Perinatal support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma

Perinatal support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma

Valerie Ah Chee, Kirsty McLean, Debra Bowman and Dana Shen
9 March 2022

This webinar explored approaches to working effectively with Aboriginal and Torres Strait Islander families through the perinatal period.

Indigenous Australian mother sitting on the ground in the desert around dusk with an about 18 month old child in arms.

Audio transcript: Perinatal support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma

Audio transcript (edited)

Dana Shen: Good afternoon, everyone, and welcome to today’s webinar: Perinatal Support Strategies for Aboriginal Torres Strait Islander Parents Experiencing Complex Trauma. Co-produced by CFCA and Emerging Minds.

My name is Dana Shen, and I’m a social services consultant and cultural consultant for Emerging Minds. In today’s presentation we will be exploring understanding and approaches to working effectively with Aboriginal and Torres Strait Islander families through the perinatal period.

But before we get started, I wanted to acknowledge and recognise and pay respect to Aboriginal and Torres Strait Islander peoples, as the traditional owners of the lands we work, play and walk on throughout this country. We acknowledge and respect their traditional connections to the land and waters, culture, spirituality, family and community, for the wellbeing of all Aboriginal and Torres Strait Islander children and families.

I also feel like I need to acknowledge the things that are going on in our world at the moment. I wanted to let people know, if you’re from Sydney or Brisbane, and Queensland and New South Wales, that if you’re experiencing things with the floods, that we are thinking of you. And also, just to recognise what’s happening in the Ukraine, and in other places in the world at the moment.

So, first of all, let’s have a think about the learning outcomes, so that we understand what it is that you can expect out of the next hour. This webinar will support practitioners to extend their awareness of historical and contextual factors impacting Aboriginal and Torres Strait Islander communities; increase their understanding of the impacts of intergenerational trauma on Aboriginal and Torres Strait Islander communities; understand the important role of service providers during the critical perinatal period for parents experiencing complex trauma; and finally, outline key principles and practice approaches for fostering safety in perinatal care.

I just want to touch on a couple of things before we get to the main focus today. This webinar is part of a series that CFCA and Emerging Minds, with a focus on infant and child mental health. Webinars, including responding to child mental health concerns in culturally and linguistically diverse communities, supporting children who have disclosed trauma. And also, recent webinars that have happened, understandings and supporting infant mental health, supporting children’s wellbeing when working with separating parents, and how to recognise complex trauma in infants and children, to promote wellbeing. You might be interested to have a look at some of these.

Okay, so I have this wonderful delight to introduce our panellists. So, I would like to introduce Valerie Ah Chee, Kirsty McLean, Deborah Bowman. And of course, my name is Dana, and I will be facilitating the session today.

So, I just wanted to give our panellists a chance to say hello first, before we get into the substance of the webinar. So, Valerie first, can you talk a little bit about who you are, where you are from, and one thing that gives you an inspiration in the world we live in today? Valerie.

Valerie Ah Chee: Yeah, hi everyone. My name is Valerie Ah Chee. I am a Bindjareb woman from the southwest of Western Australia, one of the Noongar nations. I also have family ties to the Palkyu people in the Pilbara. And I’m married to a Nyikina man from the Kimberley. I’m a midwife, I’m a mum, I’m a grandmother, and I have to say my inspiration is my mother, and also my granddaughters. My mother for the changes she made, and for the changes I want to see when my granddaughters are grown up. Thanks.

Dana Shen: Wonderful, thank you so much, Valerie. Kirsty, could you please let us know a bit about who you are and where you’re from, and one thing that gives you an inspiration?

Kirsty McLean: No worries. So, I’m Kirsty. I’m a Miriwoong, Gajirrawoong woman from Kununurra, so that’s up in the north of Western Australia. But I’ve been down here on Noongar Boodjar for about 10 years now, so quite a while.

My background is in medicine, so I’m currently a medical student completing my medical studies. But I am doing some research here. And I think for me, women’s health is really important for me, because growing up with my family and all, having chronic illness, and seeing the way that we are treated in the medical system, that’s what inspires me to do this, to start empowering our mob in our medical system.

Dana Shen: Wonderful, thanks Kirsty. And Deborah, can you say a little bit about yourself and where you’re from, and what gives you inspiration?

Deb Bowman: Hi, everyone. My name is Deb. I’m an Ngemba woman from Brewarrina in New South Wales. And I’m currently here on the lands and waterways of the Wodi Wodi, Wanda Wandian and Jerrinja people of the Yuin Nation.

I guess a bit of my background is, I’ve worked in disability, I’ve been a counsellor, and now lucky to be working with University of Melbourne as a research assistant. So, I guess what inspires me is, my mum has inspired me a lot throughout my journey and my life. The way we are, Aboriginal people I guess are treated in the healthcare and education system, so that really inspires me for the work that I do today.

Dana Shen: Thanks so much, Deborah. And welcome to all of you, and we’re so glad to be with everybody that’s listening today to the webinar. So, we’re going to move on to the main focus of the webinar now. And I want to hand over to Deborah in the first instance, to first of all give us a bit of an introduction around her work, and in particular healing the past by nurturing the future. Deborah.

Deb Bowman: Thanks, Dana. Hello everyone. I’m part of the Onemda Unit at University of Melbourne. And the name of our unit is a Woiwurrung word, meaning love and spirit, that was given by Wurundjeri Elder, Aunty Joy Murphy, in 2005. And it reflects the idea of wellbeing that is central to the work of the unit. So, it was established in 1999, and it was then known as the VicHealth Koori Research and Community Development Unit. And it has a long history of community engagement, as we prioritise the co-design of research into Aboriginal health and wellbeing. And that work carries on today.

So, I guess the next slide. So, healing the past by nurturing the future is one of our key projects, and recognises that pregnancy, birth and the transition to parenting can be a critical period for parents from Aboriginal and Torres Strait Islander communities, who have been impacted by complex and intergenerational trauma. So, when we speak of complex and intergenerational trauma, we often recognise the impact, the negative impact that it has on both our social and emotional wellbeing for our parents.

But rather than focus on the negatives, our research takes a strengths perspective, and acknowledges that there is a lot of positive work that can be done with our parents during the perinatal period. Because that’s a period of transition, which can create opportunities for positive change.

What we do know though, is that it is important that practitioners and service providers, who support parents through this transition, have the understandings and expertise to provide a culturally and emotionally safe care, especially where parents are experiencing that trauma, and emotional wellbeing challenges.

Our co-design research has led to the recognition that parenthood appears to be the only natural turning point at which negative life course trajectories can be altered for parents. And those first couple of years are also a time of key development for the baby. At the same time, parents are attending frequent scheduled contacts with service providers. So, this then offers a unique opportunity for those practitioners to ensure parents healthcare experiences are safe and not retraumatising, being able to identify new risks of social and emotional wellbeing issues. And by changing the narrative I guess, and the language to what has happened to you, rather than what is wrong with you, allows people to stay strong as the experts of their lives, and separate them from their problem stories.

So, listening to those trauma stories and the stories of resilience and mutual understanding and acceptance, there is a window of opportunity for service providers to offer culturally specific support that empowers our Aboriginal parents to thrive, and interrupt the cycles of intergenerational trauma.

So, being kind and compassionate to our ways of being, allows a shared learning and allows us to yarn with a purpose and with meaning. So, having new beginnings and fresh start, changing roles, and feeling connected to be given compassionate care, which empowers our choices, creates safety, and a trusting environment.

So, the diagram with the basket, the grasses, the weave in the basket represent the collective nature of connectedness and wellbeing and parenting. So, the grasses from which the baskets are made, grow from country, and represent connectedness to place and culture. The weave facilitates the grasses transformation into a basket and relies upon generational transfer to Aboriginal and Torres Strait Islander knowledge and cultural practices. So, handing down our knowledge and sharing knowledge. So, without knowing how to weave, a basket cannot be made.

The painting on the right is around generations, and how those generations stay connected through our ancestors, and generations over time. Now, there’s so much love for our babies, and this can be a very sacred time for families to nurture, bond and connect, to celebrate new life and new beginnings. I know it is sometimes, I’ve grown up believing when there’s birth, there can sometimes be sorry business as well. So, it’s that life cycle of life, death, life. And our babies, and connection to our ancestors that somehow come back and share that wisdom through our little ones.

So, the healing the past, nurturing the future project is Aboriginal led, community-based action research project, and it co-designs some perinatal strategies to support our parents experiencing complex trauma. So, we are working to identify strategies that are considered acceptable to Aboriginal parents and feasible for our service providers. So, the piloting, implementation and evaluation of the effectiveness of perinatal strategies, take place following this formative design stage that’s pictured there.

So, the four domains of perinatal care is around awareness of the impact of the trauma on parents, or trauma aware perinatal care, to minimise the risks of triggering and compounding trauma responses. The safe recognition of parents who may benefit from assessment and support with processes to reduce risk of harm. Assessment of complex trauma symptoms to accurately identify parents experiencing distress, and support strategies for parents to heal from psychological or emotional, social, cultural and physical.

So, communication, trusting relationships, and continuity of care are important practice in minimising the trauma. So, positive descriptions of care involve respect, empathy, compassion, understanding, personalised and individualised care, asking people for permission before touching them, being gentle and respectful as individuals. So, providing culturally safe spaces, building trust in relationships, deep listening and understanding, being present in the moment is really important, being strength based, trauma informed, and culturally aware. And being culturally responsive as well can support the prevention of intergenerational transmission of trauma.

So, we find that practitioners need to gain a deeper understanding of the values and principles that underpin Aboriginal and Torres Strait Islander childcare rearing practice. So, this will create opportunities for both ways learning. We’ve recently developed some online learning modules for practitioners who are keen to develop their learning in this space, and they can be found on the Emerging Minds website right now. They’ve actually gone live last week I think, and people can access those right now.

I think that’s me, thanks Dana.

Dana Shen: Wonderful, thank you so much Deborah. I know that people will have questions coming through, and we’ve certainly had previous ones when people were registering. So, we will explore some of what you said in just a moment. Thanks so much, Deborah.

I now want to hand over to Kirsty and Valerie, to talk us through their program that they are working with, Baby Coming You Ready.

Valerie Ah Chee: Thanks, Dana. So, me and Kirsty are both, I just want to acknowledge that me and Kirsty are both Zooming in from Wadjak Boodjar and we pay our respects to Elders past, present as well.

So, Baby Coming You Ready is a new way to help support the social and emotional wellbeing of First Nation parents. It came about from community responding to the fact that perinatal mental health outcomes weren’t improving, and it was seen as a better way, or it would possibly be a better way to screen Aboriginal parents in the perinatal period, and replace the Edinburgh Postnatal Depression Score, which we know is culturally irrelevant, and culturally unsafe. Thank you.

You can keep going Dana, I did a quick acknowledgement, thanks.

So, we’re going to go straight into the statistics with Aboriginal women and distress. So, we know that a third of young Aboriginal women report high distress, and it’s double the rate of non-Aboriginal women. Concerningly, 30% of WA Aboriginal infants, is born to a mother with a hospital mental health contact, whether that be as an inpatient or through emergency. We know that the rates of mental distress are rising, and we also know that research shows Aboriginal women are being under-screened and poorly managed – and on top of that, not being screened in a way that is relevant to them.

So, this slide I actually really, really love this slide. It’s quite simple in the message that it’s trying to send, and as Deb was sort of laying this foundation as well with intergenerational trauma. So, this is basically just a picture of a grandmother being pregnant, and also as we know, female babies are born, the eggs are in utero when they’re developing. So, this is just a quick snapshot that we know culture starts in the womb, that whatever the mum is feeling, the babies are experiencing, and this is transmitted into generations.

And it’s not a big jump to actually acknowledge and recognise that what happened to my grandmother affected my mother, and what happened to my mother is affecting me and my children. So, this is just a really, really quick snapshot of visual, a way of seeing this transmission.

But I also want people to remember as well, that while intergenerational trauma is being transmitted through the generations – resilience and strength is also being transmitted, as a buffer to this trauma. And that’s really important to remember.

So, as my scope is midwifery, and so working in perinatal mental health, you sort of have to realise the responsibility that you carry working with families who are affected by trauma. Especially so in the perinatal period, because it’s such a vulnerable time. And this is a trauma tree picture, and all I want to say here is that the green watering can is the way that professionals who are working with vulnerable people can re-traumatise in a system that we know is culturally unsafe. And they can do this by not recognising, and perpetuating power inequities; ignorance, not recognising the cultural diversity between individuals and communities; the assumptions and bias that we have. Labelling women, and we know that this happens, and labelling families. Judgements, passing judgements on women who come into their care, and we know that racism exists in the health system, and that it continues to retraumatise vulnerable families.

So, it’s really important here to just remember what role we play, and to absolutely check ourselves when we are caring for families, and to see how we can improve our care – and to make sure that we don’t perpetuate this cycle of trauma, when we are caring for families.

This slide is another quick snapshot of the proportion of hospital discharges against medical advice by indigenous people. This to me is a reflection, is totally a reflection of the system, and not of the person. We know that Aboriginal people discharge when they don’t feel safe, when they don’t feel listened to, when they feel disrespected, when they feel that they have been judged, and when they experience racism. And this slide shows that Aboriginal people are leaving the system in droves. It’s happening in my family, and I know that it is a reflection of the system, and this is what needs to change.

How can we make sure that when Aboriginal people and Torres Strait Islander people are seeking health, that they are actually being cared for in a way that will help with healing? And not in a way that’s not going to help healing, because we know that health and healing are different for different people as well, and that they do sometimes exist in separate scopes.

So, I’m going to pass over to Kirsty, but I think it’s really important here to know that Baby Coming You Ready was developed by community, in response to community issues. Thanks, Kirsty.

Kirsty McLean: Yeah, so exactly, just like what Val had been saying, Baby Coming You Ready was developed by community. And not just community, but we’ve heard Elders, and then we’ve also had community involvement with mums, dads who are Aboriginal or Torres Strait Islander, and then non-Aboriginal and Torres Strait Islander people who are practitioners, managers and health workers.

So, this is really important actually, design part of Baby Coming’s design is, it’s really been community led. And that’s taken a really long time, about six-seven years now it’s been in the making, and we’ve just started piloting. But it’s an iPad app that we’ve had designed for non-indigenous practitioners, that will help them enhance their practice. So that we’re giving back control to our mums, because we want to empower our community to feel like when they are coming back, each time they are learning new things, and they are feeling empowered to say, “I actually want something else,” or, “This isn’t good for me.”

So, yeah, we’ve also, Baby Coming also screens for family and domestic violence, alcohol and drug, and a general social emotional wellbeing assessment. So, it’s a really holistic look at a mum’s life.

So, if we move onto the next slide. And you can see it’s supposed to be used with the practitioner in a yarning style. You sit side-by-side, and it’s a time for you to share your journey as well. Because it’s really important for Aboriginal people to feel like they are connecting with their practitioners, that the practitioners or professionals really genuinely care. So, we’ve got the Baby Coming app, which will look at FDV and alcohol and drug, and doing K5+2 instead of the EPDF.

And if we move onto the next one, you can have a look. It’s an image-based app with voiceovers on each side. This is also, we have a Baby Coming You Ready website, that’s available to the general public. Anyone can go on here, so I’d encourage everyone to do that. You can have a look at our mum’s page – this provides information that mums and dads said that they weren’t really receiving when they’d gone to the doctors. So, the mum’s tab has stuff that’s about foetal movements and other things to do with birth, and dads also look after them. And then you can see in the practitioners, that’s a side that contains training for the people that are using Baby Coming, and that training is based on trauma-informed care, and the effect of colonisation on our current medical system.

If we move on, we can have a look at some of the – and the resource tabs, this is actually really good. You can access that on our site as well. And you can, these are all services that are Aboriginal specific services that support cultural safety. And you can look via location nearby you, things like accommodation support, or breastfeeding support, counselling, that kind of stuff. So, this is a really good resource to find specific supports that your mum may need.

So, onto the next tab. So, this is the frontpage of Baby Coming You Ready. You can see we have a voiceover. And into the next page, this one just introduces it. And then you can see we have the image-based with voiceovers explaining things in a really nice maternal voice, or a peer-sounding voice, explaining the questions. And we’ve had artists do really nice images that show the – sorry, Valerie, would you mind jumping in?

Valerie Ah Chee: Yeah. So, we’ve tried to capture the diversity that Aboriginal communities and people may experience. And we’ve tried to capture every sort of lived experience that may be relevant to Aboriginal women and fathers, and their families. Baby Coming You Ready has, this is absolutely, absolutely strength based.

And the one thing that we need to remember with Baby Coming You Ready is, the woman is sitting in front of you telling you who she is, and not the other way around. So, you, the practitioner actually has to sit and be present and listen, and the woman will tell you, and share with her what she needs.

We have skip logic embedded, so anything that’s not relevant to the woman is not going to come up and won’t have to be discussed. And that’s a really, really – that’s something that the Elders really wanted embedded into Baby Coming You Ready. It was really important.

Kirsty McLean: Yeah, and as mums work through it with the clinicians, the clinicians are there to support them through it, and try and encourage yarning, so that you can begin to incorporate a more yarning style practice.

So, if we move onto the next tab. And you can see here these are some of the images that we have that are really strength based, and really nice to see. And I think it’s good, not to just be able to see themselves represented in a nice way, because when you have a look in most health handouts, you will see a lot of risks and a lot of representations in those ways, but not in a strength-based way.

Valerie Ah Chee: And just before we move on, I think it’s important to remember as well, that if you do have a really good strong relationship with your mother or someone in your life, that’s actually a really important buffer to the stress, and the stress women and dads may be experiencing.

Kirsty McLean: So, you can see, that women when they go through the app, they get to choose a list of things that keep them and baby strong, and they come up on this strong tree of life. And then you can see some of the worries that the mums may have had throughout. And this is really good, because it gives you a visual representation of the supports and the support system that someone has, and then they can focus on a couple of the worries and think about starting to help change that.

So, Baby Coming isn’t just a screening app, it’s also a brief intervention, where we can start to help mums move forward and access the support they need.

So, if we go onto the next slide, you can see this. So, instead of the PDS, we’re doing the K5+2 scale. We have some focus groups, and Elders come in and look at the many different screenings that are available for depression, and they have chosen these as the most relevant questions. And we have the smiley-face scale. And then at the end, this is all reported in our clinical events summary.

So, this is good. The mum goes through the app, she clicks everything that’s going on in her life. So, it is an accurate representation of what the mum wants to work on in her life. And you can see in the clinical events summary, it’s all laid out in this for clinicians to understand, and priority tables so you can see what’s going on in the mum’s life.

Valerie Ah Chee: And all of that information that’s documented. Because everything the woman has selected, allows the practitioner to actually really be present, because she doesn’t have to be documenting while she’s listening to the woman. Everything that’s selected is generated in the clinical events summary. So, the documentation is done for the practitioner. Because a lot of the time we are sitting with the woman, and we’re worrying about the next woman we have to see, because we know that the system is overloaded.

So, this is a really, as much as we know that Baby Coming You Ready needs a standalone appointment, and that may be an issue for some settings – this is how in the end it sort of balances out, because the practitioner doesn’t actually have to document while she’s listening to the woman.

Kirsty McLean: And so far, we’ve been piloting Baby Coming in the Wheatbelt, and a few different services in the Perth Metro area, and it’s been going really well. And it’s been going really well; it takes a little bit of time to get Baby Coming incorporated into a service, that’s just training, and having it brought into general practice, instead of using the EPDS. But when we’ve had practitioners do it, they have come back with really good feedback.

And yeah, you can have a read of it there. So, thank you all.

Valerie Ah Chee: And just before we finish, I do want to say that Baby Coming You Ready is a very adaptable tool – and when I say that, I mean that if a community feels like they would like to use this, it can be absolutely adapted to reflect their community and their language and everything like that. So, it’s very flexible.

Kirsty McLean: Yeah, it’s been designed to be adaptable to each community, because each community is different throughout Australia. And what we’re hoping with Baby Coming, is that each time it is implemented into a new community, that people are engaging the elders beforehand, ensuring that there is community input to it before it’s implemented. Because that’s how it’s been done the whole time here, on Wadjak Noongar Boodjar, and over in the Wheatbelt.

Dana Shen: Wonderful, thank you so much Kirsty and Valerie, talking about Baby Coming You Ready. We are now going to go into our Q&A discussion, which includes previous questions that have been asked by registrants – also questions that are coming through now. I’m just going to quickly, I’ve just seen some that have come through, which I know are easier ones to answer. So, we’ll just start with those first.

So, this is a question for Kirsty and Valerie. So, people are asking about the availability of Baby Coming You Ready, and is the screening designed for medical practitioners only?  I wondered if you could briefly answer where the stages of the process is up to for this project?

Kirsty McLean: That’s a really good question actually. It’s not for medical practitioners only, actually – we’ve been having social workers do it, we’ve had psychologists that have been interested in doing it. We’d really like to have the Aboriginal health liaison officers that are working in the midwifery practices to implement it as well. So, I think it’s for any professional that is working with vulnerable Aboriginal communities, that might need social emotional wellbeing assessments.

Valerie Ah Chee: Yeah, I agree. While we know that the majority of medical professionals are non-Aboriginal, and until that parity is improved, the onus is on non-Aboriginal practitioners to actually up their game and find ways of delivering culturally safe care.

However, having said that, we also know that in the system, the biggest resources for cultural safety and security is Aboriginal health workers, in the absence of Aboriginal doctors, midwives, nurses. So, we absolutely want Aboriginal health workers to be trained in how to use it as well, because they are the grassroots people that are the frontline workers in Aboriginal communities.

So, it wouldn’t make sense not to have outside of that medical scope, it wouldn’t make sense not to have other people being trained in how to use it, absolutely. Thank you.

Kirsty McLean: Currently they Baby Coming is in pilot phase though. So, it’s not available for individuals to use in their practice. But we will be doing a state-wide trial I think, maybe at the end of next year. We’ll see how it goes, yes.

Valerie Ah Chee: And this pilot is giving us opportunity – yeah, sorry Kirsty.

Kirsty McLean: No, go on.

Valerie Ah Chee: This pilot is also giving us the opportunity to see how Baby Coming is, real time in the real world, and addressing all the little issues that may not be working at this time, and sorting those out prior to the trial. So yeah, it’s a really important pilot yeah, for getting all of that feedback. And we’re getting lots of feedback, it’s great.

Dana Shen: Thank you. Now, one of the things that I really observed as I was looking at both of your presentations is how beautiful it is, the imagery, the pictures, things that reflect our culture et cetera. Why is this so important that this is there? And Deb, I wondered if I could start with you – why this imagery, symbols, why is it so important in this work?

Deb Bowman: I think it connects with people in a way that, you know, for storytelling. Every picture has a storytelling, and a different meaning for each person. So, having imagery there for people to connect with, and for people to draw their own stories, whether their strengths and some of their hopes and dreams come from those pictures as well too. So, I think that’s really important to have those images.

Dana Shen: Thanks, Deb. And Kirsty or Valerie, did either of you want to mention anything more about the imagery in Baby Coming You Ready? There’s such a beautiful – we can see ourselves in it.

Valerie Ah Chee: Is that okay Kirsty, I’ll have a go?

Kirsty McLean: Yeah, go.

Valerie Ah Chee: I think Aboriginal people are a visual people. We look at things, and it resonates within us. And for me, art is a therapy. And I also know that the health system, we aren’t really reflected in many positive ways within the health system. And a lot of the time when there is things in the health system that’s supposed to represent Aboriginal people, it’s very risk based. And for me anyway, it’s sending messages of what is wrong with us, rather than how deadly we are.

So, for me, the imagery is really positive, and it’s very reflective of so many lived experiences, and good and the bad. And it’s very, very woman and family centred which is really important as well.

Deb Bowman: I think too, we need to remember through generations that a lot of Aboriginal and Torres Strait Islander people weren’t given access to education. So, we need to have that as a reminder too, that our feelings and our stories and our emotions are reflected through those images, and every image tells a story.

Dana Shen: Thanks, Deb. Another question that’s come up from people that have participated today is, really trying to understand how can service providers best talk about trauma in the right way with families – how do we do that in the right way? Deb, I wonder if I could start with you, how do you do it in a sensitive way, with mums and families?

Deb Bowman: I think being culturally aware, being connected to your community, knowing what’s going on in your community, having a genuine interest, I guess. And we need to, practitioners sometimes need to decolonise their thinking, and be more informative in finding out ways that they can engage with their community. And when they do, ways that they can keep community coming to their service for support. Yeah, I think it’s being culturally aware, and culturally responsive within the communities.

Dana Shen: Thanks, Deb. Valerie, how about for you, what is the most sensitive ways to have conversation around trauma, that’s tricky.

Valerie Ah Chee: Yeah, I think it’s different for everybody. But within my own practice, I think it’s really acknowledging and recognising that trauma exists in the first place, that it does affect people, and it affects people differently. And it actually, the symptoms manifest differently. And the symptoms of trauma are specific to each individual, and each individual will do what they need to, to get through each day.

So, actually recognising that trauma is different for everybody. And knowing that many, many people walk around having experienced trauma, and at whatever point in time, they may not have actually recognised that they have trauma as well. I know that it took me a lot of years of my life to get to a space where I actually recognise the trauma within myself and where it came from, and how it manifested in my life.

So, I think as a practitioner, to absolutely listen and recognise the many, many, many symptoms of trauma for that person who may be in front of you. And sometimes, you just have to sit and be okay with silence and let somebody trust you enough, to actually share with you what their trauma is for them.

Dana Shen: Thanks, Valerie. Thanks. Another question that’s come through, through people that are online right now, is this one. And it’s really referring to psychologists and counsellors, and ask the question, where is the line to connect through yarn, whilst not making it about our experiences? So, what’s that kind of boundary around self-disclosure? Yeah, I’m just really wondering about your views on that. Kirsty, did you have a view about that?

Kirsty McLean: That’s interesting. Make sure you’re not talking more than the person in front of you, I guess I one easy way of doing it. I think it’s important to definitely share, but you want to make sure that the other person is also getting the chance to share. So, bits and pieces here like, “Oh, I’m also from Wadjak Noongar Boodjar” or things like that is really good – what do you think, Val?

Valerie Ah Chee: Yeah, I think understanding that it’s going to take time, and patience as well. And I know that a lot of people can’t sit with silence it can be quite awkward, and so they feel like they have to fill that silence. And I’m guilty of that myself. I filled it by talking about me, and it probably wasn’t – in fact, I know it probably wasn’t appropriate. But you actually learn from that. It’s actually saying to yourself, that if I can learn something from this, that’s okay.

But yeah, I feel like to me the most important thing is to actually build the relationship, so you get to a point where that person trusts you enough to actually let you into their life, and not take over, and be sincerely present and listen, and listening. And then working together to come up with a plan that is reflective of what that person needs, and not something that you thought up.

We are the expert in our own life, we need to be able to tell you what we need to heal, and move on, and move forward. And you need to support us to do that. I hope that answers your question.

Dana Shen: Yeah, it did, thank you so much. Deb, another question that has come up is around, how do you create safe spaces and interactions with families – how do you create that cultural safety, what do you have to do to make sure that happens, Deb? I’m just wondering if you had any thoughts about that.

Deb Bowman: I worked at an Aboriginal women’s organisation in Nowra, called Waminda. And there was a lot of ways we can create those safe spaces. And it’s around making the space, but letting the women that came in there that accessed the service, to create the space for the way they need it. And I guess it’s really looking at what’s in that space, putting in things that have meaning and have connection to Aboriginal people.

And I think too, I think the biggest thing is changing our language. Sometimes you can go into a space, and it’s around what is wrong with you, instead of what has happened to you. What can we do to create that space for you to come and sit and be comfortable, offering food, a cuppa – it’s always nice to sit and yarn over a cuppa.

And I think just being present in the moment and just really listening to that person that presents there on that day, and really focussing on what their needs are at that time, and just being with them. I’m sure Val and Kirsty will -

Dana Shen: Yeah, do you have something to add, either Kirsty or Valerie?

Valerie Ah Chee: Yeah, I agree with Deb. It’s about making sure that when Aboriginal people come into a space, that they feel like they belong there. That’s really important, to find connection, to find meaning, to find reflection.

Kirsty McLean: They bring the whole mob along as well, it was, bring our whole family along to an appointment. Some of them they’re there for a reason, the kids, so don’t feel put out about that. Yeah, be really welcoming and open to having lots of people in the consult.

Deb Bowman: Sorry, Kirsty. Sometimes it’s nice you know, letting them know that they can have someone with them that can support them, if they need that support as well.

Dana Shen: Thanks so much, all of you. Another question that’s come up, and I know that you’ve touched on this in your presentation Kirsty, was being able to think about brief interventions for people, particularly in crisis. Can you talk a little bit more about how Baby Coming You Ready is doing that, is aiming to do that?

Kirsty McLean: Yeah, so Baby Coming You Ready is aiming to do that by identifying when women need support. So, it’s helping the practitioner do that.

And then we have the resources page, and we also provide Foodbank – we also have Foodbank rights, so women can go and get Foodbank cards and stuff like that. So, instead of just screening like we would do with an EPDS, you would screen and then you’d refer off to someone else to do something, right.

At the end, you can create a plan with your mum, for looking at your strength-based trees and your worries, and you can go towards doing, taking the first kind of steps towards making a change for mum.

So, it’s good in that we can start doing some motivational interviewing as well, there’s the space in there for that. Val, did you have something to say?

Valerie Ah Chee: Yeah, I did have something, and it’s gone out of my head. Oh yeah, that was it. There is a bit of a cultural divide when it comes to worries. I think one good thing about Baby Coming You Ready, is that the woman will identify what worries her, not you, and she will tell you. Having the biggest mob of people in the house, it may not be a worry to her. I know that for some non-Aboriginal practitioners, that can be like, “Oh my God, this house is overcrowded,” and it can be an issue. But if it doesn’t worry her, is that something that you should continue pressing her on? This is the thing with Baby Coming, the mum is going to identify her worries.

So, with the brief intervention it could be, and motivational interviewing, because a lot of practitioners, and I absolutely had no idea about motivational interviewing. It took me a lot of learning to actually get my head around it, and the stages of change. Because we’re all at different stages of change in our life.

So, it’s about if a woman does share a worry with you, the brief intervention part is how can we plan together to actually make those worries less of a worry, what can we do. And it might be something just as simple as food insecurity. Well, Baby Coming You Ready has, like Kirsty said, referring rights. So, the woman doesn’t have to be referred to an external third charity to get like Foodbank assistance. The midwife, or the social worker or the nurse, or the health worker can refer her straight from the clinic. It gets rid of that thirty party, and it gets rid of another obstacle or barrier so that she can get food. It’s sometimes as simple as that.

Dana Shen: And if I think about, because we’ve got so many people online that are coming from all different professions – I would say that the transferability of the things that you’ve just said, are basically that you are listening to the person in front of you, about what they need, and when they need it. And that’s what you’re paying attention to. And you’re going to try to do what you can to get the barriers out of the way of access. That’s yeah beautiful.

Valerie Ah Chee: The last thing we want to do is make someone’s journey harder, that’s the last thing we want to do is to put up more obstacles and barriers. Yeah, totally.

Dana Shen: Yeah, absolutely. Another question that came through too, is really about working with young mums and new mums, and the kinds of things that are important to think about in there. But I don’t know, particularly from your midwife background Valerie, were there particular things that you think are important? Particularly with new mums that have got some, a level of isolation in their lives – maybe they don’t have lots of family or connections. What do service providers need to think about?

Valerie Ah Chee: I know there’s lots of movements around the country that’s delivering really good continuity of care. And there’s Aboriginal-specific maternity group practices that are around the country that are doing amazing jobs as well.

And I feel like within my own experience, and within my own family – not as a midwife, but as a nanna and as an aunty, I feel like if you are working as a midwife and young Aboriginal mums come to you, I think the number one obligation for me is from their first presentation in clinic pregnant, to me that tells me that they are here, they are excited about their baby, and they want to feel that excitement and empowerment. And the last thing you should do is, if they are a teenage mum or a young mum, the last thing you should do is let your judgements carry into your delivery of care. From that moment, you should be all about empowering, and information and everything that they need, so that by the time the baby comes, they know they’re going to smash it.

And making sure that, because I know that while there are Aboriginal midwifery group practices, and specific Aboriginal maternity clinics, there’s not enough. So, when you are in that scope, making sure that you absolutely use the resources that you have at hand. And Aboriginal health workers, Aboriginal maternal infant care workers, they are the most valuable resource between the clinic and the community and the woman. I can’t stress that enough. They are really important. Deb, Kirsty?

Deb Bowman: I agree with you, Val. It’s around that holistic wraparound care that we want for our mums and our bubs, and being able to sit down and let her be in that decision making process. And what’s good for her, what her needs and wants are, and how she will go forward for the future for bub.

Valerie Ah Chee: Yeah, and to empower, yes. And birth is powerful, you know, and it should be transformative. It’s a right of passage, birth, and you want women to go into it feeling like they can do it. So, make sure that your care delivers that. And regardless of the issues, because at the end of the day, birth is birth. And yes, it might be these different levels of risk or whatever, but supporting that woman to birth, and birth powerfully, is going to make waves, I believe.

I believe that birthing powerfully is something that will make waves in a woman’s life, and in her children, and her partner – especially if her partner sees, you know, dads are really important too.

Deb Bowman: Yeah. And I think that often gets overlooked too, is dads. So, we need to make sure we bring them into the picture, and empower them – see them as a dad, and not everything else that they get labelled with. There’s some really great dads and great role models, and we need to build on that and empower Aboriginal Dads.

Kirsty McLean: We actually, Baby Coming has a dad’s rubric as well. So, while we’re focussing on mums at the moment, if we have a mum and dad come in, they’re absolutely welcome to do the dads sided of the rubric. It’s quite similar, but we just don’t have the – we’re not collecting data from that or anything. So, that’s also still in the works.

Dana Shen: Well, thanks so much for all the things that you’re doing at the moment, as I said earlier. The first question I really want to pose to the three of you, you mentioned a couple of times, decolonising – decolonising our thinking, decolonising systems. I wondered if you could each talk a bit more about what that means to you? Deb, what does decolonising mean to you?

Deb Bowman: For me I think it’s breaking down the discourses of racism and colonisation that Aboriginal and Torres Strait Islander people have been oppressed by for many, many years. So, I guess recognising that Australia has a black history, and really wanting to understand. I don’t think I’m answering this right, sorry.

Dana Shen: You are, Deb. You’re answering it right. It’s your view, so yeah.

Valerie Ah Chee: Yeah, absolutely.

Deb Bowman: I think that’s the biggest thing is recognising that there is a black history here in Australia, and accepting that events like Australia Day, just doesn’t sit with Aboriginal people. We need to look at ways of changing those days and being inclusive for everyone to share.

Dana Shen: Thanks, Deb. Thank you. And how about Kirsty, what does decolonising mind, or services, or systems mean to you?

Kirsty McLean: Well, I think decolonising is definitely something that every individual person has to do, just in general, because we live in a colonised system. And part of doing that I think, is to confront your own internal biases. We all have them – you need to confront them, and acknowledge that you have an internal bias, and then you can work from there. So, educating yourself, be willing to listen and acknowledge and respect the knowledge of Aboriginal and Torres Strait Islander people.

And being able to, I think in practice, decolonising is to take a step back from that really paternalistic practice, and giving valour to your mum or dad, to your client, giving the power back to them. They know what’s best for them, and they know themselves the most. Yeah, so I think it’s the thing that you don’t know everything.

Dana Shen: Thanks, Kirsty. And finally, Valerie, your view about that, what does it mean for decolonising minds and services?

Valerie Ah Chee: It’s really, because I think in some way, we all do it. We try and all do something anyway. For me, as an individual in my own mind, it’s processing what’s happened to my family, my community, my culture. I know what happened, I understand why it happened, but I actually have to process it, accept, but then find my own way back to connecting. You know what I mean?

Noongar people were really, really, really affected. Sorry Dana, everybody was affected, but my own stories with Noongar people. So, processing what happened, and how I can reconnect back to my Noongar knowledges and culture, and actually bringing those knowledges into my day-to-day living, and my day-to-day practice. And yeah, moving on, and taking everything I can. This is really hard, Dana.

Dana Shen: Yes, it’s a big question.

Valerie Ah Chee: And I think I might just move on to the system, is actually suspending your cultural lens, and applying a different cultural lens to the system, and actually seeing it through Aboriginal and Torres Strait Islander people’s eyes. And how it can be changed to suit what they need to heal and be healthy, because it’s different. Even the view of health and healing is different between the dominant culture, and what Aboriginal people need to heal. And I guess that’s part of the decolonisation as well isn’t it. And valuing indigenous knowledges – yeah, valuing.

Deb Bowman: It’s that two-way sharing isn’t it.

Dana Shen: Okay, we’re just going to go through some of the other participant questions, and Deb, I wanted to start with you. Are there any labels we should avoid that retraumatise, or leave people discharging against advice, the language we use, the way we talk about people et cetera? Deb, I just wondered if you had a view about that?

Deb Bowman: Labels. As a narrative practitioner, people are labelled every day, and labelled in so many ways, that they start believing that they are that label. Definitely the language has to change in our health and education systems, to build our people up, to know that we’re human as well, we’re not seen as a thing. We see one bad black person, and we’re all labelled as being the same. So, lifting those labels off.

This is really hard, you know. Labels throughout my life, the hurt and the pain and the emotions that you go through, is so difficult. We need to really look at that language and address that language. And people need to recognise – mainstream people need to recognise that we are people too, we do have feelings, we do have emotions, and everyone’s individual, everyone’s unique. I don’t know what else to add to that really.

Dana Shen: I think what I’m hearing, and I think it’s important, that participants know what’s – you’re actually speaking from lived experience, aspects of what you’re talking about, and as Valerie was, and Kirsty is as well. So, you are talking about the things that have affected you as an Aboriginal person, as well as what it might be when you look across at a system. So, just wanted to recognise that.

Valerie Ah Chee: Yeah, because we can’t separate that can we either.

Dana Shen: That’s right. Okay, so there’s a few more questions that have been posed, and the first one is for Kirsty. Once identified, how to practitioners help with some of the non-health issues – I guess we’d call is non-medical maybe, non-health, such as overcrowding, some of the social issues et cetera. How do practitioners best help with those?

Kirsty McLean: Well, I think the first thing to help with is, is it actually something that needs help with? Does the mum or your client want this, do they consider it overcrowded, or do you consider it overcrowded?

Going from there, I think the best thing to do is, you’ve got a mum sitting in front of you and she’s got a set of needs or supports that are needed. But one of the things that makes it really hard for us mob to access all of them, is having to go from different institution to different institution to access all of the supports we need. Because often we’ll come in and you’ll get referred to three different other services, and that makes it really hard.

So, I think the best thing you can do to try and help support someone when it’s not a health-related thing, is to be able to take away some of those barriers for them. So, instead of getting them to call to get a psychologist appointment, you call and book the psychologist appointment, can you help arrange someone to take them there, can you help arrange transport to go and get food parcels, or things like that.

So, if you can take away as much of that extra work and little things that build up when you’re referring patient, or when you’re referring mums, I think that’s the best way to go.

Dana Shen: Thank you, Kirsty. Now we’ve got some Baby Coming You Ready specific questions. So, Valerie, I wondered if you can answer the first one – is it okay for non-Aboriginal people to use the BCYR app with Aboriginal women?

Valerie Ah Chee: Absolutely. It was actually designed to be utilised by non-Aboriginal health professionals as well, because that was where the issues were around practice, and how to deliver culturally secure care. So, it’s absolutely designed to be used by non-Aboriginal health professionals, so long as you do the training. And for me, it’s about sincerely wanting to use it, and embed it into your practice.

For me, intention and motivation are big things around why people do things, and why they choose to do things. So, are you going to use it for how it was intended? And it was intended to improve perinatal mental health outcomes. So yeah, do the training. When it does get to be across the board, absolutely do the training, and absolutely do the e-Learning, and do the face-to-face training, and absolutely keep in touch. And we are there for you – the Baby Coming You Ready team is there for you for any questions, concerns, anything.

Dana Shen: Thanks, Valerie. And another one, so people know that it’s not ready for everybody yet, so they ask this question. Until it is ready across all states, what can organisations and practitioners do now to incorporate into their screening, what should they be thinking about right now, want to incorporate into their screening work? So, Kirsty or Valerie?

Valerie Ah Chee: Sorry, I know that it shouldn’t be a tick box. Screening does have a purpose, and screening is there to identify women and families who need help, who may be struggling. So, there is a purpose to screening, so I don’t think that screening should just be a tick box. It should be on the back of relationship building and having patience and time, to understand the woman in front of you and what she may need.

Kirsty McLean: So, the question is what to do, how to do screening in a culturally safe way, is that right?

Dana Shen: Yeah, they’re really saying, what a wonderful product – is there anything I can think about right now, given it’s not available to actually use?

Kirsty McLean: Yeah, so I think they can use the website, so they can use that to give to their mums, and they can peruse that. They can use the website for resources. Currently we only have WA based resources, and I think it’s mostly Noongar, wasn’t it, Valerie?

Valerie Ah Chee: It’s WA.

Kirsty McLean: So, it won’t be of use to other state people. But I think when you’re screening people, and especially Aboriginal people, doing some clinical yarning by yourself, just doing that social emotional wellbeing assessment, check how they’re doing, ask them how they’re feeling at home in all of these things. Because social emotional wellbeing assessments aren’t really – there’s not a huge focus on it. It’s mostly a focus on the little numbers that you do, like the K10 and the EPDS. You don’t really necessarily need a piece of paper to write some good care, you just have to be in tune with the patient and be there for them.

Dana Shen: Thanks very much, thank you. Okay, we’ve got a final question that I am going to ask to Valerie. As a nurse, how can we advise new mothers that have advice from their mothers or grandmothers, that may be unsafe or not beneficial – how do we do this in a way that is not dismissive of that strong set of relationships? I just wondered if you had any thoughts on that.

Valerie Ah Chee: Yeah, I think it’s a really good question, and I’ve actually come across this question before. I think it goes back to just respect, because you do not want to come from your point of view, and not value the indigenous knowledge that our mums and grandmothers are passing down to us. And I think that you have to find a way where you can integrate the indigenous knowledges, and the clinical knowledge, and have them be complementary to each other.

You absolutely have to discuss – and it’s not just enough to dismiss them out of hand, you actually have to go into that deeper. Even if that means brining the nana with you, or the mum with you into the clinic space. Or going outside and sitting under a tree and just talking about it, and let’s say, “Let’s do some knowledge sharing, and we can bounce off each other. Because I really want to learn as well.” Because you can’t just be in a community and have knowledge and learning be a one-way street, and it’s all coming from you, and going into community. We know that doesn’t work.

So, it’s all about finding a middle ground, and having enough respect for that woman and her family, and her culture and her community and her knowledge, to say, “Look, we really need to get together and have a yarn about what you think is best, and how I can integrate my knowledge.” And put the onus on you to actually have your service be complementary to community, and not the other way around, because we know that doesn’t work.

Having said that, a perfect example is co-sleeping. I know I’ve done it; I have co-slept with my children, and I know that a lot of my family co-sleeps. But we know from a clinical and a mainstream and a systems perspective, that co-sleeping isn’t safe. But that’s a real big collective statement as well. So, as much as we need to talk about safe sleeping, we also need to talk about safe co-sleeping, because we know that women are going to do it, either purposely or inadvertently.

So, it’s about doing it in a way that is respectful – respectful to the woman and her mum and her nan, as well as giving that information that we can be complementary and not undermining. Because the last thing I would want is for the nanna to be thinking that what she has to give, in regards to supporting her granddaughter or her daughter, is not important or valued. So, I think it’s acknowledging your implicit bias, acknowledging that you don’t know everything, and how can we come together respectfully and share knowledge and ways of doing.

But it’s a hard question, it really is. We’re going to get the answers from lots of other people as well, but know your place in that community, and know that your way of doing isn’t always the best way, I suppose. Yeah, it’s really tricky. I hope I’ve helped.

Dana Shen: We’re close to the end, and I just thought, I want to ask a question, a couple of questions – one or two questions to really finalise. Given everything that you’ve learnt across your programs, what are the one or two key things that practitioners across the board, no matter what field they’re in, should really be thinking about? What are the most important things that you want people to take away from this, around the perinatal stage, culturally responsive care, et cetera. I know that’s a big question, but I also know we want to make sure that a bunch of these people out there, with such different professions, can really take that away.

So, Deb, I want to start with you – just one or two things that are most important to take away?

Deb Bowman: I think for me, it’s that continuity of care. Having families be part of that decision-making process, to build and empower themselves to have happiness and to have hope for the future.

Dana Shen: Al right, thanks Deb. And how about yourselves, Kirsty and Valerie – Kirsty, do you want to start first, is there a key thing, one thing, two things that are really important that all practitioners need to take away from this?

Kirsty McLean: I think all practitioners need to personally work on decolonising their practice. So, currently the medical system was built not for Aboriginal people, not for any person of colour – it’s built for white men basically. So, you need to actively decolonise your beliefs and your practices in your practice.

And secondly, I think a way to really do that is to ensure that you’re listening, and you respect Aboriginal knowledge. So, if your practice is in a particular area, like if you’re in a hospital, you can access the Aboriginal health liaison officers – they are your biggest source of cultural knowledge in your workplace. And I think people are really underutilising Aboriginal health liaison officers, everywhere we go.

So, I think it’s just important in your community, to talk to someone within the Aboriginal community that you’re in, to ensure that you know the basic cultural protocols for that community.

Dana Shen: Great, thanks Kirsty. And Valerie, just in the next 30 seconds, is there a final thing you want to say?

Valerie Ah Chee: So, really quickly, absolutely learning, understanding, acknowledging the history of this country as the first step to decolonising the system, and making it more culturally secure. Aboriginal people have not lived in a vacuum for 200 years, we’ve had so much crap happen to us. And what I know more than anything is that we are survivors. We are absolutely strong and resilient, so work with us.

And more importantly, value what we bring to the system, value all of the Aboriginal staff, and the women and men and children who come through the doors. We are the experts in what we need, and we need allies and accomplices to move forward and make change.

Dana Shen: Great, thank you so much. So, thank you Valerie, Kirsty and Deborah. I just want to acknowledge everything that you do, it’s such wonderful work. And thank you to everyone for attending online today. And see you next time everyone, and everyone take care.

Valerie Ah Chee: Thank you everyone.

Kirsty McLean: Thank you.

Deb Bowman: Bye.

WEBINAR CONCLUDED

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Slide outline: Perinatal support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma

Slide outline

1. Perinatal support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma
Valerie Ah Chee, Kirsty McLean, Debra Bowman and Dana Shen

2. Acknowledgements

We recognise and pay respect to Aboriginal and Torres Strait Islander peoples as the Traditional Owners of the Lands we work, play, and walk on throughout this Country. We acknowledge and respect their Traditional connections to their Land and Waters, culture, spirituality, family, and community for the wellbeing of all Aboriginal and Torres Strait Islander children and their families.

3. Learning outcomes

This webinar will support practitioners to:

  • extend their awareness of the historical and contextual factors impacting Aboriginal and Torres Strait Islander communities.
  • increase their understanding of the impacts of intergenerational trauma on Aboriginal and Torres Strait Islander communities.
  • understand the important role of service providers during the critical perinatal period for parents experiencing complex trauma.
  • outline key principles and practice approaches for fostering safety in perinatal care.

4. Webinar series

CFCA and Emerging Minds webinar series: Focus on infant and child mental health

Upcoming webinars include:

  • Responding to child mental health concerns in culturally and linguistically diverse communities.
  • Supporting children who have disclosed trauma.

Recent webinars include:

  • Understanding and supporting infant mental health.
  • Supporting children’s wellbeing when working with separating parents.
  • How to recognise complex trauma in infants and children to promote wellbeing.

5. Housekeeping

  • Send through your questions via the question box at any time during the webinar.
  • All our webinars are recorded.
  • The slides are available in the handout section on the webinar platform.
  • The video, audio, transcript and presenters’ responses to additional questions will be posted on the CFCA and Emerging minds websites in the coming week.

6. Presenters

  • Valerie Ah Chee
    Senior Project Officer,
    Ngangk Yira Research Centre for Aboriginal Health & Social Equity,
    Murdoch University.
  • Kirsty McLean
    Research Officer,
    Ngangk Yira Research Centre for Aboriginal Health & Social Equity,
    Murdoch University.
  • Debra Bowman
    Research Assistant,
    Indigenous Health Equity Unit,
    University of Melbourne.
  • Dana Shen
    (Facilitator)
    Aboriginal Cultural Consultant.

7. Onemda: Aboriginal and Torres Strait Islander Health, Wellbeing, Equity and Healing Unit

8. Text description

Songs of Strength, Ink on paper, 2018 © Shawana Andrews
A black and white drawing of a father, mother and child wearing possum skin cloaks and looking to the ancestors and past generations. The parents are connected with a songline which gives them strength. The stones below represent a strong foundation and the stitching on the cloaks represent the relational connectedness of Aboriginal people and worldview.

Cultures Child, Ink on paper, 2018 © Shawana Andrews
A black and white drawing of a father mother and child wearing possum skin cloaks sitting by a myrnong daisy. The father 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 baby 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.

9. Transformation of compounding cycle of hurt to a reinforcing cycle of nurturing

Chamberlain et al 2021. Healing the Past by Nurturing the Future: Aboriginal parents’ views of what helps support recovery from complex trauma: Indigenous health and well-being: Targeted primary health care across the life course. Primary Health Care Research & Development, 22.amberlain et al 2021. Healing the Past by Nurturing the Future: Aboriginal parents’ views of what helps support recovery from complex trauma: Indigenous health and well-being: Targeted primary health care across the life course. Primary Health Care Research & Deve

10. Healing the past, nurturing the future framework

The co-design strategies aim to improve four key domains of perinatal care:

  • Awareness
    • Trauma-informed perinatal care to minimise triggers
  • Recognition
    • Safe perinatal process for identifying parents who may need more discussion about complex trauma (exposure)
  • Assessment
    • Process for assessing complex trauma (impact/symptoms)
  • Support
    • Strategies/pathways for support depending on need and choice.

11. References

  • Chamberlain C, et al. BMJ Open 2019;9:e028397. doi:10.1136/bmjopen-2018028397 http://bmjopen.bmj.com/
  • Johnson, C. (2015). Yarning with a purpose. An Aboriginal perspective. Aboriginal narrative practice: Honouring stories of pride, strength and creativity. Adelaide, Australia. Dulwich Centre Publications www.dulwichcentre.com.au (Video) http://narrativetherapyonline.com/Moodle/mod/resource/view.php?id=815
  • Drahm-Butler, T. (2015). Decolonising identity stories: Narrative practice through Aboriginal eyes: Honouring stories of pride, strength and creativity. Adelaide, Australia. Dulwich Centre Publications www.dulwichcentre.com.au
  • Chamberlain, C., Ralph, N., Hokke, S., Clark, Y., Gee, G., Stansfield, C., … The ‘Healing the Past by Nurturing the Future’ group. (2019). Healing the Past by Nurturing the Future: A qualitative systematic review of pregnancy, birth and early postpartum experiences of parents with a history of childhood maltreatment. PLoS ONE, 14, e0225441. 
  • Andrews, S. (2020). Sage Journals. Cloaked in Strength – how possum skin cloaking can support Aboriginal women's voice in family violence research https://doi.org/10.1177/1177180120917483

12. Baby Coming You Ready?
A new way to help support the social and emotional wellbeing of First Nations parents

13. Kaya noonakoort!

I acknowledge the people of the Nyoongar Nation as the Traditional Owners of Nyoongar Boodja on which we stand today.

I pay my deepest respect to Elders past and present and recognise the strength, resilience and capacity of all Aboriginal peoples in maintaining connection to land and culture.

14. Aboriginal women and distress

  • 1/3 of young Aboriginal women report high distress
  • X2 rate of non-Aboriginal women (AIHW, 2021)
  • 30% of WA Aboriginal infants born to mother with a hospital mental-health contact (Lima et al, 2021)
  • Rates of mental distress are rising (ABS, 2016)
  • Research shows Aboriginal women are under-screened and poorly managed (Gausia et al, 2013/15)

15. Epigenetic effects on foetal development

Culture starts in the womb

16. Trauma Tree

Professionals who work alongside Aboriginal community and families need to recognise that they can re-traumatise by perpetuating:

  • Power inequities
  • Ignorance (cultural diversity
  • Assumptions
  • Labels
  • Judgements
  • Cultural bias
  • Racism

17. Proportion of hospital discharges against medical advice by Indigenous status from July 2013 - June 2015

Bar graph showing that there are high levels of hospital discharges against medical advice in Aboriginal people compared to non-Aboriginal.

18. Nothing about us, without us

BCYR was co-designed by all key stakeholders:

  • Aboriginal & Torres Strait Islander people
    • Elders
    • Mothers
    • Fathers
  • Aboriginal & non-Aboriginal
    • Practitioners
    • Managers
    • Organisations
    • Policy makers

19. BCYR

  • Wrap-around Program designed to:
    • Improve maternal/infant outcomes
    • Gives control back to the mother
    • Focuses on enhancing strengths not risks
  • Innovative solution to
    • Overcome screening barriers
    • Replace the EPDS, FDV, AoD screens
    • Provide SEWB assessment
    • Develop mutual trust
    • Therapeutic engagement
    • Support best practice

20. Using the BCYR App

  • Sit side-by-side to share the journey
  • Starts with easy domains of inquiry
  • Progress to exposures to
    • History of abuse
    • Current threat
    • Childhood trauma
  • Identifies:
    • Strengths and protective factors
    • Worries
    • Accumulation of ‘Negative Life Events’
    • Includes K5+2
  • Facilitates individualised
    • SAFER PLAN
    • Management plan

21. Baby coming. You Ready? - Resources tab

https://babycomingyouready.org.au

22. Resources tab of Baby Coming. You Ready? website

23. Baby Coming. You Ready? website landing page

24. Family - Growing up

Growing up, who did you look up to?

  • Mother
  • Grandmother
  • My father
  • Grandfather
  • Uncle/brother
  • Auntie/sister
  • Can't recall

25. Illustrations from the Baby Coming. You Ready? website

26. Baby Coming. You Ready website

  • My strong Tree of Life
  • Things that make it had to stay strong.

27. Kessler 5+2 distress scale

Results returned as visual (externalised) emotions

28. BCYR Clinical Event Summary (CES) example for clinicians

29. BCYR Feedback

“I thought I knew a lot about … but she disclosed so much more things about herself that I had no idea of”

We used the goal setting to make a birth plan and address her fears around birth

“I was nervous to start with but once I got started it was so easy the next time”

“She took hold of the iPad and really engaged with the images and telling her story”

“I used BCYR with one of my mums while sitting out in the garden, it was a really nice experience”

“I found it really easy to use and the women really love it”

30. Thank you for your time

Questions

Q & A Discussion

This webinar was held on Wednesday, 9 March 2022

Pregnancy, birth and the transition to parenting is a critical period, particularly for parents from Aboriginal and Torres Strait Islander communities living with complex and intergenerational trauma. It is vital that practitioners who support parents through this transition have the understanding and expertise to provide culturally and emotionally safe care, especially where parents are experiencing complex social and emotional challenges.

This webinar drew on the voices, experiences and knowledge of Aboriginal and Torres Strait Islander practitioners to explore how services can work through the perinatal period to support the social and emotional wellbeing of infants and their families.

This webinar supports practitioners to:

  • extend their awareness of the historical and contextual factors impacting Aboriginal and Torres Strait Islander communities
  • increase their understanding of intergenerational trauma on Aboriginal and Torres Strait Islander communities
  • understand the important role of service providers during the perinatal period for parents experiencing complex trauma
  • outline key principles and practice approaches for fostering safety in perinatal care.

The presenters offered their perspectives on what these considerations might mean for mainstream service providers working with Aboriginal and Torres Strait Islander families, and for cross-cultural partnerships between services and practitioners. This webinar was facilitated by Dana Shen. 

This webinar is of interest to professionals working with Aboriginal and Torres Strait Islander families and children in health, education, social and community service settings.

Questions answered during presenter Q&A

To view the presenter Q&A, go to 32:42 in the recording

  1. What is the availability of Baby Coming You Ready application?
  2. Is the screening within Baby Coming You Ready designed for medical practitioners only?
  3. Why is imagery, pictures and symbols so important in this work?
  4. How can service providers best talk about trauma with families?
  5. How can practitioners connect with mothers and families through yarn, whilst not making it about their own experiences?
  6. How do you create culturally safe spaces and interactions with families?
  7. How can Baby Coming You Ready be used as a brief intervention?
  8. What kinds of things are important to think about when working with young or new mums?
  9. What does decolonising our thinking and systems mean to you?
  10. Are there any labels we should avoid that might retraumatise people or lead them to discharge against advice?
  11. How can practitioners help with some of the non-health issues that might be identified?
  12. Is it okay for non-Aboriginal people to use the Baby Coming You Ready application with Aboriginal women?
  13. Until the Baby Coming You Ready application is ready across all states, what can organisations and practitioners do now to incorporate screening into their work?
  14. New mums can sometimes receive advice from their mums and grandmothers that is not in line with current medical recommendations. How can practitioners talk with the new mum about this in a way that is not dismissive of that strong set of relationships?
  15. What are the one or two key things that all practitioners should really be thinking about?

Related resources

  • Healing the Past by Nurturing the Future
    This is a community-based participation project by the University of Melbourne aimed at developing perinatal awareness, recognition, assessment and support strategies for Aboriginal and Torres Strait Islander parents experiencing complex childhood trauma. This website provides information on the project.
  • Baby Coming You Ready?
    Baby Coming You Ready? (BCYR) is a digitised web-based rubric that provides an engaging, culturally safe solution to the many barriers to effective screening and primary prevention that is currently available in the perinatal setting. The resources page on this website allows you to search for different types of support available based on your postcode.  

This webinar was co-produced by CFCA and Emerging Minds in a series focusing on children’s mental health. They are working together as part of the Emerging Minds: National Workforce Centre for Child Mental Health, which is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.

Emerging Minds logo


The feature image was produced by Artist Made Productions for Emerging Minds.

About the presenters

Valerie Ah Chee

Valerie Ah Chee is a Bindjareb woman from the south-west of Western Australia with family ties to the Palkyu people of the Pilbara. She is a proud mum of 6 sons, a nana to 4 beautiful grandchildren, a registered midwife, and Senior Project Officer and Research Assistant working at Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University. She is working on the pilot of Baby Coming You Ready? and is deeply concerned about the inequity and disparity in the health of Aboriginal people and the wider community. She recognises history and intergenerational trauma as a health and social determinant, but also believes the intergenerational strength and resilience we carry with us can buffer that. She wants to see a culturally safe health care system, particularly for First Nations women in the perinatal period.

Kirsty McLean

Kirsty McLean is a Miriuwung Gajerrong woman from Kununurra, Western Australia who is completing her medical degree while working as a Research Officer for Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University. She is passionate about decolonising health care and returning power back to community. She is working on the pilot of Baby Coming You Ready? - a community developed tool to help provide holistic and culturally safe care to Aboriginal and Torres Strait Islander women in the perinatal period. 

Debra Bowman

Debra Bowman is a proud Ngemba woman from Brewarrina, NSW and is living on Jerrinja land, part of the 13 tribes of the Yuin Nation on the southeast coast of Australia. Deb is a proud mum to four adult children and nan to six beautiful grandchildren. She is a narrative practitioner and grateful to find herself working at The University of Melbourne on Wurundjeri country as a Research Assistant with the Indigenous Health Equity Unit. She has a background in women’s health and disabilities. She is passionate about elevating Indigenous voices of community to challenge the discourses of colonisation and racism and question why there is still so much inequality in our health and education systems.

Dana Shen

Dana is Aboriginal/Chinese, a descendant of the Ngarrindjeri people in South Australia and has a passion for working with Aboriginal people and communities. Dana is an Aboriginal cultural consultant, with over 20 years’ experience working across the public and not-for-profit sectors in the areas of health, families and child protection. She brings a unique skill set in facilitation, Aboriginal cultural consultancy, mainstream service delivery and systems change. Her current work includes supporting organisations to plan for the future and improve service delivery, particularly with Aboriginal people and communities.