Abstract
Background and PurposeBecoming a parent can be an exciting and also challenging transition, particularly for parents who have experienced significant hurt in their own childhoods, and may be experiencing ‘complex trauma.’ Aboriginal and Torres Strait Islander (Aboriginal) people also experience historical trauma. While the parenting transition is an important time to offer support for parents, it is essential to ensure that the benefits of identifying parents experiencing complex trauma outweigh any risks (e.g., stigmatization). This paper describes views of predominantly Aboriginal stakeholders regarding (1) the relative importance of domains proposed for complex trauma assessment, and (2) how to conduct these sensitive discussions with Aboriginal parents.Setting and MethodsA co-design workshop was held in Alice Springs (Central Australia) as part of an Aboriginal-led community-based participatory action research project. Workshop participants were 57 predominantly Aboriginal stakeholders with expertise in community, clinical, policy and academic settings. Twelve domains of complex trauma-related distress had been identified in existing assessment tools and through community consultation. Using story-telling and strategies to create safety for discussing complex and sensitive issues, and delphi-style methods, stakeholders rated the level of importance of the 12 domains; and discussed why, by whom, where and how experiences of complex trauma should be explored.Main FindingsThe majority of stakeholders supported the importance of assessing each of the proposed complex trauma domains with Aboriginal parents. However, strong concerns were expressed regarding where, by whom and how this should occur. There was greater emphasis and consistency regarding ‘qualities’ (e.g., caring), rather than specific ‘attributes’ (e.g., clinician). Six critical overarching themes emerged: ensuring emotional and cultural safety; establishing relationships and trust; having capacity to respond appropriately and access support; incorporating less direct cultural communication methods (e.g., yarning, dadirri); using strengths-based approaches and offering choices to empower parents; and showing respect, caring and compassion.ConclusionAssessments to identify Aboriginal parents experiencing complex trauma should only be considered when the prerequisites of safety, trusting relationships, respect, compassion, adequate care, and capacity to respond are assured. Offering choices and cultural and strengths-based approaches are also critical. Without this assurance, there are serious concerns that harms may outweigh any benefits for Aboriginal parents.
Highlights
Becoming a parent is an exciting time, but it can be a challenging transition, for parents who have experienced maltreatment in childhood and continue to experience complex trauma
While many participants noted the importance of talking with Aboriginal parents about complex trauma, there were concerns about asking direct questions and extensive comments about the importance of having discussions in a way which was respectful, caring and understanding
This study aimed to understand perspectives of predominantly Aboriginal key stakeholders involved in supporting Aboriginal parents experiencing complex trauma regarding; the importance of proposed domains for inclusion in an Aboriginal Complex Trauma Questionnaire, and why, by whom, where and how these discussions should be held
Summary
Becoming a parent is an exciting time, but it can be a challenging transition, for parents who have experienced maltreatment in childhood and continue to experience complex trauma. Essential criteria specify that any screening or assessment process must be acceptable to the population and that the benefits outweigh the harms (Wilson and Jungner, 1968; Department of Health, 2018) This is important for Aboriginal parents following a legacy of harmful policies which have led to family disruption and increased rates of intergenerational or complex trauma; and fostered an environment which is highly sensitive about assessment of complex trauma, within perinatal care services. We report on an innovative combination of Aboriginal leadership, participatory design and methods to elicit the perspectives of key stakeholders working with Aboriginal parents regarding complex trauma assessment in the perinatal period. Using story-telling and strategies to create safety for discussing complex and sensitive issues, and delphi-style methods, stakeholders rated the level of importance of the 12 domains; and discussed why, by whom, where and how experiences of complex trauma should be explored
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