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In health care and care scholarship, care is often cast as a gift that exploits caregivers, or generates social debts and inequalities among people who require it. I broaden understandings of how care acquires and distributes value through ethnographic engagement with Yolŋu (an Australian First Nations people) with lived experience of kidney disease. I expand Baldassar and Merla's concept of the circulation of care to argue that value, like blood, circulates through caregiving practices of generalized reciprocity without transferring worth between caregivers and receivers. Here, the gift of care is neither agonistic or purely altruistic, entangling individual and collective value. [ABSTRACT FROM AUTHOR]

Abstract \nPoints of interest The relationship between race, disability and criminality is complex and poorly understood. Scant information, and lack of action, exists on how to best keep Indigenous people with disability out of the justice system, and support this cohort while in the system. This systematic scoping review collates grey and peer-reviewed literature in Australia, Aotearoa (New Zealand), the United States and Canada, to gain insight into the current practices in place for justice-involved Indigenous people with disability, and list promising principles which may inform future practice. We identified 1,301 sources, and 19 of these met the inclusion criteria. Across these sources, nine key principles emerged: need for Indigenous designed, led and owned approaches; appropriately identify and respond to disability/needs; appropriate court models; appropriate diversionary options; therapeutic, trauma-informed, strengths-based and agency-building responses; facilitate connection to family, community and support networks; break down communication barriers; protect human rights; and provide post-release support. Internationally, Indigenous people with disability are over-repre.sented in criminal justice systems. The reasons for this are complex and not well understood. Existing evidence suggests that long-lasting effects of colonisation; discrimination on the basis of race and disability; problems identifying and reporting disability; and lack of proper services contribute to this issue. Often, criminal justice systems do not recognise or support a person’s disability until they reach crisis point. There is a critical need for culturally-appropriate and disability-appropriate interventions, such as diagnostic tools; training programs for police, correctional officers and other service providers; community court models; and more accessible communication. There is some evidence that Indigenous-led programs – involving country, culture, art, social connection and holistic healing – help prevent Indigenous people with disability from entering and re-entering justice systems. More research and evaluation is needed to determine how to better support Indigenous people with disability in contact with the justice system. Internationally, Indigenous people with disability are over-repre.sented in criminal justice systems. The reasons for this are complex and not well understood. Existing evidence suggests that long-lasting effects of colonisation; discrimination on the basis of race and disability; problems identifying and reporting disability; and lack of proper services contribute to this issue.Often, criminal justice systems do not recognise or support a person’s disability until they reach crisis point.There is a critical need for culturally-appropriate and disability-appropriate interventions, such as diagnostic tools; training programs for police, correctional officers and other service providers; community court models; and more accessible communication.There is some evidence that Indigenous-led programs – involving country, culture, art, social connection and holistic healing – help prevent Indigenous people with disability from entering and re-entering justice systems.More research and evaluation is needed to determine how to better support Indigenous people with disability in contact with the justice system. [ABSTRACT FROM AUTHOR]

Disability is experienced and understood by Indigenous people internationally in distinct ways from other populations, requiring different approaches in disability services. Furthermore, Indigenous populations access disability services at low rates. In response, policymakers, service providers and Indigenous organisations have developed specific models of care for Indigenous people with disability. Social care services, comprising personal care, transport and social activities, can support Indigenous people with disability to live with their families and in their communities. However, little is known about the range of social care models for Indigenous people with disability. To inform policy and practice, we conducted a scoping review of community‐based models of social care designed to meet the needs of Indigenous peoples in Australia, Aotearoa New Zealand, Canada and the United States. Our methods were informed by best practice scoping review principles and a collaborative approach that centred Indigenous voices within research appraisal and project governance processes. Literature searches (conducted March–April 2021) yielded 25 results reporting on 10 models of care. We identified two over‐arching themes (funding and governance arrangements; service delivery design) that encompass nine key characteristics of the included models. Our analysis shows promising practice in contextually relevant place‐based social activity programs, support and remuneration for family carers and workforce strategies that integrate Indigenous staff roles with kinship relationships and social roles. While more research and evaluation are needed, disability funding bodies and service systems that facilitate these areas of promising practice may improve the accessibility of social care for Indigenous peoples. [ABSTRACT FROM AUTHOR]

People with chronic diseases are likely to require some form of domestic care, however their care needs acquire low visibility in housing policy frameworks. Amongst Yolŋu (Indigenous Australians from north-east Arnhem Land), high rates of kidney disease reinforce needs for housing and care. I consider how access to housing shapes relations and practices of care in the families of Yolŋu renal patients in Darwin, Australia; and how Yolŋu relations and practices of care are implicated in housing policy. Through an ethnographic case study approach, I show that in Yolŋu families, practices of extending shelter to kin are care practices fundamental to the performance of domestic labour. I argue that while housing policy frameworks rely on familial relations and practices of care to reduce rough sleeping and achieve other policy objectives, Yolŋu relations and practices of care are also marginalised through the governance of public housing. The politics of care that play out in their places of residence reproduce housing precarity. [ABSTRACT FROM AUTHOR]

In remote Indigenous communities, people with end stage kidney disease have limited access to dialysis services and the vast majority of patients contend with urban displacement in order to access treatment. Through ethnographic encounters with Yolŋu renal patients and other actors in Northern Territory healthcare systems, this paper explores how the threats posed by end stage kidney disease are multiply conceptualised and imbued with different forms of moral and political value. Drawing on Mary Douglas' cultural theory of risk, I consider how Yolŋu, health professionals and health policymakers construct topographies of safety and danger. I argue that medical risk is deployed in Northern Territory healthcare systems to perform the 'dirty work' of governing uncertainties and threats to renal patients' health and of distributing treatment amongst patients and over space. The 'dirty work' of medical risk recasts questions of value and the distribution of resources into matters of safety and liability. [ABSTRACT FROM AUTHOR]

Objective: To report the impact of the Indigenous e-mental health training course 'Yarning about Indigenous Mental Health using the AIMhi Stay Strong App'.Method: Participants were trained in e-mental health and the use of one of the first culturally adapted e-mental health interventions - The AIMhi Stay Strong App. Between October 2013 and December 2014, 138 participants completed the 'Yarning about Indigenous Mental Health using the AIMhi Stay Strong App' training course and 130 completed pre- and post-training questionnaires to explore knowledge and confidence in a number of areas trained.Results: Paired t-tests showed significant improvements across all measures of skill and knowledge except for confidence in using computers.Conclusions: E-mental health is a relatively new development that may contribute to improved access to mental health services for rural and remote Indigenous Australians, particularly where such tools are culturally adapted. Whilst current knowledge and use of e-mental health tools in this group of Northern Territory service providers was limited, perceived knowledge and confidence in use was significantly improved following training. [ABSTRACT FROM AUTHOR]

In many settler-colonial countries, Indigenous people do not access disability services at rates commensurate with disability prevalence. Existing research suggests that services often do not reflect Indigenous values and social practices, impacting on accessibility. Furthermore, disability services have historically been implicated in processes of colonisation. There is an urgent need to decolonise disability services. Understanding Indigenous knowledge and experience of disability is a necessary step towards achieving this. We systematically reviewed the disability conceptualisations, practices and experiences of First Nations peoples of Australia. Twelve studies met inclusion criteria. There was a consensus among these studies that Western constructs of disability do not resonate with many First Nations people across Australia. The studies reported that many First Nations people conceptualise most disabilities as unremarkable conditions that reflect the normal range of human diversity, although some conditions may be associated with social stigma. Inclusive attitudes and practices of caregiving in First Nations families facilitate the participation of First Nations people with disabilities in family and community life. However, ableism and racism in broader society combine to exclude many First Nations peoples with disabilities from public spaces and from labour markets. Disability services regularly fail to reflect First Nations values and social practices, and can lead to further disempowerment and marginalisation due to diagnostic processes; displacement from country and communities; gendered discrimination; and poor relationships with service providers. We argue that intersectional experiences of colonialism, racism, ableism and sexism, particularly in disability services, can lead to the marginalisation of First Nations participants and families. The decolonisation of disability services requires services to embrace diverse First Nations values and practices associated with human capability, social participation and caregiving. Decolonising disability services also necessitates First Nations control of the governance of disability services and reform across service, organisational, systemic and conceptual levels. • This is the first systematic review of Indigenous views of disability and services. • The WHO biopsychosocial model does not adequately reflect First Nations experience. • Many First Nations people desire greater support for family caregiving. • The intersection of racism, ableism and sexism impacts disability experience. • A decolonisation agenda in disability services necessitates systemic change. [ABSTRACT FROM AUTHOR]

Background: The mental health needs of young people are often inadequately met by health services. Quality improvement approaches provide a framework for measuring, assessing and improving the quality of healthcare. However, a lack of performance standards and measurement tools are an impediment to their implementation. This paper reports on the initial stages of development of a clinical audit tool for assessing the quality of primary health-care for Australian Indigenous youth aged 12-24 including mental health services provided within primary care. Methods: Audit items were determined through review of relevant guidelines, expert reference group consensus opinion and specific inclusion criteria. Pilot testing was undertaken at four Indigenous primary healthcare services. A focus group discussion involving five staff from a health service participating in pilot testing explored user experiences of the tool. Results: Audit items comprise key measures of processes and outcomes of care for Indigenous youth, as determined by the expert reference group. Gaps and conflicts in relevant guidelines and a lack of agreed performance indicators necessitated a tool development process that relied heavily on expert reference group advice and audit item inclusion criteria. Pilot testing and user feedback highlighted the importance of feasibility and context-specific considerations in tool development and design. Conclusions: The youth health audit tool provides a first step in monitoring, assessing and improving the way Indigenous primary healthcare services engage with and respond to the needs of youth. Our approach offers a way forward for further development of quality measures in the absence of clearly articulated standards of care. [ABSTRACT FROM AUTHOR]

Cross-cultural considerations and difficulties recruiting and retaining skilled workers in rural and remote regions may contribute to poorer service use for Aboriginal and Torres Strait Islander people. However, electronic resources may provide the opportunity for remote workforces to deliver structured, evidence-based, culturally appropriate treatments with limited training burden. The aim was to develop and determine the acceptability, feasibility, and appropriateness of a new e-mental health resource (the Australian Integrated Mental Health Initiative [ AIMhi] Stay Strong App) for service providers working with Aboriginal and Torres Strait Islander people in the Northern Territory. Eleven semi-structured interviews were conducted with 15 service providers and managers from a range of rural and remote primary health care service settings in the Northern Territory. All participants were given the resource to trial for at least 1 month before being interviewed about perceived barriers and enablers, acceptability, and feasibility. Thematic analysis revealed support for the acceptability, feasibility, and appropriateness of the resource among service providers. Major themes identified included acceptability, building relationships, broad applicability, training recommendations, integration with existing systems, and constraints to implementation. This is one of the first studies to explore the acceptability of e-mental health approaches for Aboriginal people among the remote health workforce. It is likely that e-mental health interventions, such as the AIMhi Stay Strong App will assist services to deliver evidence-based, structured interventions to improve well-being for Aboriginal and Torres Strait Islander clients. [ABSTRACT FROM AUTHOR]

Background: A three-phase implementation program was carried out to support Indigenous primary healthcare organisations in Australia to integrate e-mental health approaches into the day-to-day practice. The present study aimed to evaluate the process and the effectiveness of the program.Methods: A concurrent triangulation design was employed to collect and compare quantitative and qualitative data from organisations that participated in the implementation program (case studies) to those that participated in training only (non-case studies). Quantitative methods, i.e., t-tests and descriptive statistics, were used to measure outcomes relating to the frequency of e-mental health usage and levels of organisational readiness. Qualitative data were analysed separately, using theoretical thematic analysis, to gain an in depth understanding of the implementation process. The findings were integrated and interpreted within the implementation science literature.Results: The case studies evidenced greater use of e-mental health approaches than the non-case studies. They also demonstrated increased organisational readiness over the course of the implementation program. The program helped organisations to work and improve on essential aspects within the organisation so that they better supported e-mental health adoption. The key areas addressed were Information Technology resources and infrastructure, leadership and support, policy and protocols around e-mental health utilisation and its integration into practice.Conclusions: By addressing and improving essential aspects relating to e-mental health implementation, the program helped organisations to increase organisational readiness and enhance uptake of e-mental health approaches. [ABSTRACT FROM AUTHOR]