Healing The Past BY Nurturing The Future (Shawana Andrews, 2018)

Co-designing a screening tool, assessment processes and strategies for healing complex trauma Important question for us to consider: Why would we want to develop a screening tool, assessment processes and therapeutic strategies for young Indigenous parents experiencing complex trauma?

Why design tools, assessment processes and strategies? Studies among Aboriginal people reveal high levels of trauma exposure and symptoms of posttraumatic distress, including Posttraumatic Stress Disorder (PTSD), Complex trauma, and cultural idioms of distress  As high as 10 -12 different traumatic events experienced in a life time (Atkinson, 2008; Gee, 2016) Elevated rates of PTSD: 14-16% (Ralph et al., 2006), 20% (Holmes and McRae-Williams, 2008), 55% (Nadew, 2012), 58% (Atkinson, 2008), 40% (Gee, 2016) PTSD, Complex trauma symptoms and cultural idioms of distress have all been documented Intrusive memories (flashbacks), emotional numbing, avoidance, high anxiety, hyper arousal shame, guilt, low self worth, difficulty managing emotions, difficulty maintaining relationships fragmented identity, disconnection from community However, no studies worldwide have specifically examined the impacts of trauma for young Indigenous parents during the neo-natal to 24 month period

. WHY IS THIS IMPORTANT? Because from professional and lived experienced, we know that many of our young people have been effected by trauma. BUT HOW MANY? We don’t know….. Highly likely that a significant proportion of young Indigenous people entering parenthood are suffering from the impacts of historical trauma and adverse childhood events (e.g., PTSD, Complex trauma) Large body of non-Aboriginal research shows that harsh parenting practices among parents suffering from trauma, mental health and SEWB difficulties are transmitted across up to three generations (e.g., Kerr et al., 2009). However, safe, secure and stable parenting practices recently found to be linked across generations and mitigate harsh parenting practices (e.g., Schoefield, Lee & Merrick, 2013). Qualitative research in Aboriginal context supports theories of parenting breaking cycles (Gee, Lesniowska, Santhanam & Chamberlain, in submission)

The Challenges How can we work together to co-design safe, acceptable assessment processes and screening tools that will help identify young Indigenous parents who experience complex trauma - in ways that are sensitive to our cultural needs? How can we we work together to develop culturally grounded therapeutic strategies? Some considerations We need to investigate whether Aboriginal organisations and practitioners currently screen/asses for complex trauma among young parents. And do they have strategies to support healing? Do they? If so, how? What is needed to build capacity? What types of processes and domains of trauma, mental health and Social and Emotional Wellbeing need to be considered?

Some considerations for researchers, trial sites and participants We’ve located 22 screening tools used with young parents that assess (1) trauma exposure (2) trauma symptoms, (3) or both. None were developed with Aboriginal people (some used in Aboriginal populations). We know of one adapted Aboriginal designed trauma measure. The Aboriginal Australian Version of the Harvard Trauma Questionnaire (Atkinson, 2008) - assesses trauma exposure, PTSD, Complex Trauma symptoms and cultural idioms of distress. Recently Complex trauma has been included in the ICD-11 mental health diagnostic system and research demonstrates clear differences from PTSD. Some possibilities for us - adapt a world-wide non-Indigenous measure? further develop the AAVHTQ? build are own measure? What is missing from nearly all of these tools (except the AAVHTQ)? Cultural determinants. THIS KNOWLEDGE EXISTS WITH US, IT DOES NOT EXIST OUTSIDE OUR COMMUNITIES.

Suggested plan so far in steps 1 Ask key people and organisations if and how they currently screen and assess young parents impacted by trauma, and what types strategies and therapeutic practices they use to support young parents to heal. 2 Broadly map current screening and assessment approaches and strategies 3 Review 22 screening tools and the AAVHTQ (listing items and domains) 4 Interview trial sites and key people about assessment and therapeutic strategies 5 Identify any important cultural domains missing from review 6 Develop a preliminary measure consisting of multiple items and domains

Suggested plan so far in steps 7 Form steering committee of Aboriginal practitioners to review screening tool 8 Refine the items to develop a preliminary measure 9 Focus groups with 24-30 parents e.g., one at each trial site (n= 8-10) to review acceptability of the tool, appropriate assessment and explore strategies 10 Validate screening tool via interviews with125 parents (n=40 from each site) (Strengths-based measures could be included to help validate items) 11 Work with trial sites, steering committee and key people to develop a resource that includes the screening tool, assessment approaches and strategies for healing

Today we’d like to ask you about your experiences in screening, assessment and working with complex trauma Group Work Three areas of the room for (1) Screening (2) Assessment (3) Therapeutic Strategies Please form 3 groups of 8-10 people and pick one area to start at Your group will have 25 minutes at each of the three areas Take 10 minutes to yarn together about how you work in this area Take another 10 min to describe on the wall how you work in this area (words, diagrams, pictures, anything you like). As group share with everyone what you’ve come up with

Screening Questions and Tools Strategies for Support and Healing Questions for screening, assessment and strategies for healing complex trauma Screening Questions and Tools Assessment Processes Strategies for Support and Healing Do you or or your organisation use any screening questions or tools to identity whether young Aboriginal parents or clients have been impacted by trauma? If not, why? If so, what questions or screening tools have you used? What do you feel is important to consider in terms of screening questions and tools? Do you or your organisation have any type of structured assessment processes that you use to assess the impact of trauma among young Aboriginal parents or clients? If so, what types of trauma impact do you assess, and how? What do you feel is important to consider in terms of assessment processes? Do you or your organisation use any types of strategies, therapeutic practices or modalities to support young Aboriginal parents or clients to heal from trauma? If so, what are they? What strategies/therapeutic practices and modalities have you found helpful?