Trauma Aware and Anti-Oppressive Arts-Health and Community Arts Practice: Guiding Principles for Facilitating Healing,Health and Wellbeing

Abstract

There is a growing call for arts-health and community arts professionals to work in ‘trauma informed ways’ to prevent re-traumatisation and promote healing. This paper reports on a scoping review of existing literature that deal with trauma aware and informed practice and its applications in arts-health and community arts. Trauma informed practice does not seek to target or treat trauma but, rather, seeks to provide a safer and more informed space for people who experience post-traumatic stress conditions and symptoms to engage in facilitated arts activities. We particularly examine the extent to which existing literature acknowledges the presence of oppression-related collective trauma – such as racial trauma – and offers appropriate creative, anti-oppressive and trauma aware practice approaches. A total of 19 articles were included following librarian input and team checking. Included articles were written in English, published in peer reviewed academic journals, included a creative arts component, and adopted an intentional trauma informed or aware approach to practice. An additional three sources were included as part of descriptive synthesis to foreground leading First Nations resources for practice. Although no specific guidelines for trauma aware practice in arts-health or community arts were found, findings are consolidated at the end of the paper to offer interim principles, values and activities for trauma aware and informed practice in arts-health and community arts. Findings can also inform general trauma related research and therapy by highlighting the growing role of arts and creativity in responding to diverse experiences of trauma and its effects.

Keywords

trauma informed arts and music healing health,and wellbeing oppression collective trauma

Introduction

This paper aims to contribute to the fields of arts and health (henceforth arts-health) and community arts by reviewing existing interdisciplinary literature combining any form of intentional anti-oppressive and trauma aware practice with arts activity. The field of arts-health is broad and can range from professional, regulated art, dance and music therapy in clinical health settings through to arts based educational and health outreach, community arts and social development, and broader social justice agendas that utilise the arts as a resource (Clift & Camic, 2016; Moss, 2016). Arts-health professions include artists and arts-therapists working across diverse settings such as ‘hospitals, schools, community centres, prisons, the natural environment or urban streets’ (Raw et al., 2012, p. 97).

Regulated arts-health workers – such as music and art therapists – often work alongside other health clinicians using evidence informed approaches to practice (Raw et al., 2012, p. 97). Yet, many arts-health and community arts workers operate outside clinical settings using ‘informal or intuitive styles of practice… [across] any artform… towards a vast range of health, aesthetic and social outcomes’ (Raw et al., 2012, p. 97). We include community arts alongside arts-health in this review to recognise proven healing, health and wellbeing benefits that can accrue from communal arts activities, whether or not a tributary health and wellbeing outcome is sought (Clift & Camic, 2016). We also recognise that musical activities intended to support participants’ healing, health and wellbeing will not always accrue positive results and may produce negative outcomes (Bergh & Sloboda, 2010; Lenette & Sunderland, 2016; Moss, 2020). For example, Moss (2020, np) found that music and art therapy service user’s ‘arts preferences and needs’ were often neglected ‘due to arts practitioners focus on their own practice needs and recognition of their identity within the diverse field’. In their study of music in conflict settings, Bergh and Sloboda (2010) found that multicultural music and art projects can focus on differences and, as a result, not bring people together. A critical and reflexive approach is therefore crucial to understanding music and art project outcomes (Lenette & Sunderland, 2016; Robertson, 2010).

The authors of this review come together as diverse collaborators to explore existing knowledge on trauma aware and informed approaches to arts-health activities. Sunderland is a proud descendant of the Wiradjuri First Nations People of Australia, an interdisciplinary arts-health researcher and community musician. Stevens is a trauma informed practitioner, trauma sensitive yoga teacher and lecturer at Griffith University. Knudsen is a research assistant and medical student particularly interested in trauma informed care and creative therapies. Cooper is a proud descendant of the Warrimay/Worimi First Nations People of Australia, visual communication designer and practice-based researcher. Wobcke is an Indigenous midwife, artist and researcher who acknowledges the Turrbal and Jagera people from the land where she was born. While the review seeks to inform arts-health and community arts practice in particular, findings can inform any trauma related research and therapy by highlighting the growing role of arts and music in responding to highly diverse experiences and contexts of trauma. Likewise, while we draw on First Nations cultural frameworks and rationale for trauma aware and informed practice – due to leading resources from those communities – our review is intended to be relevant to diverse cultural and intercultural contexts. We first provide background to the review by discussing what we mean by healing, health, wellbeing and trauma aware and informed practice. We then outline the methodology used to conduct a scoping review of relevant literature. We present and discuss the findings of that review before discussing those findings and highlighting key principles for creative, anti-oppressive and trauma aware practice in arts-health and community arts arising from the review.

Background

Healing, Health, and Wellbeing

We use the connected terms healing, health, and wellbeing in this paper to expand the ways that trauma specialists, arts-health and community arts researchers and practitioners might conceptualise connections between arts activity and health and wellbeing. Authors of international arts-health literature typically define health according to the World Health Organisation’s (WHO) long-standing definition of health as a ‘state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO, 1946/1995, p. 1). In that context, ‘[w]ellbeing refers to a positive rather than neutral state, framing health as a positive aspiration’ that has both individual and societal causes and effects (Health Knowledge, n.d., np).

While the WHO definition of health asserts an aspiration toward wellbeing across physical, mental and social domains, we find that the concept and practice of healing provides a potentially more holistic paradigm for health and wellbeing that creatively incorporates body, mind, spirit and environment that can be linked to diverse cultural traditions and spaces, particularly those who have experienced profound historical and ongoing marginalisation such as First Nations Peoples. As the Healing Foundation in Australia describes:

Healing gives us back to ourselves. Not to hide or fight anymore. But to sit still, calm our minds, listen to the universe and allow our spirits to dance on the wind … [and] drift into our dreamtime. Healing ultimately gives us back to our country. To stand once again in our rightful place, eternal and generational. Healing is not just about recovering what has been lost or repairing what has been broken. It is about embracing our life force to create a new and vibrant fabric that keeps us grounded and connected’ (Healing Foundation, n.d., np)

We argue that the agentic and restorative notion of healing ‘giving us back to ourselves’ is important in the context of anti-oppressive, and trauma aware practice in arts-health and community arts as we will explore throughout this paper.

Trauma

Professional understandings of trauma were established in the fields of medicine, neuropsychology, counselling, and psychiatry. At earlier times, a person could be pathologized based on their experiences of particular traumatic events or experiences with resulting diagnoses of conditions such as post-traumatic stress disorder (PTSD) (Van der Kolk, 2014). Recent understandings of trauma are not as focused on adverse experiences or events per se but, rather, on the internalised or shared response a person or community has in relation to an event or experience. As Gabor Maté (in Maurizio Benazzo & Benazzo, 2021, np) states, ‘[t]rauma is not what happens to you but what happens inside you as a result of what happens to you’. Trauma responses, then, are the aftereffects of an experience that shape personal health and wellbeing, in particular feelings of safety (Gerge & Pedersen, 2017).

Traumatic experiences and responses are diverse and complex. Traumatic stress can result from a single traumatic experience, a series of events, or a prolonged period in an individual’s or community’s life. While individuals can experience traumatic events and associated negative stress, entire families, communities and societies can be affected either through direct experience or ‘vicarious’ and intergenerational traumatisation through relationships with or proximity to those who have experienced trauma (Atkinson, 2002; Gorst-Unsworth & Goldenberg, 1998). Existing research shows that traumatic experiences can deeply affect family and social relationships. For example, research with people who experienced forced migration has shown that psychological distress associated with traumatic experiences is often heightened by changes in family dynamics and increased relational conflict during resettlement (Karageorge et al., 2018, p. 304). At the same time, family and community support and healing are often protective factors in navigating the effects of trauma on individuals (Atkinson, 2002; Simich et al., 2003).

Lapum et al., (2019, p. 566) confirmed that trauma ‘is often communicated through the body via physical ailments, particularly when words are insufficient to capture an individual’s experience or when adequate processing of the trauma is not possible due to profound stress’. Hence, both subtle and overt aftereffects of traumatic experience can become deeply embodied experiences that require embodied opportunities to heal (Atkinson, 2002). Ongoing traumatic stress has been associated with ‘hyperarousal’ and attention problems that can affect sufferers’ learning and other abilities when their brain is in ‘survival’ mode (Macfarlane et al., 2019). Hyperarousal refers to a primary symptom of post-traumatic stress where a person’s body can be suddenly ‘kicked into high alert’ in the form of fight, flight, freeze or faint in response to situations that are perceived as similar to a previous trauma event (Healthline, n.d., np). Even though actual danger may not be occurring, ‘the person’s body acts as if it is, causing lasting stress after a traumatic event’ (Healthline, n.d., np). In such cases, finding ways to regulate an over-stimulated nervous system becomes paramount to healing, health and wellbeing.

Trauma Aware and Informed Practice

Fields such as education and social work have developed trauma aware and informed approaches to practice that are open and responsive to the potential presence of trauma in any human interaction whilst not being exclusively focused on it (Knight, 2015). Additionally, leading cultural organisations such as the Healing Foundation in Australia advocate the need for trauma aware practice across all services and professions that interface with First Nations People. Various terms have emerged to describe trauma aware or informed practice including: trauma sensitive practice; trauma integrated practice; trauma responsive practice; and trauma informed care. We use the connected terms trauma aware and trauma informed practice in this paper to emphasise the need for a background awareness of trauma alongside active trauma informed ways of responding that can be useful in diverse arts-health and community arts settings. We use the dual terms as a way of, ideally, making this practice approach accessible to diverse arts-health, community arts and other practitioners who use creative and arts based approaches.

Fallot and Harris (2009) suggest a range of reasons for adopting trauma-informed practice as a default approach: trauma is pervasive; trauma is very broad and impacts on many life domains; the impact of trauma is often deep and life-shaping; violent trauma is often self-perpetuating; trauma is insidious and preys particularly on more vulnerable members of our community; trauma can affect how people approach helpful relationships; trauma could have occurred in service contexts; and trauma affects staff members as well as consumers in health and human service programs. Essentially, trauma aware and informed services focus on avoiding re-traumatising people who are engaging with the service including staff (Fallot & Harris, 2009). Service delivery that is not trauma-informed can contribute to staff burn out, bullying and ‘toxic’ workplaces (Bowie, 2013).

A trauma aware and informed approach to practice in any discipline, profession or context ‘changes the common question “What is wrong with you?” to the more relevant “What happened to you?”’ (Oehme et al., 2019). Trauma-informed practice seeks to prioritise ‘physical, emotional and cultural safety, as well as the client’s choice, self-determination, collaboration and control over their treatment’ (Arthur et al., 2013; Harris & Fallot, 2001 as cited in Lapum et al., 2019, p. 567). Trauma-informed practice does not require participants to disclose traumatic experiences but, instead, seeks to provide safety and personal power by creating an environment based on an understanding the effects of trauma for individuals (Arthur et al., 2013; Lapum et al., 2019). An organisation, profession, arts program or individual that implements trauma-informed practice therefore sets the intention of ‘safety first’ and commits to ‘do no harm’ (Bowie, 2013).

Music and the arts have been a popular and growing medium for responding to trauma and promoting trauma responsive spaces and practises internationally (see Atkinson, 1994; Barney & Mackinlay, 2010; Dieterich-Hartwell & Koch, 2017). Bloom (2010, 198) observed the fragmenting effects of trauma on individual and community sense of self and argued that ‘[f]rom ancient times to the present, artistic performance in all its variety has been connected to healing of self and community’ and ‘is as a primary integrating mechanism for traumatised individuals and groups, without which human beings may not be able to fully heal’. Not all arts activities, however, will automatically be therapeutic or welcoming for people who have experienced trauma and its ongoing effects (Moss, 2020). Apart from related research and practises in the field of music therapy, such as therapeutic songwriting (Baker, 2016; Baker et al., 2008), there is sparse literature offering specific research on, or frameworks for, trauma aware or informed practice in arts-health and community arts. A promising recent development in the area is UK based PhD candidate Katherine Birch at York St. John University who is developing trauma-informed approaches to community music practice (Birch, 2020).

Anti-Oppressive Practice and Collective Trauma

Since the 1990s, fields such as social work have developed anti-oppressive practice as an important response to collective experiences of marginalisation and oppression across axes of identity such as sexuality, ability, culture and socio-economic status. The purpose of anti-oppressive practice in social work has been described as

securing social relations which endorse social justice… sustaining a people-oriented social environment which allows each person, community or group to develop their full potential whilst cherishing their cultural traditions and respecting the rights and dignity of others. Moreover, there is a refusal to endorse a hierarchy of oppressions and a commitment to recognising diverse identities as being on an equal footing (Collins, 1990, in Dominelli, 1998, p. 6).

Since Dominelli’s early work, researchers have extended anti-oppressive theory and practice to include concepts of ecological justice alongside social justice: that is, to subvert human oppression of non-human species and nature alongside the forms of oppression that occur between human beings (Ramsay & Boddy, 2017).

Researchers, professionals and activists are starting to combine anti-oppressive theory and practice with understandings of collective trauma. A key purpose of this paper is to draw arts-health and community arts research and practice into those discussions. While the term collective trauma was originally used to describe societal or mass trauma relating to natural and human disasters, it also describes the distinct trauma experienced by groups who experience systemic oppression (Krieg, 2009). Racial trauma, for example, is recognised as a form of collective or mass trauma. Comas-Díaz et al. (2019, p. 1) describe racial trauma as ‘People of Colour and Indigenous individuals’ (POCI) reactions to dangerous events and real or perceived experiences of racial discrimination’. Such experiences may include ‘threats of harm and injury, humiliating and shaming events and witnessing racial discrimination toward other POCI’ (Comas-Díaz et al., 2019, p. 1). Although racial trauma can be similar to posttraumatic stress conditions, it is ‘unique in that it involves ongoing individual and collective injuries due to exposure and reexposure to race-based stress’ (Comas-Díaz et al., 2019, p. 1).

In framing this scoping review, we therefore emphasise that experiences of collective trauma must be interpreted with a deep and growing understanding of historical and ongoing dynamics of oppression. We apply that lens as part of our interpretation and review of existing selected literature. This is primarily because being culturally, politically and economically marginalised and disadvantaged greatly increases individuals’ and groups’ likelihood of experiencing complex and intergenerational trauma (Comas-Díaz, et al., 2019). As Harden, Mann, Edwards, List & Martinson (2015) observed, for example, minority youth in low-income urban communities are far more likely to experience community violence on more than one (i.e. on many) occasion(s) than those who live in relatively affluent and majority population neighbourhoods. Not coincidentally, such groups are often a focus for arts-health and community arts programs and activities.

Complex oppression-related collective trauma is often experienced intergenerationally. As First Nations’ Elder and intergenerational trauma specialist Aunty Judy Atkinson (1994, p. 10) describes:

...trauma, layering itself from the first waves of colonisation, may result from ungrieved family deaths and injury from introduced diseases, starvation because of economic (land) dispossession; overt physical and sexual brutality covert structural violence including forced removal of people to reserves and the separation of children from their parents; and the psychological and physical suffering which has been the Indigenous experience in the colonising process.

Yet, oppression-related collective trauma is not always intergenerational. As Kelly et al. (2020, p. 1522) found, for example, ‘[c]ollective trauma in queer communities differs from trauma in communities of colour in a variety of ways; most notable is the lack of intergenerational transmission of community history in queer communities’.

Methodology

This paper reports the findings of a collaborative, interdisciplinary scoping review of how trauma aware and informed practice is being practised and conceived of in arts-health and community arts settings internationally. Intentionally trauma-informed approaches to promoting healing, health and wellbeing through arts-health and community arts appear to be relatively new. Therefore, it was decided to use a scoping methodology, which is useful to rapidly map the key concepts underpinning emerging research (Mays, 2010), regardless of study design. The review was based on Arksey and O’Malley’s (2005) scoping approach, involving four phases which are outlined below.

Phase 1: Identifying the Research Question

Authors 1 and 2 were involved in all stages of the review and collaborated to identify the research questions. The scoping review sought to examine these guiding questions:

1. How are arts-health and community arts professionals and researchers implementing trauma aware and informed practice in their work?

2. Which guiding principles for creative, anti-oppressive and trauma aware practice emerge from existing literature?

Phase 2: Identifying and Selecting Relevant Studies

Authors 1-3 developed the search approach in consultation with two research librarians as recommended in Arksey and O’Malley’s (2005) scoping approach. It was collectively decided to search six databases, three with a health/science focus (Scopus, Psycinfo, CINAHL) and three with an arts and music focus (Music Periodicals, Music index, JSTOR). Selection of search terms involved preliminary screening of search strings for relevant results. It was decided to use ‘trauma-informed’ and like terms to limit the scope, as it was only desired to find papers specifically using that approach. By contrast, the terms for ‘arts’ and ‘music groups’ were many and a wide approach was used. Searches were limited to key fields (differing slightly by database) such as keyword, headings, title, and abstract. Results were limited to journal articles only to determine the degree of existing research evidence available for trauma informed practice in arts settings or that used arts activity as a significant component of activity. Results were also limited to English language [post-search] to avoid the cost and time necessary for translation. No date limits were used due the relatively small number of articles retrieved from the initial searches.

Excluding duplicates, non-journal articles, and papers not published in English language, 396 papers were identified in the database search. The title and abstract of these papers were screened for relevance by Authors 1–3. A total of 81 full-text articles were then screened by Knudsen for eligibility, with 62 being excluded for reasons including discussion of therapies not naming a trauma informed approach, discussion of therapies or interventions not related to the creative arts and discussion of broader theoretical concepts with no direct relevance. A total of 19 articles were included for full review with an additional three added during interpretive synthesis to supplement known First Nations resources in the review. Figure 1 presents the outcomes of the scoping review phases.

Phase 3: Charting the Data

Data charting was completed by Authors 1 & 2 and involved discussion of key information from included studies such as publication details (author(s), year of publication, study location), intervention type and duration, study populations, study aims, methodology, outcome measures, and important results.

Phase 4: Collating, Summarising, and Presenting Results

Authors 1 and 2 collated data into a narrative account of existing literature. Authors 4 and 5 entered this process to offer intercultural and inter-arts perspectives and visualise the outcomes of the scoping review as presented in Figure 2 later in the paper.

Findings

Selected articles that met inclusion criteria were primarily from art therapy, music therapy, drama therapy, arts in psychotherapy, social work, psychology, education and criminology journals with one article from American Music. Relatively few articles were found that adopted trauma aware or informed approaches in focused arts-health or community arts journals. Findings of the review are presented under thematic headings below.

Oppression-Related Collective Trauma

Our review indicated that there is little explicit attention to the role of oppression in producing and reproducing individual and collective trauma. Notable exceptions included Harden et al.’s (2015) work with young people in minority communities who experienced community violence and Muenzenmaier, Margolis, Langdon, Rhodes, Kobayashi & Rifkin’s (2015) work with women experiencing serious mental illness. Karageorge et al.’s (2018) work with ‘newly resettled refugees’ acknowledged the collective nature of trauma experienced by people who experience forced migration, but an overt critical or anti-oppressive approach was not evident. Muenzenmaier et al. (2015) combined a trauma informed approach with the critical concept of intersectionality to acknowledge the layering up of traumatic experiences that can occur due to race, gender, ethnicity, socioeconomic status, immigration and severe child abuse. Citing Knudsden (2006), Muenzenmaier et al. (2015, p. 142) state that ‘intersectionality provides an integrated and overarching picture of how gender, class, race, ethnicity, disability and sexuality among other identities interact and affect a person’s mental health’. In taking an intersectional approach to trauma informed practice, Muenzenmaier et al. (2015) acknowledge the ways that cultural, political, economic and historical inequities can produce intergenerational patterns of trauma and its effects in families and communities.

Citing Sajnani (2012, p. 186), Muenzenmaier et al. (2015, p. 149) argued that ‘creative arts therapies enable an embodied, affective and interpersonal responsiveness to change, amidst suffering, against oppression and as an experience in social justice’. By combining creative arts-based trauma informed practice with intersectionality theory, Muenzenmaier et al. (2015, p. 142) sought to create an ‘integrated’ understanding of, and response to, the person receiving care. They argued that it is critical to include ‘the dynamic interplay of gender, race, culture, minority status, low socioeconomic status (SES), disability, recent migration history, poverty, violence and oppression within the therapeutic relationship’ (p. 142).

Background Awareness of Trauma and Its Effects

A key aspect of trauma aware or informed practice in the literature was developing an informed background awareness of both trauma and the specific experience of people with whom we work. As indicated above, in Muenzenmaier et al.’s work, mental health professionals and arts workers were asked to generate a critical background awareness of the intersectional and overlapping nature of political, cultural, historical and economic disadvantage that may affect participants. In such cases workers may ask and educate themselves around questions such as how gender and religious inequity might have affected or reproduced a person’s experience of trauma or how poverty and racism has generated a socially constructed vulnerability to traumatic experiences. Such self-education and reflection is repeated as a key quality of effective allyship discussed by Goodman (2011).

Lapum et al., (2019) emphasised that practitioners should have a sound knowledge of the ‘psychological, neurological, biological, social and spiritual effects that trauma and violence can have on individuals’ (Lapum et al., 2019, p. 567). In their 10-week trauma-informed hip-hop dance program for young people aged 11–17 who had experienced abuse or exposure to violence, Lapum et al. (2019) required all researchers and program facilitators to receive training in both trauma and research skills. This included a ‘basic understanding of child abuse, violence and trauma, as well as their legal responsibilities with regard to the duty to report suspected child abuse’ and ‘an introduction to the adaptive functions of trauma-related symptoms and behaviours, how to support youth who have experienced trauma, and a discussion about vicarious trauma as well as the supports that are in place to prevent and address vicarious trauma’ (Lapum et al., 2019, pp. 570–571)

Karageorge et al. (2018, p. 309) emphasised that professionals who work in trauma-informed ways have a ‘broad mandate of care’ due to the complexity of people’s experiences and needs. In those cases, workers’ trauma-informed practice involved keeping ‘the broader refugee context in mind’ when dealing with clients (p. 309). Workers in Karageorge et al.’s study reported that ‘potential negative effects of traumatic experiences were “always in the back of our minds”’. Therefore, workers approached everyone through a trauma-informed lens of ‘how our sensitivity helps the client to feel safe and open up’, and ‘always being respectful’ that a person who may have never discussed their trauma may be ‘finally’ seeking help or an opportunity to share their experiences.

In the context of child adoption, Malloy (2017, p. 137) advocated that art therapists must know ‘how to work with trauma, attachment and loss, and … possess skills to effectively support clients through the uncertain nature of the permanency planning process’. Such studies suggest that arts-based workers should develop an awareness of: a) the life contexts and experiences that may generally shape arts program participants such as migration or foster care; b) the systems that surround arts program participants; and c) the nature of trauma and its potential effects on arts program participants.

Systems and Communities of Care

Several articles examined the ways that workers could support their clients and themselves through systems and communities of care. For example, Malloy (2017, p. 135) advocated a trauma-informed approach that ‘strives to align all caregivers in the child’s life and encourages collaboration with providers and legal personnel to determine the best placement decision for the child’. Music and other arts activities are often used as one part of wider responses to trauma and its effects. For example, a multi-institution Student Resilience Project in the United States provided students with trauma informed options for music therapy, music-based relaxation and expressive writing alongside resources from positive psychology and web-based outreach (Oehme et al., 2019). That project adopted a trauma informed approach to promoting higher education participation and success for young people who had experienced trauma. Music and inter-arts activities and professionals were part of broader interdisciplinary and interprofessional system of care within and across higher education institutions.

In their Culturally Informed Trauma Integrated Practice approach, Australian First Nations’ community organisation We Al-li Australia advocate for self-reflexive ‘communities of care’ in trauma informed practice and community healing (Atkinson et al., 2017, p. 12). The Community of Care approach can be an extension of the inter-professional ‘systems of care’ discussed by Malloy (2017) and others that has the added benefit of caring for workers as they care and support others. Communities of care can be important within organisations or networks offering arts and music programs to people who have experienced trauma and offering safe and sustainable workplaces or professional networks for facilitators.

In a different way, Palidofsky and Stolbach (2012) found that collaborative theatre in incarceration settings for young women created a new sense of community between participants, opportunities for self-presentation and agentic reconnections to broader external communities. The program aimed to create ‘a community where all members have the power to collaboratively shape the product through writing and performing’ and highlighted ‘the universality of participants’ trauma histories by presenting these histories transformed as works of “art” to the community’ (Palidofsky & Stolbach, 2012, p. 240).

Holding Space and ‘Giving’ Care

Atkinson et al., (2017) emphasise the importance of ‘holding space’ in healing work from a First Nations’ culturally informed and trauma integrated perspective. Holding space generally means that we generate a safe, non-judgemental and non-directive context for others to self-heal: that is, we do not seek to ‘fix’ others but facilitate spaces where they can make self-directed choices for their own healing, health and wellbeing. In holding space, we again enact the qualities of effective and humble allyship as described by Goodman (2011). Such practises are an important part of avoiding retraumatization for First Nations and other people who have experienced profound abuse and dislocation of personal agency and control due to historical and ongoing dynamics of colonisation (Goodman, 2011).

Malloy (2017, p. 137) emphasised that arts workers and therapists can provide a unique space for ‘holding’ participants’ who have experienced trauma and, by extension, their personal stories. Malloy (2017) discussed the role of art therapists in care-giving for individual clients or program participants. Citing Malchiodi (2014), Malloy (2017) emphasised that the act of providing art materials, for example, can be experienced by participants as a gesture of non-verbal care-giving. Access to caring environments and arts materials can provide both verbal and non-verbal opportunities for participants to ‘express’ and release’ embodied trauma and related stories. Hence, arts workers and therapists can perhaps uniquely demonstrate and give care through the sensitivity and materials they bring to creative encounters with others.

Mindfulness, Embodiment and Grounding

Selected literature indicates that arts and creativity can help those affected by trauma to reconnect with their body, regulate the nervous system, and develop mindful relationships with themselves, others, and the natural environment (Atkinson et al., 2017; Lapum et al., 2019). Further, Lapum et al., (2019) examined trauma informed dance programs as a form of expression and release when participants could not or did not wish to speak about traumatic experiences. Dance offered a non-verbal, deeply embodied response to trauma and its effects for participants. Existing research indicates that young people involved in body movement-based activities have experienced lower depression, anxiety and psychological distress (Grijalva & Vasquez, 2019). The purpose of providing a somatic approach to working with trauma is to provide an opportunity for people to reconnect with their bodies as a method of self-regulating and expressing. Offering participants a safe space to notice themselves and how they physically respond to sensations is a method in teaching self-awareness and inviting the person to reconnect with themselves.

Culturally informed trauma integrated practises often link embodiment to arts practice and mindful experience of ‘Country’ which is a special Australian First Nations’ term for mother Earth, the natural environment and ancestral lands (Atkinson, 1994). We Al-li facilitators, for example, open group healing and training sessions by encouraging facilitators and participants to practice grounding and Dadirri or ‘inner deep listening’ modelled on Northern Australian Elder and artist Miriam Rose Ungenmerr’s (1993) description as follows:

Dadirri, a special quality, a unique gift of Aboriginal people is inner deep listening and quiet still awareness. [It] recognises the deep that is inside us all. It renews us and brings us peace. It makes us feel whole again. In our Aboriginal way we learnt to listen from our earliest times. We could not live good and useful lives unless, we listened.

We Al-li facilitators emphasise mindful and quiet listening to others who wish to share personal stories of trauma in any creative form. Dadirri extends that mindful listening to include mindful connecting with living Country, which holds spiritual and cultural significance for many First Nations and other people. We Al-li facilitators always have a range of art and craft materials available for participants to access during workshops and as part of trauma mapping and storytelling activities (Atkinson et al., 2017). Participants can tell and listen to stories while playing and working with art and craft materials. Such accessibility provides multimodal and multi-arts opportunities for grounding, body-mind-emotion-spirit release and self-regulation while attending to potentially challenging topics.

Promoting Cultural and Personal Safety

Promoting safety for participants and staff is a common theme in the literature reviewed. Selected articles traversed diverse territory from promoting cultural safety through to referral pathways for therapies and supports. In the hip hop dance program with young people discussed by Lapum et al. (2019), facilitators established safety through the following measures: check-ins if a participant was absent from a session without notice; emergency resources and supports for participants who may require trauma therapy; normalising if a participant shared a story about previous traumatic experience and validating stories that were shared; enquiring if participants would like to set time aside to check-in with a trauma therapist at the end of the dance session. If an immediate safety crisis occurred, for example if a young person was unable to regulate their emotions and discharged those emotions using physical or verbal violence, an onsite trauma therapist would assess the situation and activate additional service referrals as needed (Lapum et al., 2019). During dance sessions, facilitators provided ongoing choices to participants such as whether or not to close their eyes and be standing, sitting or lying down for some activities. Facilitators also established a shared signal with the group if someone felt the need to step out of the room (Lapum et al., 2019). A key foundation of that program is that young participants are not ‘asked about their trauma’ (Lapam et al., 2019, p. 572). Instead, the program is designed ‘from a trauma-informed approach in which the focus is on dance’ (Lapam et al., 2019, p. 572).

In refugee resettlement, Karageorge et al., (2018) observed the importance of ‘bicultural’ workers in refugee support programs who shared deep cultural knowledge with and of participants alongside commitment and compassion for participants (p. 310). Creatively combining culturally familiar and ‘safe’ activities such as music making, cooking or sport with unfamiliar or challenging tasks can be a way of safely extending participants’ threshold for discomfort. Karageorge et al. (2018) found that culturally familiar interest-based group activities were supportive for people who experienced forced migration related trauma and ongoing relational trauma during resettlement. The groups allowed participants to ‘get to know each other, to come out of their spaces and to know the community’. Karageorge et al. (2018, p. 309) found that for men in particular, the groups ‘provided an alternative to more isolated behaviours, such as alcohol dependence, as a means of coping...’.

In their systematic review of school-based interventions for young people exposed to traumatic events, Yohannan and Carlson (2019) concluded that trauma intervention literature often does not account for diverse group experiences of trauma and related supports. They recommend that ‘there are eight dimensions that need to be considered when working with diverse youth and families: language, persons, metaphors, content, concepts, goals, methods and contexts’. However, in our view, Yohannan and Carlson (2019, p. 459) problematically claim that through those dimensions ‘the practitioner thoroughly understands the cultures of those they are working with and how this can impact intervention outcomes’. We observe that such an approach, from an anti-oppressive perspective, could breach the intent of trauma aware or informed practice entirely by retraumatizing diverse participants who have experienced collective trauma via cultural genocide, theft, appropriation and exclusion.

Workers in Karageorge et al.’s (2018) study also developed referral pathways as part of safety. Even if they could not directly help a participant with a particular need, workers tried not to turn clients away, recognising that some clients may be approaching another for help for the very first time. In such cases, workers would listen to clients, let them know about the programs on offer, and suggest pathways to receive support (Karageorge et al., 2018, p. 309). Likewise, Palidofsky and Stolbach (2012, p. 241) found that a theatre program with young, incarcerated women formed a ‘gateway’ to therapy and new decision-making skills. This was primarily achieved through a post-show interaction where audience members and the young, female actor/writers could ‘replay’ scenes from the show to explore different decisions and new endings. Palidofsky and Stolbach (2021, p. 241) claimed that ‘[r]eplaying the scenes with different endings reinforced the notion that there are always alternatives’ and provided opportunities for the young women to explore emotional and other consequences of choices.

In their evaluation of a ‘holistic’ healing program that included a substantive creative arts and crafts component with incarcerated women, Praetorius et al. (2017) found that women most valued these aspects of the program: ‘intentionality, process[ing] feelings, discovery of self-worth, solidarity, justification of programming elements and emotional safety’. Notably, the program asked women to journal about their experiences as part of the program evaluation. Based on that work, it appears that creative activities such as arts, crafts and journaling can sit productively alongside other trauma supports such as life skills and PTSD education to assist in recovery.

Incidental and Informal Counselling

Incidental and informal ‘counselling’ emerged as both a valued and challenging dynamic of trauma aware and informed practice. Karageorge et al. (2018) spoke about the ‘accidental’ and ‘informal’ counselling that bicultural trauma-informed support workers undertook. In Karageorge et al.’s study, workers were prepared for those situations and had supporting networks for referring program participants for in depth counselling and support. In contrast, Frydman and Pitre (2019) found that educators working with children and young people who have experienced trauma are often required to work beyond their professional skill level when attending the to the social-emotional needs of students (Frydman & Pitre, 2019). As a result, Frydman & Pitre (2019) found that underprepared teachers could experience occupational stress and burnout when teaching and working with students who had experienced trauma. Their findings suggest that, due to lack of training, educators had minimal confidence in offering social-emotional support to students and struggled in defining the difference between teaching and offering social and emotional support. Such outcomes indicate the potential risks of diverse professionals working with trauma survivors when they are not adequately supported to do so.

Worker Wellbeing

Selected articles covered important topics relating to worker wellbeing such as secondary trauma and the need for self-care and supervision. Alisic (2012) for example, found that facilitators’ well-being may be at risk when they are consistently working with participants who have a trauma history. Such experiences could trigger facilitators’ own trauma or result in secondary (vicarious) trauma. Frydman and Pitre (2019) define secondary trauma as the exposure to working with people who have experienced trauma, and the result is behavioural and emotional responses that can be the result from being exposed to others’ trauma. Some of these challenges have been described by Frydman and Pitre (2019) as reduced energy in the classroom, unhealthy behaviour responses (self-medicating, self-harm), difficulty in maintaining concentration, decision-making, hypervigilance, less tolerance for student’s needs, withdrawing from collegial supports and an overall lower motivation in professional performance. Frydman and Pitre (2019) suggest that high workloads, management of groups and classrooms and engaging with student’s adverse experiences heighten staff vulnerability to secondary trauma.

The importance of clinical and peer supervision and support for trauma-informed workers was discussed across several articles. For example, bicultural workers in Karageorge et al.’s (2018) study of refugee family support emphasised the importance of reflective practice, clinical supervision and peer support to ensure that workers continually ‘grew’ (p. 311). Workers in that study met with a program coordinator fortnightly for team supervision and debriefs to ‘reflect on challenging aspects of care’. Their accounts suggested that ‘group debriefing and discussion is an important aspect of the work, both for the mental health management of the professionals, and for workforce development opportunities’ (Karageorge et al., 2018, p. 311). Recommendations in supporting educators in working with students who have experienced trauma are approaches such as cognitive-behavioural therapy (CBT), mindfulness and relaxation, social-emotional skills, psychoeducation, social support and professional development (Frydman & Pitre, 2019).

Discussion

In this scoping review, we found that professionals from diverse disciplines are adopting arts-based or arts inclusive methods for working with people who have experienced trauma and, in some cases, who are still exposed to situations that may increase trauma such as incarceration. Our focus on anti-oppressive and trauma aware and informed arts-health and community arts practice and policy mirrors ongoing research in the field of public health advocating for ‘social ecological’ responses to health inequity by tackling known political, social and cultural determinants of health (Golden & Wendel, 2020). Essentially, those approaches to health promotion advocate for collective and societal level responses to individual experiences of disease and ill health, including mental health. The same can be true when responding to experiences of oppression related collective trauma.

While there was some recognition of oppression-related collective trauma in the reviewed literature, we found that there is a general and problematic understatement of the need for trauma aware approaches to also be anti-oppressive. As Audergon (2006) states, [a]lthough trauma is usually examined as an individual experience, it is a collective dynamic. Whole communities are traumatised and dynamics of trauma involve all of us and affect the course of history. An orientation to understanding trauma is needed that is at once personal, communal and political.

Based on this review, traumatic experiences often emerge from social disadvantage and exclusion that may or may not be experienced intergenerationally (Krieg, 2009; Goodman, 2011; Harden et al., 2015; Lubitow et al., 2020). Collective trauma, such as racial or gender-based trauma, is experienced unevenly by social groups who experience other forms of disadvantage such as poverty, social exclusion, racism and homophobism (Crenshaw, 2017). If trauma responses are focused on individual traumatic experience alone, professionals may risk retraumatising individuals who have experienced collective oppression. An example of how such retraumatisation can occur was evident in Yohannan and Carlson’s (2019, p. 459) uncritical recommendations regarding cultural competence critiqued earlier in this article. Hence, the ‘background awareness’ of trauma described as a key component of trauma aware and informed practice (Karageorge et al., 2018; Lapum et al., 2019; Malloy, 2017; Muenzenmaier et al., 2015), must include ongoing professional self-education on the nature, history and extent of oppression related collective trauma participants may have experienced (Goodman, 2011).

Muenzenmaier et al. (2015) adopted an intersectional approach to gender when working with women, a group affected by both collective and intergenerational trauma (Atkinson, 2002; Covington, 2008; Moreton-Robinson, 2021). We agree that an intersectional approach to gender responsiveness in trauma work is vital in anti-oppressive and trauma informed approach: that is, recognising not only the effects of gender but, also, how it intersects with other sources of collective trauma such as racism, gender and sexual diversity, poverty and ableism (Crenshaw, 2017; Moreton-Robinson, 2021). As increasingly recognised in literature, trauma and gender responsive approaches must also move beyond binary norms to reflect gender non-binary and diverse LGBTIQ+ people’s disproportionate experiences of abuse and violence in communities, policy and institutions (Allen, 2019; Hunt, 2018; Kelly et al., 2020; Messina et al., 2019).

Anti-oppressive and trauma informed practises are particularly important in health and wellbeing contexts that have traditionally limited gender identity to binary sex-assigned at birth (i.e. male female). For example, Author 5 Wobcke’s work as a trauma informed and arts-inclusive midwife has historically focused on creating a culturally safe environment for marginalised young Indigenous mothers. However, it has become key to evolve to an anti-oppressive, trauma informed, culturally safe and arts-inclusive approach which recognises that those who give birth may not identify as ‘female’ (Allen, 2019; Wilson, 2014; Wobcke, 2015). Such an approach, which spans intersections of gender, age and culture, requires arts and health professionals to respect and hold space for multiple aspects of diversity including gender fluidity and expansive cultural understandings of human spirituality and wellbeing beyond physical health (Eckersley, 2007; Wobcke, 2015). Doing so, responds to growing evidence of the intergenerational effects of mothers’ childhood and during-pregnancy-trauma on their babies and children (Tu et al., 2021).

Edwards (2017) argued for creative arts therapy professionals to adopt trauma informed approaches to working with all people. That category of regulated arts therapists does not, however, cover the growing range of artists and musicians reflected in this review and current conceptions of the arts-health workforce which include regulated art and music therapists alongside professional and community artists and musicians (Moss, 2020). Given the growing role of the arts – and artists – in trauma responses, it is important to consider how arts and creative industries education and training can contribute to, or prevent, re-traumatising individuals. For example, trauma aware and informed creative professionals are in a position to intervene into the debilitating impact of the ‘colonised aesthetic’ of mainstream documents, resources, forms or policies that are not creatively designed in a way to engage or respond to the needs of First Nations People and others who experience cultural exclusion and erasure (Fforde et al., 2013; Neath, 2012; Sunderland et al., 2020).

Such trauma informed and anti-oppressive representation and inclusion links to universal human rights declarations and movements. As stated in the Universal Declaration of Human Rights, a person has the right to personal safety and freedom from torture and degrading treatment (Mersky et al., 2019). Emphasising that trauma is not only a breach of Human Rights but is acknowledged as events that are disproportionately impacted on different members of society. Different adverse childhood experiences are disproportionately affected in economically disadvantaged groups, suggesting trauma is a social and economic issue that needs to be addressed (Mersky et al., 2019). As a society, addressing this inequity to combat the impact of trauma in our more vulnerable groups is imperative. To facilitate a universal social policy to consider trauma informed practice in all levels of government, education and non-government service providers to truly capture and honour the impact of trauma related experiences would be a positive contribution in reducing, minimising or preventing long term effects of harm to potentially vulnerable and economically disadvantaged groups.

Resources for Policy, Practice and Research

Outside of arts-health and community arts, there is a large academic and grey literature that provides frameworks and models for trauma informed policy and practice across professions. Practice guidelines established by a leading Australian training and support organisation The Blue Knot Foundation, for example, suggest core principles of trauma-informed care include ‘safety’, ‘trustworthiness’, ‘choice’, ‘collaboration’ and ‘empowerment’ (Kezelman & Stavropoulos, 2012). To supplement such resources, we have distilled key principles for creative, anti-oppressive and trauma aware practice that emerged from our review. Table 1 summarises the key principles, values and activities that emerged. Figure 2 then presents a creative visualisation of how we see those principles, values, and activities layering as a resource to support art-health and community arts practice. We observe that using such visuals is a trauma-aware response which recognises the need for soothing, culturally expansive and non-textual resources (Malchiodi, 2020).

Table 1.

Critical findings: Principles for anti-oppressive and trauma aware practice in arts-health and community arts.

Principles	Values	Examples of Activities	Sources
Care-giving	•Caring approach	•Offering food and drink	Muenzenmaier et al., 2015
	•Consideration	•Sharing art materials
	•Compassion	•Soothing environment and amenities, for example, chairs and accessible facilities for diverse participants
	•Understanding	•Offering support as relevant, for example, assistance with travel to attend programs
	•Acceptance	•Attention to diverse individual needs and experiences	Frydman & Pitre, 2019
	•Equity	•Mindful and deep listening	Frydman & Pitre, 2019
	•Equality	•Social-emotional support	Atkinson et al., 2017
	•Support	•Non-verbal support and engagement
	•Respect
	•Listening
Caring communities	•Worker development	•Regular team supervision and debriefs	Karageorge et al., 2018
	•Worker wellbeing	•Reading and discussing professional development materials
	•Collective healing	•Professional reflection
	•Worker self-care	•Storytelling and listening
	•Worker safety	•Collaborative decision making and shared responsibility
	•Equality and empowerment	•Trust building
	•Lifelong learning	•Peer mentoring and support
	•Connecting	•Clinical supervision
	•Listening	•Reflective practice
		•Communities of care
			Atkinson et al., 2017
			Muenzenmaier et al., 2015
			Cohen & Paldiofsky, 2013Cohen & Palidofsky, 2013
Choice	•Participant agency	•Participants are given choices regarding what they do with their own bodies	Grijalva & Vasquez, 2019
	•Self determination	•Options to ‘opt-out’ or ‘step out’ are negotiated and known
	•Avoid retraumatization
Collaboration	•Consistency	•Align caregivers and workers surrounding clients experiencing trauma and its effects	Malloy (2017)
	•Safety	•Examine opportunities for arts-based work alongside other activities, for example, counselling
	•Development	•Establish pathways for emergency and ongoing therapeutic care if needed
	•Empathy	•Exploring and learning new skills
	•Care	•Building meaningful relationships
			Cohen & Palidofsky (2013)
			Goessling (2020)
Comfort and challenge	•Cultural familiarity	•Social support groups for activities that are culturally familiar, for example, cooking, music and soccer	Karageorge et al., 2018
	•Social inclusion	•New challenges, for example, songwriting are introduced to a comfortable setting
	•Moving outside comfort zone	•Social reconnection based on familiar strengths and activities
	•Releasing	•Offering social gatherings and arts activity based on shared interests
	•Listening
			Malloy, 2017
			Atkinson et al., 2017
Complexity	•Seeing person in context(s)	•Accidental and informal counselling by prepared workers	Karageorge et al., 2018
	•Background awareness	•Referral pathways to other services or groups	Karageorge et al., 2018
	•Ongoing self-education	•Awareness of individual diversity within groups.	Malloy, 2017
	•Allyship	•Approaching individuals with an awareness of what the case for them might be.	Goodman, 2011
	•Intersectionality	•Ensuring that if people share stories of trauma, perhaps for the first time, that they have a positive experience and are validated	Muenzenmaier et al., 2015
Cultural affirmation and connection	•Cultural connection	•Storytelling circles that provide access to arts materials of their choice to assist with ‘self-regulation’ and grounding	Atkinson et al., 2017
	•Critical awareness	•Offering choices for expression across diverse art and craft forms	Atkinson, 2002
	•Connecting with self, other, and environment	•Storytelling and cultural mentoring	Healing Foundation, The (n.d.)
	•Avoid cultural appropriation which can retraumatize	•Cultural renewal and remembering through the arts	Harden et al. (2015)
		•Cultural identity development and expression through the arts
		•Helping young people reconnect with and develop cultural practises and identities
Diversity	•Dynamism and change	•Flexible modes of creative activity that respond to participant preferences and talents	Malloy, 2017
	•Nonjudgement	•Arts activities and resources presented in a way that demonstrates care, attention and choice	Malloy, 2017
	•Collective experience	•Recognize individual level of diversity, not just social groups	Muenzenmaier et al., 2015
Holding space	•Nonjudgement	•Storytelling circles that emphasise compassionate and deep listening	Malloy, 2017
	•Nondirective	•Mindfulness and acceptance activities that promote listening to self, other and environment	Atkinson et al. 2017
	•Participant agency	•Worker training in culturally informed approaches to listening	Cohen & Palidofsky, 2013
	•Self-expression	•Community Choirs
	•Allyship	•Not attempting to ‘fix’ participant or their challenges
	•Listening	•Promoting participant choice and agency regarding potential professional support, for example, counsellors
Intersectionality	•Equity	•Professionals self-educate to develop background awareness of participants’ potential experiences of oppression	Muenzenmaier et al., 2015
	•Complexity	•Recognize collective experiences	Goessling, 2020
	•Trauma is political, cultural, and economic	•Coping and self-regulation skills	Grijalva & Vasquez, 2019
	•Historical and Structural factors	•Self-care strategies
	•Historical and Structural factors	•Staff training on oppression related collective trauma
Multisensoriality, embodiment, and emplacement	•Managing activation	•Arts and musical activities that engage multiple senses and sooth to the nervous system, for example, listening to music, pleasant smells, soft touch	Malloy, 2017
	•Self-soothing	•Cooking, drinking and eating healthy foods that help regulate an over-stimulated nervous system
	•Holistic health and wellbeing
	•Emotional regulation	•Conscious mindful listening and connection to natural environment
	•Releasing trauma	•Grounding activities	Atkinson et al. 2017
Safety	•Trauma awareness	•Establishing ground rules and protocols for groups	Lapum et al., 2019
		•Check in and check out circles	Karageorge et al., 2018
		•Team includes a trauma therapist or referral path	Gerge & Pedersen, (2017)
		•Team is trained in trauma and its effects	Muenzenmaier et al., 2015
		•Emergency response plans are in place	Atkinson et al., 2017
		•Participants share a cue that they need to step out to regather composure	Praetorius et al., 2017
	•Cultural awareness
	•Agency	•Get in contact if potentially vulnerable participants are absent without notice (e.g. through buddy system)
	•Self determination	•Guided journaling
	•Support	•Participants are not required to share stories of trauma, but if stories are shared they are normalised and validated.
	•Nonjudgement	•Participants are given choice at all times, for example, whether to close eyes during meditation
	•Non directive	•Make spaces and activities accessible and welcoming

Key principles, values and activities presented across Table 1 and Figure 2 include: allyship care-giving; caring communities; choice; collaborating; collective experience; comfort and challenge; complexity; connecting; culturally informed; diversity; holding space; listening; multisensoriality, embodiment, and emplacement; releasing; and safety. While those principles share commonality with some existing frameworks in health and human services, our review indicates additional affordances and considerations when working with arts-informed and led approaches including: creative embodiment, creative expression and release with or without speech, care giving through arts practice and materials, providing choice of artistic medium, arts as cultural practice, and body-mind-spirit-environment regulation and [re]connection. Hence, we argue that there is a need for specific trauma aware and informed frameworks for arts-health and community arts practice that is not currently being met in a consolidated way.

As an interim response, we offer Table 1 and Figure 2 as resources for policy and practice. Figure 2 can be used, for instance, as a discussion starter with participants in trauma aware arts activities or to guide facilitator action and program composition. A collective story to accompany the artwork is provided with Figure 2 below. Golden (2020) and others (Lenette, 2019) have advocated for arts-based research approaches as part of broader trauma responses. Table 1 and Figure 2 can offer resources for trauma informed arts-based research.

Limitations and Areas for Future Research and Practice

The limitations of this review relate to inclusion and exclusion criteria used in the scoping review process. Our review is limited to articles offered in English language and does not include grey literature which may have excluded existing ‘practice wisdom’ on offer within arts-health and community arts professions. Given the findings of this review, we argue that future research and resulting frameworks for trauma aware and informed practice in arts-health and community arts must critically account for the complexity as well as the potential of arts and creativity in trauma aware and informed practice: while creativity offers much promise, the arts are not unquestionably healing, positive or inclusive experiences. Future research and practice should also account for dynamics of oppression and collective trauma, alongside individual trauma.

We acknowledge the review is limited to academic literature which precluded us from considering existing trauma related ‘practice wisdom’ (Klein & Bloom, 1995) in the fields of arts-health and community arts. Based on ongoing discussions with professionals, educators, and representative bodies in the field, future research would ideally seek to uncover, distill and share relevant knowledge generated through practice to combine with existing academic literature. Design based research (Reimann, 2011) to generate and test frameworks for anti-oppressive trauma informed practice in arts-health and community arts would be desirable.

Conclusion

This paper presented an interdisciplinary scoping review examining existing research and practice that combines an explicit trauma aware or informed approach to healing, health and wellbeing with arts and musical activities. The review indicates that there are a growing number of healing, health, or wellbeing programs that involve arts activities. Overall, though, specific frameworks and guidance for conducting arts-health and community arts activities from an explicit trauma aware and informed approach are limited. A key related finding was that recognition of oppression-related collective trauma was limited in the selected literature and that anti-oppressive approaches to trauma aware and informed practice are needed. Figure 2 provides an example of how anti-oppressive and trauma aware creative arts practice can communicate complex information in a way that not only prioritises cultural and communication diversity, but also trauma-informed principles of nervous system regulation and cultural safety. Principles for trauma aware and informed practice and policy distilled through this review, as presented in Table 1 and Figure 2, may offer interim guidance to arts-health and community arts practitioners and researchers seeking to develop trauma aware and informed practice for the benefit of participants and themselves.

Footnotes

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 work has been supported in part by Australian Research Council Indigenous Discovery Project number IN210100044.

ORCID iD

Naomi Sunderland

Author Biographies

Professor Naomi Sunderland: Naomi is a member of the School of Health Sciences and Social Work and Creative Arts Research Institute at Griffith University. Naomi is a descendant of the Wiradjuri First Nations’ People of Australia. She has an extensive research and publishing record in anti-colonial, participatory, creative, place based, and community-based research in the areas of arts-health, well-being, First Nations’ social justice, and arts-based development. Naomi was recently awarded an Australian Research Council Fellowship (2021–2024) to study the effect of First Nations’ music on social and cultural determinants of health. Naomi has a PhD in applied ethics and human rights from the Queensland University of Technology.

Fiona Stevens: Has been working in the field of Human Services and Social Work for the past 25 years. Fiona has worked in a variety of areas from Child Protection and Youth Justice, Youth outreach, AOD counselling and support, Youth residential substance withdrawal and Government Youth Justice program design and delivery. Fiona’s most recent clincial experience has been in Private Practice delivering trauma informed programs for staff and service users in the area of trauma and complex trauma. Fiona is now working in Academia with social work students in field education.

Kate Knudsen: Kate is a medicine student at Griffith University with a passion for creative and trauma informed practice approaches. She is an active musician and research assistant across diverse research projects at Griffith University.

Dr. Rae Cooper: Rae is a lecturer and early career researcher at the Queensland College of Art, Griffith University. Her research and teaching practice focuses on design, culture and politics, built upon a foundation of over 10 years professional practice as a commercial visual communication designer across government and private sectors. Her Warrimay/Worimi First Nation Australian and European heritage is a growing influence in her engagement with research, design and the critical impact design research-practitioners can have on our rapidly evolving, global society.

Marianne Wobcke: Marianne is a Girrimay First Nations woman from North Queensland who was born on Wakka Wakka land. Marianne is a trained nurse and midwife working specifically on birthing practices and trauma recovery.

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