Browsing by Author "Mackean T."
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Item A framework to assess cultural safety in Australian public policy.(2020-12-29) Mackean T.; Fisher M.; Friel S.; Baum F.The concept of cultural safety (CS) has been developed as a critical perspective on healthcare provided to Indigenous service users in neo-colonial countries such as New Zealand, Australia and Canada. Unlike other frameworks for culturally competent healthcare, a CS approach recognizes impacts of colonization and power inequalities on Indigenous peoples and asks how these may manifest in healthcare settings. It has been argued that CS thinking is suited to critical analysis of public policy, but there has been limited work in this direction. Drawing on literature on CS in Australian healthcare, we defined a CS framework consisting of five concepts: reflexivity, dialogue, reducing power differences, decolonization and regardful care. Our research examined whether and in what terms this framework could be adapted as a tool for critical analysis of Australian public policy as it affects Aboriginal and Torres Strait Islander peoples. We used a collaborative inquiry process combining perspectives of an Aboriginal researcher and a non-Indigenous researcher. We developed a thematic analysis framework to examine how the five concepts might be reflected in contemporary writings on policy by leading Aboriginal or Torres Strait Islander thinkers. We found the framework is applicable as a tool for policy analysis; bringing together key concerns raised by Aboriginal and Torres Strait Islander leaders and critical concepts such as sovereignty and interface thinking. We concluded the framework is likely to be a useful tool for critical, systemic thinking about public policy as it affects Indigenous peoples and for specifying areas where performance can be improved to achieve culturally safe policy.Copyright © The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.Item Aboriginal perspectives of child health and wellbeing in an urban setting: developing a conceptual framework.Priest N.; Mackean T.; Davis E.; Briggs L.; Waters E.Health and wellbeing is defined internationally as a multi-dimensional and holistic concept, particularly within Indigenous worldviews. However, in Australia there is a lack of detailed frameworks supporting such definitions that are founded on Aboriginal knowledges. This study aimed to explore Aboriginal perspectives of child health and wellbeing in an urban setting. Qualitative interviews with 25 care-givers of Aboriginal children living in Melbourne, Australia were conducted. Aboriginal people and community controlled organisations were collaborative partners in all stages of the research. A conceptual framework of Aboriginal child health and wellbeing in an urban setting was developed comprising four main themes: Strong Culture; Strong Child; Strong Environment; and Strengths and Challenges. Aboriginal conceptions of culture are considered central to Aboriginal child health and wellbeing in an urban context. A holistic framework that privileges Aboriginal knowledge of child health and wellbeing has not previously been available. Further exploration of socio-ecological models within Aboriginal child health and wellbeing contexts is needed. This study identifies dimensions for further exploration in research, policy and practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved)Item Coproducing Aboriginal patient journey mapping tools for improved quality and coordination of care.(2017-12-15) Kelly J.; Dwyer J.; Mackean T.; O'Donnell K.; Willis E.This paper describes the rationale and process for developing a set of Aboriginal patient journey mapping tools with Aboriginal patients, health professionals, support workers, educators and researchers in the Managing Two Worlds Together project between 2008 and 2015. Aboriginal patients and their families from rural and remote areas, and healthcare providers in urban, rural and remote settings, shared their perceptions of the barriers and enablers to quality care in interviews and focus groups, and individual patient journey case studies were documented. Data were thematically analysed. In the absence of suitable existing tools, a new analytical framework and mapping approach was developed. The utility of the tools in other settings was then tested with health professionals, and the tools were further modified for use in quality improvement in health and education settings in South Australia and the Northern Territory. A central set of patient journey mapping tools with flexible adaptations, a workbook, and five sets of case studies describing how staff adapted and used the tools at different sites are available for wider use.Journal compilationCopyright © La Trobe University 2017.Item Indigenous research methodology - weaving a research interface.Ryder C.; Mackean T.; Coombs J.; Williams H.; Hunter K.; Holland A.J.A; Ivers R.Q.Indigenous research Knowledges and methodologies have existed over millennia, however it is only recently that Indigenous scholars have been able to challenge institutional Western hegemony to reclaim sovereignty in the research space. Despite the high volume of quantitative research describing Aboriginal and Torres Strait Islander health, there has been limited evaluation of the value added through incorporation of Indigenous Knowledges and methodologies. 'Research at the interface' has been discussed as an Indigenous research methodology for researchers to contextualise and inform their research practices, between Indigenous and Western systems of knowledge. In this article we address the significance of 'research at the interface' for Aboriginal and Torres Strait Islander research, as an exciting opportunity for innovation to ensure strength, self-determination and resilience for Aboriginal and Torres Strait Islander communities engaged in research. We also introduce weaving a methodology for 'research at the interface' as a process for conceptualising Indigenous and quantitative research methodologies at the interface. (PsycInfo Database Record (c) 2021 APA, all rights reserved)Item Integrating trauma and violence informed care in primary health care settings for First Nations women experiencing violence: a systematic review.(2022-09-02) Cullen P.; Mackean T.; Walker N.; Coombes J.; Bennett-Brook K.; Clapham K.; Ivers R.; Hackett M.; Worner F.; Longbottom M.It is imperative that access to primary health care services is equitable as health care practitioners are often the first responders to women who experience violence. This is of particular importance for First Nations women who disproportionately experience interpersonal and structural violence when compared to non-First Nations women, as well as the ongoing impact of colonization, racism, and intergenerational trauma. To understand how primary health care services can provide equitable and effective care for First Nations women, we explored how trauma and violence informed care is integrated in primary health care settings through the lens of an equity-oriented framework. A systematic search of electronic databases included Medline (via Ovid), Scopus, Informit, and PubMed and grey literature. Six studies were included in the review and we undertook a narrative synthesis using the equity-oriented framework to draw together the intersection of trauma and violence informed care with culturally safe and contextually tailored care. This review demonstrates how equity-oriented primary health care settings respond to the complex and multiple forms of violence and intergenerational trauma experienced by First Nations women and thus mitigate shame and stigma to encourage disclosure and help seeking. Key attributes include responding to women's individual contexts by centering family, engaging elders, encouraging community ownership, which is driven by a culturally competent workforce that builds trust, reduces retraumatization, and respects confidentiality. This review highlights the importance of strengthening and supporting the workforce, as well as embedding cultural safety within intersectoral partnerships and ensuring adequate resourcing and sustainability of initiatives.Item Responses to the primary health care needs of Aboriginal and Torres Strait Islander women experiencing violence: a scoping review of policy and practice guidelines.(2021-12-09) Walker N.; Mackean T.; Longbottom M.; Coombes J.; Bennett-Brook K.; Clapham K.; Ivers R.; Hackett M.; Redfern J.; Cullen P.Issue addressed: It is demonstrated that primary health care (PHC) providers are sought out by women who experience violence. Given the disproportionate burden of violence experienced by Aboriginal and Torres Strait Islander women, it is essential there is equitable access to appropriate PHC services. This review aimed to analyse whether Australian PHC policy accounts for the complex needs of Aboriginal and Torres Strait Islander women experiencing violence and the importance of PHC providers responding to violence in culturally safe ways. Methods: Using the Arskey and O'Malley framework, an iterative scoping review determined the policies for analysis. The selected policies were analysed against concepts identified as key components in responding to the needs of Aboriginal and Torres Strait Islander women experiencing violence. The key components are Family Violence, Violence against Aboriginal and Torres Strait Islander Women, Social Determinants of Aboriginal and Torres Strait Islander Health and Wellbeing, Cultural Safety, Holistic Health, Trauma, Patient-Centred Care and Trauma-and-Violence-Informed Care. Results: Following a search of Australian government websites, seven policies were selected for analysis. Principally, no policy embedded or described best practice across all key components. Conclusions: The review demonstrates the need for a specific National framework supporting Aboriginal and Torres Strait Islander women who seek support from PHC services, as well as further policy analysis and review. So what: Aboriginal and Torres Strait Islander women disproportionately experience more severe violence, with complex impact, than other Australian women. PHC policy and practice frameworks must account for this, together with the intersection of contemporary manifestations of colonialism and historical and intergenerational trauma.Copyright © 2020 Australian Health Promotion Association.Item Strengths and challenges for Koori kids: harder for Koori kids, Koori kids doing well-exploring Aboriginal perspectives on social determinants of Aboriginal child health and wellbeing.Priest N.; Mackean T.; Davis E.; Waters E.; Briggs L.This study explored Aboriginal perspectives of child health and wellbeing in an urban area in partnership with Aboriginal people and organisations. In depth interviews were conducted with 25 grandparents, parents, aunties or uncles of Aboriginal children. Interviews were transcribed and thematically analysed. A major conceptual theme was related to social, historical, and political factors seen by participants as influencing urban Aboriginal child health and wellbeing. This theme was called 'Strengths and Challenges: Harder for Koori Kids/Koori Kids Doing Well'. Increased challenges to achieving good health and wellbeing faced by Aboriginal children due to factors in their social, historical and political environment were emphasised. Many of these factors can be related back to historical and contemporary forms of racism. On the other hand, there was also a clear call to recognise and celebrate that many Aboriginal children were doing well in the context of these added challenges. (PsycInfo Database Record (c) 2021 APA, all rights reserved)Item Trauma and violence informed care through decolonising interagency partnerships: a complexity case study of Waminda's model of systemic decolonisation.(2020-11-03) Cullen P.; Mackean T.; Worner F.; Wellington C.; Longbottom H.; Coombes J.; Bennett-Brook K.; Clapham K.; Ivers R.; Hackett M.; Longbottom M.Through the lens of complexity, we present a nested case study describing a decolonisation approach developed and implemented by Waminda South Coast Women's Health and Welfare Aboriginal Corporation. Using Indigenous research methods, this case study has unfolded across three phases: 1) Yarning interviews with the workforce from four partner health services (n = 24); 2) Yarning circle bringing together key informants from yarning interviews to verify and refine emerging themes (n = 14); 3) Semi-structured interviews with a facilitator of Waminda's Decolonisation Workshop (n = 1) and participants (n = 10). Synthesis of data has been undertaken in stages through collaborative framework and thematic analysis. Three overarching themes and eight sub-themes emerged that centred on enhancing the capabilities of the workforce and strengthening interagency partnerships through a more meaningful connection and shared decolonisation agenda that centres Aboriginal and Torres Strait Islander families and communities. Health and social services are complex systems that function within the context of colonisation. Waminda's innovative, model of interagency collaboration enhanced workforce capability through shared language and collective learning around colonisation, racism and Whiteness. This process generated individual, organisational and systemic decolonisation to disable power structures through trauma and violence informed approach to practice.Copyright © 2020 by the authors. Licensee MDPI, Basel, Switzerland.Item 'Yarning up with Koori kids' - hearing the voices of Australian urban Indigenous children about their health and well-being.(2018-06-07) Priest N.; Thompson L.; Mackean T.; Baker A.; Waters E.Objective: Australian Indigenous children experience some of the most substantial health inequalities globally. In this context, research regarding their health and well-being has overemphasised physical illnesses with limited exploration of a diverse range of dimensions and determinants, particularly those based on Indigenous holistic understandings of health and well-being. This deficit-based approach has thus missed many strengths and assets of Indigenous children. This research aimed to gain insight into the perspectives of Indigenous children about their health and well-being in an urban setting in Australia. It joins a limited international literature examining views and experiences of non-majority children. Design: Participatory and qualitative child-friendly research methods were utilised. The project was developed in partnership with Indigenous community organisations and members. Photo-elicitation activities and focus groups were conducted with 31 Indigenous children aged 8-12 years. Qualitative data were analysed thematically, combining focus group and interview data. Results: It was evident an urban Indigenous child perspective of health and well-being includes rich understandings of the interconnectedness of physical, social-emotional and cultural dimensions of holism, as well as the integral importance of family and community relationships. The study also found that specific worries regarding loss of loved ones and racism were highly salient in Indigenous children's lives. Conclusion: The overwhelming conclusion to be drawn from this research is that Indigenous children in urban areas need ongoing recognition of both their agency and resilience in the face of adversity, within a wider context of historical and contemporary racialisation and racism.