Stroke and traumatic brain injury (TBI) affect Aboriginal Australians at disproportionate rates compared to other Australian populations yet few frameworks are available to guide culturally secure rehabilitation practices. Our previous research delivered a novel service model that aimed to enhance the cultural security of speech pathology rehabilitation. It was feasible to deliver and acceptable to Aboriginal people with an acquired communication disorder (ACD) following stroke. The model incorporated yarning principles and involved an Aboriginal co-worker (ACW) working jointly with a speech pathologist (SP). The current project, conducted 2019, extended this work by adding a telehealth component and explored the feasibility and acceptability of this model.

Eleven Aboriginal adults with an ACD after stroke or TBI received either face-to-face therapy or therapy utilising telehealth technology which involved 16 x 1 hr treatment sessions provided twice weekly within their place of residence in metropolitan Perth. Feasibility was measured by analysing the number of sessions conducted jointly by the SP and ACW and participant attendance. Semi-structured interviews were used to explore the participants’, the ACW’s and the SP’s perceptions on the acceptability of, and change achieved through the therapy. All interviews were analysed through qualitative descriptive analysis.

Across all sessions 235/258 (91.1%) were attended by the ACW and SP and 10 of the 11 participants completed all prescribed sessions. Positive feedback was provided by participants, the ACW and SPs on the key components of the program including the use of telehealth technology.

This study provides direction for clinicians who provide services to Aboriginal people to improve quality of care and provide culturally secure services. The work demonstrates that it is feasible and acceptable for therapy to be delivered via telehealth in the participant’s home but that an ACW being physically present with the participant is an important part of this rehabilitation approach.

Attendees will take away knowledge on:
1. Embedding principles of yarning in working with Aboriginal Australians with an acquired communication disorders.
2. The importance of working collaboratively with Aboriginal Health Workers within speech pathology practice.
3. The use of tele practice in working with adults with acquired communication disorders.

Our previous projects (Missing Voices-NHMRC #1046228; 2013-162; AIATSIS 2010-12) explored the experiences of Aboriginal Australians with acquired communication disorders (ACD) following brain injury, their families, Speech Pathologists (SP), Aboriginal Health Workers and General Practitioners. Aboriginal people with ACD reported that they benefited from Speech Pathology intervention, when it was provided, and often wanted more than was offered. Many encountered a mismatch between health professionals and family in terms of communication and expectations. Assistance from an Aboriginal Liaison Officer was identified as a likely benefit, but was missing in most peoples’ experience. SPs felt unsure as to how to provide appropriate supports and therapy and reported a need for a model for delivering culturally secure services. To address these identified areas of need, our team’s Wangi (talking) project (n=9) (Stroke Foundation #1621; 2016-2017), trialled a culturally secure SP treatment protocol for people with ACD after stroke, informed by the findings above. The sessions were conducted by a SP and Aboriginal co-worker and integrated a ‘yarning’ framework. Participants found the treatment acceptable and reported improvements in communication. The current study extended the Wangi (talking) project and tested the feasibility of the intervention using telehealth technology. This study involved three Aboriginal investigators who provided guidance in the development of the study, the initial analysis of findings as well as input on conference presentations. Additionally, the study employed Aboriginal research officers/ Aboriginal co-workers who were involved in the participant interviews, assessment and treatment sessions. The Aboriginal co-worker role was key for the success of the project in creating a culturally safe environment for the participants. Three different people were employed in the position across the project. The individual employed within this role for an extended period of time will be a co-presenter for this presentation, if it is accepted for the 2024 conference. Finally a reference group was formed as part of the study and met three times across the active, data collection phase of the project. The group provided an important forum to discuss issues that arose within the project implementation and to provide guidance around these issues. Initial results were also discussed with the group in order to obtain their thoughts and reflections on the findings.