# Implementing Cultural Safety in Research Methodology: The Co‐Design Process of a Brief Therapeutic Intervention for Aboriginal and Torres Strait Islander Young People Who Engage in Self‐Harm and/or Suicidal Behaviours

## TL;DR

This paper describes a culturally safe co-design process for adapting a therapeutic intervention for Aboriginal and Torres Strait Islander young people who engage in self-harm or suicidal behaviors.

## Contribution

The study introduces a co-design process that integrates cultural safety principles into research methodology for Indigenous youth mental health interventions.

## Key findings

- A culturally safe process can be an outcome in itself and supports decolonizing research methodologies.
- Flexible and culturally appropriate approaches led to increased participant comfort and richer data collection.
- Aboriginal and Torres Strait Islander young people in rural communities define suicidal behaviors more broadly than Western definitions.

## Abstract

Aboriginal and Torres Strait Islander Peoples share rich cultural traditions unrivalled across the world; however, the continued impact of colonisation led to sustained, profound trauma that has spanned generations. With Aboriginal and Torres Strait Islander people presenting to hospital emergency departments (ED) for self‐harm and suicidal behaviours at a rate 2.9 times higher than non‐Indigenous people, there is a need to develop culturally appropriate interventions to address this growing problem.

This paper sought to describe the co‐design process of culturally adapting a brief therapeutic intervention for Aboriginal and Torres Strait Islander young people who display self‐harm and/or suicidal behaviours. The adaptation focus was Therapeutic Assessment (TA), a brief intervention provided to young people who present to the ED with self‐harm.

The process was split into two phases located in Geraldton and Meekatharra, two communities in the Mid‐west of Western Australia.

In phase one, three male Aboriginal young people (aged between 16 and 19 years old) and eight Aboriginal Elders participated in two yarning circles run on one day. In phase two, 26 Aboriginal young people (aged between 12 and 25 years old), five Aboriginal senior members of the community and one Aboriginal carer participated in a combination of small yarning circles and/or single interviews.

This paper describes the elements of the culturally safe process of adapting a brief intervention for Aboriginal and Torres Strait Islander young people experiencing self‐harm and/or suicidal behaviours.

Two points are important to note. The first is that implementing a culturally safe process can be an outcome in itself, and second, that the principles supporting cultural safety can assist in evaluating how non‐Indigenous researchers implement this process.

Aboriginal and Torres Strait Islander young people are over five times as likely to die by suicide than their non‐Indigenous peers.Aboriginal and Torres Strait Islander young peoples living in rural communities define suicidal behaviours much more broadly than in traditional Western understandings.A culturally safe outcome can only be derived from a culturally safe process and adherence to fixed conventions are not helpful when decolonising research methodologies.

Aboriginal and Torres Strait Islander young people are over five times as likely to die by suicide than their non‐Indigenous peers.

Aboriginal and Torres Strait Islander young peoples living in rural communities define suicidal behaviours much more broadly than in traditional Western understandings.

A culturally safe outcome can only be derived from a culturally safe process and adherence to fixed conventions are not helpful when decolonising research methodologies.

By employing a culturally safe approach (e.g., taking time to explain the key terms and the interview process), participants appeared to demonstrate a decrease in heightened emotional affect as interviews and yarning cirlces progressed.It was observed that through employing a culturally safe co‐design approach, participants voluntarily disclosed increasingly more sensitive information as interviews and/or yarning circles progressed.By remaining flexible and providing greater options (e.g., having the interview on Country or in an office, option of bringing a support person, sharing in a group or individually), it positioned participants with greater autonomy and control which elicited richer data.

By employing a culturally safe approach (e.g., taking time to explain the key terms and the interview process), participants appeared to demonstrate a decrease in heightened emotional affect as interviews and yarning cirlces progressed.

It was observed that through employing a culturally safe co‐design approach, participants voluntarily disclosed increasingly more sensitive information as interviews and/or yarning circles progressed.

By remaining flexible and providing greater options (e.g., having the interview on Country or in an office, option of bringing a support person, sharing in a group or individually), it positioned participants with greater autonomy and control which elicited richer data.