'All Aboriginal and Torres Strait Islander children should have access to the ASQ-TRAK': Shared vision of an implementation support model for the ASQ-TRAK developmental screener.

ISSUE ADDRESSED: The ASQ-TRAK, a strengths-based approach to developmental screening, has high acceptability and utility across varied Aboriginal and Torres Strait Islander contexts. While substantive knowledge translation has seen many services utilise ASQ-TRAK, we now need to move beyond distribution and support evidence-based scale-up to ensure access. Through a co-design approach, we aimed to (1) understand community partners' perspectives of barriers and enablers to ASQ-TRAK implementation and (2) develop an ASQ-TRAK implementation support model to inform scale-up. METHODS: The co-design process had four phases: (i) partnership development with five community partners (two Aboriginal Community Controlled Organisations); (ii) workshop planning and recruitment; (iii) co-design workshops; and (iv) analysis, draft model and feedback workshops. RESULTS: Seven co-design meetings and two feedback workshops with 41 stakeholders (17 were Aboriginal and Torres Strait Islander), identified seven key barriers and enablers, and a shared vision - all Aboriginal and Torres Strait Islander children and their families have access to the ASQ-TRAK. Implementation support model components agreed on were: (i) ASQ-TRAK training, (ii) ASQ-TRAK support, (iii) local implementation support, (iv) engagement and communications, (v) continuous quality improvement and (vi) coordination and partnerships. CONCLUSIONS: This implementation support model can inform ongoing processes necessary for sustainable ASQ-TRAK implementation nationally. This will transform the way services provide developmental care to Aboriginal and Torres Strait Islander children, ensuring access to high quality, culturally safe developmental care. SO WHAT?: Well-implemented developmental screening leads to more Aboriginal and Torres Strait Islander children receiving timely early childhood intervention services, improving developmental trajectories and optimising long-term health and wellbeing.

A rapid review of implementation frameworks underpinning Aboriginal and Torres Strait Islander children's health and social care programs.

OBJECTIVE: This rapid review aimed to identify (1) key frameworks and components underpinning the effective implementation of Health and Social Care (HSC) programs for Aboriginal and Torres Strait Islander children; and (2) participatory and co-design frameworks guiding the implementation. METHODS: Four databases were searched for peer-reviewed English-language articles published between 2015 and 2021. The focus was on HSC models, frameworks, projects or services with an implementation focus for Aboriginal and Torres Strait Islander children aged 0-12 years. RESULTS: Seven studies identifying components supporting effective implementation of Aboriginal and Torres Strait Islander HSC programs were included. Continuous Quality Improvement was the most widely applied approach. Most studies described participatory and co-design approaches to ensure suitability for Aboriginal and Torres Strait Islander children and families. CONCLUSIONS: There remains a paucity of evidence on the effective implementation of Aboriginal and Torres Strait Islander children's HSC programs. Implementation approaches that foster cultural safety and Aboriginal and Torres Strait Islander leadership, support diverse partnerships and promote localised application may facilitate the effective implementation of HSC programs. IMPLICATIONS FOR PUBLIC HEALTH: Future research in this area would benefit from greater consideration of appropriate implementation frameworks and co-design approaches, and emphasis on reporting interventions, implementation frameworks and co-design approaches for HSC programs for Aboriginal and Torres Strait Islander children.

Identifying and dismantling racism in Australian perinatal settings: Reframing the narrative from a risk lens to intentionally prioritise connectedness and strengths in providing care to First Nations families.

INTRODUCTION: The perinatal period is a time when provision of responsive care offers a life course opportunity for positive change to improve health outcomes for mothers, infants and families. Australian perinatal systems carry the legacy of settler-colonialism, manifesting in racist events and interactions that First Nations parents encounter daily. OBJECTIVE: The dominance of a western risk lens, and conscious and unconscious bias in the child protection workforce, sustains disproportionately high numbers of First Nations infants being removed from their parents' care. Cascading medical interventions compound existing stressors and magnify health inequities for First Nations women. DESIGN: Critical discourse was informed by Indigenous ways of knowing, being and doing via targeted dialogue with a group of First Nations and non-Indigenous experts in Australian perinatal care who are co-authors on this paper. Dynamic discussion evolved from a series of yarning circles, supplemented by written exchanges and individual yarns as themes were consolidated. RESULTS: First Nations maternity services prioritise self-determination, partnership, strengths and communication and have demonstrated positive outcomes with, and high satisfaction from First Nations women. Mainstream perinatal settings could be significantly enhanced by embracing similar principles and models of care. CONCLUSIONS AND RELEVANCE: The Australian Anti-racism in Perinatal Practice (AAPP) Alliance calls for urgent transformations to Australian perinatal models of care whereby non-Indigenous health policy makers, managers and clinicians take a proactive role in identifying and redressing ethnocentrism, judgemental and culturally blind practices, reframing the risk narrative, embedding strength-based approaches and intentionally prioritising engagement and connectedness within service delivery.