Kimberley Ann Jones

Background/objectives: Hospital settings can be unsafe for Aboriginal and Torres Strait Islander peoples, creating healthcare access barriers and perpetuating cycles of inequity. Healthcare service providers play a critical role in improving health equity. The Healing the Past by Nurturing the Future project (HPNF) delivered a training programme that aimed to improve service providers’ awareness, skills, and confidence in providing culturally safe, trauma-informed care. Methods: A mixed-methods evaluation assessed the acceptability and changes in self-reported knowledge, attitudes and practice (KAP) of one-day, face-to-face training sessions delivered at a large tertiary hospital in regional Victoria, Australia, from November 2023 to December 2024. Self-reported knowledge, attitudes, and practices were measured on a five-point Likert scale pre-training, post-training, and three months post-training. Participant perspectives were collected through evaluation forms and analysed using an inductive framework approach. Results: A total of 547 service providers participated in one of 38 training sessions. Responses to a KAP survey designed for this study showed positive changes in self-reported knowledge, attitudes and practice immediately after training that remained after three months among the smaller number of people that completed the survey. Participants expressed a need and desire for the training. Many highlighted new learning relating to Aboriginal and Torres Strait Islander culture, Australian history, colonisation, and the neurobiology of trauma. Conclusions: Aboriginal co-designed face-to-face culturally safe trauma-informed training is highly acceptable for service providers. The HPNF training was followed by positive changes in service providers’ self-reported knowledge, attitudes, and practices in working in a safe and sensitive manner with Aboriginal and Torres Strait Islander peoples. Such training may contribute to changes in health service providers’ capability to provide culturally responsive and trauma informed care. This may reduce healthcare access barriers and contribute to closing the gap in health and wellbeing outcomes and improve health equity.

Issue Addressed: Oppression and violence associated with colonisation have contributed to intergenerational trauma and health inequities for Aboriginal and Torres Strait Islander peoples. Health promotion can help reduce inequities by strengthening connections that support social and emotional wellbeing and enable conditions for communities to lead healthy lives. While culturally responsive health promotion strategies exist, it is unknown the extent to which these account for trauma. Methods: We conducted a narrative review to examine the intersection of evidence describing social and emotional wellbeing, trauma and health promotion for Aboriginal and Torres Strait Islander peoples. Literature was identified between April 2025 and June 2025, with an update performed in July 2026, through iterative searches of Google Scholar, Medline and HealthInfoNet, supplemented by citation tracking of key publications and relevant grey literature. Sources were selected based on relevance to the review aim, with the scope iteratively broadened from trauma‐informed approaches within Indigenous health promotion internationally to include trauma‐informed approaches in health promotion more broadly and health promotion for Aboriginal and Torres Strait Islander peoples. Results: Limited guidance was identified on how to apply trauma‐aware, healing‐informed approaches within health promotion for Aboriginal and Torres Strait Islander peoples. While frameworks exist in trauma‐informed care and health promotion separately, limited evidence of the integration of these two concepts was found. Where integration occurs, the guidance found was largely conceptual and lacks detail for implementation. Conclusions: Recognising the influence that trauma can have on health behaviours and applying trauma‐aware, healing‐informed principles may strengthen the safety, relevance and effectiveness of health promotion initiatives for Aboriginal and Torres Strait Islander peoples. So What?: Continuing to apply health promotion strategies without accounting for the social, historical and cultural impacts of colonisation and trauma may risk disengagement or unintended harm. A trauma‐aware, healing‐informed approach builds on existing culturally responsive, strengths‐based and community‐controlled health promotion by making explicit how trauma shapes health behaviours, which helps create the conditions for healing. This review provides the evidence and conceptual rationale for the development of a community‐led framework to guide the design, implementation and evaluation of trauma‐aware, healing‐informed health promotion for Aboriginal and Torres Strait Islander peoples.

Colonisation and oppression of Aboriginal and Torres Strait Islander peoples have resulted in intergenerational trauma and systemic health inequities, making culturally responsive, healing-informed approaches that uphold self-determination essential. This review aimed to identify and describe healing services for Aboriginal and Torres Strait Islander people affected by trauma, violence or abuse. A four-step search strategy located peer-reviewed studies, grey literature reports and organisational websites (2012-2025). Eighty services/programs were identified across Australia with 15 exemplars included. Most were delivered by Aboriginal Community Controlled Organisations spanning justice, family violence prevention, primary health care, and community services. All exemplars included culturally grounded components such as yarning, storytelling, and time on Country. Evaluations suggested improvements in wellbeing, cultural connection and family and community relationships, though evaluation approaches varied. Synthesis of 31 healing frameworks produced an umbrella framework encompassing three guiding principles and eight service elements, including culturally centred, community-led, and holistic approaches. Exemplar services are aligned strongly with this framework. Healing-informed, culturally-grounded, community-led and flexible wrap-around approaches support wellbeing, cultural connection, and relationships for those affected by trauma, violence and abuse. Findings provide an evidence-informed framework for designing, delivering and evaluating future services, highlighting the need for Indigenous-led evaluation.

Aboriginal and Torres Strait Islander ways of knowing, being and doing have fostered physical, social, and emotional wellbeing for millenia, forming a foundation of strength and resilience. However, colonisation, systemic violence and discrimination—including the forced removal of Aboriginal and Torres Strait Islander children, which continues today—have disrupted this foundation, leading to compounding cycles of intergenerational and complex trauma. The enduring impact of intergenerational and complex trauma is exemplified in increasing proportions of Aboriginal and Torres Strait Islander children being removed from their families and involved in the child protection and youth justice system—which represents a national crisis. Despite this crisis, the national response remains insufficient. To address these urgent issues, over 200 predominantly Aboriginal and Torres Strait Islander stakeholders, participated in Gathering the Seeds Symposium, the inaugural meeting for the Replanting the Birthing Trees project held in Perth in April 2023. This meeting marked the beginning of a public dialogue aimed at Closing the Gap by advancing community-led strategies to break cycles of trauma and foster cycles of nurturing, recovery, and wellbeing for Aboriginal and Torres Strait Islander parents and children across the first 2000 days. We outline critical shortcomings in the current child protection and youth justice systems, and the urgent need for child wellbeing reform. Importantly we highlight recommendations made in submissions in 2023 to two key Australian inquiries—the National Early Years Strategy and the Human Rights Commission inquiry into out of home care and youth justice systems. We argue that structural reforms and culturally safe and skillful care for parents experiencing trauma and violence is a serious gap, and a national priority. The first 2000 days represents a critical window of opportunity to transform cycles of trauma into cycles of healing. It is time to ‘replant the birthing trees’ and ensure that all Aboriginal and Torres Strait Islander babies and families can have the best possible start to life through comprehensive models of care grounded in recognition of the right to self-determination and culture.

Introduction Complex trauma can have serious impacts on the health and well-being of Aboriginal and Torres Strait Islander families. The perinatal period represents a ‘critical window’ for recovery and transforming cycles of trauma into cycles of healing. The Healing the Past by Nurturing the Future (HPNF) project aims to implement and evaluate a programme of strategies to improve support for Aboriginal and Torres Strait islander families experiencing complex trauma. Method The HPNF programme was codesigned over 4 years to improve awareness, support, recognition and assessment of trauma. Components include (1) a trauma-aware, healing-informed training and resource package for service providers; (2) trauma-awareness resources for parents; (3) organisational readiness assessment; (4) a database for parents and service providers to identify accessible and appropriate additional support and (5) piloting safe recognition and assessment processes. The programme will be implemented in a large rural health service in Victoria, Australia, over 12 months. Evaluation using a mixed-methods approach will assess feasibility, acceptability, cost, effectiveness and sustainability. This will include service user and provider interviews; service usage and cost auditing; and an administrative linked data study of parent and infant outcomes. Analysis Qualitative data will be analysed using reflexive thematic analysis. Quantitative and service usage outcomes will be described as counts and proportions. Evaluation of health outcomes will use interrupted time series analyses. Triangulation of data will be conducted and mapped to the Consolidated Framework for Implementation Research and Reach, Effectiveness, Adoption, Implementation and Maintenance frameworks to understand factors influencing feasibility, acceptability, effectiveness, cost and sustainability. Ethics and dissemination Approval granted from St Vincent’s Melbourne Ethics Committee (approval no. 239/22). Data will be disseminated according to the strategy outlined in the codesign study protocol, in-line with the National Health and Medical Research Council Aboriginal and Torres Strait Islander Research Excellence criteria.

Complex post-traumatic stress disorder (complex trauma) describes a cluster of symptoms frequently associated with prolonged exposure to inescapable threats or abuse. For Aboriginal and Torres Strait Islander peoples in Australia impacted by complex trauma, there may be compounding factors, such as experiences of historical trauma, loss and socio-economic deprivation stemming from colonisation. However, there is no culturally appropriate tool to assess complex trauma. This paper presents the psychometric evaluation of a preliminary version Aboriginal and Torres Strait Islander Complex Trauma and Strengths Questionnaire (ACTSQ). Following 2 years of rigorous Aboriginal-led co-design, participants were recruited through community networks and partner health services in South Australia, Victoria, and Northern Territory (October 2020–May 2022). A trained interviewer contacted Aboriginal (n = 109) and Torres Strait Islander (n = 1) parents aged >16 years by phone to complete the ACTSQ. Underlying domain structures were investigated with exploratory factor analysis and reviewed by experts to refine. Reliability and inter-rater reliability were assessed using McDonald’s Omega and Intraclass Correlation Coefficient (ICC). Forty-four items on five factors were retained. Factors were labelled complex trauma symptoms (16 items), grief, loss and disconnection (6 items), support and relationships (9 items), sense of self and strengths (7 items), and Cultural connections and resources (6 items). There were moderate correlations between factors, with the exception of factor 5. Omega was >0.75 for all factors. The inter-rater reliability for each factor was fair to good (ICC 0.5–0.7). This study conducted a comprehensive psychometric validation that provides initial evidence towards the cultural validity of the ACTSQ to support assessment of complex trauma and strengths among Aboriginal and Torres Strait Islander peoples. Future studies are required to replicate and further evaluate the psychometric properties of the ACTSQ using larger samples.

Background Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post‐traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life‐course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. Objectives To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio‐emotional wellbeing. Search methods In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. Selection criteria All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio‐emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. Data collection and analysis Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre‐designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta‐analyses using random‐effects models. Main results We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma‐related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent‐child relationships slightly compared to usual service provision (SMD 0.45, 95% CI ‐0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low‐certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI ‐0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low‐certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self‐harm. Psychological interventions Psychological interventions may result in little or no difference in trauma‐related symptoms compared to usual care (SMD ‐0.05, 95% CI ‐0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low‐certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low‐certainty evidence, SMD ‐0.34, 95% CI ‐0.66 to ‐0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low‐certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low‐certainty evidence). Benefits for parent‐child relationships were very uncertain (26 participants, very low‐certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low‐certainty evidence). No studies assessed the effects of psychological interventions on parents' self‐harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma‐informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low‐certainty evidence). No studies assessed the effects of service system interventions on parents' trauma‐related symptoms, substance use, relationship quality, self‐harm, parent‐child relationships or parenting skills. Authors' conclusions There is currently a lack of high‐quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio‐emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve...

This Aboriginal-led study explores Aboriginal and Torres Strait Islander parents’ experiences of COVID-19. 110 Aboriginal and Torres Strait Islander parents were interviewed between October 2020 and March 2022. Participants were recruited through community networks and partner health services in South Australia, Victoria, and Northern Territory, Australia. Participants were predominantly female (89%) and based in Victoria (47%) or South Australia (45%). Inductive thematic analysis identified three themes: (1) Changes to daily living; (2) Impact on social and emotional wellbeing; and (3) Disconnection from family, community, and culture. COVID-19 impacted Aboriginal and Torres Strait Islander families. Disruption to cultural practice, and disconnection from country, family, and community was detrimental to wellbeing. These impacts aggravated pre-existing inequalities and may continue to have greater impact on Aboriginal and Torres Strait Islander parents and communities due to intergenerational trauma, stemming from colonisation, violence and dispossession and ongoing systemic racism. We advocate for the development of a framework that ensures an equitable approach to future public health responses for Aboriginal and Torres Strait Islander people.

The Coronavirus Disease 2019 (COVID-19) pandemic impacted peoples’ livelihoods and mental wellbeing. Aboriginal and Torres Strait Islander peoples in Australia continue to experience intergenerational trauma associated with colonization and may experience trauma-related distress in response to government responses to public health emergencies. We aimed to develop a culturally responsive trauma-informed public health emergency response framework for Aboriginal and Torres Strait Islander peoples. This Aboriginal and Torres Strait Islander-led study involved: (i) a review of trauma-informed public health emergency responses to develop a draft framework (ii) interviews with 110 Aboriginal and Torres Strait Islander parents about how COVID-19 impacted their lives, and (iii) a workshop with 36 stakeholders about pandemic experiences using framework analysis to refine a culturally responsive trauma-informed framework. The framework included: an overarching philosophy (cultural humility, safety and responsiveness); key enablers (local leadership and Eldership); supporting strategies (provision of basic needs and resources, well-functioning social systems, human rights, dignity, choice, justice and ethics, mutuality and collective responsibility, and strengthening of existing systems); interdependent core concepts (safety, transparency, and empowerment, holistic support, connectedness and collaboration, and compassion, protection and caring); and central goals (a sense of security, resilience, wellbeing, self- and collective-efficacy, hope, trust, resilience, and healing from grief and loss).