Indigenous Children and Young People in Residential Care: A Systematic Scoping Review

Abstract

In Australia and internationally, Indigenous children are seriously overrepresented in the child welfare system. This article provides an overview of literature investigating the needs of Indigenous children in residential care facilities. The provision of culturally safe and trauma-informed therapeutic care to Indigenous children and young people in residential care recognizes that the trauma and violence that they have experienced is exacerbated by their Indigeneity due to the colonial histories presenting. Utilizing a systematic scoping review methodology, the study returned a total of 637 peer-reviewed articles that were identified and reviewed for inclusion. The process of exclusion resulted in the inclusion of eight peer-reviewed studies and 51 reports and discussion papers sourced from gray literature. Findings from this study, though dearth, indicate that trauma-informed and culturally safe interventions play a significant role in Indigenous children’s health and well-being while in care. Their experiences of abuse and neglect transcend individual trauma and include intergenerational pain and suffering resulting from long-lasting impacts of colonization, displacement from culture and country, genocidal policies, racism, and the overall systemic disadvantage. As such, a therapeutic response, embedded within Indigenous cultural frameworks and knowledges of trauma, is not only important but absolutely necessary and aims to acknowledge the intersectionality between the needs of Indigenous children in care and the complex systemic disadvantage impacting them.

Keywords

Aboriginal and Torres Strait residential care Indigenous trauma over-representation systemic disadvantage colonization

In Australia, where this study was conducted, the submission to the Senate Inquiry into out-of-home care (OOHC) by Secretariat National Aboriginal and Islander Child Care (SNAICC, 2004) highlights the array of composite factors that have led to the current overrepresentation of Aboriginal and Torres Strait Islander1 children and young people in OOHC. This includes intergenerational trauma caused by assimilatory policies and the dominance of Westernized policies in child protection practice. The most recent national data suggest that, overall, Aboriginal and Torres Strait Islander children were 11 times more likely than non-Aboriginal and Torres Strait Islander children to be placed in OOHC during 2017–2018 (Australian Institute of Health on Welfare [AIHW], 2019). Numerous studies have highlighted that the violent, colonial history, and the intergenerational trauma evident in Aboriginal and Torres Strait Islander communities has had profound impact on their families and communities (Atkinson, 2013; Bamblett & Lewis, 2007; Bamblett, Long, Frederico, & Salamone, 2014; Human Rights and Equal Opportunity Commission, 1997). In his seminal book, Stolen Generation Education, Sheehan (2012, p. 87) stated that “through the institutions of colonialism, Aboriginal identity [becomes] an enforced embodiment of shame…” adding that, “processes that dehumanise and force abject shameful images on [Aboriginal] generations have a deeply negative and enduring impact on social and emotional wellbeing” (p. 87). Atkinson (2002, 2013) also argued that traumatic historical events have continued to influence life experiences of Aboriginal and Torres Strait Islander families in Australia. The challenges thus far remain many and extensive, but there are emerging practices and frameworks that have demonstrated the effectiveness of trauma-informed interventions implemented by skilled, culturally competent practioners (Atkinson, Nelson, Brooks, Atkinson, & Ryan, 2014, p. 16). In Canada, the Mental Wellness framework advocates for a similar approach that recognizes the history of trauma in First Nation communities and the development of healing and wellness practices that are centered on compassion, and prioritization of trauma survivor’s safety, choice, and control (Health Canada, 2015). Acknowledgment of trauma within Indigenous contexts enables a recognition of the complex interaction between intergenerational trauma and adverse childhood experiences and facilitates an integration into policies and procedures that inform everyday practice (Klinic Community Health Centre, 2013).

This article provides a discussion of published and grey literature investigating the needs of Indigenous children in OOHC. This is a timely review given Indigenous children across the world face unique challenges in the child welfare system, and the specific dimensions of this problem are challenging, complex, and multifaceted. It also considers “what works” literature, highlighting promising frameworks and practices in Australia where this study was conducted.

Research Design and Methodology

A Systematic Scoping Review

This scoping review was conducted systematically to assess the quantity and scope of research on the topic of Indigenous children in residential care in Australia and internationally. The method of inquiry employed techniques that are used in systematic evidence reviews, analyzing not the quality but rather the quantity of the research available. These techniques are about identifying a clear question, employing a transparent approach to the search criteria in the databases—using clearly defined and consistent key words and inclusion and exclusion criteria—and then coding and analyzing the final results (Pham et al., 2014 as cited in Pickering & Byrne, 2014; Tilbury & Ramsay, 2018). As an approach and a methodology, systematic scoping reviews are employed to investigate the quantity and the scope of research, as an exercise to identify research gaps and a form of knowledge synthesis that aims to inform future research priorities (Tilbury & Ramsay, 2018, p. 142).

This study’s review was informed by the methodological framework established by Arksey and O’Malley (2003) and more recently applied by Daudt, van Mossel, and Scott (2013). From the overarching research question, “What is the evidence base for therapeutic residential care?” four domains/subquestions were identified to comprehensively guide the inquiry. These questions were as follows:

What are the backgrounds of children and young people in group care and the implications of their backgrounds for their care needs?

What are the needs of Indigenous children and young people in care?

What are the needs of children of diverse backgrounds?

What is known about effective “therapeutic” models of residential or group care?

This article focuses on the research findings of the second domain, which seeks to establish the needs of Indigenous children and young people in residential care.

Inclusion and Exclusion Criteria

In September 2019, the research team, supported by the university librarian, brainstormed the inclusion and exclusion criteria guiding this study. The key inclusion criteria for database searches (which we refer to as Search 1) included peer-reviewed academic journal articles only, published between 2008 and 2018, and written in English. The time frame was selected to focus on more recent research, particularly because the dynamics and the statistics involving children in care are always changing. An examination of gray literature was conducted simultaneously with the systematic review of academic, peer-reviewed literature, and was assessed separately. The gray literature contained information that was unpublished or that which that has been published in nonacademic form or noncommercially. This includes literature found in government documents, research reports, policy statements, issue papers, webpages, fact sheets, and dissertations.

To locate articles exploring the specific needs of Indigenous children in care, we searched eight electronic databases, namely, Academic Search Premier, CINAHL, Expanded Academic Complete, InformIT, Medline, ProQuest, PsycINFO, and Scopus. The following search terms were used to search for relevant titles and abstracts: “Therapeutic residential care” OR “Residential care” OR “group homes” OR “out of home care” AND “child*” OR “youth” OR “young people” OR “looked after children” AND “Aboriginal” OR “Indigenous” OR “First Nations” OR “Torres Strait.” The second part of the search involved exploring gray literature. Reports from key organization websites on Indigenous child and family welfare services were explored. Significant consideration was paid to the Australian, New Zealand, and Canadian and American contexts as those are the jurisdictions that seemed to produce results on Indigenous children in care in Search 1.

In Search 1, we returned a total of 637 articles after the initial scope in all eight databases. All the duplicates across and within the databases were removed, leaving a total of 138 articles. Three researchers screened these titles and abstracts, and interrater reliability checks were performed. We further eliminated more articles after considering the exclusion and inclusion criteria following title and abstract screening, leaving 42 articles. We then read the full texts of the remaining 42 articles and eliminated the ones that did not adequately address fit the context of the study. At this phase, most articles were removed because their focus was Indigenous children and young people in foster care (rather than in residential care). Others were removed as they focused on children and young people placed in residential care due to severe disability and others did not clearly address the experience of Indigenous children and young people. We ultimately retained eight peer-reviewed articles, and the data were entered into EndNote.

Search 2, which included an examination from the gray literature, returned a total of 51 reports, policy briefs, and discussion papers. Some of the key organizations that were searched for gray literature in Australia included Victorian Aboriginal Child Care Agency (VACCA)—Victoria, Child Protection Peak—Queensland, Aboriginal Family Services, South Australia, National Voice for Our Children (SNAICC), the (AIHW), the Healing Foundation, and the Centre for Aboriginal Economic Policy Research. Internationally, particularly in Canada, we looked at the Aboriginal Children in Care Working Groups, First Nations Child and Family Services, and the Canadian Council of Child and Youth Advocates. In the United States, we examined resources from the National Indian Child Welfare Association and the Indian Child Welfare Act. Google was the primary search engine that was used in Search 2 to source key reports, policy briefs, and discussion papers, which might have been missed in Search 1. In addition, the reference lists of key reports and identified articles were manually searched for relevant content. Please refer to the PRISMA chart.

Collating Data

We then carefully reviewed the data, looking for and coding emerging and recurring themes. The overall themes were reread by the different researchers in the team to account for accuracy. The themes with significant commonalities were clustered together. All the articles and reports discussed the overrepresentation of Indigenous children in the child welfare system, the need to develop culturally safe models of therapeutic residential care, the importance of cultural connections and trauma-informed care (Bamblett et al., 2014; Krakouer, Wise, & Connolly, 2018; McDowall, 2016; Raman et al., 2017), the structural and systemic inequalities that affect Indigenous children placed in care (deFinney, Dean, Loiselle, & Saraceno, 2011), and policy, practice, and gaps in OOHC affecting Indigenous children and young people (Douglas & Walsh, 2013; Fernandez & Atwool, 2013). Data also showed some promising practice frameworks and promising policies that are employed within Australia. In total, four dominant themes were identified. These include (1) historical contextualization of removing Indigenous children, (2) the overrepresentation of Indigenous children in care, (3) systemic complexities and challenges, and (4) culturally appropriate and trauma-informed interventions.

Charting the Data

Data were charted through the PRISMA (see Figure 1).

Figure 1.

PRISMA chart.

Results

The search returned a total of eight peer-reviewed articles, while the gray literature search returned a total of 51 reports and discussion papers. Of the eight peer-reviewed articles that specifically explored the needs of Indigenous children and young people in OOHC, six studies provided an Australian context, one provided a Canadian context (deFinney et al., 2011), while the final one provided both an Australian and a New Zealand perspective (Fernandez & Atwool, 2013). Our search criteria included the terminologies “First Nations,” “Indigenous,” and “Aboriginal” hoping to capture more data across the world, but only one study from Canada was returned in our search. Two articles utilized a mixed-method approach (McDowall, 2016; Raman et al., 2017), three utilized a qualitative approach (Bamblett et al., 2014; deFinney et al., 2011; Douglas & Walsh, 2013), and the other three were conceptual arguments and literature reviews (Fernandez & Nicola, 2013; Krakouer et al., 2018; Tilbury, 2009). The discussion of the methodologies used in the papers ranged from minimal to very detailed information. See Table 1 to illustrate the summary of Search 1.

Table 1.

Search 1 (Peer-Reviewed) Results Summary.

Number	References	Title of the Study	Overview of Paper	Country of Origin	Research Methodology	Key Messages From This Research	Implications
1	Bamblett, Long, Frederico, and Salamone (2014)	Building an Aboriginal Cultural Model of Therapeutic Residential Care: The Experience of the Victorian Aboriginal Child Care Agency	This article presents the approach undertaken by an Aboriginal community organisation (Victorian Aboriginal Child Care Agency—VACCA) in developing a therapeutic residential care programme for Aboriginal children in their care		Qualitative (Aboriginal-led framework)	Aboriginal children’s experiences of trauma go beyond the individualistic or familial and incorporate pervasive intergenerational trauma—Contextualizing trauma in Aboriginal children and young people Historical contextualization of colonization and marginalization of Indigenous people in Australia Healing for Aboriginal children requires a therapeutic response embedded within an Aboriginal cultural framework The importance of culturally informed and culturally safe interventions in child welfare systems	Encourage Aboriginal and Torres Strait Islander children and young people to explore their sense of cultural identity as they are more likely to experience positive emotional and physical well-being while doing so Connection to culture is intrinsic to Indigenous well-being and development Connection to community is crucial for identity and for building skills in resilience Crucial for child welfare organizations to concentrate their focus on community cultural engagement and adhere to best interest principles and Aboriginal child placement principles
2	deFinney, Dean, Loiselle, and Saraceno (2011)	All children are equal, but some are more equal than others: Minoritization, structural inequities, and social justice praxis in residential care	This article examines structural inequities facing children and youth in residential care. The paper conceptualized residential care as a site for radical advocacy and social change, tracking the impact of minoritization by exploring links between historical structural inequities and the positioning of minoritized groups as being in need of professional intervention	Canada	Qualitative	Overrepresentation of Indigenous Children and Young people in out-of-home care (OOHC) Systemic challenges such as racism, systemic disadvantage (poverty, poor health, poor education outcomes for Indigenous children) Historical contextualization of colonization and minoritization of Indigenous people in Canada Structural inequalities that lead to overrepresentation of minoritized children in care Indigenizing residential care	Critical unpacking of how minoritization manifests in societies, how they can be dismantled in order to reform trends of Indigenous young people entering residential care
3	Douglas and Walsh (2013)	Continuing the Stolen Generations: Child Protection Interventions and Indigenous People	This study aimed to find how lawyers who work with Indigenous parents in child protection matters in Queensland, Australia, experience their role in this context	Australia	Qualitative	Overrepresentation of Indigenous children and young people in OOHC Systemic, legal and policy challenges that uniquely affect Indigenous children in care Importance of understanding intergenerational trauma, colonization, and Stolen Generation The importance of cultural competence	More support in preparing Aboriginal and Torres Strait Islander parents who are facing ongoing engagement with child protection authorities Improvements to accessible housing for Indigenous families in order to strengthen successful reunification Improvements to public transport in rural and remote Indigenous communities Safe homes for Indigenous children and young people as an alternative to traditional home-based care Adoption of U.S. model whereby the State has to prove that “active efforts” have been made to provide support and services to an “at-risk” family before the child/ren is/are able to be removed Continued support for kinship carers More cultural competency training for caseworkers in child welfare services
4	Fernandez and Atwool (2013)	Child protection and out of home care: Policy, practice, and research connections Australia and New Zealand	This article outlined the early development of care and protection in Australia and New Zealand as a backdrop to an overview of child protection systems and policies and the current child protection profile in both countries. The paper concludes with a brief comparative analysis identifying similarities and differences in child welfare systems in both Australia and New Zealand	New Zealand and Australia	Literature review	Overrepresentation of Indigenous children and young people in OOHC The history of child protection in Australia and New Zealand Policy frameworks informing child protection in Australia and New Zealand Systemic challenges facing Indigenous families and their children who enter care	Improved data collected on children and young people from Indigenous backgrounds living in stable placements More time focused on reunifying children with their families and culture Focused support on young people transitioning out of care and providing ongoing assistance to care leavers Focus on the educational and mental health needs of Indigenous young people in care
5	Krakouer, Wise, and Connolly (2018)	We Live and Breathe Through Culture: Conceptualising Cultural Connection for Indigenous Australian Children in Out-of-home Care	Highlights the vital importance of cultural connection for Indigenous child development. Article states that family connection is crucial in order to strengthen and maintain cultural connection	Australia	Conceptual paper/literature review	Overrepresentation of Indigenous children and young people in OOHC Cultural connection is fundamental to Indigenous identity and well-being but requires family connection if it is to be fostered and strengthened When Indigenous children live in OOHC, family welfare services need to ensure that children are connected to culture Family welfare services need to understand the impact of the Stolen Generation, colonization, and the systemic disadvantage that Indigenous people face The historical significance of culture in the Indigenous Australian context Rethinking more Indigenous-led frameworks of OOHC	Families must be connected in order to obtain successful cultural connection Responsibility of social workers in child and family welfare to ensure Aboriginal and Torres Strait Islander children and young people have access to pathways toward a deeper connection with their community and culture
6	McDowall (2016)	Connection to Culture by Indigenous Children and Young People in Out-of-Home Care in Australia	The paper explored extent to which connection to culture determines the outcomes of Indigenous Children and Young People in OOHC in Australia and to identify mechanisms that might facilitate this connection, including the level of cultural support planning and contact with family members	Australia	Mixed method	Overrepresentation of Indigenous children and young people in OOHC Importance and value of cultural connectedness and cultural knowledge Importance of culturally informed policy frameworks	Caseworkers working with Aboriginal and Torres Strait Islander young people in OOHC need to become more involved in helping them discover the importance of being included in their culture. This can be done via cultural support planning and direct facilitation of connection to culture. Connecting young people with their fathers, if present, could also be useful in enhancing their experience of cultural education Better documentation of Aboriginal and Torres Strait Islander young people’s family history is also crucial
7	Raman et al. (2017)	Taking culture seriously: Can we improve the developmental health and well-being of Australian Aboriginal children in out of-home care?	The paper aimed to identify child, carer, and intervention characteristics that contribute to improved health or development outcomes in children and to identify enablers and barriers to providing culturally competent intervention	Australia	Mixed method	Cultural engagement is a major factor in Aboriginal children’s positive developmental health and well-being Systemic challenges that uniquely affect Aboriginal children in care A trauma-informed and culturally embedded program of therapy and supports, individualized for each child, is essential for Aboriginal children in care Overrepresentation of Aboriginal children in Care Colonization, racism, and historical context of removing Aboriginal children	Further studies measuring the health and service needs of children in stable placement care are needed Cultural engagement needs to be encouraged to further ensure Aboriginal and Torres Strait Islander children’s health and well-being
8	Tilbury (2009)	The over-representation of indigenous children in the Australian child welfare system	This paper examines the levels of disproportionality at key decision points in the child welfare system. The data analysis shows that child welfare interventions are persistently more intrusive for Indigenous children and that levels of disproportionality have not improved over time	Australia	Literature review	Overrepresentation of Indigenous children and young people in OOHC More comprehensive child and family welfare policies and more political goodwill are needed to address Indigenous disadvantage Systemic challenges such as racism, systemic disadvantage (poverty, poor health, poor education outcomes) Historical context of colonization and Stolen Generation Development of community engagement and genuine collaboration with Indigenous communities and agencies as a way of ensuring cultural connectedness and “bridging the gap”	Policies and programs from a community governance framework would likely deliver better outcomes than previous, paternalistic and coercive state interventions which lacked cultural compatibilities with Aboriginal and Torres Strait Islander family and community customs and traditions

Limitations of the Study

There were several methodological limitations. It is likely that the review has not identified all relevant research applying to this study due to our database searches and our search criteria and terminologies. There is also a possibility that research from Australia has been overrepresented due to the search terms such as “Aboriginal” and “Torres Strait” which tend to be very specific to the Australian context. There might be search terms that were not used that could have provided more scope. A third limitation was that only publications in English and only those within 2008–2018 were analyzed.

Presentation of Thematic Findings

That there is such an overrepresentation of Indigenous children and young people globally in the OOHC system is an indication that something in the design and delivery of OOHC interventions does not address critical issues affecting Indigenous families and communities and is very possibly contributing to reproducing their very marginalization and minoritization. Here, we present and discuss the four dominant themes that emerged from the research findings. The key message that is clear from the available literature is that the experiences of Indigenous children and young people are layered with complex historical and cultural nuances. These include (1) historical and structural racism, including the positioning of Indigenous social norms as inferior; (2) forceful removal of children from Indigenous communities and cultural context; (3) persistent structural and system inequity/entrenched systemic disadvantage; and (4) ongoing removal of children linked to aforementioned systemic issues (poverty, domestic violence, unstable housing) leading to overrepresentation in OOHC system and as such the need for appropriate culturally safe interventions.

Historical contextualization of removing Indigenous children

To understand the needs of Indigenous children in the child welfare system, one must consider history and the context in which this discussion is placed. Historical and structural racism, including the positioning of Indigenous social norms as inferior, are just but some of the complex and pervasive colonial histories that still resonate and inform the present experiences of Indigenous people across the world (Human Rights and Equal Opportunity Commission, 1997). The overwhelming message in all the literature located is that the imposition of colonial and foreign laws and policies which forced the separation of children from their families and culture have had a direct significance to the intergenerational trauma experienced in Indigenous families and communities to date. The Bringing Them Home report was the first and most groundbreaking report which clearly exposed the perverseness of the Stolen Generations and the extent of the resulting trauma and damage this had on Indigenous families and communities. Other numerous studies and reports in this review highlighted that the violent, colonial history, and the intergenerational trauma evident in Indigenous communities has had profound impact on their families and communities (Atkinson, 2013; Bamblett & Lewis, 2007; Bamblett et al., 2014).

While theorizing the impact of colonization on Indigenous families in Australia, Bamblett and Lewis (2007) describe Australia as an unsafe and “toxic” environment for Aboriginal people due to the colonial undertones and the domination of Western policies and structures, which are punctuated by racism. The Family Matters report by Lewis et al. (2017) states that the legacies of the Stolen Generation, compounded with ongoing social inequity, political marginalization, and underinvestment in Aboriginal and Torres Strait Islander community “have made things worse, not better.” The Healing Foundation (2017) also reiterates that the displacement and disconnection from culture, language, family, community, and country has caused grief, loss, and sadness which persists to date. The extensiveness and the pervasiveness of the individual and collective loss, grief, and trauma within Indigenous families and communities expose Indigenous children and young people to the likelihood of reexperiencing complex trauma in even more repeated, multiple, and interactive ways (Bamblett et al., 2014). To amend these historical injustices, the Family Matters report by Lewis et al. (2018) has emphasized that for cultural and generational healing to occur, the traumas of colonization, forced removal of children, the historical and structural racism, entrenched poverty, and systemic disadvantage must be addressed. In the Canadian context, deFinney, Dean, Loiselle, and Saraceno (2011) provides a similar theorization. They argue that Canada is “dominated by normative social values and practices that have systematically, over many generations, positioned Indigenous cultural and social norms as inferior” (p. 369). Similar to the Australian history, colonial policies in Canada have previously enabled the forceful removal of children from their families (Downe, 2005). At the present, the historically racist ideologies of the Indian Act inform the contemporary context in which Indigenous children in Canada continue to be grossly overrepresented in child welfare cases and out-of-home placements.

The overrepresentation of Indigenous children in care

Research shows that the rates of overrepresentation of Indigenous children continue to increase across countries and in different jurisdictions. The overwhelming removal of Indigenous children across many developed countries in the West remains well-documented in literature (Fernandez & Atwool, 2013; Keddell & Davie, 2018; McDowall, 2016; Mosher, 2018; National Indian Child Welfare Association, 2007; Valerie & Regina, 2010; Whitesaid et al., 2014). In Australia, the Family Matters report (2018), which measured the trends on the overrepresentation of Aboriginal and Torres Strait Islander children in OOHC in Australia, projected that “the population of Aboriginal and Torres Strait Islander children living in OOHC will more than triple by 2037, and the level of overrepresentation will also increase” if a significant and radical measure to redress this problem is not actualized (p. 6). This means that not only is there a failure to close the gap between Indigenous and non-Indigenous children and young people entering the care system, there is also a failure to arrest the widening of the gap. In Australia, Indigenous children and young people are 11 times more likely to be represented in child welfare, and these numbers are particularly concerning because, despite the fact that the Indigenous population constitute on 3% of the total population, they represent 24% of the children placed in OOHC systems. Krakouer, Wise, and Connolly (2018, p. 265) argued that “the high numbers of Indigenous children currently being observed in out of home care are symbolic and similar to the number of Aboriginal children that were removed during the stolen generation” era.

Looking at the international context, the trends of overrepresentation for Indigenous children in care remain similar. In Canada, Indigenous children and young people are 4.2 times more likely than non-Indigenous children to be placed in care. The study by deFinney et al. (2011) discusses how the minoritization of Indigenous children and young people contributes to their overrepresentation in child welfare cases and out-of-home placements, with Sinclair (2007) describing the high rate at which Canadian Indigenous children are removed as the “Millennium Scoop.” This overrepresentation is often linked to systemic issues including poverty, poor housing, and domestic violence (Canadian Human Rights Tribunal, 2016; Mosher, 2018; Valerie & Regina, 2010). Similar patterns are observed in the United States, with the National Indian Child Welfare Association (2007), reporting that American Indian and Alaskan Native children are overrepresented in the nation’s foster care system at more than 1.6 times the rate of other children. This also remains the case for New Zealand (Keddell & Davie, 2018).

Structural and system inequity: Systemic issues, challenges, and complexities

The overrepresenting of Indigenous children and young people in child welfare systems is not accidental but a result of a complex structural interrelationship between “historical and contemporary macro, meso, individual, and systemic factors” (Krakouer et al., 2018, p. 266). Available literature establishes that there are systemic issues, challenges, and complexities that facilitate the reproduction of the overrepresentation of Indigenous children and young people in care. deFinney et al. (2011) argue that it is necessary to “problematize the systemic minoritization of certain groups of children and youth to understand their over-representation in residential care” (p. 362). Superficial efforts that do not seek to address systemic issues of colonization, marginalization, racism, and structural disadvantage only fall short of any optimum results and instead contribute in reproducing disadvantage and inequality for the most vulnerable communities. The fact that Indigenous children in some countries like Australia are 11 times more likely to be removed from their family is an indication that the problem is not about “problematic individuals” but about a problematic system (McDowall, 2016). Speaking to the systemic nature of the problem in Canada, deFinney et al. (2011, p. 364) state that thinking about the issues affecting Indigenous families and communities simply at an individual level is shortsighted. deFinney et al. (2011) state that structural and systemic inequities have a deep-seated impact on the social reality of Indigenous people. Due to the complexity of marginalization, Indigenous people are more likely to become the outliers to the dominant (White) structures, where they are systemically and systematically excluded socially, politically, and economically. This exclusion results in diminished access to opportunities, employment, education, social services, and child and health-care support services, among other amenities.

The entrenched intergenerational socioeconomic problems; dire poverty; social, economic, and political marginalization; and lack of political goodwill in addressing historical injustices lead to structural inequity. Additionally, the mostly White child–rearing structures that dominate child welfare systems and the unwillingness to accept the diversity of parenting and family structures from Indigenous societies have made a significant contribution to the overrepresentation of Indigenous children in care (Fernandez & Atwool, 2013). As such, acknowledging that the approach toward protecting Indigenous children and young people needs a multipronged approach—one that aims to acknowledge the intersectionality between the overrepresentation in care and the complex systemic disadvantage that is punctuated by both historical and current contexts.

There is an important point made by Tilbury (2009) who argues that sometimes during the framing and naming of the issues, there is often an oversimplification of the problem—also layered with pathologization of Indigenous cultures. Past government policies have attempted to employ strategies to “intervene” on what it views as “bad” culture. Some of the punitive measures employed in Indigenous communities are geared to motivate a move away from the “cultural practices” that are seen to cause harm to children or to “save” Indigenous children from their “problematic” contexts. However, the limitations of this “child saving” approach are palpable, particularly when the connection between higher levels of socioeconomic disadvantage and related problems and the overrepresentation of minority racial groups in the child welfare system is made. Tilbury (2009) urges governments to look beyond the criminalization and pathologization of Indigenous families and communities and instead focus on improving outcomes in health, education, employment, cultural connections, and mental health, in Indigenous communities as a way to ensure a holistic response for families and communities. As Douglas and Walsh (2013, p. 32) argue systemic responses, particularly those that will vastly improve access to culturally appropriate services, will result in more long-lasting solutions that can keep Indigenous children and young in their communities and culture.

Looking at the international context, different countries have moved at different paces due to the laws and policies they have put into place to redress the issues of overrepresentation in OOHC. Countries such as Canada and New Zealand, which are making significant progress (though a lot of work is still needed to bridge the gap between Indigenous and non-Indigenous children), “have been much more willing to consider models involving Indigenous participation and authority in decision making” (Tilbury, 2009, p. 63). Policy redefining and redevelopment is good start, but it needs to be followed by clear implementation plans and should be done in consultation with Indigenous communities in order to address the aforementioned structural and systemic issues.

The importance of culturally appropriate/safe and trauma-informed interventions

Following the systemic challenges and complexities of overrepresentation in child welfare systems, SNAICC (2011) reported that there is a need to provide culturally relevant and safe interventions to curb the overrepresentation in the system. They state that one of the most effective ways to keep Indigenous children at home is to provide cultural care and to support and build the capacity of Indigenous families through a trauma-informed approach, so that they can effectively care for their children in their families and communities. The rationale for developing for culturally appropriate, culturally safe, and culturally informed interventions when working with children from Indigenous backgrounds is documented through literature we sourced with an aim to address the issues of overrepresentation of Indigenous children in care (Aboriginal Child Family and Community Care State Secretariat [AbSec], 2018; Atkinson, 2013; Australian Institute of Family Studies, 2015; Bamblett et al., 2014; Banblett & Lewis, 2007; Healing Foundation, 2017; Klinic Community Health Centre, 2013; Krakouer et al., 2018; SNAICC, 2016; Raman et al., 2017).

The UN Convention on the Rights of the Child (1989) states that an Indigenous child

shall not be denied the right, in community with other members of his or her group, to enjoy his or her own culture, to profess and practise his or her own religion, or to use his or her own language. (p. 9)

In the Working together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice document, Walker, Schultz, and Sonn (2014, p. 197) state that failure to engage in culturally safe practices undermines fundamental cultural and human rights for Indigenous people. There is a need to establish processes and protocols to ensure culturally safe practices that are culturally responsive for diverse Aboriginal community contexts in Australia. Raman et al. (2017), in their article which explores why taking culture seriously in OOCH is important, state that engagement and connection to one’s culture is a significant factor in Indigenous children’s developmental health and well-being in OOHC. They argue that Indigenous children and young people in care who have strong cultural connection and knowledge develop a more grounded and centered sense of “belonging” and identity.

Culturally safe and culturally informed practices and interventions are seen as not only key but also necessary. Culturally informed practice therefore moves beyond competence or even awareness—it is the deliberate deconstruction and reconstruction of societal attitudes, and the development of policies that acknowledge, respect, and enable child welfare agencies to practice effectively and safely within different cultural contexts. Bamblett et al (2014) argue that a culturally informed practice should not just be an add-on to the best interests of the child in care but one that understands that denying an Indigenous child their cultural identity is damaging “to their attachment needs, their emotional development, their education and their health.” This means that merely removing an Indigenous child from harm is not enough and that spiritual and cultural safety should be considered as they are intrinsically linked to the overall well-being of Indigenous children. William (1999) defined cultural safety as:

An environment which is spiritually, socially and emotionally safe, as well as physically safe for people: where there is no assault, challenge or denial of their identity, of who they are and what they need. It is about shared respect, shared meaning, shared knowledge and experience, of learning, of learning together with dignity and truly listening. (p. 213)

This means that OOHC for Indigenous children and young needs to enable the cultural relationships to other Indigenous people, to the land, and to cultural norms and practices (VACCA, n.d.) As established, this sense of cultural safety and respect has a direct link to Indigenous children’s emotional and physical safety while they are in residential care. Put simply, it is important and indeed necessary that Indigenous children and young people in care to “know where they are from, and are taken to visit their ‘country’ to see, feel and experience their land and to meet their own community Elders and members” (Bamblett et al., 2014, p. 209). Important to note is that culturally appropriate interventions need to be trauma informed. This means that a thorough understanding of past and present trauma that continues to affect Indigenous families and communities is necessary. Table 2 highlights the critical findings of this systematic scoping review in regard to Indigenous children and young people in residential care.

Table 2.

Critical Findings From the Systematic Scoping Review.

Critical Findings	Summary
Gap in literature concerning Indigenous children and young people in residential care	The findings from this systematic scoping review which resulted in 8 peer-reviewed articles and 51 reports, statements, and discussion papers from gray literature have established that this is a grossly underresearched area that has been largely ignored by academia and that is of significant concern.
Long-term impacts of European colonization on Indigenous communities	Displacement and dislocation from community, culture, and country has created generations of trauma, grief, loss, and entrenched disadvantage, particularly in the case of child removals.
Overrepresentation of Indigenous children and young people in care	There is a global trend in the overrepresentation of Indigenous young people in the child welfare system (Australia, United States, and Canada, for example). We are not closing the gap, nor are we stopping the gap from widening. Overrepresentation is commonly compounded by broader systemic issues such as socioeconomic disadvantage from poor or no access to education and employment, poor housing, and health and issues around family and domestic violence.
Detrimental impacts of pathologizing Indigenous culture	Past state interventions have removed Indigenous children and young people from their families as a means of “saving” them from cultural practices and customs deemed “unsafe” or “risk-laden” and in the “best interests of the child.” Removals have not contributed to improvements in Indigenous children’s health, safety, and overall well-being. Research has shown that past and current child removals are contributing to extensive damage to their physical and emotional well-being due to their disconnection from their family, community, and culture.
Importance of culturally appropriate and trauma-informed interventions	Not only are culturally safe and appropriate practices crucial for Indigenous children and young people’s health, safety, and well-being, but it is also an important cultural and human right for all Indigenous people (Walker, Schultz, & Sonn, 2014). It is important for child welfare systems to employ strict conditions prior to removing children. Removals should only occur after every effort has been exhausted to work with the child/ren’s family to restore family cohesion, safety and overall well-being prior to removal.
Closing the gap between Indigenous and non-Indigenous children	A focus on early intervention programs is required in order to appropriately implement the priority to ensure that Indigenous families and communities are supported to be in a position to provide their children with safe, supportive environments to grow and develop in. These early intervention and prevention programs are necessary to reverse conditions which lead to family breakdowns, separations, and ultimately removals.
Importance of pathways to safety and well-being for Aboriginal and Torres Strait Islander children	In Australia, this policy direction commits to applying a child-focused approach and an inclusive, collaborative approach which ensures Aboriginal and Torres Strait Islander communities have control over decision affecting the safety and well-being of their young people.

Recommendations for Policy and Practice

The literature identified above establishes that the forced removal of Indigenous children and young from country and from their families and institutionalization and abuse have caused significant trauma to Indigenous families and communities (Healing Foundation, 2017a; Human Rights and Equal Opportunity Commission, 1997; SNAICC, 2015). Although trauma research in relation to Indigenous children and young people children, their families and communities is in its infancy (Atkinson, 2013), some promising practice focused on cultural healing and recovery are gaining momentum. Based on available, published information, 13 approaches were found by this review to be promising but only 3 of these approaches were uniquely designed to respond to the cultural needs of Aboriginal and Torres Strait Islander Children and young people. Given this significant gap in literature, we offer the following recommendations:

Address systemic disadvantage: There should be a systemic response acknowledging that the complex issues impacting on Indigenous families and communities, including domestic violence, poverty, and substance misuse, are connected to intergenerational trauma and from ongoing colonization. Research has already established the link between higher levels of socioeconomic disadvantage and related problems in Indigenous communities and the overrepresentation of Indigenous children and young people in the child welfare system. It is recommended that a systemic change that addresses the underpinning gaps between indigenous and non-Indigenous Children and young people entering the care system is essential. Although this might be challenging, it is a long-term solution, and it is encouraging to observe the emerging promising approaches, practices, and frameworks that offer alternatives and solutions. This gives us a collective sense of hope and appreciation for the efforts that are being made to rectify the issues raised in this review and provides a vision for the future.

Promote cultural safety: Given the centrality of connectedness to culture as part of children and young people’s developing identity, it is recommended that particular care be taken to develop and design therapeutic programs that are strongly culturally contextualized. This may include but is not limited to local indigenous consultancy and governance, local indigenous staffing of programs and explicit opportunities for young people to connect to their culture and community as opportunities for healing and growth. Any practice in child welfare that involves Indigenous children and young people should be centered on and grounded in the acknowledgment of the trauma that has been experienced by Indigenous peoples, as well as the respect and the deep recognition of culture, and Indigenous ways of knowing, being, and doing.

Address trauma (past and present) through healing: As established in this review, historical and ongoing dispossession, systemic marginalization, and racism experienced by Indigenous peoples contribute to collective personal and intergenerational trauma and grief (HREOC, 1997). Atkinson (2013) states that developing trauma-informed services to support Indigenous peoples is an important way to foster healing. She further explains that within these services, knowledge of trauma must set the foundation for service delivery, with core values guiding intervention and support. In addition, when providing trauma-informed care, culturally specific factors must be considered—being most powerful when led, designed, and developed by Indigenous-specific approaches (Atkinson, 2013).

Address racism and discrimination: Historically and currently, the treatment of Indigenous children and young people across many developed countries in the West has been layered with racism and discrimination. Consistent with what AbSec (2018, p. 8) reports, the overrepresentation of Aboriginal and Torres Strait Islander children and families within the child protection system in Australia, and the underrepresentation of early intervention supports is not accidental but a reflection of Eurocentric White-dominated practice that marginalizes Indigenous ways of knowing, being, and doing. The institutionalized racism that informed policies and practices and advocated for the removal of Indigenous children from their families and communities has led to the ongoing fear and suspicion of “the system.” This includes fear of police, justice system, government agencies, social workers, and the media. It is recommended that people working with Indigenous families have a rigorous understanding of how racism impacts the mental and emotional well-being of Indigenous peoples and actively seek to decolonize their knowledge and practice.

Table 3 provides a summary for the implications for future research in this area.

Table 3.

Implications for Future Research, Policy, and Practice.

Research	Policy	Practice
Impact of minoritization of Indigenous communities and how it impacts upon the safety and well-being of the community, particularly its young people	Development of collaborative, inclusive policies which appoints Indigenous communities as leaders of change	Using Indigenous-led frameworks which are informed by cultural responses to systemic challenges
Trauma-informed research practice	Policy should address historical and ongoing dispossession, systemic marginalization, and racism experienced by Indigenous peoples contribute to collective personal and intergenerational trauma and grief	Developing trauma-informed services to support Indigenous peoples is an important way to foster healing
Racism and discrimination in child protection	Policy should prioritize Indigenous ways of knowing, being, and doing. The institutionalized racism that informed policies and practices and advocated for the removal of Indigenous children from their families and communities has led to the ongoing fear and suspicion of “the system.” The undertones of racism continue to be felt in Indigenous communities as far as child protection policies are concerned	People working with Indigenous families have a rigorous understanding of how racism impacts the mental and emotional well-being of Indigenous peoples and actively seeks to decolonize their knowledge and practice
Improved data collected on children and young people from Indigenous backgrounds living in stable placements	Policy development should be informed by what is working in stable placements	Use of a therapeutic response, embedded within Indigenous cultural frameworks, and knowledge of trauma is not only important but absolutely necessary
More participatory action research including the voices of young people when exploring solutions to improving supports for care leavers	Future policy frameworks on transitions from care should be informed by consultations with young people and their communities	Focused support on young people transitioning out of care and providing ongoing assistance to care leavers

Concluding Comments

The findings from this systematic scoping review which considered eight peer-reviewed articles and 51 reports, statements, and discussion papers from gray literature has established that this is a grossly underresearched area that has been largely ignored by academia and that is of significant concern. The findings, though dearth, highlight that in Australia and internationally, Indigenous children are overrepresented in the child welfare system. It has shown that the provision of culturally safe and trauma-informed therapeutic care to Indigenous children and young people in residential care recognizes that the trauma and violence they have experienced is moved beyond “the personal.” It’s systemic and generational. For Indigenous children and young people in care, their experiences of abuse and neglect transcend individual trauma and include intergenerational pain and suffering resulting from long-lasting impacts of colonization, displacement from culture and country, genocidal policies, racism, and overall systemic disadvantage. Although more research is required, findings from this study indicate that trauma-informed and culturally safe interventions play a role in Indigenous children’s health and well-being while in care. For Indigenous children and young people, therefore, a therapeutic response, embedded within Indigenous cultural frameworks and knowledges of trauma, is signposted as not only important but necessary. The approach toward protecting Indigenous children and young people needs a multipronged approach—one that aims to acknowledge the intersectionality between the needs of Indigenous children in care and their complex systemic disadvantage.

To conclude this article, we highlight the importance of using Indigenous-led frameworks, which have been reported to be useful in the efforts to mitigate the current issues that affect Indigenous children in care. A key message from literature, and in particular from Aboriginal and Torres Strait Islander-led organizations in Australia such as SNAICC, is that efforts that do not seek to address systemic issues of colonization, marginalization, racism, and structural disadvantage, and do not promote connection to culture and country, only fall short of any optimum results and may instead contribute to reproducing disadvantage and inequality for the most vulnerable children placed in care. This means that emerging frameworks and policies need to consistently review and reflect on their practice to ensure that Aboriginal and Torres Strait Islander children, and other minoritized children, receive the best and most relevant support while in care. The underpinning message in the majority of the literature sourced (including the gray literature) is that the best and most effective practice in child welfare that involves Indigenous children and young people should be centered on and grounded in the acknowledgment of the trauma that has been experienced by Indigenous people, as well as the respect and the deep recognition of culture, and Indigenous ways of knowing, being, and doing.

Supplemental Material

Supplemental Material, TVA-19-029.R1_Appendix_Table_2-_Summary_of_Search_2-_Grey_Literature_(4) - Indigenous Children and Young People in Residential Care: A Systematic Scoping Review

Supplemental Material, TVA-19-029.R1_Appendix_Table_2-_Summary_of_Search_2-_Grey_Literature_(4) for Indigenous Children and Young People in Residential Care: A Systematic Scoping Review by Kathomi Gatwiri, Lynne McPherson, Natalie Parmenter, Nadine Cameron and Darlene Rotumah in Trauma, Violence, & Abuse

Footnotes

Acknowledgments

We acknowledge that terminologies defining Aboriginality and Indigeneity vary in space and context. In Australia, the commonly accepted term is “Aboriginal and Torres Strait Islander,” while “First Nation” is used in Canada, and “Native” is used in America. This exemplifies the array of diversity in discussion. In this article, some of these terms will be used unambiguously to reflect specific context but generally, the term “Indigenous” will be used broadly to reflect the diversity across different contexts. This systematic scoping review was commissioned by Family and Community Services (FACS), New South Wales, Australia, and undertaken by the Centre for Excellence in Therapeutic Care in January 2019.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by ACF through FACs.

ORCID iD

Kathomi Gatwiri

Supplemental Material

Supplemental material for this article is available online.

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