JCPSLP Vol 19 No 1 March 2017

Communication between Aboriginal clients and non- Aboriginal clinicians is important for effective engagement with health services, including non-Aboriginal clinicians having respect for cultural differences (McBain-Rigg & Veitch, 2011) and an understanding of historical events and their impact on Aboriginal health and well-being today (Cox, 2007). It has been identified that some Aboriginal peoples’ access to health services has been negatively impacted upon by their feelings of being treated differently by staff or organisations based on perceptions related to their race (DiGiacomo et al., 2013; Martin & DiRienzo, 2012). If Aboriginal families feel safe and welcomed, they will be more likely to engage with services (HNELHD, 2014). Presence of Aboriginal staff The presence of Aboriginal staff (Martin & DiRienzo, 2012; Wylie et al., 2013) or employment of Aboriginal people as liaison officers (DiGiacomo et al., 2013; Nelson & Allison, 2004) to assist communication between the client and non-Aboriginal clinician has been reported to facilitate Aboriginal people accessing mainstream health services. Unfortunately, Aboriginal people are underrepresented in the health workforce (Pink & Allbon, 2008). While there has been a small increase in the number of Aboriginal speech- language pathologists in recent years (Byrne, 2015), they make up only 0.2% of the SLP workforce (Health Workforce Australia, 2014). However, it is likely that additional factors also need to be addressed, and asking families may shed light on what they see as the issues influencing access to SLP services and ultimately lead to finding appropriate solutions. Facilitating culturally appropriate mainstream services A survey by McBain-Rigg and Veitch (2011) reported that Aboriginal peoples’ perceptions of health services were negatively impacted by feelings that their specific cultural differences and needs were not taken into account. This includes understanding that family commitments, such as caring for family members or attending funerals, will often take precedence over health care appointments (Nelson & Allison, 2004; Williams, 2012). Increasing awareness of Aboriginal culture among non-Aboriginal staff, through initiatives such as cultural education to address individual racism, has been cited as a way to make health care services more culturally appropriate (Martin & DiRienzo, 2012). This pilot study aimed to explore caregiver experiences within an urban paediatric SLP service, and to identify (a) factors that facilitate Aboriginal families accessing the services, (b) ways to increase engagement of Aboriginal families with the service, and (c) ways to make the service more culturally appropriate. Method Approval to conduct this research was granted by the Hunter New England Human Research Ethics Committee (reference # 13/08/21/4.04) and the Aboriginal Health and Medical Research Council Ethics Committee (reference # 954/13). Research design A qualitative research methodology via telephone interview was employed to allow exploration of an area in which there is limited pre-existing knowledge (Bowling, 2002). The methodology was developed in consultation with the Hunter New England Aboriginal Health Unit to ensure

cultural and ethical suitability (AH&MRC, 2013), and procedures and interview questions were reviewed by health professionals working with Aboriginal people and an Aboriginal caregiver to ensure they were culturally appropriate. All documentation for the research provided to prospective participants identified the support and collaboration with the Aboriginal Health Unit (e.g., Aboriginal Health Unit logo and artwork). The principles of appreciative inquiry (Cooperrider & Whitney, 2005) were adopted in developing the interview questions, whereby participants were encouraged to identify positive experiences (e.g., “what’s worked well?”) of their engagement with the SLP service, and also to identify what would motivate them to continue to engage with the service. This contrasted with existing studies into health care access and SLP experience (not specifically focused on Aboriginal peoples) which have focused on barriers to service use. Appreciative inquiry has been found to be a culturally safe methodology with Aboriginal communities (Murphy, Kordyl, & Thorne, 2004), and health research (Fowler et al., 2012). The decision to use interviews was based on the observation by Form, Bourchier, Cvetkovski, and Stewart (2012) that they are less prone to bias when compared to other methods (e.g., written surveys) and doing so is endorsed by Aboriginal community organisations. Sharing information via interviews also aligns with the strong oral culture of Aboriginal people (Gorman & Toombs, 2009), and alleviates embarrassment surrounding potential literacy issues (SCRGSP, 2009). Study setting The study was conducted with the support of clients, caregivers, and staff at a paediatric speech pathology service provided in one of the seven community health centres in the Greater Newcastle area. According to the Australian Bureau of Statistics (2011), the Aboriginal population in Greater Newcastle is approximately 2.8% of the total and a review of service data at the time of the study indicated that 10.4% of clients referred to the SLP service identified as Aboriginal. The SLP service had instituted a number of initiatives directed at improving engagement with Aboriginal clients (e.g., contacting the caregiver via telephone at the first point of contact, maintaining the same clinician, encouraging support people to attend appointments, and allowing extra appointment time). Despite these initiatives, speech-language pathologists reported that attendance and engagement of Aboriginal families at the service remained lower than that of non-Aboriginal families. None of the speech-language pathologists in the service identified as Aboriginal and both of the authors had completed specific Aboriginal cultural Twenty-four participants were invited by speech-language pathologists to participate in the study over a 6-month period, and 12 consent forms were returned to the first author, indicating a response rate of 50 per cent. The participants were caregivers of children currently attending regular speech-language pathology services, as they could indicate the factors that assisted families to attend. The inclusion criteria for the participants were that the clients (children) were Aboriginal and were currently attending therapy. The participants’ demographics are presented in Table 1. Ten interviews were conducted in total, as two individuals who initially responded were unable to be contacted. respect training. Participants

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JCPSLP Volume 19, Number 1 2017

Journal of Clinical Practice in Speech-Language Pathology