Protocol to implement and evaluate a culturally secure, strength-based, equine-assisted learning ...
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Australian Aboriginal people experience stressors that stem from inequalities across life situations, including deep and entrenched disadvantage and exclusion [1\u20133]. The impact of unaddressed childhood trauma is permeating and intergenerational. The 2005 Western Australian Aboriginal Child Health Survey (WAACHS) findings suggest that 35.3% of assessed Aboriginal children lived in households where at least one carer experienced forced separation from their natural family [4]. Carers from these households were nearly twice as likely to be arrested or charged with a crime and 1.61 and 2.1 times more likely to report alcohol and gambling issues, respectively. Although the WAACHS data is almost twenty years old, the high rates of over-representation of Aboriginal young people in the WA's out-of-home care and youth justice systems suggest the past keeps impacting Aboriginal Australian communities. Aboriginal young people account for an estimated 55% and 64% of all young people in out-of-home care and under youth justice supervision, respectively [5\u20137]. In 2020, the unequal positioning of Aboriginal children in Australia was shown by an incarceration rate 17 times higher than Australian youth of all other ethnicities combined [8]. Of concern is that although Aboriginal children comprise 6% of the Australian population aged 10\u201317, daily on average (between June and August 2020), they comprised 48% of those in youth detention [8]. An Australian study on a remote Indigenous community in the Fitzroy Valley, in WA, found the highest rate of Foetal Alcohol Syndrome Disorder (FASD) reported in the literature: 12%-19.4% [9,10]. Young people with FASD are over-represented in youth justice settings; a prevalence of 36% was reported in a youth justice setting [11], the highest documented rate worldwide [12]. Medication use for conditions such as FASD and Attention Deficit Hyperactivity Disorder is alarmingly high in Aboriginal communities [13], as is the rate of suicide [14,15]. Suicide in Aboriginal males in WA is twice that in non-Aboriginal males (48.6 deaths vs. 20.2 deaths per 100,000 population), and three times worse in Aboriginal females (21.0 deaths vs. 6.7 deaths per 100,000) [16]. Reducing suicidal behavior and deaths by suicide in Aboriginal Australians is of significant concern in many communities and is a recognized bipartisan public health priority [16,17].
The situation of aboriginal children and young people in the Kimberley region of Western Australia (WA)
The 2019 State Coroner's Inquest into the deaths of a cluster of 13 Aboriginal children and young people in the Kimberley region of WA between November 2012 and March 2016 found that the cause of death for all 13 cases was a result of ligature compression of the neck (hanging), with 12 deaths due to suicide and in one case an open finding was made [18]. Five children were between 10 and 13 years old, three aged 16 or 17, and the remaining were young adults aged 18 and 24 [18]. WA’s Coroner, Ms. Fogliani, described the deaths as “profoundly tragic, individually and collectively” [18]. The Inquest concluded that the underlying conditions, life events, and behaviours of these children and young people in the Kimberley signal the prolonged exposure to intergenerational trauma and poverty, including complex home environments, poor school attendance rates, little to no involvement with mental health services, and recurrent experiences of grief and loss, with several children belonging to families who had previously lost a close family member to suicide [18]. The term ‘complex home environment’ is used to describe multifaceted factors that, when combined, diminish the ability to care for children and young people, hindering their ability to thrive and develop according to the broader expectations of Australian society. The Inquest laid bare the deep inequalities in remote Aboriginal communities in the Kimberley region. A recurrent theme throughout the Inquest concerned Aboriginal people’s desire to be consulted on matters that affect them and that purported solutions are not imposed upon them without consultation. Recommendations from the Inquest urged government agencies and services to acknowledge the importance of culture and inclusivity embedded in cultural healing for Aboriginal children, young people, and communities and to adopt a more collective and inclusive approach in developing and implementing programs targeting youth mental health in the Kimberley [18].
Trauma and human development
Convergent developmental and neurobiological evidence suggests that prolonged or repeated exposure to adverse childhood events can lead to a traumatic response defined by often profound dysregulations of social and emotional functioning [1,2]. The capacity to learn and concentrate, develop trust and reciprocal relationships and use self-soothing or calming strategies to regulate behavior is impaired in children who have experienced trauma, including intergenerational trauma [19,20]. Trauma leaves indelible footprints on the brain. Functional Magnetic Resonance Images show changes in the amygdala, hippocampus, corpus callosum, cerebellum, and prefrontal cortex [21,22].
The limbic system encompasses various brain structures situated above the brainstem and beneath the cortex, including the hippocampus and amygdala, which are integral to emotion and memory [23].
The amygdala, often called the brain's alarm center, is pivotal in the response and memory of fear and the regulation of emotions. When faced with a threatening situation, the amygdala initiates the body's emergency survival mechanisms (fight, flight, freeze, or fawn response) [24]. Given its crucial role in our reactions to danger and the retention of emotional memories, individuals with a smaller-than-average amygdala may exhibit inadequate responses to stimuli. Chronic early-life stress is linked to alterations in the amygdala. When individuals with an atypically developed amygdala perceive a threat, they may experience intensified fear responses, anxiety, and flashbacks [25].
The hippocampus is responsible for forming new neural connections and storing memories, and it plays a role in regulating stress hormones. Traumatic events can cause this region to lose volume, leading to difficulties in memory recall. Damage to this area can impair the formation of new memories and increase stress hormone levels, further hindering memory recall [25].
The corpus callosum serves as a conduit, connecting the left and right hemispheres of the brain, and undergoes significant development in children aged three to six years. This development is related to attention and behavioural planning. In children aged six to thirteen, the corpus callosum continues to develop significantly in relation to language and memory [26], potentially explaining language impairments observed in some traumatized children [27].
The cerebellum, located at the back of the brain, is the most neuronally rich region of the brain and is involved in processes such as motor control, language, working memory, cognition, and emotion [26,28]. Decreased cerebellum volume has been observed in children with a history of trauma exposure [29]. Researchers suggest that reduced cerebellum volume may contribute to disturbances in language, working memory, and cognitive abilities, such as planning [26,28].
The prefrontal cortex is critical for mature cognition. Trauma significantly reduces activity in this brain region, leading to difficulties with memory and attention, emotional and behavioral regulation, and inhibition, personality, decision-making, abstract reasoning, and learning [29,30]. Traumatized children and young people respond to their environment with limited access to the resources in their prefrontal cortex responsible for thinking, logic, analysis and problem-solving. Such alterations often manifest as problem behaviours in school, including aggression against self and others, difficulties establishing interpersonal relationships, substance use, depressive disorders, and suicide [19,20,23,31].
Experiences of trauma stay in the body [32] after the stressful or traumatic situation has passed. Trauma impacts the body's physiological systems, particularly the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS). The HPA axis regulates the body's stress response, releasing cortisol during stressful situations. Chronic trauma exposure can dysregulate this system, leading to either hypercortisolemia (excess cortisol) or hypocortisolemia (insufficient cortisol), both of which can have detrimental effects on health [33].
The ANS, which controls involuntary bodily functions, also shows dysregulation in trauma survivors. The sympathetic branch of the ANS, responsible for the 'fight or flight' response, can become overactive, resulting in chronic stress and anxiety. Meanwhile, the parasympathetic branch, which promotes 'rest and digest' functions, may be underactive, contributing to difficulties in relaxation and recovery [34]. These physiological responses reflect how trauma can alter bodily functions, perpetuating a state of heightened arousal