Founded in 2016, Birth Trauma Australia (BTA), previously known as the Australasian Birth Trauma Association (ABTA), is the peak charity dedicated to preventing, diagnosing, and treating birth-related trauma. We are a peer-led organisation working with women+ and families who are impacted by birth-related trauma and the professionals supporting them. Over the past nine years, we have gained unique and valuable insights into the nature, scope, and impact of birth-related trauma through:

• Working directly with families and health professionals;
• Implementing our highly successful peer-to-peer support programs,
• Conducting community engagement activities;
• Undertaking research activities.

Our vision is for safer births and better healing.

The ThinkNatalTM GP Training and Awareness Program is a Pilot program for Queensland only, funded by the Queensland Mental Health Commission. The project timeline is 16 months, and is being led by Birth Trauma Australia. There is a fixed budget of $192.500.

It is proposed that the accompanying research partnership with ACU will enhance the project outcomes through the opportunity to publish evidence-based research, maintain a holistic approach to birth-related trauma, and offer a multidisciplinary approach with input from clinicians, community perspectives, and families with lived experience.

Birth trauma-encompassing both psychological and physical trauma arising from childbirth-is increasingly recognised as a significant public health issue in Australia. Through our national advocacy, including the Birth Injuries Report and Your Birth, Your Voice, BTA has documented widespread reports of women feeling dismissed, unheard, and unsupported following traumatic birth experiences. Many describe ongoing physical morbidity, symptoms consistent with post-traumatic stress, relationship strain, and disengagement from healthcare services.

The 2024 NSW Birth Trauma Inquiry further highlighted systemic gaps in postnatal follow-up, fragmented models of care, and limited clinician training in trauma-informed principles. General Practitioners (GPs) are often the first point of contact for women following discharge from maternity services. However, women report variable experiences in primary care, including minimisation of symptoms, limited awareness of ongoing physical challenges and inadequate recognition of psychological trauma. This contributes to delayed help-seeking, reduced trust in healthcare, and poorer long-term outcomes.

While our programs at BTA are grounded in community consultation and internal evaluation, they have not yet undergone rigorous, ethically approved research that can inform national policy and clinical guidelines.

Does a co-designed trauma-informed care training program for General Practitioners improve clinician knowledge, attitudes and self-efficacy regarding birth trauma, and does it enhance women's reported experiences of validation, safety and access to appropriate referral pathways in primary care?

Secondary questions include:

1. What barriers and enablers influence implementation of trauma-informed practice in general practice settings?
2. How do women with lived experience define high-quality, trauma-informed primary care?
3. What measurable changes occur in referral patterns, follow-up care, and patient-reported outcomes following implementation?

The overarching objective is to co-design, implement and rigorously evaluate a trauma-informed GP training program that improves primary care responses to women experiencing birth trauma.

Specific objectives are:

1. Co-design with lived experience and clinical stakeholders - to collaboratively develop a training curriculum informed by women with lived experience, GPs, pelvic health professionals, perinatal mental health clinicians and community advocates. The curriculum will integrate trauma-informed principles, including safety, trustworthiness, choice, collaboration and empowerment.
2. Strengthen GP capability and confidence - to assess changes in GP knowledge, attitudes, and self-efficacy regarding birth-related physical injury, psychological trauma, and trauma-informed communication. We aim to identify measurable improvements in clinicians' capacity to recognise symptoms, validate experiences, and initiate appropriate referrals.
3. Improve women's experiences of care - to evaluate whether women attending participating practices report increased feelings of being heard, believed and supported. Patient-reported experience measures will assess perceived safety, shared decision-making and continuity of care.
4. Enhance access to appropriate services - to examine changes in referral pathways (e.g., pelvic physiotherapy, perinatal mental health, specialist clinician review) and timeliness of care. We will explore whether training reduces delays in the diagnosis and treatment of birth injuries/ongoing physical challenges from birth.
5. Identify implementation facilitators and barriers - to generate practice-based knowledge regarding organisational, systemic and cultural factors influencing uptake of trauma-informed care in general practice.
6. Build research capacity within BTA - to transition existing quality assurance processes

into ethically approved, publishable research outputs. This includes developing internal capability in data governance, research ethics processes, and knowledge translation.

Intended outcomes include:

• A validated, scalable trauma-informed GP training model.
• Evidence demonstrating measurable impact on clinician behaviour and patient experience.
• Policy-relevant recommendations for primary care reform.
• Strengthened collaboration between BTA, ACU researchers and community stakeholders.

Ultimately, the project seeks to advance the dignity and wellbeing of women affected by birth trauma by embedding trauma-informed principles into routine primary care practice.

Research activities

This project will adopt a mixed-methods design over approximately 18 months:

1. Scoping literature review - review of trauma-informed care in primary care, perinatal mental health, and implementation science to inform curriculum development and evaluation design.
2. Co-design workshops - facilitated sessions with women with lived experience, GPs and allied health professionals to refine training content and evaluation measures.
3. Pre-post quantitative evaluation
   • GP surveys assessing knowledge, attitudes and self-efficacy.
   • Patient-reported experience measures within participating practices.
   • Analysis of de-identified referral and service utilisation data.
4. Qualitative interviews and focus groups - semi-structured interviews with GPs and women to explore perceived impact, barriers and enablers.
5. Implementation analysis - application of an implementation framework to identify contextual factors influencing sustainability.

Expected outputs

• A comprehensive research report co-branded by BTA and ACU.
• A peer-reviewed journal article on training effectiveness and implementation.
• A practice-oriented summary guide for GP clinics.
• Policy briefing documents for state and national stakeholders.
• Conference presentations (primary care, perinatal health, health services research).
• Community-facing summary materials and digital dissemination via BTA networks.

These outputs will ensure findings are translated across clinical, academic and community audiences.

In the initial implementation phase, we anticipate training approximately 50-80 GPs across multiple practices. Assuming each GP cares for 1,000-1,500 active patients annually, the indirect reach is substantial. Conservatively, hundreds of women per year presenting with postnatal concerns across participating practices may experience improved recognition and support.

A validated and scalable training model has national applicability. If adopted more broadly, the project has the potential to benefit thousands of women and families annually, by strengthening early intervention, improving trust in healthcare, and reducing long-term morbidity associated with BRT.

The ThinkNatalTM GP Training and Awareness Program has been funded for 16 months, commencing in March 2026. We are committed to a research project for the same period of time; there is potential for project extension nationally beyond this, with a finalised Evaluation and Sustainability project plan.

Birth Trauma Australia routinely collects both quantitative and qualitative data through its programs and advocacy work. This includes:

• De-identified survey data from women with lived experience of birth trauma, including physical injury, psychological symptoms, care experiences and access to services.
• Narrative submissions and thematic data from national reports (e.g., Your Birth, Your Voice).
• Program evaluation data from training initiatives, including attendance records, participant feedback and pre-post self-assessment measures.
• Stakeholder consultation data from clinicians, advocacy groups and policymakers.
• Referral pathway information related to primary care and allied health access (where provided voluntarily and de-identified).

Current evaluation processes are primarily quality assurance-focused. With SESU partnership, these data will be strengthened through formalised research protocols, enhanced data governance processes, and ACU ethics approval where required. All data collection will align with the National Statement on Ethical Conduct in Human Research (2023), with particular attention to safeguarding vulnerable adults and trauma-sensitive research practice.

BTA provides support to Aboriginal and Torres Strait Islander families, and proposes to have an Identified mother involved in the Family Advocacy Group to provide project governance and oversight. BTA is committed to the inclusion of Indigenous ways of knowing, being and doing to provide cultural safety to all families who engage with our organisation.

We are not currently in partnership with an Aboriginal Community Controlled Health Organisation, but there is an opportunity to engage with ACCHO community hubs, with input for toolkit resources from GPs, midwives and health workers - e.g. The Institute for Urban Indigenous Health in South-East Queensland, and Waminda in South Coast, New South Wales.

No.

A) Birth Trauma Australia brings extensive expertise in birth-related trauma through nearly a decade of direct engagement with families, health professionals, and community stakeholders. As Australia's peak charity dedicated to preventing, recognising and supporting recovery from birth-related trauma, the organisation has developed deep insight into the lived experiences of affected families and the systemic gaps in perinatal care.

Through peer-to-peer support programs, education initiatives, and advocacy work, BTA has built strong networks with clinicians, researchers, and multidisciplinary healthcare professionals.

B) Project Lead - Kara Williams (ThinkNatal ProjectManager). Kara is a Registered Midwife and Child Health Practitioner who has experience in perinatal health projects, clinician education and program implementation. She will coordinate co-design processes, oversee data collection in collaboration with ACU researchers, and ensure alignment between research outputs and community priorities.

BTA will require assistance with general oversight for all research activities, including ethics protocol, data collection, data analysis, publication and dissemination.

Birth Trauma Australia will provide substantial in-kind contributions, including:

• Staff time from the Project Lead, research assistants and administrative support.
• Access to existing program materials and training curriculum drafts.
• Collation of de-identified service and evaluation data.
• Recruitment support through our national networks of women with lived experience and GP stakeholders.
• Facilitation of co-design workshops, including provision of venues (where applicable) and online platforms.
• Stakeholder advisory group participation to test and refine findings.
• Communications and dissemination support via BTA's website, social media and partner networks.
• Contribution to drafting and reviewing reports, policy briefs and community summaries.

We are committed to contributing operational resources and expertise to ensure project success. This partnership will enable us to extend beyond quality improvement activity into rigorous, publishable research that advances the common good and strengthens wellbeing for women+ experiencing birth trauma.

The proposed scope of the project will need to be negotiated during co-design sessions with both partner agencies to ensure feasibility within a 18-24 month timeline. The analysis of existing data requested by the partner agencies will need specific exploration with the Research Ethics Secretariat.

The Welcome Futures Project: Designing a Future Service Model for St Mary's House of Welcome

St Mary's House of Welcome is a specialist open access point providing essential services to people who are homeless, experiencing poverty, severe and persistent mental health issues, especially those who are socially isolated and marginalised. Many of those who come to St Mary's House of Welcome for help have experienced multiple life challenges and issues including having to sleep rough, drug addiction, poverty, childhood trauma, mental illness and institutionalisation, all of which can cause chronic social and health problems. St Mary's House of Welcome's fundamental purpose is to enable people to find hope, experience belonging and be helped to achieve to their full potential.

St Mary's House of Welcome is an open access service located in Brunswick Street, Fitzroy, that supports individuals experiencing homelessness, social isolation, and a range of disadvantaged circumstances. As an open-door policy, it provides essential services and a point of connection for people who may face significant barriers when engaging with more formal or structured support systems. Unlike many homelessness services that operate through structured programs, appointments, or case-management pathways, SMHOW's service delivery model is largely episodic. This means individuals may access support on a day-to-day basis depending on their immediate needs, without necessarily engaging in a continuous or long-term case management plan.

While this open and flexible approach allows SMHOW to reach a broad and diverse population, it also differs from the more standardised models commonly used across the homelessness sector. As a result, there are opportunities to better understand how people interact with this model and whether it effectively supports pathways toward stability, wellbeing, and long-term outcomes. Exploring the strengths and limitations of our service model will be important in identifying ways to enhance service delivery while maintaining the accessibility and welcoming environment that is central to SMHOW's mission.

While SMHOW's now defunct NDIS program went through an evaluation project several years ago, the organisation's broader service model has not been evaluated.

How do vulnerable individuals experience St Mary's House of Welcomes current service model and what strengths and limitations to the current service model emerge from these experiences?

Based on this evaluation, design a new service delivery model within SMHOW that improves wellbeing, social inclusion and housing stability.

1. Design and evaluate a new service delivery model within SMHOW that aims to improve wellbeing, social inclusion, and housing stability for individuals experiencing homelessness.
2. Assess the strengths and limitations of the current service model while identifying opportunities to strengthen programs and supports that better meet the needs of those accessing services.
3. Gain deeper organisational insight into how individuals perceive and navigate the existing system.
4. Inform SMHOW of an enhanced service delivery approach that is more responsive, accessible, and effective in supporting long-term outcomes.
5. Focus on a holistic service model aligned with Catholic Social Teaching principles that improves service delivery and access to support.
6. Explore how individuals engage with and navigate current service systems and help identify opportunities to enhance service delivery, improve accessibility, and improve overall well-being.

This research will aim to develop practical recommendations for SMHOW to enhance and/or modify support services and models to strengthen outcomes for individuals experiencing homelessness. It will identify both areas of strength within the current system and opportunities for improvement, generating practical, evidence-based recommendations to support the wellbeing of the community.

Activities could include the following:

• A literature review to examine existing service or practice models and identify current research relevant to the service.
• Analysis of existing program or service data to document and evaluate how services are delivered.
• Surveys and/or interviews with service participants and stakeholders to assess client outcomes and the overall impact of the program.

The findings will inform more effective pathways for supporting individuals experiencing homelessness and contribute to the development of a proposed holistic service model for SMHOW that integrates best practices in homelessness support services. The research will also outline a practical framework for how this model could be implemented within SMHOW, including service delivery approaches, opportunities for collaboration with other organisations, and strategies to strengthen support services. Ultimately, SMHOW will benefit from a stronger evidence base to guide strategic planning, service delivery, and advocacy within the homelessness sector.

Outcomes:

• Increased engagement by service users resulting from improved service delivery model
• Service users will be able to express their needs and goals with greater confidence
• Service delivery will be more accountable and person-centred
• Literature review to align to best practice
• Defined program framework
• Pilot project to test the framework's impact.

The research will contribute to a further understanding of how to effectively support a diverse population experiencing homelessness. On average, SMHOW supports around 100 individuals each day, highlighting the scale and complexity of needs within the community and reinforcing the importance of developing an effective service delivery model.

Months 1-3: Project Initiation and Design

Establish governance and a steering group, confirm evaluation questions, and review existing program documentation. Develop the evaluation framework, logic model, and methodology. Prepare and submit ethics approval and finalise the data collection plan.

Months 4-6: Stakeholder Engagement and Baseline Review

Conduct stakeholder mapping and consultations with program staff, partners, and participants. Analyse baseline program data and service delivery processes. Finalise evaluation tools including surveys, interview guides, and focus group protocols.

Months 7-11: Data Collection

Implement mixed-methods data collection, including surveys, interviews, focus groups, and case studies. Gather operational data on service utilisation and participant outcomes. Provide a midpoint update to stakeholders.

Months 12-14: Analysis and Interpretation

Undertake quantitative and qualitative analysis to assess program effectiveness, strengths, and gaps. Validate preliminary findings with stakeholders and prepare a draft evaluation report.

Months 15-17: Program Framework Development

Facilitate co-design workshops to develop a future service model, including delivery components, staffing, referral pathways, and monitoring approaches.

Month 18: Reporting and Dissemination

Deliver the final evaluation report, recommended program framework, and implementation roadmap.

SMHOW collects both quantitative and qualitative data that can be used for this research (de-identified). SMHOW utilises Specialist Homelessness Information Platform (SHIP) which is sector-wide case noting system. SMHOW utilises other documents to capture qualitative data such as housing outcomes and other specialist referral pathways.

Service user data collected by St Mary's House of Welcome (SMHOW) is used to provide and improve the support services offered to people accessing the organisation. The information helps staff assess client needs, deliver services such as case management, referrals, meals, and other assistance, and coordinate support with other service providers when consent is given. It is also used to understand the demographics and needs of service users, evaluate program effectiveness, report to funders and stakeholders, and ensure the organisation meets its legal and administrative responsibilities.

St Mary's House of Welcome has a long-standing commitment to providing a culturally safe and welcoming environment for people experiencing poverty, homelessness and social exclusion, including Aboriginal and Torres Strait Islander peoples. Around 10-15 per cent of the people who access services at SMHOW identify as First Nations peoples.

Staff work to build trusted relationships with First Nations clients through consistent engagement, listening and responding to individual needs. The organisation recognises the ongoing impacts of colonisation, intergenerational trauma and systemic disadvantage, and aims to provide support that is respectful of culture, identity and community.

SMHOW maintains connections with local Aboriginal organisations, community services and culturally specific programs to support appropriate referrals and collaborative responses when required including Ngwala, VACCA and Djirra. These partnerships help ensure First Nations service users can access specialised services, cultural support and broader community networks.

SMHOW is committed to strengthening its engagement with Aboriginal and Torres Strait Islander communities and continuing to learn from First Nations voices to improve culturally responsive practice across its services.

No.

St Mary's House of Welcome has been working with people experiencing homelessness and poverty since 1960, and has a very strong record in helping those in need through the provision of emergency relief and specialist support. As an organisation based around community and inclusion, we are in a position to be able to work with a very diverse set of client needs and vulnerabilities.

With the experience we have working closely with people experiencing homelessness, poverty, mental health issues and social isolation, we have built up a strong team of staff who tailor individual support. We are non-judgmental and build trusting relationships with service users to provide purposeful, individualised and group support and work towards realistic service user outcomes.

The project lead would be Jodie Douglas, SMHOW Manager Policies and Programs.

Ideally, this project would involve researchers with experience in:

• Service design and co-design with vulnerable communities
• Homelessness and community service systems
• Qualitative and participatory research
• Program evaluation and impact frameworks
• Systems thinking and service integration

St Mary's House of Welcome will provide the following:

• Access to existing program/client data,
• Introduce the project team to other relevant staff, partners/stakeholders,
• Facilitate access and provide meeting space to interview service users,
• Facilitate access to key staff to provide insight and feedback
• Participation in data collection activities as required,
• Communications and updates that may impact project progress.

The proposed scope of the project will need to be negotiated during co-design sessions with the partner agency to ensure feasibility within a 18-24 month timeline. The analysis of existing data requested by the partner will need specific exploration with the Research Ethics Secretariat.