Improving the aftercare journey of First Nations children and their families following burn injury

SYDNEY, JUNE 30 - The George Institute has secured government funding to develop a culturally appropriate discharge model for safe pathway from hospital to home for First Nations children and families, after its researchers found gaps leading to poorer outcomes following burn injury.

The recently published study is the first that privileges the voices of Australia’s First Nations families on access to burn aftercare for children.

Australia’s First Nations children experience burns at a rate at least double that of non-Indigenous children. Ongoing burns care is a complex issue with multiple barriers to ensuring good long-term outcomes, however little is known about how well this occurs in the after care of burns in First Nations children.

George Institute researchers explored the experiences of First Nations families in accessing appropriate burn aftercare by listening to the voices of children and their families through yarning (dialogue) and Dadirri (deep listening).

Julieann Coombes, lead author and Research Fellow, Aboriginal & Torres Strait Islander Health Program at The Institute, said that previous studies had largely focussed on describing the burden from routinely collected hospital data.

“Burn injuries can be devastating not only for the injured child but also for their family and their community. This is the first study to focus on listening to the voices of families to help identify opportunities to improve burn aftercare for these children,” she said.

First Nation families of 18 children younger than 16 years who had sustained a burn injury were asked to describe their lived experiences of their own journey from the time of injury to the time of recovery including accessing appropriate burn aftercare. Data were gathered in South Australia, the Northern Territory, Queensland and New South Wales, Australia, from city, urban, remote and very remote areas.

The study found that a lack of cultural safety in the health system including communication between service providers and family members, in addition to institutionalised racism, were found to be the major barriers to accessing healthcare services.

“This lack of cultural safety from ongoing issues from colonisation causes fear, distrust and anxiety to the child and to family members,” said Julieann. “Communication breakdowns from and between care teams led to families missing appointments, which reinforced stereotypical assumptions about First Nations families.”

“Ensuring a clear pathway for the child’s aftercare needs that involves the family, Aboriginal health workers and multidisciplinary team members working together will lead to a smoother transition from the burns unit post discharge to facilitate optimal healing for the child,” she added.

A further barrier to children and families accessing appropriate care is the significant distance between burn aftercare facilities and family homes and the lack of transport services, forcing dislocation and separation of families.

Julieann said that some service providers encouraged families to relocate and told them that their child would not receive the level of care needed, if they did not move from their community to live in the city.

“To First Nations people, Country means connection, it is a spiritual belonging, and community and family are paramount to their psychosocial and cultural wellbeing. Some families expressed feelings of hopelessness about their child’s ongoing care as a result of these comments,” said Julieann.

First Nations Health Workers played an integral role in positively impacting the health and wellbeing of children and families during their hospital stay but the importance of their role has not been recognised in Australia’s health systems to date.

“First Nations children who have experienced a serious burn and need a multidisciplinary team for ongoing aftercare to achieve a healthy, happy and productive life would benefit from the continued support and involvement of First Nations Health Workers,” added Julieann.

The findings of this study have led to further work on how to improve discharge models and safe pathways for future medical treatment for First Nations peoples.

“Health services in Australia need to incorporate culturally responsive healthcare as part of their routine burn aftercare to ensure they are responsive to First Nations children and families’ needs in a vulnerable space,” Julieann said.

Leads

• Dr Julieann Coombes

  Senior Research Fellow, Aboriginal and Torres Strait Islander Program