Baby Coming, You Ready? - Ngangk Yira Institute

Growing Strong Together

Designed by Aboriginal peoples and Aboriginal and non-Aboriginal professionals, BCYR provides 'wrap-around' solutions to the many barriers impacting trusting engagement, effective assessment, routine screens and effective woman-centred care.

The program centres around a web-based app. Sensitive touchscreen images and Aboriginal voiceovers guide both users through a self-reflective, engaging, culturally safe 'yarn' that supports women in identifying their strengths and worries and then creating their own solutions.

Background

Monitoring mental health is integral to maternal healthcare. Health professionals routinely use standard risk screens to assess alcohol, tobacco, family/domestic violence and depression/anxiety. Jayne Kotz, a nurse practitioner, midwife, child health nurse and senior researcher at Ngangk Yira, talked to 107 Aboriginal women, finding that these screens were unanimously considered unhelpful and culturally unsuitable. Women said they felt judged and distrusted and declined to disclose any real concerns owing to a genuine fear of child protection involvement or having their baby removed.

To address these inequities in current practice, Jayne Kotz worked closely with Aboriginal and Torres Strait Islander communities from 17 Clans and Nations and Aboriginal and non-Aboriginal healthcare providers across Western Australia (WA) to develop a technology-based solution.

Project aims

Aboriginal and Torres Strait Islander mothers experience alarmingly high rates of mental health problems while remaining under-screened and poorly managed. Pregnancy is an ideal opportunity to enhance support and engagement with health services. However, evidence shows that Aboriginal Australians distrust mainstream health services, experiencing these as culturally unsafe, resulting in current approaches to their perinatal mental health screening and follow-up care being ineffective.

The objectives of the Baby Coming You Ready project were to:

• demonstrate the impacts of culturally responsive care approaches on maternal/infant outcomes.
• evaluate the acceptability and adaptability of these approaches in diverse jurisdictions.
• future-proof technology for use in intermittent/poor internet connectivity areas and virtual use for pandemic conditions.

Approach

A comprehensive consultation was undertaken to explore the barriers and supportive influences for effective screening and strong parenting practices among Aboriginal and Torres Strait Islander parents. Over seven years, they jointly designed solutions using a 'desire-based' approach. The BCYR program emerged as a trauma-aware and healing-focused program to support Aboriginal and Torres Strait Islander parents and their health professionals to be the best they can be.

BCYR centres around a digital web-based assessment used on iPads, providing an alternative to all current risk screens. Sensitive touch-screen images capture experiences and practices common to Aboriginal and Torres Strait Islander mothers at this time. Aboriginal voiceovers on each slide guide the users through a culturally safe, strengths-based self-reflective yarn between the mother and her health professional. Alongside her health professional, she selects images she relates to, capturing her personalised story. This allows her to reflect on her cultural, social, spiritual, and emotional well-being, strengths, and worries. She then prioritises these and creates her own solutions.

Voice-over recordings and over 500 culturally sensitive images were created and digitised. Selected images generate the text-based record and care plan, which are then uploaded to My Health Record. This ensures the women's cultural story and care plans travel with them through services.

"It's the first time I realised how strong I was."

 - Pilot participant

"I felt comfortable; there was no judgement at all."

- Pilot participant

Successes

Over 300 women and 47 health professionals participated in the successful pilot across eight maternity health settings in metropolitan and rural Western Australia. The women and professionals all said that using the BCYR program built trusting, honest, open, and therapeutic relationships.

Conclusion

The BCYR program enables women to own their story, tell it their way in safety, and regain control over their maternal assessment and care. The generated record ensures women don't have to re-tell their story throughout their pregnancy journey, minimising culturally biased assumptions, misunderstandings and inappropriate care. Importantly, it allows parents to identify their strengths and what they need support for in a culturally relevant and sensitive way.