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The Aboriginal mothers in prison project: an example of how consultation can inform research practice.

Abstract: Aboriginal and Torres Strait Islander (1) women comprise the fastest growing subgroup among the prisoner population and are severely over-represented in Australian prisons. Despite the striking over-representation, research into their health and other needs has, to date, been limited. This paper describes the consultation process undertaken in Western Australia for the Social and Cultural Resilience and Emotional Wellbeing of Aboriginal Mothers in Prison project (hereafter, the Aboriginal Mothers in Prison project). The project aims to better understand the health, treatment and other needs of Aboriginal mothers in prison in Western Australia and New South Wales, and was conducted over two phases, the consultation phase and the applied research phase. This paper focuses on the results of the first phase of the research. It outlines the history of the development of ethics in this field and reviews the formal documents available to guide researchers working with Aboriginal and Torres Strait Islander peoples, tenets of which were infused throughout the research process. The paper then discusses how key stakeholders were identified in the area and provides an overview of the central findings from the consultation phase. In addition, the paper illustrates how being true to the consultation process and actively incorporating the feedback of diverse (and sometimes competing) stakeholders ensures the project acknowledges, respects and actions (where possible) the needs and concerns of the various agencies and individuals with investment in the issue.

The development of accountability in research with Aboriginal peoples and communities

There remain significant disparities between Aboriginal and non-Aboriginal Australians across most social indicators. Aboriginal Australians experience the lowest standards of health, education, employment and housing, and are overrepresented in their contact with the criminal justice system (NIDAC 2009). Research has the potential to address the social determinants of health and improve the conditions in which Aboriginal Australians live. However, as Marmot (2011) highlights, the challenge is to apply the findings of research to the social determinants of health to enable Indigenous Australians to lead lives that they have reason to value.

Australia's peak health and medical research organisation, the National Health and Medical Research Council (NHMRC), is responsible for funding research and setting standards for the conduct of ethical research in the health area. The need for accountability in Aboriginal health research was originally flagged in November 1986 at a national conference convened by the NHMRC and Menzies Foundation (National Aboriginal Health Strategy Working Party 1989). A resolution from this conference was for the NHMRC to fund a national workshop to address the 'contentious' issue of ethics in Aboriginal health research. It was contended that much research was being conducted in ways considered to be unethical. Subsequently, the national workshop was convened with the purpose of bringing together Aboriginal community representatives to produce a set of guidelines on the ethical responsibilities of researchers in Aboriginal health and to identify the mechanisms necessary to establish a nexus between the guidelines and the funding of research. The working party developed and recommended a set of national guidelines for Aboriginal health research to be adopted by researchers and research institutions (National Aboriginal Health Strategy Working Party 1989).

In 1991 the NHMRC published the Guidelines on ethical matters in Aboriginal and Torres Strait Islander health research (NHMRC 1991). These guidelines focused on the key areas of:

* community consultation

* community involvement

* ownership and publication of data.

It was intended that these guidelines should be dynamic and were to be reviewed every ten years by the NHMRC.

In 2002 the NHMRC set out to review the National Aboriginal Health Strategy and initiated The NHMRC road map; a strategic framework for improving Aboriginal and Torres Strait Islander health through research (NHMRC 2002). The overall objective of the Road map was to support the NHMRC 'to advise the Australian community on the achievement and maintenance of the highest practicable standards of individual and public health, and to foster research in the interests of improving those standards' (NHMRC 2002:1).

In 2007 a review of the Road map was conducted in consultation with the NHMRC Aboriginal and Torres Strait Islander Health and Research Advisory Committee. A similar consultation process was undertaken as for the original Road map. Overall, the review found that the commitment to the Road map and its tenets remained and the framework was expanded to further emphasise the link between research involvement and improvement of health outcomes. The Road map II defined successful research with Aboriginal peoples as that which 'breaks through the barriers to positive social participation caused by poverty and psychosocial stress' (NHMRC 2010:3). Six underlying research principles were identified as particularly important when conducting research with Aboriginal communities (NHMRC 2010:3):

* health being conceived of '... not just as the physical wellbeing of the body but a whole of life view, which embraces the life, death, life concept'

* Aboriginal and Torres Strait Islander community involvement in the development, conduct and communication of the research

* communication of research plans, progress and results to support effective capacity exchange

* ethical research aiming to be of practical value to Aboriginal and Torres Strait Islander people and their service providers

* research support including the enhanced development of skills, knowledge and capacity in the Aboriginal and Torres Strait Islander workforce

* a focus on identifying 'positive models' or examples of success.

A number of key documents now exist to guide and inform researchers conducting research with Aboriginal peoples and communities. These include The NHMRC road map (NHMRC 2002), the Road map II (NHMRC 2010), the National statement on ethical conduct in human research (NHMRC et al. 2007a), the Australian code for the responsible conduct of research (NHMRC et al. 2007b), Values and ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander health research (NHMRC 2003), and Keeping research on track: a guide for Aboriginal and Torres Strait Islander peoples about health research ethics (NHMRC 2006).

The Road map II enables researchers and grant committees to identify areas of research priority in Aboriginal health and medical research, and provides a framework for conducting ethically sound research (NHMRC 2010). However, despite the efforts of the NHMRC, there continue to be concerns about research not being targeted to the key health issues and thus having negligible impact on the social determinants of health among Aboriginal Australians. A recent briefing paper by the Aboriginal Health Council of Western Australian (AHCWA) concluded that 'current research activities in Aboriginal health must be better aligned with the major health concerns impacting on Aboriginal people's lives, and be directed by the people most affected and best placed to understand and address these health concerns' (AHCWA 2013:1). Following the principles for ethical research developed in the documents described above--particularly those relating to community consultation, communication and involvement, and the production of practical outcomes--this research seeks to better target the issues as prioritised by Aboriginal people.

Aboriginal women in prison

Although the proportion of women in prison is small compared to men (approximately 7.7 per cent; ABS 2014), the rate at which the female prisoner population in Australia is increasing outstrips that of males, a pattern that is reflected elsewhere (West and Sabol cited in Celinska and Siegel 2010; WHO Regional Office for Europe 2009). Of the rising female prisoner population in Australia, Aboriginal women comprise the fastest growing subgroup. In 2009 Aboriginal women were 16 times more likely to be incarcerated than their non-Aboriginal counterparts (Bartels 2010). Between June 2009 and June 2010 alone, the rate of imprisonment of Aboriginal women jumped by 9 per cent, compared to 3 per cent among non-Aboriginal women and 2 per cent among Aboriginal men (ABS 2012a). These rates show no signs of abating. Between June 2013 and June 2014, Aboriginal women's custody rates again rose, this time by a massive 18 per cent (ABS 2014). This is of major concern for the families and communities of these women.

Evidence demonstrates that Aboriginal women often enter the criminal justice system as juveniles, which is a factor shown to increase the likelihood of future adult offending and incarceration. (2) They tend to serve shorter sentences than non-Aboriginal women and are incarcerated for relatively minor crimes such as public order offences (Bartels 2010). However, according to other sources, Aboriginal women are both the victims and perpetrators of violent crime to a greater extent than non-Aboriginal women (ATSISJC 2002; Behrendt et al. 2009). Aboriginal women are more likely to be on remand than non-Aboriginal women. Women remanded in custody face a number of immediate stresses associated with, for example, negotiating bail and loss of accommodation and belongings, and issues around parenting (Lawrie c. 2003). Research has also shown that remand status is associated with a heightened vulnerability to self-harm and suicide in prison (Dear et al. 2001; Mahoney 2005).

The rate of imprisonment of Aboriginal women in Western Australia is particularly startling. Western Australia is geographically vast, with seven prisons currently housing remanded and/ or sentenced female prisoners across the state. (3) As of November 2013, Aboriginal and Torres Strait Islander women made up 48 per cent of the total female prisoner population in Western Australia and at least 71 per cent in the five regional sites (DCS 2013). This is despite Aboriginal women making up only approximately 3 per cent of Western Australia's total female population (ABS 2012b).

Aboriginal mothers in prisons

It has been shown around the world that 'among sentenced prisoners, mothers are much more frequently the principal custodians of the children than are fathers [and] parenthood issues are gendered in this context' (Poso at al. 2010:519). Aboriginal women have been, and continue to be, the primary carers of children in their communities and yet very little is known about their experiences as mothers in prison. It has been estimated that at least 80 per cent of incarcerated Aboriginal women identify as mothers (Bartels 2010). Aboriginal women in prison tend to be younger than their non-Aboriginal counterparts (ABS 2010) and to be mothers of more than one biological child, with 86 per cent of participants of one Australian study reported having between one and six biological children (Lawrie c. 2003). They are also frequently the carers of non-biological children and/or the carers of other relatives, such as parents or grandparents (Lawrie c. 2003).

Managing mothering and care-giving from prison presents many practical challenges for incarcerated mothers. In Western Australia these challenges are compounded by the vastness of the state, the diverse prisoner population and the geographical locations of the prisons. For example, the only prison housing women with all security ratings is Bandyup Women's Prison, which is approximately 22 kilometres north-east of Perth. (4) Aboriginal women charged with serious offences are detained at Bandyup, which means they may be far from their families and communities. Bandyup is also the prison that runs the majority of key programs women undertake to improve their chances of securing parole. This means Aboriginal women from regional and remote parts of the state may serve at least some of their sentence out-of-country--regardless of their rating--which adds to the diversity of the female prisoner population, the complexity of these women's needs, and the challenges relating to the maintenance of relationships with children and family.

The Aboriginal Mothers in Prison project

Aboriginal Mothers in Prison is a four-year NHMRC-funded project focusing on the social and emotional wellbeing and cultural resilience of Aboriginal mothers in prison. The project is currently being conducted across two regions, Western Australia and New South Wales. The impetus for the project emerged from a previous study called Mothers and Gestation in Custody: Investigating the Impact of Incarceration whilst Pregnant (MAGIC). MAGIC explored the pregnancy and birth outcomes of female prisoners in New South Wales. An Aboriginal Advisory Group was formed during the course of the MAGIC research to provide expertise, and as the project progressed members of this group determined that, for Aboriginal women, children and communities, the impacts of incarceration are unique and warrant further investigation: the Aboriginal Mothers in Prison project was born. The project has been directed by Aboriginal investigators in both sites and the research process has been guided by the frameworks described above. This paper outlines the Western Australian community consultation phase undertaken as Phase One of the research.

The Aboriginal Mothers in Prison project seeks to better understand the experiences, health (physical, emotional and spiritual) needs and resilience of Aboriginal mothers in prison across the state. The project is being conducted over two complementary phases, which each required separate ethics approval from Curtin University's Human Research Ethics Committee and the West Australian Aboriginal Health Ethics Committee. Phase One, which is ongoing for the life of the research, has been comprehensive to date and has involved extensive consultation with stakeholders in the community. Phase Two, which is currently being undertaken, involves interviewing Aboriginal mothers, Correctional Officers and Prison Health Services staff across the state, analysis of data and dissemination of results. Phase Two also required the approval of Western Australia's Department of Corrective Service's Research and Evaluation Committee.

The consultation process in Western Australia

The commencement of consultation early in the research process is a recommendation of the Road map II (NHMRC 2010). Consultation can be described as a process of seeking 'advice or information' on a particular matter or topic and is 'designed to recognize and accommodate the relevant particularities of a given community for a specific project' (Dickert and Sugarman 2005:1123). The approach we adopted included the involvement of community and organisational representatives to define and answer research questions and identify actions to be implemented. This process draws upon participatory action research, which is a collaborative and collective approach that brings together researchers, partnering organisations and participants as central players, collaborators and co-researchers. Central to the participatory action research methodology is a commitment to the translation of research into social transformation and change (Evans et al. 2009).

The first step in our consultation process involved mapping key stakeholders in the area. As the project involved Aboriginal mothers in prison, we identified that we needed to speak with those people responsible for detaining these women, providing services to them and protecting their rights, and who were potentially involved with their children and families. One author (JJ), who is familiar with the justice landscape in Western Australia from previous work, was able to determine which stakeholders to approach initially. These included the West Australian Department of Corrective Services (DCS), AHCWA, the Office of Aboriginal Health, the Department of Child Protection (DCP), the West Australian Country Health Service, the Ombudsman, and the key Aboriginal community-controlled services in Perth (Derbarl Yerrigan Health Service and the Aboriginal Alcohol and Drug Service). These organisations were approached by telephone and email, and appointments were made for face-to-face meetings.

At the meetings we explained the project and encouraged the participants to relay their experiences rather than asking direct standardised questions. The consultation was largely influenced by the participants' experiences, concerns and interests, and because many participants were members of Aboriginal communities, as well as representatives of their organisations, their perspectives were often both organisational and/or personal. However, all were asked what they felt were key issues facing Aboriginal mothers in prison and how they felt the project could benefit their individual organisations and Aboriginal mothers, families and communities across Western Australia. In line with the tenets of the Road map II (NHMRC 2010), these questions aimed to ensure the research was meaningful to Aboriginal people and had the potential to produce practical and beneficial outcomes for their communities.

Two authors (MW and JJ) were present at all consultation meetings. Meetings were either with individual stakeholders or took place in small groups. They were not recorded and notes were taken by MW. The initial analysis of consultation notes was performed by MW and JJ and involved identification of areas of commonality and difference among participants. These descriptions were then analysed according to themes or meanings. The themes were discussed with the broader research team (in Western Australia and New South Wales) and presented to the two project reference groups (discussed below). This process enabled the authors to check for consistency and accuracy in interpretation. To get word out about the research, we also presented the project at the Aboriginal Community Controlled Health Services State Annual Conference (Jones and Wilson 2011), which was an opportunity to obtain feedback and advice from those working in the community-controlled sector.

The initial consultations led to a snowballing effect whereby stakeholders recommended we speak to other individuals or organisations. Snowballing identified, for example, those who provided services in the prisons and to the families and communities of incarcerated women. The majority of the consultation process took place over an 18-month period during which 18 organisations were visited and 30 Aboriginal and non-Aboriginal stakeholders participated.

In addition, the formation of two ongoing project reference groups was, and is, a key component of Western Australia's consultation methodology and ensures that Aboriginal and non-Aboriginal peoples working in the area are continually informed about the project and have the opportunity to be actively involved in the research process. The first group was made up of grassroots, departmental (DCS) and consumer representatives, including service providers and ex-prisoners, and the second employs the diverse expertise of university and medical professionals with backgrounds, for example, in social work, anthropology and psychiatry. Two reference groups were established to ensure that the opinions and voices of all levels of experience and expertise were captured. The research team also agreed that it was important to create a safe environment where grassroots members and ex-prisoners could share their views in a less intimidating environment. To date, members of these groups have participated in the research process by highlighting key issues Aboriginal mothers face in prison, identifying gaps in service provision for these women, and contributing significantly to the design and development of research tools.

Key findings from the consultation process

The following findings are based on the opinions and experiences of stakeholders involved in the consultation phase. It was evident early in consultation that a large majority of participants could identify ways in which incarcerated Aboriginal mothers, their children and their communities could be better supported. Concern was raised by ten out of the 30 participants about the suitability of prison facilities for housing vulnerable babies and children, with one participant from a nursing background stating, 'If the prison can't accommodate children they [the prison] shouldn't have them'. Another, with a midwifery background, expressed concern about the absence of midwives in prisons that allow at-risk mothers to have their babies and children live with them on site. Five of the seven participants who had hands-on contact with mothers and babies concurred with what they saw as inconsistencies around prison rules and procedures concerning children's care, (5) which impacted on them (as service providers) and the mothers. Others (eight participants) were troubled by the DCS approach that views resident babies as 'guests' and therefore takes minimal responsibility for their health and other care. A medical practitioner, who was particularly concerned about this departmental viewpoint, explained that 'the child is the sole responsibility of the mother, a mother who may be dealing with very complex issues of her own'. Eight stakeholders, predominantly from the Aboriginal community-controlled sector, also believed more needed to be done--by the prisons and by the DCP--to ensure a continuing relationship between incarcerated mothers and their children in the community, especially those who are out-of-country. Interestingly, the representative from the DCP commented that he would like to see DCP have more input into decisions around placement of babies with mothers, believing that, in some cases, prison may provide a safer environment and the opportunity to maximise bonding between mother and child.

Other key concerns arising primarily from Aboriginal participants working in the area and in the community-controlled sector included what was perceived as the inability of existing prison counselling services to respond to the levels and types of grief, trauma and spiritual anxiety experienced by Aboriginal women in prison. Seven of ten participants spoke about the 'one-size-fits-all' approach to prison programs and questioned the appropriateness of these programs for Aboriginal women. Staff at the services consulted highlighted that good practice models and programs related to healing, and addressing drug and alcohol use among Aboriginal offenders, exist. However, they believed that funding for services delivered to offenders tends to go to mainstream services, some of which may not be culturally safe for Aboriginal women. The accessibility and availability of programs for women on shorter sentences, remanded to custody or charged with violent offences (especially in regards to programs beneficial for women in obtaining parole) was also raised by six participants from the community, non-government and government sectors. The lack of Aboriginal staff employed within the criminal justice system was felt to be problematic by four participants.

However, the consultation process also revealed what stakeholders believe is currently working well in the prisons. In particular, seven stakeholders commented that for some women their access to education and/or programs increased while they were incarcerated. In Boronia Pre-release Centre for Women, (6) for example, women are encouraged to lead constructed rather than structured days (7) and a high proportion of prisoners take part in education and work programs. Six stakeholders also felt that a woman's access to health services increases while she is in prison. In relation to mother/baby units in prison, the focus on up-skilling women through basic nutrition and parenting programs was believed by three participants to benefit the mothers. For another two participants, prison offered the women a break from the 'chaos' of their lives on the outside and provided an opportunity to rebuild fractured relationships between mothers and their children. Nevertheless, the important role external agencies need to play in supporting these women to return to their communities was not missed. Nine participants believed that any good work done in the prisons could quickly be undone when a woman was released if the support did not continue beyond the prison walls.

Stakeholders were able to also identify potential benefits of the Aboriginal Mothers in Prison project for their organisations and for Aboriginal women and their communities and children. It was felt by 15 participants that the project would improve knowledge of this population in relation to their levels of post-traumatic stress, experiences of abuse, and their current health status and key health concerns. This could result in a more targeted and appropriate delivery of mental health and other health services for these women. Given the project's focus on mothering, seven stakeholders saw it as an opportunity to put the health of vulnerable babies of incarcerated mothers on the state agenda. Ten other participants saw it as a chance to inform future practice; for example, in the provision of culturally appropriate parenting programs for Aboriginal mothers in prison and building relationships between service providers and Corrective Services. Historically, Australian prisons have been organised around the custodial needs of men and five stakeholders recognised the unique potential of the project to give female prisoners a voice; one participant described us as 'advocates' for an extremely vulnerable and silenced population. Furthermore, it was hoped that the project findings would influence availability of funding to create better and more appropriate services for these women.

Why do consultation and what does it bring to a project?

Consultation was successful in garnering formal backing for the project--a necessary step in showing research and ethical bodies that the project is supported by the local community. It also illustrated to us that stakeholders and community members recognised the need for such a project and believed it could potentially produce beneficial outcomes. Consultation was valuable for highlighting issues of specific concern in relation to Aboriginal mothers in Western Australian prisons, which would later feed into the development of interview tools.

Consultation involves respecting and heeding the advice of consultants--as much as reasonable --into research practice, otherwise the consultation process is little more than symbolic (Dickert and Sugarman 2005). For example, as outlined above, a key concern arising from conversations with stakeholders in Western Australia was the welfare of the children resident in prison with their mothers. This was not an initial line of inquiry for the research. However, in the development of the interview schedule we were able to return to our consultation notes and a series of questions relating specifically to the experiences of women who have or have had their babies and children in prison with them was created.

A second example of how consultation came to influence the research process was in highlighting the inadequacy of the definition of 'mother' used in the original funding proposal to capture the range of mothering experiences of Aboriginal women. The proposal's formal definition of 'mothers' was 'women who are of reproductive age (defined as 18-44 years), and were the primary carer of one or more dependent child'. Discussions emerging from the consultation and with the Western Australia reference group members brought to the fore that Aboriginal women's mothering roles extend further than their relationships with biological children and can include shared caring arrangements and responsibilities, which throw into question terms such as 'primary carer' and 'dependent'. In addition, it was highlighted that identifying as a mother does not end when a child is not in the mother's care or her reproductive years are over. Examples of mothering relationships include grandmothers rearing their children's children, women caring for non-biological children and women assuming mothering responsibilities for younger siblings or a sister's children (Yeo 2003). These issues were brought to the attention of the larger research team and a more inclusive portrayal of mother was developed for which a variation was sought from the NHMRC. The final description became, 'by mothers we mean a woman who has given birth, adopted or fostered a child; or identifies as a mother or significant carer of a child'.

A final example of how drawing on the expertise and experience of others can influence research decisions occurred when we began developing our research tools. The research utilised a mixed methods approach and therefore included identifying qualitative open-ended questions and choosing validated scales for measuring aspects of the women's health and wellbeing. As the project was simultaneously taking place in New

South Wales, researchers in this setting were also considering questions and tools. One tool that was put forward by the New South Wales team was the Australian adaptation of the Harvard Trauma Questionnaire (Atkinson 2008). The questionnaire was developed to measure posttraumatic anxiety and depression symptoms among those who may have experienced significant trauma in their lives (for example, among refugees) (see Shoeb et al. 2007). The Australian version was adapted by Atkinson (2008) for use among Aboriginal people.

We had reservations about using the Harvard Trauma Questionnaire in Western Australia for a number of reasons, but particularly because of its potential to re-traumatise participants and our inability to respond appropriately to their distress, either at that time or later. As noted above, some stakeholders had already expressed concern about the capacity of prison counselling services to respond to Aboriginal women's specific experiences of grief and trauma. We decided to seek the advice of our reference group members about the inclusion of the questionnaire, and, with the exception of one participant, members felt the questionnaire was unsuitable to be used with these women in the prison setting. Their main concerns included that the questions would take women to the negative sides of their lives and may trigger concerns for their children, and that the questionnaire should only be administered in a therapeutic, caring environment. As one group member, herself an Aboriginal social worker, stressed, 'They [the questions] would leave the women more traumatised and they are in prison and some will have children and family outside. I would assume that to survive prison time you would need some inner strengths--I believe these questions could shake that inner strength'. While the New South Wales reference group endorsed its use, we reached the conclusion that the potential risks posed to the women by its use outweighed any benefit it could provide to the objectives of the project.

The consultation process also brought to attention issues that were equally as important, but were outside the domain of the current research or were at odds with the research objectives. For example, we were asked whether we would be interviewing the young mothers in juvenile detention. (8) Unfortunately, this was something we could not act on. It was anticipated that access to these young women through DCS would be difficult, and seeking to gain access would add another layer to an already lengthy and complex ethics process. Another stakeholder believed that Aboriginal men in prison have their own important issues relating to parenting from prison and the project should focus on their parenting experiences also. As this project was funded specifically to explore women's mothering experiences, it was outside the objectives of the research to include men's fathering experiences. However, as a result of these discussions, the possibility of future research projects exploring the experiences of young mothers in juvenile detention and fathering from prison have been considered. Consultation involves taking on board the ideas and priorities of various parties--some of which may conflict with the researcher's own ideas or the project goals --and according these 'careful consideration' (Dickert and Sugarman 2005:1124). However, it is not always possible or practical to act on these, as the two examples above illustrate.

It is important to note that unanticipated hurdles can present themselves within any research, no matter how well planned or ethically conducted. Although DCS is supportive of research and recognises the benefits it may have for offenders, it is also aware of the possible risks it poses for offenders, staff and the department. In the case of the Aboriginal Mothers in Prison project, conducting research in the prison setting involved lengthy consultation and negotiation with the DCS Research and Evaluation Committee. This occurred for a variety of reasons. First, given the number of researchers requesting access to prisoners and the quantity of research projects already underway in Western Australian prisons, research projects are staggered due to the risk of overburdening the population and interfering with the management and routine of the prisons. Second, in late 2012 the department instigated a new Risk Management Process Agreement, which sought to ensure the same level of researcher accountability in the local prisons as in the community and to minimise the impact of the research on the day-to-day running of the prisons; this is particularly relevant for research relating to mental health. The Risk Management Process Agreement requires researchers to identify potential risks of the research to participants, staff and the department. If the research is approved, researchers are given the details of a nominated prison liaison person at each site they are to visit and a formalised referral agreement is negotiated and signed by all parties before the researchers can enter the prison. As this was a newly introduced system and was still being streamlined, and because our use of the Kessler Five (9) instrument would potentially identify women experiencing high levels of distress, this process took some time.

In addition, we were unable to fulfil two of the ten research objectives originally envisaged--to conduct an analysis of policies, procedures and models of care relating to the health of Aboriginal women in prison, and to compile descriptive data on the health status of Aboriginal women in prison using prison medical notes. Access to existing health services policies was denied by the Directorate of Health Services because the policies were under review. Access to prison medical notes was also denied. This was due to the perceived unreliability of the data, which would not be helpful to the rigour of the study and had the potential to reflect negatively on the department. As Byrne (2005:226) observed, the researcher wishing to undertake prison-based research is faced with obstacles:
   associated with the realities of multiple gateways
   guarded by state and local administrators
   with varying understanding of research,
   diverse vested interests held by formal and
   informal gatekeepers, security issues related
   to inmate access, the forensic orientation of
   a prison system, and existing suspicions of
   prison administrators, staff, and inmates
   derived from negative experience with the
   media, medical personnel and system politics.


We were able to reach a compromise in relation to access to the medical records of the women, and the department agreed to provide us with a basic health summary of the women who consented to participate in the research. Unfortunately, the health policies remain under review, which will create difficulty when making policy-informed recommendations from our findings. The combination of these experiences impacted our ability to fulfil all our project objectives and put the research far behind the predicted time-lines.

However, the experience also highlighted the importance of being transparent in all our dealings with the department. While at times we, as researchers, felt frustrated about the delays and hurdles, we were able to listen to and address the concerns of departmental staff and endeavoured to continually communicate with them, eventually forming a positive working relationship.

It is, of course, difficult to anticipate the hurdles that may be encountered when conducting research in the prison and other settings that require negotiation of the many interests of those formally and informally involved (Byrne 2005). However, allowing for a reasonable period of consultation can enable researchers to recognise the sensitivities around a particular research project and to work in partnership with 'gatekeepers' to reach agreeable compromises on issues that may initially be in conflict.

Conclusion

Women account for 7 per cent of the Australian prisoner population (ABS 2012a) and, like female prisoners elsewhere, comprise a small proportion of the total prisoner population (WHO Regional Office for Europe 2009). However, the rate at which women have been imprisoned in Australia has seen a sharp incline and this is particularly the case for Aboriginal women (Bartels 2010). Despite this, research into Aboriginal female prisoners' health and other needs has been inadequate. The Aboriginal Mothers in Prison project seeks to go some way to address this dearth. The first phase of the research involved extensive consultation. Conducting community consultation provided access to a body of expertise that enriched and contributed significantly to the research process. Additionally, it meant that our research was conducted in an ethical manner. It ensured that the tools we were using to collect data were appropriate and safe for the women, and that terms such as 'mother', for example, reflected the diversity of their experiences. It also provided the opportunity to include interview questions that were meaningful to stakeholders and to collect data that would potentially produce practical outcomes and positively impact the health and wellbeing of incarcerated Aboriginal mothers. Our processes reflect the key principles outlined in the Road map II (NHMRC 2010), particularly those of consultation, community involvement, communication, and the prioritisation of practical research outcomes for the community and service providers. The consultation phase also brought to light sensitivities and tensions around the research, which highlights that even the best laid research plans may meet obstacles and necessitate a further layer of consultation, negotiation and compromise.

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Mandy Wilson

National Drug Research Institute

Jocelyn Jones

National Drug Research Institute

Marisa Gilles

Western Australian Centre for Rural Health

NOTES

(1.) For the rest of this paper, when we speak of Aboriginal people we include those who identify as Aboriginal, Torres Strait Islander, and Aboriginal and Torres Strait Islander.

(2.) Young Aboriginal women aged 10-17 were almost 45 times more likely to be in detention on any one day in the 2010-2011 period than non-Aboriginal young women (AIHW 2012).

(3.) Two of the regional prisons, Broome and Roebourne, hold small numbers of women; at the time of writing the numbers of Aboriginal female prisoners were two and three respectively (DCS 2013).

(4.) Bandyup is the state's main reception and releasing centre (OICS 2011).

(5.) This situation is not unusual and many prisons around the world have 'no agreed practices [which] exist on how to manage the children's affairs' (Poso et al. 2010:518).

(6.) Boronia Pre-release Centre for Women is centrally located in the inner-city suburb of Bentley. Boronia is a minimum security prison that accepts residential children up to the age of four, and overnight and weekend stays for children up to 12 years. Stakeholders frequently held Boronia up as an example of good practice in relation to incarcerated women and their children.

(7.) This guiding philosophy is based on empowerment and involves women being active participants in their incarceration. Women are encouraged to take personal responsibility and give thought about how to live their lives and fill their days (Superintendent, pers. comm., 12 July 2011). For more information on Boronia's guiding philosophy, see DCS n.d.

(8.) During the consultation phase we were told by two different participants that a young mother in juvenile detention currently had her baby inside with her. One of these women expressed particular concern about the welfare of the young mother and baby because the centre was not set up for children and no specialised child health services were delivered there.

(9.) The Kessler Five is a tool developed to measure the level of distress experienced by a participant. It is an abridged version of the Kessler Ten and has been validated for use among Aboriginal peoples. In our study, women recording a score above 12 require referral to mental health and/or prison counselling services.

Dr Mandy Wilson works as a Research Fellow on the Aboriginal team at the National Drug Research Institute, Curtin University of Technology. An anthropologist, she taught the anthropology of gender and sexuality at The University of Western Australia for a number of years before taking her full-time research position. She currently works on a variety of projects that reflect her interests in Aboriginal health. In particular, her current research involvement includes projects exploring justice and substance use issues, with a particular focus on young people and women.

<mandy.wilson@curtin.edu.au>

Jocelyn Jones is a senior Aboriginal researcher with many years of experience in the prison and health sectors in Western Australia. She also has experience of clinical service provision and was manager at the Derbarl Yerrigan Aboriginal Health Service. Jocelyn currently holds an adjunct position at the National Drug Research Institute at Curtin University and is a doctoral candidate at the Telethon Kids Institute in Western Australia. She is conducting research on 'Pathways to contact with the juvenile justice: Developing a profile of the risk and protective factors to support a strategy for change'.

<j.jones@curtin.edu.au>

Dr Marisa Gilles is the public health physician for the Midwest/Gascoyne region and holds an adjunct position as an Associate Professor at the Western Australian Centre for Rural Health. She has a strong academic background and has completed two Masters degrees in Australia and participates in research whenever it is possible within her clinical workload. Dr Gilles has been an investigator on a number of key projects, particularly those focused around Indigenous health outcomes.

<Marisa.Gilles@health.wa.gov.au>
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Author:Wilson, Mandy; Jones, Jocelyn; Gilles, Marisa
Publication:Australian Aboriginal Studies
Geographic Code:8AUST
Date:Sep 22, 2014
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