Juli Coffin

Background: Aboriginal Australians experience stroke up to 3 times more frequently than non- Aboriginal Australians. Linked hospital data has revealed broad demographic, inpatient and discharge information related to acute hospital admissions for Aboriginal people with brain injury. However little detail is known about the nature of services received during the admission.

Aims: To investigate speech pathology services provided to Aboriginal people with an acquired communication disorder (ACD) following stroke during their acute hospital admission. Methods: A retrospective exploratory review of available medical files for Aboriginal people who had a documented ACD following stroke in 2006 – 2016 was completed in 4 metropolitan and 5 rural hospitals across WA. Details of diagnoses and speech pathology (SP) services provided were extracted.

Results: Of 109 files reviewed, 49 (45%) related to first-ever stroke. Of these, 49% were female, 74% were _65 years of age and 80% lived outside a metropolitan area. Dysarthria was the most frequent diagnosis (49%) followed by aphasia (18%). All were assessed by a speech pathologist (63% within one day of admission) and 53% received intervention following assessment. Records noted family involvement for 16% of individuals and use of an interpreter for one person, but no recorded involvement of Aboriginal Liaison Officers in SP sessions.

Conclusions: The demographic profile of the patients is consistent with the linked hospital data profile previously published. Notwithstanding all reviewed cases receiving some SP service, this descriptive data on SP intervention raises important questions regarding culturally secure care in the acute setting for Aboriginal people with ACD.

This workshop will explore methodologies useful for working with Indigenous peoples in the field of acquired brain injury for both research and clinical purposes. Qualitative methods including in-depth interviewing within a yarning framework (Bessarab & Ngandu, 2010) and the use of focus groups will be presented. These methods will be discussed within the context of a two way philosophical framework and kaupapa Māori theory. The frameworks involve a genuine partnership between Indigenous communities and researchers or service providers where communities have active input into framing research questions, methods and in the rehabilitation framework, ultimate models of service delivery. Long term engagement of professionals with communities is essential, with researchers and service providers working with Indigenous communities to establish trust. The workshop will include discussion of experiences gained through a number of recent studies within the field of communication disorders with Aboriginal people in Western Australia and with Maori in New Zealand. These include experiences related to interviews with people with communication disorders and their families, consultation surrounding the development of a communication screening tool, and the recruitment and training of Indigenous research assistants in this area. Bessarab, D., & Ng'andu, B. (2010). Yarning about yarning as a legitimate method in Indigenous research.

This paper considers how the social construction of place and identity acts as an obstacle to Indigenous and non-Indigenous male secondary students from rural and remote areas choosing to study health-related courses at tertiary level. These obstacles are particularly relevant given that students from rural and remote areas of Western Australia (WA) are under-represented in health-related courses at university. The paper draws on data from an inter-collaborative research project that was carried out in WA in 2000 and literature that considers the significance of place in the representation of rural identities.

Twelve rural high schools were randomly selected in two stages throughout WA. Semistructured interviews were conducted with students in years 10, 11 and 12, teachers, Aboriginal and Island Education Officers (AIEOs) and parents.

Results show that the social construction of place and identity underpin career choices of young males from rural and remote areas, and that constraining structural factors inform this construction. Predominant ideologies associated with rural Australia that inform the nature of social and self-identity support images of a frontier built upon mateship, masculine ideals and a sense of belonging and obligation to the community. However, the declining role of agricultural and extractive production in Australia also impacts upon the everyday lives of rural people. Within this context, young rural males are socialised to a strongly masculinist and anti-urban culture, yet may also be constrained by the lack of opportunities provided for them within local communities. The project upon which this paper is based, identified that gender stereotyping of many health professions, cultural influences of local industry and a perceived lack of academic ability all contributed to an unwillingness to consider health as a career. Indigenous males were also disinterested in pursuing health careers due to specific cultural factors. The prohibitive cost for some families of students relocating to Perth and the anticipated social dislocation associated with relocation also contributed to obstacles faced by young rural males when considering career choices.

The results of this project acknowledge the complex interplay between cultural and structural factors that should be considered in developing a framework for the appropriate promotion of health careers to young males in rural and remote areas.

Background: Aboriginal Australians experiencing stroke and traumatic brain injury remain underrepresented in rehabilitation programs. Remoteness, comorbidities, cultural and access issues influence this situation. Our previous study, Missing Voices (NHMRC#1046228), provided the first comprehensive information on the extent and impact of these issues for Aboriginal Australians in Western Australia (WA), and gave voice to what ‘healing right way’ after brain injury entails for Aboriginal Australians.

Aims: To report on the preparation for, and progress of, the first randomised controlled trial (RCT) for Aboriginal Australians with acquired brain injury, investigating the effect of a two-component culturally secure program and incorporating a costing model.

Methods: The multidisciplinary Aboriginal and non-Aboriginal research team established partnerships with key WA-wide stakeholders including the WA Department of Health, the WA Country Health Service, Aboriginal Community Controlled Health Organisations, the Neurological Council of WA, and the Stroke Foundation. These partnerships will roll out the intervention over four years in this stepped wedge cluster RCT (N¼312) for Aboriginal participants with traumatic brain injury or stroke, 18 years and over.

Results: In 2017, protocols were finalised, an electronic data entry system established, and multiple ethics approvals obtained. By 2018 Healthcare Governance from all sites was achieved. Four rural and four metropolitan WA healthcare sites completed site preparation training; partnership roles were clarified and operationalised. Recruitment commenced in 2018.

Conclusion: This landmark study has established cross-sector partnerships and provides a novel, integrated and complex intervention in an under-represented population. The trial will provide vital information for future service improvements and research.