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Australian Indigenous HealthBulletin Australian Indigenous HealthBulletin
Volume 1 Issue 1 Article 1
2020
An exploration of interventions for healing intergeneration trauma An exploration of interventions for healing intergeneration trauma
to develop successful healing programs for Aboriginal to develop successful healing programs for Aboriginal
Australians: A literature review Australians: A literature review
Alison J. Simpson
Twofold Aboriginal Corporation
, allyjsimpson@hotmail.com
William Abur
Deakin University
, william.abur@deakin.edu.au
James A. Charles
Deakin University
, james.podiatrist6@gmail.com
Follow this and additional works at: https://ro.ecu.edu.au/aihhealthbulletin
Part of the Community Health Commons, Community Psychology Commons, and the Health Services
Research Commons
Recommended Citation Recommended Citation
Simpson, A. J., Abur, W., & Charles, J. A. (2020). An exploration of interventions for healing intergeneration
trauma to develop successful healing programs for Aboriginal Australians: A literature review.
Australian
Indigenous HealthBulletin, 1
(1).
Retrieved from https://ro.ecu.edu.au/aihhealthbulletin/vol1/iss1/1
This Research Article is posted at Research Online.
https://ro.ecu.edu.au/aihhealthbulletin/vol1/iss1/1
An exploration of interventions for healing intergeneration trauma to develop An exploration of interventions for healing intergeneration trauma to develop
successful healing programs for Aboriginal Australians: A literature review successful healing programs for Aboriginal Australians: A literature review
Cover Page Footnote Cover Page Footnote
We would like to acknowledge the traditional owners of all the many Aboriginal and Torres Strait Islander
Nations that make up the great continent of Australia. We pay respects to the Aboriginal and Torres Strait
Islander Elders past and present, also the young community members, as the next generation of
representatives. Disclaimer: In some instances, in this paper the term ‘Aboriginal’ will be used, this will
occur when the author is speci;cally referring to Aboriginal Australians. 'Indigenous' will be used to
describe Indigenous groups globally.
This research article is available in Australian Indigenous HealthBulletin: https://ro.ecu.edu.au/aihhealthbulletin/vol1/
iss1/1
Introduction
Australia has one of the highest life expectancies in the world (Australian
Institute of Health and Welfare (2018b), ranked as the second highest quality of
life ranking compared to all other countries (United Nations Development
Programme, 2016). Australia is ranked as number 1 for civic engagement and
‘above average’ in other areas such as income and wealth, jobs and earnings,
education and skills, housing, health status, subjective wellbeing and social
connections (Australian Institute of Health and Welfare, 2018a). However, not
all Australians have the privilege of enjoying a high quality of life, Aboriginal
Australians have not benefited from Australia’s economic success, we should
be receiving the highest quality of culturally appropriate health care and
education (Australian Institute of Health and Welfare, 2017) and enjoy the
socio-economic advantages of a wealthy country (Australian Human Rights
Commission, 2014). The ‘Report’ released in November 2016, shows a; 77%
increase of Aboriginal Australian adults being imprisoned since 2000 and a 56%
increase in hospitalisation due to self-harm and suicide attempts over the last
decade. The report also highlights the need to improve psychological status of
Aboriginal Australians (Australian Human Rights Commission, 2014;
Productivity Commission, 2011). In 2017, the leading cause of death for
Aboriginal children between the ages of 5 and 17, and Aboriginal people
between the ages of 15 and 34 was suicide, these rates are too high and
Aboriginal Australians want to see this improved (Australian Bureau of
Statistics, 2018). The ‘Australia’s Health 2018’ report (Australian Institute of
Health and Welfare, 2018, p.33), states Aboriginal Australian’s want to share
the same employment rate, hours worked and household income as non-
Aboriginal Australians, closing the current health gap from 27% to 17%
(Australian Institute of Health and Welfare, 2018a). Despite ongoing policy
attention, there are still many Aboriginal Australians who believe there needs to
be substantial improvement with various social and economic issues (Steering
Committee for the Review of Government Service Provision, 2016). A decade
ago, the Council of Australian Governments (COAG) made an official
commitment to improve conditions in Aboriginal communities (FaHCSIA,
2009). The COAG commitment comes in the form of a National policy, the
‘Closing the Gap’ initiative, with the gap referring to the life expectancy and
inequality between Indigenous and non-Indigenous Australians (Australia,
2016; Closing the Gap Report, 2019; Closing the Gap, the Prime Minister's
Report, 2018). The most recently announced national agreement on Closing the
Gap from the National Indigenous Australians Agency has increased the number
of outcomes to 16 and have a broader focus (National Indigenous Australians
Agency, 2020). This new agreement includes targets on reducing levels of
incarceration, family violence, self-harm and suicide while improving social
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and emotional well-being (National Indigenous Australians Agency, 2020),
which in many cases are related to intergenerational trauma.
Improving social and emotional well-being, physical health and the
socioeconomic status of Aboriginal Australian’s has proved for many years to
be an extremely complex task, which is yet to be successfully achieved. This is
evident through the results of several ‘Closing the Gap’ reports that highlights
some targets which have stagnated, such as health, education and employment,
and others not improving at all and in fact, are going backwards (Closing the
Gap Report, 2019; Closing the Gap, the Prime Minister's Report, 2018;
Department of the Prime Minister and Cabinet, 2018). When looking at social
and emotional well-being, physical health, and education in Aboriginal
communities, it is crucial that we see it through the context of intergenerational
trauma (Price-Robertson, 2011). The impact of colonisation has on Aboriginal
Australian’s health, social and emotional well-being, family violence, suicide,
high incarceration rates, as well as children in out of home care, in many cases
are linked to intergenerational trauma (Weston, 2018). Over the past few
decades, a number of researchers have put forward intergenerational trauma as
an explanation for the plethora of health issues which impact on Indigenous
communities globally (Menzies, 2010).
The concept of historical trauma was termed in the 1980s from Native
American social worker and mental health expert, Maria Yellow Horse Brave
Heart. This term, which described a certain trauma that Maria Yellow Horse
Brave Heart people in the United States were experiencing. Braveheart
describes historical trauma as “cumulative emotional and psychological
wounding across generations, including one’s own lifespan” (Braveheart-
Jordan & DeBruyn, 1995). Evans-Campbell (2008, p. 320), defines
intergenerational trauma as “a collective complex trauma inflicted on a group
of people who share a specific group identity or affiliation…. It is the legacy of
numerous traumatic events a community experiences over generations and
encompasses the psychological and social responses to such events” (Evans-
Campbell, 2008). What both Braveheart and Evans-Campbell are claiming is
that the descendants of those people who have experienced
intergenerational/historical trauma are, themselves, more predisposed to
pathological dysfunction as a result of the trauma endured by their ancestors and
are at least, partly independent of their own traumatic experiences (Gone, 2013).
Intergenerational trauma is rightly described by Gagné (1998) as the
transmission across generations, of historical oppression and the negative
consequences that accompany it (Gagné, 1998). Trauma which is experienced
by multiple generations becomes institutionalised within the family unit and has
an overflow effect out in the community (Brave Heart, 1998). This type of group
trauma can have an overwhelming impact on an individual’s health and lifespan
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because it is both cumulative and psychological, and has been proven to not
only negatively impact on the individual but can also negatively affect future
generations (Braveheart-Jordan & DeBruyn, 1995).
When conceptualising intergenerational/historical trauma in an
Australian context, we must have a look at what history conveys, not only from
a colonial perspective, but with particular focus on government policies.
Colonisation and government policies have caused numerous traumatic wounds
which have been endured amongst Australia’s Aboriginal population for
generations (Australians Together, 2018). Dudgeon et al. 2017 states that
colonisation characterised by genocide has been collectedly traumatic and
profoundly disrupted Aboriginal Peoples traditional way of life (Dudgeon,
Watson, & Holland, 2017) Hall et al. believes that the source of addiction and
the associated issues of addiction in Indigenous communities globally, is
colonisation (Hall et al., 2015). Colonisation in Australia combined with
government policies have been instrumental in creating systems and institutions
that have attempted to eliminate Aboriginal people and their structured systems,
which have been in place for thousands of years. These attempts to eradicate an
entire race have caused significant trauma for Aboriginal Australians, which has
filtered down through generations causing intergenerational trauma (Creely,
2016). Examples of intergenerational trauma caused from colonisation and
government policies includes deep-rooted pain from the beginning of
colonisation. Jim Morrison, an Aboriginal Australian says, ‘Irrespective of
whether they are Aboriginal people from Australia, New Zealand, Canada or
the United States, colonised people experienced a similar sequence of
intergenerational trauma that separates their needs from others’ (Butler, 2012).
Government policies overtime have imposed systematic abuse and
discrimination upon Aboriginal people over several generations. There was an
attempt to assimilate us into the dominant culture through education, law,
religion, and theft of land, which have all contributed to the significant and
compounding loss for Aboriginal Australians. Loss which has contributed to the
erosion of traditional values and structures within Aboriginal society has
cumulated to the many health and social issues which we currently face (Butler,
2012). Judy Atkinson mapped six generations of one Aboriginal family and
identified transmission of historical trauma related to colonisation (Atkinson,
2002). Eduardo Duran describes intergenerational trauma as being a wound of
the soul or ‘soul wound’. If a wound of the soul if not healed, it worsens and is
passed on to the next generation causing further turmoil and pain (Duran, 1990).
Aim
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This paper explores intergenerational trauma healing methods and interventions
used for Indigenous people in four countries that share similar colonial histories
i.e. Australia, Canada, New Zealand, and the United States. The literature
review will focus on identifying the best practice healing methods from these
countries and integrate the elements into one healing intervention that has the
potential to help Aboriginal Australians to successfully overcome complications
of intergeneration trauma.
Method
Literature search
To identify interventions that have been successful in healing
intergenerational/historical trauma amongst Indigenous populations globally, a
systematic search strategy was conducted using keywords and synonyms related
to the topic.
Search Terms
The search terms below were used in each database: “Healing” or “therapy” or
“treatment” or “programs” or “methods” or “interventions”, “Intergenerational”
or “historical”, “Trauma” or “unresolved grief”, “Indigenous” or “first Nation”
or “Aboriginal” or “Torres Strait Islander” or “Native” or “Indian” and “Best
practice”.
Inclusion and Exclusion Criteria
Papers published after 2008 where included as this was the time the Close the
Gap initiative started in Australia. Papers not in English were excluded, as all
countries related to the research are English speaking. To remove irrelevant
publications, only papers that had the word ‘heal or healing’ and or two or more
of the other key words in the title were included.
Search Results
Peer reviewed academic literature was sourced from four different databases i.e.
Ebscohost, PubMed, CINAHL and Medline. The search found 89 citations, and
55 papers were identified as being appropriate to review after duplicate copies
of articles were removed. Out of the 55 papers, 23 met inclusion/exclusion
criteria and were analysed as part of this literature review.
Appraisal Technique
There were many different tools to critical appraise literature, the Critical
Appraisal Skills Programme (CASP) qualitative appraisal tool, the CASP
quantitative appraisal tool and the Joanna Briggs Institute (JBI) checklist for
text and opinion were used to analyse the papers included in this literature
review. The National Health and Medical Research Council (NHMRC)
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hierarchy of evidence was used to rank the papers which had been sourced to
assess rigour, quality, and credibility of the research.
Discussion
Interventions for healing intergenerational trauma for Indigenous people
globally are in its infancy. Whilst there is substantial research done around how
intergenerational trauma affects Indigenous people, families, and communities,
interventions for healing are limited.
Healing of Intergenerational Trauma
Healing intergenerational trauma comes from strengthening one’s own cultural
identity. Having a strong cultural identity helps to protect people against the
symptoms of mental health and protects them from stress or pain caused from
discrimination (Shepherd, Delgado, Sherwood, & Paradies, 2018). Dudgeon et
al. 2017 suggests connecting to culture and traditional healing in combination
with contemporary clinical therapies as part of holistic care for healing
intergenerational trauma (Dudgeon et al., 2017). Milroy et al. for
intergenerational trauma healing to accrue, we need to re-establish “community
and cultural norms” and support youth (Milroy, Dudgeon, & Walker, 2014).
Milroy states there are three main themes for recovery from intergenerational
trauma, 1) self-determination and governance, 2) reconnection and community
life, 3) restoration and community resilience (Milroy et al., 2014). The premise
for the research conducted by Hall et al., is based on the understanding that
embedding cultural interventions into treatment for people experiencing trauma
enables healing for the whole person, including healing their mind and spirit
(Hall et al., 2015). Possessing a positive cultural identity can provide an
individual with a strong sense of self-worth, belonging, purpose and social
support (Berry, 1999). Duran & Duran (2000) states that having a strong cultural
identity not only improves self-esteem, self-worth and sense of identity, it in
turn correlates with healthy functioning (Duran & Duran, 2000). As Harold
Orten (Peters, 1996, p. 320) clarifies through his quote “Recovering our identity
will contribute to healing ourselves. Our healing will require us to rediscover
who we are. We cannot look outside for self-image; we need to rededicate
ourselves to understanding our traditional ways. In our songs, ceremony,
language and relationships lie the instructions and directions for recovery”
(Peters, 1996).
Traditional healing has been described as practices designed to progress
the level of Indigenous peoples mental, physical and spiritual wellbeing based
on beliefs and practices which go back to the time before the spread of the
Western ‘scientific’ bio-medical model (Marsh, Coholic, Cote-Meek, &
Najavits, 2015). Indigenous people have defined traditional healing as a wide
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range of activities (James Charles, Chuter, & O'Brien, 2020; James Charles &
O'Brien, 2020). These activities can include the involvement of traditional
healers and the use of herbal medicines, physical therapies and treatments
(James Charles et al., 2020; James Charles & O'Brien, 2020). The strength of
Elders and the sharing of stories; the use of traditional language, song, dance
and music; the incorporation of traditional activities, practices and or rituals as
well as the participation in traditional ceremonial practices (Marsh et al., 2015).
Aboriginal Australians should not be defined by the negative stereotyping and
misrepresentation that has occurred over the past 200+ years, rather
acknowledgment of Indigenous knowledges and empathy for the impacts of
colonisation and government policies. It is envisaged that Aboriginal
Australians who participate in successful healing interventions for
intergenerational trauma will be able to acknowledge past trauma(s) and be
better equipped to cope with it in an effective way (Weston, 2018).
Four Day Psychoeducational Intervention
One of the most successful interventions reviewed in the literature is the work
of Brave Heart (1998), who is a leader in this field, and a Lakota woman who
coined the term ‘historical trauma’. Brave Heart conducted a four-day
psychoeducational intervention with 45 Lakota people designed to assist them
in the process of healing from intergenerational/historical trauma. The content
of the four-day intervention included didactic and videotape stimulus material
on Lakota trauma, with small group exercises and sharing. The sessions had a
gender balance and were co-facilitated by a Lakota male and female who have
experienced similar trauma to the participants. A review of the dynamics of
unresolved grief and trauma and participation in a traditional Lakota purification
ceremony. The methodology for collecting data from the intervention included
assessments which were performed at three different intervals. There was a pre
and post-test questionnaire, a self-report evaluation instrument used at the end
of the intervention and a six-week follow up questionnaire. None of these
assessments were provided with the publication and therefore unfortunately
critical analysis on the tools used could not be completed. Out of the 45
participants, 97.8% of them completed the entire study, indicating agreement
with the intervention. The results of this study concluded that 100% of the
participants had self-reported the following:
• An increase in awareness of historical trauma
• The intervention helped them to resolve grief reactions
• The intervention helped them to feel more positive about being Lakota
• The intervention helped them to feel better about themselves.
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Most of the participants indicated that because of the intervention, most grief
related affects, besides anger, increased during the intervention (as predicted)
and decreased after the intervention. The most significant change of affects
experienced by the participants were the feelings of ‘helplessness’ which was at
a rate of 54.5% before the intervention and afterwards, there were ‘zero’ feelings
of helplessness, and feelings of hopelessness was 45.5% before the intervention
and ‘zero’ after the intervention, which is an amazing result for participants
(Brave Heart, 1998). The change of affects overtime experienced by the
participants are illustrated in Table 1.
Table 1: Affects experienced often over time: before, during and after the
intervention
Feelings
Before
intervention
During
intervention
After
intervention
Sadness
66.7%
90.0%
18.2%
Grief
54.5%
78.8%
27.3%
Pride
51.5%
54.5%
81.8%
Anger
69.7%
51.5%
18.2%
Hopelessness
45.5%
12.1%
0.0%
Shame
60.6%
21.2%
6.1%
Helplessness
54.5%
30.3%
0.0%
Joy
45.5%
63.6%
75.8%
Guilt
60.6%
30.3%
6.1%
Source: (Brave Heart, 1998)
The results of this intervention are very impressive and have been to be
quite successful. However, the participants only had 6 weeks follow up, post the
intervention, which is short follow up time for treatment of intergenerational
trauma. The “feelings” were self-reported by participants, with no evidence of
anonymous reporting or blinding, which is a limitation of the study. The
evaluations could have benefited from anonymous reporting of “feelings” at
pre- peri and post evaluation, or if this happen, it should have been reported in
the paper. This program also would have benefitted from including some
objective measures of “feelings” e.g. depression survey, and the evaluation
could have possibly benefited from a long-term follow up e.g. 12 months.
Blending Traditional Aboriginal & Western Healing Methods and
‘Two Eyed Seeing’ Approach
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Many of the publications reviewed reported the benefits of blending traditional
Indigenous healing methods with Western medical practices. Marsh et al. (2015)
explored how a successful Western treatment model, ‘Seeking Safety’ could be
blended with traditional Indigenous healing methods in order to assist in the
healing of intergenerational trauma and substance abuse disorders amongst the
Indigenous population in Canada (Marsh et al., 2015). ‘Seeking Safety’ is an
evidence-based treatment program, which is aimed at healing people from
intergenerational trauma and substance abuse disorders. The implementation of
this program has been reported as successful among other minority groups in
the US, including African Americans and Hispanics. The program uses well
respected Western treatment methods such as an integrative, interpersonal and
educational approaches, which are quite similar to the holistic methods used by
Indigenous healing practices (Marsh et al., 2015). A literature review looked at
interventions used to treat substance misuse disorders in Indigenous populations
and found 19 studies in the United States and Canada which integrated both
Western and traditional Indigenous methods. The authors stated there was a
reduction of substance use in 74% of the studies and that there were benefits in
all areas of wellness (Rowan et al., 2014). Indigenous healing methods can be
integrated into Western healing practices through a concept called ‘Two Eyed
Seeing’. Mi’KMaq Elder, Albert Marshall coined the term (or Etuaptmumk in
his language) as a guiding principle by which one should live their life (Bartlett,
Marshall, & Marshall, 2012). Two-Eyed Seeing recognises the different ways
of looking at the world by finding strengths in both Western treatments and
combining them with Indigenous perspectives of knowing and doing. Two Eyed
Seeing ultimately produces beneficial outcomes in any given situation because
it places value on both Indigenous and western world perspectives (Bartlett et
al., 2012).
The ‘Seeking Safety’ program uses the Two Eyed Seeing concept. It’s a
strength-based, collaborative program that was developed to be inclusive. It is
written in a way which is empowering, culturally sensitive, and with an
understanding language that can address the needs of those who participate in
the program. Although the literature on integrating the ‘Seeking Safety’
program with traditional healing methods is positive and viable, it may have
benefitted from more evaluation of its effectiveness for Indigenous peoples.
The Yupik and Cup’ik (C/Yup’ik) people, native to Alaska, believe that
integrating their traditional practices is a way in which they can remember and
honour their ancestors and culture will be successful. In Alaska, they are
currently integrating traditional practices into their Western mental health and
substance abuse treatment plans through a program called the ‘Village Sobriety
Project’ (VSP) (Mills, 2003). This approach has been incorporated into their
healing and treatments plans because non-Indigenous approaches to substance
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abuse treatment have not been effective (Mills, 2003). One of the underlying
principles which supported the integration of traditional Indigenous healing
modalities into Indigenous treatment plans, is the use of Western frameworks
which incorporate play and or art therapy. Also, incorporating traditional
practices into treatment validates the C/Yup’ik ancestral beliefs around living a
healthy life (Mills, 2003). Some of the traditional Indigenous healing modalities
that have been incorporated in to Western treatment plans include; hunting,
fishing, berry picking, gathering edible and medicinal plants, tundra walks,
traditional arts and crafts, gathering wood, chopping wood, holding a feast,
potlatch, ceremony and steam-bath.
When being assessed, a client has the option to choose and incorporate
traditional healing practice within their treatment plan and to what extent they
should be incorporated, giving self-determination and ownership of healing. A
client could see a counsellor for anger management or substance abuse disorder
early in the week, and later in the week they may choose to go on a tundra walk
or participate in arts and crafts. Each activity must correlate with the client’s
identified goals within their personalised treatment plan, which will be
sufficiently documented for reimbursement from Medicaid (Australia’s
equivalent, Medicare) (Mills, 2003). The assessment tools which are used on
intake or admission not only contain standard questions which are found in most
behavioral intake forms, but additional cultural questions are asked for
Indigenous clients (Mills, 2003). The cultural assessment consists of a one-page
questionnaire where the client is asked some open-ended questions and to
express their agreement to some statements pertaining to their cultural
connections and interest in engaging with traditional healing practices. The
responses provided by the clients assist the clinician in identifying what
traditional modalities would best suit the client (Mills, 2003). Within the
treatment plan, there are six domains which underpin the foundation of a client’s
treatment plan e.g. need/problem, goal, modality, objective plan of action,
duration, and dates of activity. The VSP has made significant progression
toward integrating traditional modalities into treatment plans for Indigenous
people to facilitate a more holistic and culturally appropriate healing
intervention. However, it was not clear if the program been evaluated to identify
the effectiveness in healing intergenerational trauma in Native Alaskan people.
The paper also did not provide a copy of the cultural screening assessment tool,
which was discussed, which would benefit the reader.
Healing frameworks in the clinical setting
Some of the literature mentioned healing intergenerational trauma using
frameworks and screening tools within clinical treatment settings as opposed to
short term, group healing interventions. Trauma and mental health related health
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histories and diagnostic assessment tools are rarely completed in health care
settings or facilities outside of specific mental health services, even though
many people with trauma related issues seek care for physical, emotional and
behavioural health from health care services (Hiratsuka et al., 2016). To
encourage health care services to better identify and address the needs of
Indigenous people with trauma, Hiratsuka et al., conducted a community based
participatory action research study. The study was seeking input from patients,
providers, administrators, and traditional healers, to develop an appropriate
trauma screening, and referral treatment (T-SBIRT) process. This was designed
for adults which would be piloted at two large Indigenous specific health
services in the US (Hiratsuka et al., 2016). In the first round of data collection,
there were 37 participants and 33 participants in the second round. They found
that the development of such screening tools was problematic. One of the major
concerns was that health services may not be able to adequately manage or
effectively treat the large volume of individuals who would be identified as
requiring support for their trauma. Especially when many mental health services
are currently overburdened (Hiratsuka et al., 2016). Therefore, this could cause
more harm to some individuals who may be unprepared or inadequately
supported to address their trauma, particularly if the screening questions trigger
hostile reactions related to previous trauma (Hiratsuka et al., 2016). The
participants of the study stated it was paramount that whomever is using the
tools, need specific training in how to ask questions appropriately and what to
do if there is an adverse reaction (Hiratsuka et al., 2016). Having strong
knowledge of intergenerational trauma and how it significantly and negatively
affects Indigenous people would greatly assist in the screening process. The
results of the study suggest that the T-SBIRT, was a viable model. The paper
provided the data collection framework, which featured the questions asked in
the interviews for the patients, providers, administrators, and tribal leaders. The
paper was very robust and provided a table highlighting the factors which
participants believed influenced screening, brief intervention, and referral for
treatment of trauma. The paper also provided the participants feedback on their
preferences in relation to the process, which gives the reader a very good
understanding of the project. Whilst the model has promise, the paper didn’t
provide a copy of the T-SBIRT model and screening tools making it difficult to
evaluate its use for Aboriginal Australians.
The ‘Healing Constellation’ is a framework that was developed in
Alaska and designed for clinicians working with native people suffering from
substance abuse and intergenerational trauma. The framework was intended to
be used as a guide or ‘prompter’ for clinicians when assessing Indigenous
people with substance abuse disorders and or intergenerational trauma
(Arundale, 2013). The author insists that assessment and treatment needed to be
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culturally appropriate but also the clinicians delivering the care must be
culturally aware and have an understanding of Indigenous history and how it
impacts on current Indigenous society. Arundale (2013), states that the
framework’s basic principles are grounded in Indigenous knowledge systems
and that Indigenous people have shaped the development of the tool, therefore
making it relevant to them (Arundale, 2013). Although there may be a need to
evaluate the ‘Healing Constellation’ in healing intergenerational trauma
specifically.
Healing interventions in Australia
There was a scarcity of papers related to successful healing interventions for
intergenerational trauma in Australia focussing on Aboriginal Australians.
Professor Judy Atkinson, an Aboriginal Australian woman who has worked in
violence and trauma for over 15 years, describes an Aboriginal program for
healing called ‘WE AL-LI’, which evolved from the participatory action focus
of her research (Atkinson, 1994). Professor Atkinson was invited to be involved
in assisting a community to develop a program to support Aboriginal families
in addressing issues of violence. There was a group which was formed and met
for 12 months in the planning and development stages of the program and after
12 months, the group commenced implementing the workshops for the
community (Atkinson, 1994). The WE AL-LI program has a series of
workshops, the main one is called ‘Lifting the Blankets’, which was run over
nine weekends. Participants were required to identify nineteen different forms
of violent or oppressive behaviours and then they were asked to distinguish what
they could do, or how they could change the impacts of these experiences from
within their lives (Atkinson, 1994). The process of the WE AL-LI workshops
allowed the individuals to name and own attitudes and behaviours within their
relationships that were abusive, by creating safe healing circles and
environments where individuals were able to listen and share their stories
together, breaking the cycle of denial which assists in the healing process
(Atkinson, 1994). Atkinson’s article shares quotes and comments from people
who have participated in the workshops and have changed their behaviours and
relationships for the better. The WE AL-LI workshops commenced in 1994 and
have been successfully operating for the past 25 years in Australia.
A recent critical review by Le Grande et al. (2017) was designed to
identify, document, and evaluate the use of social and emotional wellbeing
measures within the Australian Aboriginal population. This study was
conducted in recognition that mainstream or Western indicators of wellbeing
were not relevant or were inadequate to use within an Aboriginal context (Le
Grande M. et al., 2017). The le Grande et al. study is important and relevant to
the research topic as it identifies the screening tools currently available in
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Australia to measure social and emotional wellbeing, which includes mental
health and trauma. Without the tools or instruments to identify trauma, it can be
hard to treat this problem effectively. Le Grande et al. understands that
Aboriginal Australian’s approach to health is very different to non-Aboriginal
Australians. The paper elucidates the fact that Aboriginal people define health
as holistic, not just the physical wellbeing of an individual but rather the social,
emotional and cultural wellbeing of the entire community in which the
individual lives and belongs (Le Grande M. et al., 2017). The study involved
conducting a literature review on social and emotional wellbeing (SEWB)
instruments or tools used that were specific for Aboriginal Australians. The
study reviewed 165 papers with 33 papers selected for relevancy and 22
instruments identified. The results of the Le Grande et al. study found that there
were three major instruments found; (1) standard non-Aboriginal instruments,
(2) standard instruments adapted for Aboriginal people and (3) instruments
which were specifically developed for use by Aboriginal Australians (Le
Grande M. et al., 2017). Based on the Le Grande et al. study, it is evident that
Aboriginal Australians, when accessing support for SEWB/mental health, are
not always being assessed using Aboriginal specific instruments. Quite often
practitioners are not always working within a holistic framework which supports
an Aboriginal context of health (Le Grande M. et al., 2017). Le Grande et al.
claims that the lack of culturally appropriate instruments for measuring
SEWB/mental health amongst Aboriginal Australians is why there is a
persistent ‘gap’ of disadvantage and inequity between Aboriginal and non-
Aboriginal Australians (Le Grande M. et al., 2017). It is important to note that
Aboriginal Australians working in Aboriginal health spaces have Indigenous
knowledge about healing trauma, and there are several successful healing
interventions, being implemented in Aboriginal communities across the country
helping Aboriginal community members. However, it would be helpful to see
formal evaluation conducted on these programs, and have the findings published
so these programs may be used more broadly and benefit more Aboriginal
communities.
Community Level Healing Programs
The Healing Foundation has worked in collaboration with aboriginal
Australians to completed extensive work developing guidelines for community-
level programs for healing intergenerational trauma (Testro, Ryan, & Hillan,
2016). The Healing Foundation recommends following the 8 principles below
as a guide when developing community-level programs (Testro et al., 2016)
which builds on guidelines previously developed by the Healing foundation in
2014.
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1) Trauma should be understood in the broader context of historical and
continuing colonisation and the forced separation of children from their
families.
2) Aboriginal and Torres Strait Islander peoples have the knowledge and skills
to resource healing from trauma.
3) Healing involves reconnection to culture and traditions, including ceremony.
4) Healing provides a safe place for people to share their stories, gain and sustain
hope, develop their sense of identity and belonging, be empowered and seek
renewal.
5) Healing attends to the needs of both survivors and perpetrators.
6) Healing is an ongoing journey to restore and sustain physical, social,
emotional and spiritual wellbeing.
7) Healing is most effective when designed, developed and delivered by
Aboriginal and Torres Strait Islander people with and for their own
communities.
8) Aboriginal and Torres Strait Islander peoples have shown great resilience
over the generations, building on these strengths is critical.
Conclusion
Seeking interventions which are capable of healing intergenerational trauma are
imperative for improving the health and wellbeing of Aboriginal Australians,
families, and communities. The success of healing interventions is certainly
influenced by the environment in which a person lives. Healing interventions
are not likely to be successful if the person is living in an environment which is
contributing to trauma. Therefore, interventions need to investigate and consider
a person’s environment as part of the healing program and have a whole of
community approach. Long-term follow up of participants is essential to
determine the effectiveness of the healing process. Especially as there is a level
of personal responsibility and commitment required by the participant to
continue their healing journey. Although well intentioned, quite often non-
Aboriginal clinicians have limited understanding and awareness of Indigenous
people’s culture, and how history and past government policies have negatively
impacted Indigenous peoples. The literature showed that there is not a ‘one
program fits all’ but a number of tools, models, frameworks and interventions
which can be applied throughout an individual’s healing journey. There needs
to be opportunities for the individual to understand their Indigenous heritage
e.g. where they are from, how they connect, knowledge of their culture and
traditional practices. Having this knowledge strengthens their cultural identity
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and assists in the healing process. Indigenous people need to be employed in
care facilities to work with Indigenous healers as an option for alternative
therapy and integrating traditional practices with Western practices and the
‘Two Eyed Seeing’ is a good example. Indigenous people also benefit from
being around other Indigenous people, listening and sharing stories, cultural
knowledge, and practices.
Recommendations
There needs to be ongoing opportunities for individuals to continue their healing
journey without an ‘end date’, long-term programs will allow individuals the
extended support they may require on their healing journey. Screening and
assessment tools used by clinicians to assess trauma, social and emotional well-
being or mental health issues need to ensure that they are culturally appropriate.
Clinicians need to ask additional questions relevant to the individual’s cultural
background, allowing both the clinician and individual to distinguish gaps in
cultural identity and providing a starting point to deliver traditional healing
modalities for treatment. The cultural components to screening and assessment
tools should be developed in collaboration with Indigenous people to ensure
they are culturally appropriate. There needs to be traditional Aboriginal healing
modalities integrated into treatment plans as options for people with substance
disorders, trauma, social and emotional well-being, or mental health issues.
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