A Literature Review - Healing Foundation

1 Page 1 Aboriginal and Torres Strait Islander Healing Programs A LiteratureReview AuthorsJane McKendrick, Robert Brooks, Jeffrey Hudson, Marjorie Thorpe, Pamela BennettAcknowledgementsKelleigh Ryan, Alma Thorpe, Britt Romani, Regina Jagiello page 2 Defining our Healing : a Literature Review Executive Summary This Review summarises existing research on Healing internationally and nationally, highlighting what constitutes an effective Aboriginal and Torres Strait Islander Healing process. This evidence enables the identification of what constitutes an effective Healing program and the gaps in our knowledge that can inform future evaluation and research Literature revealed that to be successful, a Healing program needs to be created within the local context; respond to needs identified by local community members and be supported by the local community.

2 Sustainability needs to be multi-level and include development and transfer of knowledge and resources. This includes strong evaluation frameworks that are consistent with an Aboriginal and Torres Strait Islander world view. The Literature Review has provided an inter-country context for Healing that clearly demonstrates what constitutes an effective Healing program; the interface between Healing and health and the need for quality evaluations that incorporate Aboriginal knowledge systems. The depth of this material enables the Healing Foundation to identify a clear pathway to building and developing the evidence of Healing into the has had a profound impact on Aboriginal and Torres Strait Islander peoples resulting in unresolved trauma, which continues to be passed down through the generations.

3 This is seen in community through lives marked by poverty, lack of educational opportunity, unemployment, poor health , shorter life expectancy, lack of access to services, racial discrimination, and ongoing marginalisation. Aboriginal and Torres Strait Islander communities are Healing themselves through the incorporation of traditional practices and aspects of western methodologies in Healing programs. Effective Healing programsEffective Healing programs show positive impacts on individuals, families and communities in terms of self-worth and identity. The evidence in this Review demonstrates that these have had a positive impact on health status and health disparities (Wallerstein 2006). There are also positive impacts in terms of knowledge and skills acquisition by community members and the development of individual, family and community capacity.

4 To be most effective Healing programs must be sustainable from the beginning. This is achieved by ensuring there is intra- and extra-community capacity, that intra- and extra- community networks are in place, and that there are adequate resources and funding provided to enable long term evidence of the characteristics that result in effective Healing programs are those: developed to address issues in their local community driven by local leadership based upon well-developed evidence and theory base combining both western methodologies and traditional Healing in their treatment theory base informed about and understand the impact of colonisation and intergenerational trauma and grief building upon individual, family and community capacity through the acquisition of knowledge and skills incorporating strong evaluation frameworks With a proactive rather than reactive focuspage 3 ATSI Literature ReviewHealing programs and Aboriginal and Torres Strait Islander systems of healthAchieving optimal conditions for Aboriginal and Torres Strait Islander health and wellbeing requires a holistic and whole-of-life view.

5 This must consider the social, emotional, cultural, spiritual and physical wellbeing of the whole community. This is in contrast to Western medical systems which have a focus on the individual and are disease Healing programs from the United States of America, Canada and New Zealand have more in common with each other than with western health programs. All draw on elements of their Indigenous cultures including the underpinning values and concepts, traditional Indigenous Healing practices and the essence of what it means to live a good life. Common aims of the Healing programs include increasing social and cultural identity and self-esteem, cultural knowledge and skills and cultural connectedness. The focus of the programs is not limited to the individual but extends more widely to the family and the community, with community ownership of programs and building of community capacity.

6 Evaluation of the efficacy of Aboriginal and Torres Strait Islander Healing programsTheorists and practitioners agree that current clinical and biomedical methods are not appropriate for the evaluation of community based Healing programs, and this is supported by the Literature pertaining to community based primary prevention programs. The most common method used is participatory action research (PAR) which values the knowledge systems of the community in which the program is conducted. Unfortunately rejection of the biomedical model and case control studies of efficacy raises some issues around acceptance of the findings of the PAR evaluations. Despite the debate about methodology of evaluation, the findings of evaluations using methods grounded in local Indigenous knowledge together with participatory action research and other qualitative methods are remarkably consistent across programs, tribal groups and countries, making them difficult to reject.

7 Similarly the factors found to be associated with successful Healing programs are similarly consistent across contexts. There is still a need for ongoing development of new methods for the assessment of the efficacy of Healing programs. It is recommended that innovative methods of evaluation be developed to assess early and intermediate success of Healing . These methods should incorporate: a range of definitions of efficacy a range of methodological approaches local social and cultural processes of decision making communities developing their own indicators of success sensitive measures of efficacy such as subjective attitudinal and behavioural changes. Such changes are subtle and occur over time and are not be detected by the relatively coarse clinical measures of efficacy currently Aboriginal and Torres Strait Islander people are to have access to best practice Healing programs further research is imperative.

8 This is evident in the areas of the sustainability of the programs, the transferability of knowledge, and the adaption of programs successful in one locality to other regions. Methodological development is also urgently required using both Aboriginal and Torres Strait Islander and Western knowledge. The futureThe development of Healing centres is emerging as an important approach towards addressing the Healing needs of Aboriginal and Torres Strait Islander communities. In the evaluation of the Canadian Aboriginal Healing Foundation , Healing centres were shown as one of the most effective investments towards positive outcomes for those suffering from the impact of intergenerational trauma and grief. Experts in the field of mental health and wellbeing are calling for an investment in Healing centres in Australia.

9 These investments would seek to address the social and emotional wellbeing needs of Aboriginal and Torres Strait Islander 4 The evidence presented in this critical Review of the Literature pertaining to Indigenous Healing and Healing programs indicates that the establishment of community based Indigenous Healing programs/centres established according to the principles discussed would have positive outcomes for Aboriginal and Torres Strait islander people, families and communities. Aboriginal and Torres Strait Islander communities are looking for ways to facilitate individual and community Healing . At present there is insufficient infrastructure and investment in programmatic design to allow communities to establish effective long-term programs/centres.

10 The emergence of adequately resourced Healing centres within the Australian context would enable communities to develop Healing and social emotional well being responses driven from Aboriginal and Torres Strait Islander world views. ConclusionThis Review points to: the importance of long term sustainable funding for Healing the development of effective evaluation strategies and methodologies as critical to understanding what works and the long term impact of Healing the need for quality programmatic design and theories to guide and develop Healing work nationallyThis Review creates a framework for change by contributing to: 1) the evidence base for Healing ; 2) program logic development; 3) principles and resources needed to establish viable Healing programs.