Co-designing a research project with Aboriginal youth

Opportunity

Aboriginal and Torres Strait Islander young people experience higher rates of mental health concerns and are less likely than non-Aboriginal young people to access mental health services until a crisis or chronic stage, primarily due to mistrust and the belief that mainstream services do not understand and respect Aboriginal people and their connection to their culture [3]. 

Suicide remains the leading cause of death for Aboriginal and Torres Strait Islander young people between 15 and 34 years. In 2020, suicide was the fifth leading cause of death for Aboriginal and Torres Strait Islander people compared to the thirteenth for non-Indigenous people. The median age for suicides was 31 years for Aboriginal and Torres Strait Islander people compared to 45 years for non-Indigenous people [2].

For positive change to occur, and to improve engagement with mental health services, working with Aboriginal young people is critical to developing mental health programs and interventions that are culturally appropriate [1] [4]. 

Approach 

Through a process of co-design the Building Bridges project developed an intervention to reorient existing mainstream services to deliver culturally secure mental health care for Aboriginal youth in the Perth metropolitan area. The goal was to motivate more Aboriginal young people to access youth mental health services earlier and build better and long-term relationships between the Aboriginal community and services.

The Building Bridges project drew on lessons from Curtin University’s Looking Forward Project, which aimed to improve the mental health, alcohol, and other drug service delivery for the wider Aboriginal community. A key outcome of this project was the Minditj Kaart-Moorditj Kaart (‘Sick Head to Good Head’) Engagement Framework, which emphasises the importance of trust and strong relationships in achieving systemic change within health services.

Step one

The first step involved establishing the research team (co-researchers) and the supporting network of stakeholders, which included:

• Nyoongar Elders, Aboriginal and Torres Strait Islander young people.
• Aboriginal and non-Aboriginal service partner staff. 
• Aboriginal and non-Aboriginal policy officers. 

To establish a strong foundation between Aboriginal and non-Aboriginal participants, the team applied two Aboriginal research processes from the Looking Forward project, namely the: 

• Going On Country and engaging in a storying process [5]. 
• On Country and storying research process.

These processes are mechanisms to prepare and engage non-Aboriginal people to cultural ways of relating to and sharing knowledge to deepen their understanding of an Aboriginal worldview [6].

Step two

The research team took part in a co-design process to identify the changes required to work practices to better meet the needs of Aboriginal and Torres Strait Islander young people and improve their engagement with mainstream mental health services. 

Curtin University facilitated three workshops involving Elders, young people, and participating organisations which included focus group discussions. The participants also completed an activity to identify what actions were most important, urgent, or meaningful to each group and the shared priorities across the groups. 

The data collected in this step helped to develop the working model for culturally secure systems change. 

Step three

In the final step, the team tested the impact of the working model. 

Impacts and outcomes

A key outcome of the Building Bridges project was the co-designed working model. The model outlines the critical components required to help organisations better meet the needs of young Aboriginal clients and their families [1], and emphasises the process of working in partnership with Elders, young people, and the community to deliver services that reflect a Nyoongar worldview.

The model is illustrated through a visual metaphor of a tree:  

• Tree roots: represents building trust, deepening an understanding of culture and spirit, and developing new ways of working.
• Tree trunk: represents working together with Elders and young people to make changes across the organisation.
• Canopy: represents organisations investing in community engagement, facilitating easy access to services, and responding to the needs of Aboriginal and Torres Strait Islander young people and their families. Cultural security involves both Aboriginal and non-Aboriginal workers and requires strong leadership.

While the model was a key outcome of the project, the process produced several other significant outcomes:

• Strong relationships were developed between the co-researchers and participants through storying and being On Country, which translated into new ways of working. The organisations involved in the project embraced a more culturally secure approach to their practice. For example, Youth Mental Health Service, North Metropolitan Health Services, developed a new program to recognise the Aboriginal Mental Health Practitioners and their cultural ways of working with Aboriginal youth. The service staff co-designed the Moorditj Wirn (Strong Spirit) program in partnership with the Elders and young people and launched it collaboratively during NAIDOC Week 2019.
• Greater cross-sectional collaboration between government and non-government mental health services.
• A series of key policy and practice recommendations.
• Researchers’ professional development increased.

Through the Building Bridges project, youth co-researchers developed their leadership skills by working in partnership with Elders and senior mental health staff. These invaluable skills will help them to secure consultation roles in the future and advocate for meaningful systemic change in delivering mental health services to Aboriginal young people.

In 2019 the project team successfully secured funding for five years from the Medical Research Future Fund (MRFF) Million Minds Mission. The application submitted to the MRFF for the Our Journey, Our Story Project application was critically informed and guided by the findings from the Building Bridges Project (Wright et al 2021). A key aim for Our Journey, Our Story is to scale up the project from the Perth metropolitan area to include, where possible, regional and remote areas of Western Australia. Read more about Our Journey, Our Story here.

What worked?

Cultural immersion leads to trust and meaningful relationships. 

The Building Bridges team undertook two cultural immersion activities, going On Country and engaging in a storying process to build meaningful relationships. After ‘bearing witness’ to the stories of the Elders and young people, staff were invited to share the stories of their own lives and the important events that helped shape them. The storying allowed for reflection and built a base for trust and relationships to develop [6]. The realisation of profoundly different worldviews and lived experiences helped build the foundations needed for the co-design team to work together.

Key challenges

The research approach led to periods of uncertainty. During these times, it was challenging for service staff to stay present and engaged.

Staff were encouraged to have confidence in working with uncertainty, but not knowing and staying present and engaged was challenging. A combination of time constraints and a sense of urgency were key hurdles. Working closely with the Elders, young people, and staff was very informative, but there was no clear direction on how the research approach should be followed. The project team was on a steep learning curve on how to respectfully allow participants to contribute and grow.

Projects which require deep and strong relationships to be successful take time.

Debakarn, the Nyoongar word meaning ‘steady’, became the team’s mantra. The team believes it was very successful in developing and deepening meaningful relationships between the Elders, youth, and staff. It also provided staff with the confidence, competency and capacity to work more effectively with Aboriginal youth. The team learned that given time, relationships between the Elders, young people, and staff would deepen, develop, and positively change the way services work with Aboriginal youth.

REFERENCES

1.  Westerman, T., Engaging Australian Aboriginal youth in mental health services. Australian psychologist, 2010. 45(3): p. 212-222.
   
   
2. Australia Burreau of Statistics. Causes of Death, Australia 2020. 2021; Available from: https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia.
   
   
3. Wright, M., A. Lin, and M. O’Connell, Humility, inquisitiveness, and openness: key attributes for meaningful engagement with Nyoongar people. Advances in Mental Health, 2016. 14(2): p. 82-95.
   
   
4. Commissioner for Children and Young People WA, “Listen to us”: Using the views of WA Aboriginal and Torres Strait Islander children and young people to improve policy and service delivery. 2015, Commissioner for Children and Young People WA: Perth.
   
   
5. Wright, M., et al., Making a difference: Engaging both hearts and minds in research practice. ALAR: Action Learning and Action Research Journal, 2013. 19(1): p. 36-61.
   
   
6. Wright, M., et al., Looking Forward Aboriginal mental health project final report. 2015, Curtin University: Perth.