Our journey, our story: a study protocol for the evaluation of a co-design framework to improve services for Aboriginal youth mental health and well-being

Abstract

IntroductionMainstream Australian mental health services are failing Aboriginal young people. Despite investing resources, improvements in well-being have not materialised. Culturally and age appropriate ways of working are needed to improve service access and responsiveness. This Aboriginal-led study brings Aboriginal Elders, young people and youth mental health service staff together to build relationships to co-design service models and evaluation tools. Currently, three Western Australian youth mental health services in the Perth metropolitan area and two regional services are working with local Elders and young people to improve their capacity for culturally and age appropriate services. Further Western Australian sites will be engaged as part of research translation.Methods and analysisRelationships ground the study, which utilises Indigenous methodologies and participatory action research. This involves Elders, young people and service staff as co-researchers and the application of a decolonising, strengths-based framework to create the conditions for engagement. It foregrounds experiential learning and Aboriginal ways of working to establish relationships and deepen non-Aboriginal co-researchers’ knowledge and understanding of local, place-based cultural practices. Once relationships are developed, co-design workshops occur at each site directed by local Elders and young people. Co-designed evaluation tools will assess any changes to community perceptions of youth mental health services and the enablers and barriers to service engagement.Ethics and disseminationThe study has approval from the Kimberley Aboriginal Health Planning Forum Kimberley Research Subcommittee, the Western Australian Aboriginal Health Ethics Committee, and the Curtin University Human Research Ethics Committee. Transferability of the outcomes across the youth mental health sector will be directed by the co-researchers and is supported through Aboriginal and non-Aboriginal organisations including youth mental health services, peak mental health bodies and consumer groups. Community reports and events, peer-reviewed journal articles, conference presentations and social and mainstream media will aid dissemination.

Co-Designing Health Service Evaluation Tools That Foreground First Nation Worldviews for Better Mental Health and Wellbeing Outcomes

“…There is a recognised need for evaluation frameworks to be more reflective of, and responsive to, Aboriginal worldviews to allow the cultural standpoint of Aboriginal people to directly contribute to the quality improvement of mainstream health service delivery [29,[37][38][39][40][41][42]. The development of the service evaluation is an example of how co-design that foregrounds Aboriginal ways of working can be more responsive and relevant to local cultural needs.…”

“…Key features of decolonising research methodology relevant to our study are co-design, Aboriginal governance and leadership and the privileging of Aboriginal worldviews. Codesign strategies promote collaborative leadership, trusting relationships and shared power [19,31,41,48,49]. As a decolonising approach, co-design facilitates the sharing of stories and directly hearing community voices about their lived experiences.…”

“…Their cultural authority and status [28,29,43,[50][51][52] mean they are key conduits for building relationships between Aboriginal communities and mainstream health services. In terms of Aboriginal governance, the study applies an Aboriginal-led research methodology grounded in participatory action research [10][11][12]28,29,41,52] and is held by the Elders through their cultural wisdom and guidance [51,52]. The Elder co-researcher group performs a number of leadership roles within the project.…”

“…For example, the Ngaa-bi-nya Framework is a practical evaluation guide that was designed from an Aboriginal standpoint informed by the holistic concept of Aboriginal health and used a mixture of quantitative and qualitative methods [37]. Co-designing evaluations can strengthen, improve and provide a sense of ownership for community members [38][39][40][41][42]. Foregrounding Aboriginal ways of working ensures evaluation instruments are relevant, credible and importantly, effective and meaningful in documenting outcomes [42,43].…”

“…Here, the vision is not activating evaluation as a means to an end, but rather achieving long-term sustainable benefits through deepening relationships and community inclusion, where more strengths-based evaluation processes as well as outcomes align with community priorities and their preferred ways of working [28,33,41,42].…”