A Systematic Scoping Review of Indigenous People’s Experience of Healing and Recovery from Child Sexual Abuse
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1.2. Introduction
As part of a preliminary search of the international literature, the researchers identified more than 50 systematic literature reviews, scoping reviews and meta-analyses on child sexual abuse. Of those, only five specifically targeted Australian-only populations [1,2,3,4] with one review specific to responding to Indigenous sexual assault [5]. It is therefore clear that there is a need to review the literature exploring Indigenous understandings and experiences of healing from child sexual abuse.
Given the global scale and impacts of child sexual abuse, it is surprising that currently there is a lack of shared language and consistency across countries and nations with respect to how child sexual abuse is defined and conceptualised. For the purpose of this review, consistent with the World Health Organization [6], child sexual abuse will be defined as the involvement of a child in sexual activity that he, she, or they do not fully comprehend, is unable to give informed consent or is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society.
It is important to recognise that child sexual abuse affects all nations and communities worldwide, and to dispel myths that undermine the fact that Indigenous children are sexually abused by Indigenous and non-Indigenous people alike. Alongside this recognition, child sexual abuse and its ongoing impacts have been an area of concern for Aboriginal and Torres Strait Islander communities in Australia and many Indigenous communities worldwide [7,8] for decades. Several Australian state and territory reports involving consultations with Aboriginal communities that have a specific focus on child sexual abuse have been conducted (e.g., [9,10]). Internationally, numerous other independent and governmental reports at national, state, or territory level with a focus on Indigenous communities demonstrate similar focuses on sexual violence and child sexual abuse [7,8,11]. These reports recognise that no single factor can account for childhood sexual abuse that is experienced in some Indigenous communities, and they draw on various models (e.g., [12]) to identify multiple risk factors that operate at the individual, family, community and national levels. International research demonstrates that across cultures and societies, child abuse is disproportionately reported among families and communities that experience social inequalities and/or political inequality and systemic discrimination, including factors such as poverty and unemployment, poor health, low education attainment, high incarceration rates, racism, and poor access to services (e.g., [13,14,15]).
All of these factors are relevant for Aboriginal and Torres Strait Islander communities and Indigenous communities worldwide, as are other factors linked to systemic violence associated with colonisation, such as the dispossession of land and resources, assimilationist forced child removal and institutionalisation policies, and the subsequent breakdown of kinship systems, traditional culture and lore. Due to these past and ongoing unresolved social justice issues, poor relationships with the police and welfare agencies are common within Aboriginal communities [16]. The mistrust and reluctance of some communities to engage with government agencies mean that the rates of sexual assaults may be higher than some reports suggest (for detailed reviews of violence and trauma in Aboriginal communities, see [17,18,19]). Although the data are limited, there are some data on the extent and impact of child sexual abuse in Aboriginal and Torres Strait Islander communities in Australia. According to data collected by the Australian Bureau of Statistics, in 2020, the rate of sexual assault reported to police among Indigenous children aged 0–14 years in New South Wales, Queensland, South Australia and the Northern Territory was more than twice the rate of reported sexual assault among non-Indigenous children in these jurisdictions (345 reported sexual assaults per 100,000 Indigenous children compared to 170 reported sexual assaults per 100,000 non-Indigenous children) [20].
In Australia, efforts to understand and address the impacts of child sexual abuse within Aboriginal contexts have been mixed. For example, the Australian government’s development and enactment of the Northern Territory Emergency Response following the release of the Ampe Akelyernemane Meke Mekarle Little Children are Sacred report [10] has been highly contested both nationally and abroad [21]. Whilst there was some increased provision of essential services during the intervention, Aboriginal, Torres Strait Islander, and non-Indigenous critics have argued that the Northern Territory Emergency Response violated basic human rights for Aboriginal people in the Northern Territory. For example, the 2010 United Nations Special Rapporteur report on the situation of human rights and fundamental freedoms of Indigenous people concluded that the Northern Territory Emergency Response “was racially discriminatory and incompatible with Australia’s international human rights obligations, and that the Racial Discrimination Act 1975 needed to be reinstated” [22].
Other significant large-scale initiatives in Australia, such as the Royal Commission into Institutional Responses to Child Sexual Abuse [23], which involved many Aboriginal and Torres Strait Islander survivors, have received positive responses from Aboriginal and Torres Strait Islander organisations. The Victorian Aboriginal Child Care Agency (VACCA) designed and delivered a cultural healing program to support Aboriginal survivors who came forward to share their story with the Royal Commission. This was based on survivors’ requests for healing that supported their long-term health and well-being needs and the understanding that clients “either did not access mainstream counselling or where it was accessed, it was insufficient for their healing” [24] (p. 1060).
The values and principles underpinning this cultural healing program were that any program designed to support Aboriginal people’s well-being needed to consider connections to identity, culture, family, community, ancestors and spirituality. The program included activities such as separate men’s and women’s business (i.e., ceremonies); activities to strengthen identity and connection to community; activities related to self-care; healing and well-being activities; sharing knowledge about past policies and histories of removal; discussing the impacts of removal and historical losses; storytelling and ‘yarning’; and sharing of meals [24] (p. 1067).
Black, Frederico and Bamblett (2019) [24] conducted a program evaluation of the cultural healing program and identified several core elements, which included: establishing psychological and cultural safety; the impact of culture in the healing journey (including connection to family, land, spirituality, and cultural activities); engaging the broader community (a whole-community approach including close kinship networks and localised community services and support); survivor empowerment; and understanding past, present and future healing. The authors argue that successful healing programs for Aboriginal child sexual abuse survivors require careful, safe community development processes that can be grounded in evidence-based practices.
The core elements identified by Black, Frederico and Bamblett (2019) [24] are consistent with a cultural framework for addressing child sexual abuse in Aboriginal and Torres Strait Islander communities developed by Milroy, Lawrie and Testro (2018) [25] on behalf of the National Aboriginal and Torres Strait Islander Healing Foundation that included similar key elements, including community-led responses; a holistic approach; connecting to cultural values and systems; healing; justice and reparation; and knowledge creation and sharing. The National Aboriginal and Torres Strait Islander Healing Foundation has defined healing as:
Healing is not an outcome or a cure but a process; a process that is unique to each individual. It enables individuals, families and communities to gain control over the direction of their lives and reach their full potential. Healing continues throughout a person’s lifetime and across generations. It can take many forms and is underpinned by a strong cultural and spiritual base [26].(p. 1)
We note some potential distinctions between resilience, recovery and healing outcomes. For example, prospective studies investigating outcomes for people 12 months after experiencing potentially traumatic events have found resilience trajectories to be marked by minimal impact, whereas recovery trajectories included elevated posttraumatic stress-related symptoms and functional impairment, followed by a gradual return to previous levels of functioning [27]. Within an Indigenous context, Professor Helen Milroy (2009), an Aboriginal psychiatrist, has made a distinction between recovery and healing:
Healing is not just about recovering what has been lost or repairing what has been broken…It can be experienced in many forms…Mostly, however, it is about renewal. Leaving behind those things that have wounded us and caused us pain… with hope for the future, with renewed energy, strength and enthusiasm for life [28].(p. 522)
This understanding of healing includes experiences of recovery (i.e., a return to baseline functioning and reduction in trauma symptoms of distress), but also speaks to other processes of renewal and growth. For this scoping review, we define healing as the experiences of survivors impacted by child sexual abuse that include both processes of recovery and personal growth.
There is considerable cultural diversity within different Indigenous groups and communities. In addition, individual survivors of child sexual abuse may have unique healing needs. For these reasons, there is likely to be variation in the core elements of programs and frameworks that focus on healing from child sexual abuse. As such, there is a need for a systematic examination of the current evidence base for Indigenous healing programs that aim to support survivors of child sexual abuse. Whilst common themes and elements are likely to be identified in the literature, some may have stronger evidence for successful implementation than others. Contextual factors, such as survivor characteristics (e.g., gender, age), intervention type, geographical location, and community settings, may all influence and have implications for the ways in which healing from child sexual abuse is addressed.
Currently, there are no English-language reviews on this topic to the best of the research team’s knowledge. The literature on healing from child sexual abuse in Aboriginal and Torres Strait Islander communities is also relatively limited. As such, there is a need for an international Indigenous-focused scoping review of the current literature to help identify gaps in current knowledge, support future research, and better inform the development of effective therapeutic practices, programs and policies in relation to healing from child sexual abuse. This protocol outlines the methods of a proposed scoping review that will privilege Aboriginal and Torres Strait Islander voices and experiences that address healing from child sexual abuse.
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