to support Victorian Aboriginal people to strengthen mental health, social and emotional wellbeing, community connection, and to reduce psychological distress. A second aim was to explore participants' experiences of the programs, including the feasibility and acceptability of the evaluation component. Her Tribe ran for 16 weeks and His Tribe for 12 weeks. In total, 43 women and 26 men completed assessments at pre-and post-program completion, and 17 and 10, respectively, participated in yarning circles at the 6-month follow up. For both programs, there were significant increases in participants' access to personal strengths and resources, relationship-community-cultural strengths and resources, and decreases in psychological distress. These changes were associated with small to moderate effects that were maintained at the 6-month follow up. There was a significant increase in aerobic fitness for female but not male participants, and no significant changes in weight for either group. Participants described a range of benefits from the programs, including positive elements and areas for improvement. They also viewed the evaluation as feasible and acceptable, and the findings of value. The outcomes from both pilot programs provide evidence that Aboriginal-designed programs, with a focus on physical and cultural activities, can help to strengthen mental health and wellbeing, community connection, and reduce psychological distress in Victorian Aboriginal communities.Copyright © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Item Using participatory action research to co-design perinatal support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma.(2022-08-30) Reid C.; Gee G.; Bennetts S.K.; Clark Y.; Atkinson C.; Dyall D.; Nicholson J.M.; Chamberlain C.Problem & background: Support is important for all parents but critical for those experiencing complex trauma. The The Healing the Past by Nurturing the Future project uses participatory action research to co-design effective perinatal support for Aboriginal and Torres Strait Islander parents. Aim(s): This research aims to identify and refine culturally appropriate support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma. Design(s): We presented our synthesised eight parent support goals and 60 strategies, collated from Elder and parent focus groups, previous participatory workshops, and evidence reviews, for discussion at a stakeholder workshop. Stakeholder perspectives were captured using a three-point agreement activity and, self- and scribe-recorded comments. Aboriginal and non-Aboriginal researchers analysised the qualitative data, to identify core factors which might facilitate or help enact the parenting related goals. Finding(s): Overall, stakeholders (n = 37) strongly endorsed all eight goals. Workshop attendees (57% Aboriginal) represented multiple stakeholder roles including Elder, parent and service provider. Four core factors were identified as crucial for supporting parents to heal from complex trauma: Culture (cultural traditions, practices and strengths), Relationality (family, individual, community and services), Safety (frameworks, choice and control) and Timing (the right time socio-emotionally and stage of parenting). Discussion(s): Context-specific support tailored to the Culture, Relationality, Safety, and Timing needs of parents is essential. These four factors are important elements to help enact or facilitate parenting support strategies. Conclusion(s): Further work is now required to develop practical resources for parents, and to implement and evaluate these strategies in perinatal care to address cumulative and compounding cycles of intergenerational trauma.Copyright © 2021 The Authors