Trauma-informed assessment and intervention with Indigenous youth: Exploring the impact of colonisation, culture, and adverse childhood experiences on behaviour

Abstract

The aim of this PhD was to clarify the relationship between adverse childhood experiences (ACEs) and youth externalising behaviour with consideration for cultural differences, and to propose a conceptual framework for trauma-informed supports. A connection between ACEs and youth behaviour has been consistently observed (e.g., Basto-Pereira et al., 2016; Fox et al., 2015; Tsang, 2018). In North America, colonial impacts have increased the risk of ACEs for Indigenous youth (Burnette & Renner, 2017; Gone, 2013; 2023; Serin et al., 2011), who are also overrepresented within the juvenile justice system (StatsCan, 2023). Traditional developmental models of behaviour and delinquency lack a defined role for historical trauma (e.g., Farrington, 2003; Agnew, 2001; Hirschi, 1969), and most interventions inadequately account for cultural differences (Kumpfer & Alvarado, 2003; Thomas et al., 2019).

The research commenced with two systematic reviews. The focus of the first was whether certain ACEs, some of which cultural minority youth may be more likely to be exposed to, were more strongly associated with particular externalising outcomes. The second examined trauma-informed group behavioural interventions, aiming to identify common and effective practices. Three themes were identified in the first systematic review: 1) a consistent association between ACEs and externalising behaviour, 2) disciplines differ in methodology and terminology, and 3) a lack of generalisability. Four themes were discussed in the second systematic review: 1) Externalising behaviour as a poorly defined construct, 2) effective approaches to address externalising behaviours in trauma-affected youth vary, 3) a lack of reference to trauma theory, and 4) limitations to cultural inclusivity. Minimal inclusion of Indigenous participants and consideration for cultural differences were noted across all reviewed studies.

Next, a Delphi was conducted to survey practices in trauma-informed behavioural intervention with culturally diverse youth. Researchers and clinicians (n = 10) with experience addressing externalising behaviour in these populations were surveyed over three rounds regarding best practices across several topic areas. Consensus was reached on essential components of intervention, approaches to expanding cultural understanding and accounting for differences, and barriers to services. Theories consulted to inform practice differed. Overall results suggested common understandings and strategies when working inter-culturally, but little reference to non-Western theories and models.

Study two was designed to address the absence of Indigenous and non-Western perspectives by explicitly seeking input from First Nations people. There were two components: a review of psychoeducational reports and interviews with First Nations and non-Indigenous educators, with most data being collected from on-reserve communities in Northern Saskatchewan, Canada. The reports evidenced the shortcomings of formalised assessment practices in capturing the experiences of First Nations youth (e.g., Dauphinais et al., 2018; Johnson, 1992). Findings from the interviews were examined using Reflexive Thematic Analysis (Braun & Clarke, 2019) with reference to Indigenous methodology (Kovach, 2020). Overall, First Nations and non-Indigenous perspectives differed regarding challenges in behavioural and mental health impacting youth as well as effective approaches to treatment. First Nations participants emphasised more holistic challenges (e.g., related to family and community) and the value of land-based, hands-on activities as treatment. Non-Indigenous contributors spoke more often to students’ individual needs and experiences, emphasising formal mental health services. Responses aligned with previously observed differences in worldview (e.g., Kirmayer, 2007; Linklater, 2017).

The third study was designed to examine the relationship between treatment preferences and individualist and collectivist attitudes (Triandis & Gelfand, 1998). American and Canadian participants (n = 405) from five ethnic groups (i.e., Asian; Black; First Nations, Inuit, Metis, or Indigenous (FNIMI); White; and “I describe my ethnicity in another way” [IDAW]) were recruited using Prolific. Participants rated the helpfulness of and categorised (e.g., engagement vs. diversion) a selection of activities identified previously as useful to address trauma and behavioural symptoms. ACEs, intergenerational trauma, and treatment experience were also queried. Women, FNIMI, and IDAW participants reported significantly more ACEs. A Latent Class Analysis (LCA) indicated five classes: 1) Polyvictimised racialised women, 2) Emotional and observational adversities in racialised groups, 3) Non-racialised polyvictimisation, 4) Racialised low-adversity, and 5) Non-racialised low-adversity. Activity helpfulness ratings were somewhat associated with individualist or collectivist beliefs, with collectivism predicting higher helpfulness ratings for community events, cultural activities, or religious ceremonies.

The programme of research culminated in the Framework for Relational and Reflexive Assessment and Intervention for Trauma (FRRAIT). It encourages practitioners and researchers to 1) practice reflexivity, 2) query differences in worldview, 3) prioritise relationship building, 4) consider alternatives to Western assessment and healing approaches, and 5) account for the impact of historical trauma.

Finally, limitations and avenues for future exploration were outlined. Concerns including representativeness of sampling and recruitment strategies and the cultural relevance of the applied methodology are highlighted. Researchers and practitioners are encouraged to continue challenging Western-centric epistemology and methodology alongside opposing the clinical and political status quo that restricts engagement with Indigenous ways of knowing and healing.