Injury, trauma & recovery

Aboriginal Suicide Prevention Review Research Project

Funding: NSW Ombudsman
Dates: 2021-24

Background:

Suicide is a leading cause of early death among Aboriginal and Torres Strait Islander peoples in Australia, with young people particularly affected. In New South Wales (NSW), Aboriginal and Torres Strait Islander young people aged 0-17 have consistently experienced disproportionately higher rates of suicide compared to their non-Indigenous peers (NSW Ombudsman, 2023). Despite ongoing efforts, there remains a critical need to better understand the factors contributing to youth suicide and to develop culturally responsive, evidence-based prevention strategies.

This research was undertaken by First Nations researchers and advisors to provide an in-depth analysis of Aboriginal youth suicide in NSW and identify priority areas for action. Given the complexity of the issue, the study aimed to explore suicidality across multiple domains – including individual, family, community, service, and policy levels – to inform systemic reforms and improve suicide prevention efforts.

What we did:

The study examined NSW Child Death Review case data on 43 suicides of Aboriginal and Torres Strait Islander young people over a 10-year period (2011-2020). In addition, a comprehensive review of existing literature was conducted alongside qualitative data collection through consultation workshops held in five metropolitan and regional locations across NSW.

Findings confirmed that suicidality occurs along a continuum, ranging from ideation and threats to suicide attempts and deaths. Multiple interconnected factors contribute to the increased risk of suicide among Aboriginal and Torres Strait Islander young people, spanning individual, family, community, and systemic levels. A key challenge identified was the inadequacy of existing service models, with issues related to availability, access, referral pathways, and workforce capacity. The research highlighted an urgent need for culturally responsive and safe care, which was consistently identified as lacking across the service continuum.

The study underscores the need for widespread systemic reform, including stronger legislative and policy frameworks specific to Aboriginal youth, increased funding for culturally safe services, workforce development, and targeted action to address the broader social and cultural determinants of health. Addressing these challenges requires long-term, community-led strategies that prioritise cultural expertise and Indigenous self determination in suicide prevention efforts.

Final report: Clapham, K., M. Longbottom, C. Thomas and M. Masso (2025). Aboriginal Youth Suicide: A Report to the NSW Child Death Review Team, Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, University of Wollongong.

Community led solutions to prevent Aboriginal child injury (CHIPP)

The Australian Prevention Partnership Centre
Duration: April 2019 – June 2021 

Background

The Child Injury Prevention Partnership (CHIPP) is a partnership between several organisations working together to develop a culturally safe child injury prevention program tailored to meet the needs of families with Aboriginal children in Walgett. Walgett is a town in remote north-west NSW with an estimated population of 2,145 people, of whom 43.5% identify as being Aboriginal and/or Torres Strait Islander (hereafter Aboriginal).

The project builds on an existing formal partnership between researchers at UNSW and the Dharriwaa Elders Group, Walgett (DEG), ‘Yuwaya Ngarra-li’ (YN), meaning ‘vision’ in the Yuwaalaraay language of the Walgett region. Yuwaya Ngarra-li aims to improve the wellbeing, social, built and physical environment and life pathways of Aboriginal people in Walgett through co-led research, evidence-based programs and capacity building.

CHIPP involves partners from Walgett Aboriginal Medical Service (WAMS), Kidsafe NSW and researchers from the University of New South Wales, The George Institute for Global Health and the University of Wollongong, The DEG and YN. The team have received approval from the Aboriginal Health and Medical Research Council ethics committee to conduct the co-design and we are awaiting approval to implement and evaluate the resulting CHIPP program.

The CHIPP program is led and delivered through WAMS’ existing supported playgroup, Goonimoo Mobile Children’s Services, who work in partnership with other local children’s services and the broader program of health services provided by WAMS. CHIPP provides funds to WAMS to employ an Aboriginal Child Injury Prevention Educator to implement the program and also to contribute significantly to program design and evaluation.

What we did

The project is being conducted over three stages. The initial stage involved a review of literature on effective child injury prevention programs, regular co-design meetings with the community organisation and formal and informal yarning with staff, families and community members. In December 2019 a child injury expert group conducted a review of draft program. The revised program will be implemented and evaluated in Walgett over an 18 month period.

Evaluation of the South Coast Medical Aboriginal Corporation Strong Foundations Program

Background

In 2017, suicide was found to be a leading cause of death for children and young people aged 0-18 years old in New South Wales (NSW). In response, the NSW Government parliamentary enquiry sought information from leading experts in relation to suicide. From this enquiry, Aboriginal children were identified as a vulnerable group. The purpose of this study was to provide the South Coast Medical Service Aboriginal Corporation (SCMSAC) with a descriptive analysis of the delivery of the Strong Foundations program over a six-month period January – June 2018. The Strong Foundations program is a weekly school based program that has been informed by the Koori Kids Wellbeing Program, along with Mind Matters, Aussie Optimism and Triple P - Positive Parenting Program. The program aims to: Provide a person centred and culturally safe service for Aboriginal and Torres Strait Islander people and their families requiring mental health support.

What we did

The evaluation of the Strong Foundations program was undertaken in June-October 2018 and utilised qualitative and quantitative data which had been previously collected by the Aboriginal health staff of South Coast Medical Service Aboriginal Corporation (SCMSAC). Informal discussions were also conducted with SCMSAC staff. We also analysed data from two locally designed data collection tools developed by SCMSAC program staff: My Feelings and Understanding Culture. These tools were culturally contextualised to meet the needs of young people in the Shoalhaven region. The Strong Foundations Report provides an exploratory work to assist in contextualising the impact of the Strong Foundations program implemented by the SCMSAC.

Publication

Longbottom, M., K. Clapham and P. Kelly (2018). Strong Foundations Report. Wollongong, Centre for Health Services Development, University of Wollongong.

Reframing the representation and positioning of Indigenous families through a strengths-based and trauma informed approach in Australia and United States (Systemic Responses)

Background

The proposed cross-national in-depth study will assist to better understand how services respond to Indigenous families who experience trauma and violence. Focusing on service responses, this study will contextualise the challenges and enablers that can create vulnerability with a focus on race, gender, class, sexuality and ableism as it relates to Aboriginal Australians and Hawaiian people. This will be conducted through accessing national coronial data to provide information surrounding deaths of Aboriginal (New South Wales) and Hawaiian (Hawai’i) women, men and children, as a result of trauma or violence. A historical component will seek to understand the positioning and representation of Indigenous people. This study will be grounded in community, be based upon Indigenous protocols and research methodologies, with an Aboriginal and Hawaiian steering committee, to work in partnership with a number of Aboriginal Community Controlled Organisations (ACCO’s) in New South Wales, Australia and Native Hawaiian Community Organisations (NHCO’s) in Hawai’i, United States.

What we did

A key outcome of this study will be the development of a framework, resources and publications to informing culturally safe best practice strategies to support Aboriginal and Hawaiian families who experience trauma or violence.

Work on this project is currently underway.

First Response: Integrating trauma-informed care within primary healthcare for Aboriginal and Torres Strait Islander women experiencing violence

In partnership with the Lowitja Institute and The George Institute for Global Health Global Challenges Program
Duration: April 2018 – December 2018

Background

First Response aims to investigate how the primary healthcare workforce can be supported to integrate culturally safe trauma-informed care for Aboriginal and Torres Strait Islander women who have experienced violence. This project responds to recommendations for trauma-informed care within healthcare settings for women who have experienced violence, but also to women who have expressed a desire to seek support in healthcare settings rather than from the police or frontline services.

Furthermore, this project has been developed in response to engagement with end-users from Aboriginal Community Controlled Health Organisations (ACCHOs) and peak bodies who have described a lack of coordination between the health and justice workforce, and the need for enhanced workforce support. First Response will benefit the health of Aboriginal and Torres Strait Islander peoples by providing evidence and critical insight into how the primary healthcare workforce can be supported to provide trauma-informed care that is culturally safe.

What we did

First Response has been developed to ensure it is relevant to end-users in primary healthcare by bringing together a multidisciplinary partnership of stakeholders to direct this program of research in a meaningful and ongoing capacity. An action-oriented Steering Committee brought together stakeholders from primary healthcare, specialised services and peak bodies to provide direction and oversight of the research processes, knowledge translation and communication.

This steering committee will form the basis of an ongoing and robust collaboration that will pursue a planned program of research beyond this current project. Underpinning First Response is a strong commitment to the development of an Aboriginal and Torres Strait Islander research workforce. The project has three Aboriginal and/or Torres Strait Islander early career researchers as chief investigators.

Using decolonising methods, First Response synthesised a systematic review, interviews and yarning circles with representatives from peak bodies, specialist family violence services, and ACCHOs in NSW. First Response established a research partnership and baseline evidence that will inform service delivery and outline existing systems, processes and strengths that can support the primary healthcare workforce to integrate culturally safe trauma-informed care and ensure that the first response is the right response.

Preventing falls in older Aboriginal and Torres Strait Islander people: the Ironbark trial

National Health and Medical Research Council
Duration: March 2018 – February 2022 

Background

Australia’s Aboriginal and Torres Strait Islander population is ageing: in 1991, Aboriginal people aged 55 years and over accounted for only 6% of Australia’s total Aboriginal population and this proportion is predicted to double to 12% by 2021, with resulting increases in ageing conditions such as falls. This large scale trial in NSW, SA and WA will test the effectiveness of a community based program in reducing falls and improving function in older Aboriginal people.

The project was named after the Ironbark tree because it is native to Australia, evokes images of old, strong, trees standing tall and that is what we want to see our old people doing. Standing tall and strong as they age. The Ironbark Study is comparing two different programs aimed at improving health and wellbeing of older Aboriginal people. Both involve an ongoing program delivered weekly by a local person, in a community setting. The Ironbark: Standing Strong program is a weekly exercise and discussion program, and the Ironbark: Healthy Community program is a weekly program that involves discussions and social activities.

The study plans to recruit 60 Aboriginal community or health services in NSW, Western Australia and South Australia into the Ironbark Trial. Services participating in the study are randomly assigned to either receiving the Ironbark: Standing Strong program or the Ironbark: Healthy Community program. Both programs aim to improve the health and wellbeing of older Aboriginal people. At the end of the trial, sites that delivered the Ironbark: Healthy Community program will have the opportunity to deliver the Ironbark: Standing Strong program for a further 6 months, including all resources and equipment needed.

The study is being conducted by researchers from The George Institute for Global Health, the University of NSW, the University of Sydney, Flinders University, the University of Wollongong and Curtin University.

What we did

Ngarruwan Ngadju researchers participate in the Ironbark study on the chief investigator team, the Aboriginal governance committee and in the engagement and recruitment of sites in south-eastern NSW. From late 2019 members of the team commenced discussions with Aboriginal organisations in the region to inform them of the study, its benefits for community, and to ascertain their interest and capacity to be involved as study sites for the trial. This work is ongoing and a number of sites are expected to commence the program in mid-2020.

Navigating the Carceral State: Applying trauma-informed and culturally-grounded responses to improving the safety and quality of life of young Indigenous people who come into contact with the carceral system.

Dates:  2023-2027.

This project acknowledges the overrepresentation of young Indigenous people in child protection and incarceration rates. It aims to address the gap in knowledge of how young Indigenous people experience the carceral system and document how Indigenous community organisations support and provide vital contributions to building safer, more supportive communities, which is one of the targets of the Closing the Gap policy framework. This project will develop a theoretical model of a trauma- and culturally-informed response to improving experiences of young Indigenous people between the ages of 10–24 who come into contact with the carceral system, transferring the knowledge gained from the research back to Indigenous communities.

Exploring the impact of the Graduate Certificate of Indigenous Trauma Recovery Practice on the professional reflectiveness and community contributions of graduates in Aboriginal wellbeing workroles.

Dates: Current

This research investigates the impact of the Graduate Certificate of Indigenous Trauma and Recovery Practice, offered by the University of Wollongong, on the professional effectiveness and community contributions of graduates working in Aboriginal health and wellbeing roles.

Graduates are  invited to participate in semi-structured yarning sessions, to share how the program has influenced their understanding and application of trauma-informed practices.

Understanding burn injuries in Aboriginal and Torres Strait Islander children: treatment, access to services and outcomes (Coolamon Study)

National Health and Medical Research Council
Duration: 2014 – 2019 

Background

Burns in children can be a devastating injury, causing life-long scarring, severe psychological trauma and loss of function in multiple domains. Aboriginal and Torres Strait islander children experience burns at least double the rate of other children.

Having consistent access to high quality care is fundamental to good outcomes in burns care. There are well documented barriers to access to both tertiary and primary healthcare for Aboriginal and Torres Strait Islander people in both urban and rural/remote settings. However, despite the significant burden of burn injury, to date there has been no work that examines care received, or its impact on outcomes in Aboriginal and Torres Strait Islander children.

What we did

This study followed a group of Aboriginal and Torres Strait Islander children in four states – New South Wales, Queensland, South Australia and the Northern Territory – who went to a tertiary burn unit following a burn injury. We examined care received (including cost), described the relationship between care and functional outcome, and identified barriers and facilitators to receipt of appropriate, ongoing care.

This research allowed us to work with clinicians, policy makers and community to develop a ‘blueprint’ for reform of services, to ensure Aboriginal children receive appropriate and cost-effective care, and inform service delivery and future programs.

Understanding the cultural utility of SMART recovery for Aboriginal peoples

PhD project. University of Wollongong and Centre of Research Excellence Indigenous Health and Alcohol

Background

Substance use disorders such as those relating to harmful use of alcohol and illicit drugs and problematic behaviours such as gambling, contribute significantly to the overall disease burden for Australia’s Aboriginal peoples. They also contribute heavily to the transmission of intergenerational trauma stemming from colonisation. Mutual support groups such as SMART Recovery, are one of the world’s most popular and prevalent forms of treatment for these disorders however there is a lack of empirical literature for understanding either the cultural utility or benefits associated with attendance for Aboriginal peoples.

What we did

This PhD research involves a series of three studies to determine the cultural utility of SMART Recovery Australia. The overall thesis methodology is decolonisation research (Smith, 2013) and each study will be conducted using a combination of Indigenous and Western research methods.

Study 1 is a systematic review to determine the nature and scope of research that has addressed mutual support groups for the Indigenous Peoples of Australia, New Zealand, Canada, United States of America and Hawaii.

Study 2 is a mixed methods study to explore the views of Aboriginal people attending SMART Recovery and observe Aboriginal-led SMART Recovery groups.

Study 3 is a modified Delphi study to obtain expert feedback from a panel of Aboriginal drug and alcohol professionals and Aboriginal SMART recovery facilitators and group members regarding the cultural utility of existing SMART recovery program materials

This project will be the first of its kind conducted within Australia to explore the views and experiences of Aboriginal people who attend SMART Recovery. It is expected that the evidence gained from the research will contribute to increasing the knowledge base for understanding how mutual support groups can be used by and for Aboriginal people in ways that are appropriate and meaningful in their recovery.

Upon cessation of the study, an Aboriginal SMART Recovery governance and consultation committee is expected to be formally established serving to guide and support SMART Recovery Australia with any future program modifications or any other operations that might impact on Aboriginal people.

Publication

Dale, E., P. Kelly, K. Lee, J. H. Conigrave, R. Ivers and K. Clapham (2019). "Systematic review of addiction recovery mutual support groups and Indigenous people of Australia, New Zealand, Canada, the United States of America and Hawaii " Addictive Behaviours 98: 106038-106031-106038-106037.