About the Project
The Relighting the Firesticks project is based on extensive Aboriginal-led co-design, pilot studies, and intervention research aiming to transform intergenerational cycles of trauma into cycles of nurturing and recovery. This project represents the final steps needed to accelerate the diffusion of innovation and progress to sustainability to institutionalise and revitalise practices that promote connectedness, nurturing, and wellbeing for Aboriginal parents and babies—a priority population.
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About the research
We use the metaphor ‘relighting the firesticks’ to describe our innovative, pragmatic developmental evaluation (DE) approach that is grounded in Aboriginal worldviews. Our DE ‘see one’ (light firestick from existing fire), ‘do one’ (take back to community and light fire) and ‘teach one’ (allow others to light firesticks) approach will promote shared learning among communities and accelerate diffusion and sustainability of innovative community-led and adapted interventions, to achieve significant improvements in care, thus ensuring that all Australian babies can thrive.
This approach fosters shared learning between communities, strengthens capacity and structural competence across the perinatal and early years sector, and enables better links between care systems and access to the social determinants of health.
Project methodology
The project will:
- Integrate and evaluate Aboriginal-led trauma-aware, healing-informed health promotion interventions and
- Establish tools, resources and infrastructure to facilitate a developmental evaluation (DE) approach and progress towards sustainability.
Figure 1: Progressing from existing research projects towards sustainable health system practice
Purpose and benefits
This research program builds on over six years of Aboriginal-led co-design in partnership with communities and scaffolds onto an existing pilot (Healing the Past by Nurturing the Future) and research translation program (Replanting the Birthing Tree). Relighting will integrate priority health-promoting interventions, and accelerate the diffusion of innovative care models using a DE approach by developing tools and resources to progress towards sustainability and continuous quality improvement, aligned with Closing the Gap. These implementation and evaluation projects aim to improve care for Aboriginal families experiencing complex trauma, and use exemplary implementation science methods informed by Diffusion of Innovation in Health Service Organisations and the Consolidated Framework for Implementation Research.
The project is expected to have many positive outcomes, including:
- identify exemplar services and key stakeholders to develop a list of ‘exemplar services’
- develop protocols to create a culturally and emotionally safe research environment for staff and parents who have experienced complex trauma
- use research findings to identify evidence gaps
- develop safe, acceptable, and valid perinatal strategies for recognising and assessing complex trauma among Aboriginal parents
- develop safe, acceptable and feasible strategies to support the provision of community-led, culturally-responsive, evidence-based, trauma-aware, healing-informed continuity of care in the first 2000 days
- build the capacity and skills of Aboriginal and Torres Strait Islander researchers
- support the development and mentoring of mid-career researchers, building medical researcher capacity and capability and expanding career trajectories for the next generation to deliver a program to achieve substantial improvements in health outcomes for Aboriginal families
Four project streams
- Integration of interventions scoping review
We will conduct a scoping review of trauma-aware healing-informed health promotion interventions and identify priority areas. The findings will inform the development of a program plan, materials and implementation plan for priority health promotion interventions using a developmental evaluation approach.
- Validation of ACTSQ and ASQ-STEPS
We have completed a rigorous development and preliminary psychometric evaluation of a preliminary long version of the Aboriginal Complex Trauma and Strengths Questionnaire (ACTSQ). In this project, we will now field test a shorter inventory with additional parents in participating partner services to evaluate this questionnaire against the ‘gold standard’ International Trauma Questionnaire.
The Aboriginal Child Development (ASQ-STEPS) is a developmental outcome measure for children 1-3 years of age and has been culturally adapted for Aboriginal children and families. The ASQ-STEPS is a comprehensive measure of ability in five developmental domains: communication, gross motor, fine motor, problem-solving, and personal social. We will seek consent to link data to AEDC measures to validate the predictive validity of ASQ-STEPS and explore the feasibility of the ASQ-STEPS tool in the community-controlled sector.
- Developmental evaluation
Our ‘see one, do one, teach one’ supported by the developmental evaluation approach is an effective way of diffusing large-scale knowledge translation in Aboriginal primary health care and identifying non-clinical social outcomes that are important for Aboriginal communities.
We will use a developmental evaluation approach to support the sustainability of the intervention. Interviews and/or discussion groups with Aboriginal parents, health workers, health professionals, and other stakeholders will illustrate experiences and perceptions of outcomes. These findings will inform the design of the developmental evaluation toolkit, which has relevance to national frameworks and policies. These outcomes will inform a continuous quality improvement model, which will underpin monitoring and evaluation including an organisational readiness assessment.
- Health economic evaluation
We will analyse trends and costs before and after implementation of integrated interventions and culturally-responsive, trauma-aware, healing-informed continuity of care using a developmental evaluation approach described in workstream 3. This will enable measurement of the benefits of implementation and the positive adaptions gained through using the developmental evaluation approach.
We will develop core outcome sets to enable evidence synthesis and continuous quality improvement to evaluate the acceptability, cost, cultural and clinical safety and efficacy of the new services, compared to baseline data. Proposed primary outcomes include gestational age, birthweight, child protection notifications, investigations and substantiations and out of home care admissions, completion of scheduled care visits and maternal child health at all key ages and stages in first 12 months. Proposed secondary outcomes include smoking, alcohol or other substance use, gestational weight gains, mode of birth, maternal and infant anaemia, breastfeeding, completion of vaccinations, and Fetal Alcohol Spectrum Disorder diagnosis.