The situation of aboriginal children and young people in the Kimberley region of Western Australia (WA)

The 2019 State Coroner’s Inquest into the deaths of a cluster of 13 Aboriginal children and young people in the Kimberley region of WA between November 2012 and March 2016 found that the cause of death for all 13 cases was a result of ligature compression of the neck (hanging), with 12 deaths as a result of suicide and in one case an open finding was made [18]. Five children were between 10 and 13 years old, three were aged 16 or 17, and the remaining were young adults aged 18 and 24 [18]. WA’s Coroner, Ms Fogliani, described the deaths as “profoundly tragic, individually and collectively”. The Inquest concluded that the underlying conditions, life events, and behaviours of these children and young people in the Kimberley signal the prolonged exposure to intergenerational trauma and poverty, including complex home environments, poor school attendance rates, little to no involvement with mental health services, and recurrent experiences of grief and loss, with several children belonging to families who had previously lost a close family member to suicide [18]. The term ’complex home environment’ is used to describe multifaceted factors that, when combined, diminish the ability to care for children and young people, hindering their ability to thrive and develop according to the broader expectations of Australian society. The Inquest laid bare the deep inequalities in remote Aboriginal communities in the Kimberley region. A recurrent theme throughout the Inquest concerned Aboriginal people’s desire to be consulted on matters that affect them and that purported solutions are not imposed upon them without consultation. Recommendations from the Inquest urged government agencies and services to acknowledge the importance of culture and inclusivity embedded in cultural healing for Aboriginal children, young people, and communities and to adopt a more collective and inclusive approach in developing and implementing programs targeting youth mental health in the Kimberley [18].

Trauma and human development

Convergent developmental and neurobiological evidence suggests that prolonged or repeated exposure to adverse childhood events can lead to a traumatic response defined by often profound dysregulations of social and emotional functioning [1,2]. The capacity to learn and concentrate, develop trust and reciprocal relationships and use self-soothing or calming strategies to regulate behaviour is impaired in children who have experienced trauma, including intergenerational trauma [19,20]. Trauma leaves indelible footprints on the brain. Functional Magnetic Resonance Images show changes in the amygdala, hippocampus, corpus callosum, cerebellum, and prefrontal cortex [21,22].

The limbic system encompasses various brain structures situated above the brainstem and beneath the cortex, including the hippocampus and amygdala, which are integral to emotion and memory [23]. The amygdala, often called the brain’s alarm centre, is pivotal in the response and memory of fear and the regulation of emotions. When faced with a threatening situation, the amygdala initiates the body’s emergency survival mechanisms (fight, flight, freeze, or fawn response) [24]. Given its crucial role in our reactions to danger and the retention of emotional memories, individuals with a smaller-than-average amygdala may exhibit inadequate responses to stimuli. Chronic early-life stress is linked to alterations in the amygdala. When individuals with an atypically developed amygdala perceive a threat, they may experience intensified fear responses, anxiety, and flashbacks [25].

The hippocampus is responsible for forming new neural connections and storing memories, and it plays a role in regulating stress hormones. Traumatic events can cause this region to lose volume, leading to difficulties in memory recall. Damage to this area can impair the formation of new memories and increase stress hormone levels, further hindering memory recall [25].

The corpus callosum serves as a conduit, connecting the left and right hemispheres of the brain, and undergoes significant development in children aged three to six years. This development is related to attention and behavioural planning. In children aged six to thirteen, the corpus callosum continues to develop significantly in relation to language and memory [26], potentially explaining language impairments observed in some traumatised children [27].

The cerebellum, located at the back of the brain, is the most neuronally rich region of the brain and is involved in processes such as motor control, language, working memory, cognition, and emotion [26,28]. Decreased cerebellum volume has been observed in children with a history of trauma exposure [29]. Researchers suggest that reduced cerebellum volume may contribute to disturbances in language, working memory, and cognitive abilities, such as planning [26,28].

The prefrontal cortex is critical for mature cognition. Trauma significantly reduces activity in this brain region, leading to difficulties with memory and attention, emotional and behavioral regulation and inhibition, personality, decision-making, abstract reasoning, and learning [29,30]. Traumatised children and young people respond to their environment with limited access to the resources in their prefrontal cortex responsible for thinking, logic, analysis and problem-solving. Such alterations often manifest as problem behaviours in school, including aggression against self and others, difficulties establishing interpersonal relationships, substance use, depressive disorders, and suicide [19,20,23,31].

Experiences of trauma stay in the body [32] after the stressful or traumatic situation has passed. Trauma impacts the body’s physiological systems, particularly the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS). The HPA axis regulates the body’s stress response, releasing cortisol during stressful situations. Chronic trauma exposure can dysregulate this system, leading to either hypercortisolemia (excess cortisol) or hypocortisolemia (insufficient cortisol), both of which can have detrimental effects on health [33].

The ANS, which controls involuntary bodily functions, also shows dysregulation in trauma survivors. The sympathetic branch of the ANS, responsible for the ’fight or flight’ response, can become overactive, resulting in chronic stress and anxiety. Meanwhile, the parasympathetic branch, which promotes ’rest and digest’ functions, may be underactive, contributing to difficulties in relaxation and recovery [34]. These physiological responses reflect how trauma can alter bodily functions, perpetuating a state of heightened arousal and stress.

The embodiment of trauma often manifests as somatic symptoms, including chronic pain, gastrointestinal issues, and cardiovascular problems. Studies have shown that trauma survivors are at a higher risk for conditions such as fibromyalgia, irritable bowel syndrome (IBS), and heart disease [32]. These somatic symptoms are not merely psychological in origin but are deeply rooted in the physiological disruptions caused by trauma. Not surprisingly, traditional talk therapy can feel unsafe to people who have experienced trauma as their systems are dysregulated and overwhelmed [32], mainly if the first traumatic experience occurred in childhood [35].

While essential life skills are vital to managing relationships at home, school, work, and outside interests, for Aboriginal children and young people from complex family environments, often a legacy of intergenerational trauma, violence, and distress become normalised reactions [36]. Childhood and adolescence provide a unique window of opportunity to create new pathways and rewire brain patterning [37]. Rapidly emerging modalities to enhance recovery and build resilience include mind/body, experiential approaches, and expressive therapies, like mindfulness-based self-compassion [38], trauma-focused Cognitive Behaviour Therapy [39], trauma-sensitive yoga [40], and expressive art therapies, including psychodrama [41]. These approaches de-emphasise verbal communication and help individuals establish therapeutic relationships, safety, and trust through non-verbal modes, which improve affect regulation and cognitive processing [42]. While there is a growing body of encouraging evidence on the effectiveness of these interventions for children who have experienced trauma, systematic reviews are yet to yield sufficiently strong evidence for any approach [43,44]. Further, these modalities have yet to be explicitly utilised with Australian Aboriginal children and young people and adapted to ensure cultural appropriateness and effectiveness.

Mental health systems and their policies and practices in Australia continue to reinforce colonial ideologies [45]. The persistence of colonial ideologies within Australian mental health systems is evident in systemic disparities, cultural insensitivity, inadequate Aboriginal staff representation within the mental health workforce, and marginalising policies and practices. Systemic disparities between Aboriginal and non-Aboriginal populations in mental health are rooted in the intergenerational trauma caused by colonisation, including the loss of land, culture, and identity, which has had a lasting impact on the mental health of Aboriginal peoples [36]. The Western biomedical model, which dominates mental health care in Australia, tends to overlook holistic approaches to wellbeing that are integral to Aboriginal cultures [46]. This model often pathologises Aboriginal people’s ways of knowing and healing, further marginalising these communities. Aboriginal representation within the mental health workforce limits the availability of such care and perpetuates a cycle of cultural insensitivity [47]. Mental health policies in Australia have historically marginalised Indigenous populations by prioritising Western paradigms of care. For instance, the National Mental Health Strategy, while acknowledging the need for culturally appropriate services, has been criticised for inadequate implementation and funding of Indigenous-specific programs [46]. The coercive practices within the mental health system, such as involuntary treatment and detention, disproportionately affect Indigenous Australians. These practices can be traced back to colonial control mechanisms that sought to dominate and regulate Indigenous bodies and minds [48]. The over-representation of Aboriginal people in child protection, youth detention centres and prisons across the country underscores the continued use of these coercive measures [5,7,8,49].

Western paradigms of care have been unsuccessful in making any significant inroads in addressing the lasting effect of intergenerational trauma on Australian Aboriginal children and young people and their families [6,50]. Engaging Australian Aboriginal children and young people with additional needs with mainstream health and welfare services is often complicated as those tasked with helping them (typically teachers, therapists, practitioners, and service providers) may be viewed with mistrust or suspicion [51]. Aboriginal children and young people with additional needs continue to face several barriers to accessing mainstream health services, including shame, stigma associated with help-seeking, limited knowledge of Western medical-based approaches, fear of the consequences of a diagnosis, fear that their children will be removed if they seek help for mental health issues, different cultural beliefs, and a shortage of culturally secure mental health services that are cognisant of ‘Aboriginal ways of knowing, being and doing’ [17,48,50,52–55]. Cultural security goes beyond mere cultural awareness or sensitivity. It involves embedding cultural knowledge and respect into mental health services, ensuring that Aboriginal people feel culturally safe and understood when accessing mental health care [56]. Culturally secure mental health services are those that incorporate Aboriginal worldviews, values, and practices and that recognise the impact of historical and ongoing trauma on their mental health [56]. Although self-determination is central to providing mental health services, it is lacking in most Aboriginal policies and practices [17].

There is a growing understanding that support and services for Aboriginal Australians ought to align with the First Nations Framework of Health, honour the history of Aboriginal people, acknowledge their cultural practices and worldviews, be culturally secure, and work towards establishing trust between services, staff, and Aboriginal people, their families and communities [47,56,57]. Regrettably, there continues to be a dearth of culturally secure suicide prevention and intervention services and a workforce to meet the mental health needs of Aboriginal children and young people in WA’s Kimberley region. Recommendations from Coronial Inquests have been largely ignored, as have local community calls for actionable change. There is an urgent need for new, innovative, culturally secure ways to engage Aboriginal children and young people with additional needs in the Kimberley region.

Equine-assisted learning: A culturally responsive approach to address the social-emotional wellbeing (SEWB) needs of aboriginal children and young people with additional needs

Equine-Assisted Learning (EAL) is an experiential learning approach that incorporates safe relational experiences with horses to foster clients’ life skills, social and emotional development, growth, and learning [58,59]. Skill development and learning in EAL arise through the repeated practice of relational skills gained through planned learning activities (equine experiences) involving equine-client interactions and post-activity reflections guided by certified practitioners [59,60]. Essentially, the horse is an ‘active partner’ to support the client in developing or bolstering life and/or professional skills (e.g., leadership and team building). One of the ways horses contribute to client change is by facilitating a biofeedback loop (providing a behavioural response or ‘unique Feedback’) entailing sensory integration, relational skills, self-regulation, social-emotional wellbeing skills (SEWB), positive coping and adaptation to diverse stressors [51,58,61–63]. EAL thus aligns with traditional understanding and empirical findings that acknowledge that connecting with creation in all its forms is fundamental to the process of healing in the Aboriginal culture [64–66] and is consistent with Aboriginal ways of knowing, being and doing [66,67].

Aboriginal people have an inclusive outlook on how the systems fit together and interact [68–70]. They do not believe in power relations over other forms of living or non-living existence [71]. Such a worldview understands the individual, the collective, and the universe as an interconnected web of being [68], which is congruent with field theory embedded in the EAL approach that “everything is interconnected”[58] [p. 38]. Aboriginal understanding places the ‘Spirit’ at the centre of knowing and recognises its innate existence in all life forms. The equine (horse), like any other of Creator God’s making, has a life force or a Spirit and hence is sacred. Thus, including a horse as a ‘partner’ in the experiential learning team aligns with Aboriginal ways of knowing and being [72].

‘Ways of doing’ convey Aboriginal people’s ways of knowing and being [67]. EAL’s experiential, hands-on nature encourages learning through concrete outdoor activities (doing) and is less reliant on spoken language, thus aligning with Aboriginal ways of learning and expressing themselves [58]. Therefore, an EAL program may appeal to tactile learners and those for whom verbal modes of communication are not the primary mode or for whom, developmentally, such capacities are still emerging [58,66,73–75]. EAL is aligned with the ecopsychology approach to healing the more fundamental alienation between the recently created urban psyche and the age-old natural environment [76]. Such an ecopsychology approach perfectly aligns with Aboriginal people’s innate connection to the land [58,73,77,78].

Horses are social, perceptive, sensitive, and intelligent animals [58]. As herd animals, horses need contact with others for survival and belonging [58,79]. Further, horses have an instinctual communication system primarily based on body language [59,80]. Diverse EAL models propose that one of the ways that horses can contribute to client change is when the horse mirrors or gives unique feedback to the unique client’s approach, nervous system, emotion, and behaviour (affective mirroring), which serves as a powerful tool for learning [58,79,81]. When culturally adapted to suit Aboriginal people’s ways of knowing, being and doing, EAL sessions can afford Aboriginal young people a safe place to experience something new, to learn and reflect, enhancing the client’s potential experience of belonging, and increase their capacity for mentalising (i.e., attention to mental states, including the mental states of others, particularly in explanations of behaviour). Overall reflective functioning is increased (i.e., awareness of the nature of mental states in oneself and others, the mutual influences at work between mental states, and behaviour through an exchange with the horse) [58,66]. Engaging in activities with a horse in a natural outdoor space (on country) rather than a conventional therapy room may reduce the perceived dominance of the practitioner and perhaps offer Aboriginal young people a sense of neutrality [58,66,73] to explore their feelings and emotions in a safe and non-judgemental space [58,82–84], learn roles and responsibilities of caring for one another–which is consistent with Aboriginal peoples’ of being and doing [66,67,69].

Since each horse is unique, culturally adapted EAL sessions (included in Yawardani Jan-ga EAL) can be structured to offer young people the autonomy to choose a horse like themselves or someone in their life, thereby encouraging self-determination [58,59,66]. Young people can select the horse they partner with on the day of the EAL session and the flow of activities [66]. For example, a low-twitch horse may be drawn to a young person who feels tired and listless. Further, individual sessions in Yawardani Jan-ga are tailored to meet each young person’s unique needs [59], with consecutive EAL session schedules following progressive build-on skills [66]. Thus, Yawardani Jan-ga EAL offers a creative, flexible, and innovative modality to personalise sessions based on individual needs and continuing progress [59,67,85]. These adaptive elements make EAL an essential means to contribute to the vision of equitable health service provision for Aboriginal young people. Further, given that most of the trauma experienced by Aboriginal young people is through personal relationships (immediate, social, and system-based), the EAL approach with an animal offers a safe alternative that can assist in restoring the basis for relationships that were altered with trauma; giving the young person a safe space to learn to trust people again. Finally, as a relatively new alternative approach, EAL has no established prejudice and may appeal to Aboriginal children and young people across WA’s Kimberley region who are reluctant to engage with traditional Western therapy [66,73,86].

Evidence for EAL’s efficacy in Aboriginal children and young people with additional needs

Findings from existing scoping and systematic reviews across the broader Equine-Assisted Services space suggest that Equine-Assisted Learning approaches (EAL) can successfully engage Aboriginal children and young people with additional needs who have not previously responded to traditional therapeutic interventions or those who experienced sexual abuse or were exposed to problematic parental substance use [74,87–90]. Reported outcomes include increased prosocial behaviours [91,92], confidence and self-esteem [51,93,94], self-awareness [66], self-control and emotional regulation [82,93,95] and reduced anxiety [92,94]. Participants with a history of trauma have commented on the safety and comfort horses provide [79]. Others reported improved acceptance, trust, respect, warmth, collaboration, belongingness, connectedness, and mastery [80,96].

Only one scoping review addressing EAL has explicitly included studies with Aboriginal children and young people aged 6–26 in the sample [74]. The review included three Equine Assisted Learning (EAL) programs and one adapted Equine Assisted Psychotherapy (EAP) program that explicitly targeted Aboriginal participants with additional needs, with two programs being from Canada [60,72] and one each from the United States of America, US [97] and Australia [66]. All four programs partnered with local Aboriginal communities during intervention development and implementation and were trauma-informed and spiritually grounded. All reported positive findings for cultural safety, belonging and connectedness to culture and spirituality [74]. Reductions in anti-social behaviours [66], improvements in SEWB [60], and social adjustment at 12 months post-intervention were also evident [97]. Further, the Australian EAL program (called ’Nguudu Barndimanmanha’ or Horses Making Good) included modules on teaching leadership and problem-solving skills and reported improvements in participants’ communication skills and ability to cope with emotions and stress for Aboriginal young people 6–25 years [66]. Thus, EAL programs show promise in achieving therapeutic and learning goals in young people aged 6–26 with additional needs, including Aboriginal people with a history of trauma/abuse, mental health and learning disability [74].

Gaps in the EAL evidence base

Although individual EAL programs show promise in complex population groups with additional needs, findings from systematic, scoping reviews and meta-analyses that typically combine studies irrespective of the scope of practice (namely, combine EAL, EAP and Hippotherapy studies) have consistently critiqued the evidence base for lacking theoretical and methodological rigour and interchangeable use of terminology to describe programs [74,90,98]. The summative presentation of outcome effects in systematic reviews and meta-analysis makes parcelling out the contribution of individual intervention modalities and discernment of active intervention components challenging. Further, small sample sizes, absence of control or comparison groups or randomisation, limited detail about intervention programs and their theoretical underpinnings, and paucity of psychometrically robust measures are commonly reported flaws [74,90,98,99]. The fact that until 2023, only four studies have included Aboriginal young people in their sample suggests more work in this population is needed [74]. There is a need for standardised and culturally secure intervention manuals to safeguard implementation fidelity and psychometrically robust and culturally secure measurements of meaningful changes in outcomes over time [66,100,101]. Future studies are needed to establish the appropriateness of EAL in Aboriginal youth and the ecological validity of outcomes beyond the EAL program, especially in light of the high dropout rate amongst participants from unstable households [74]. In addition, understanding the dose required to establish program effectiveness is an essential consideration for financial feasibility.

The Yawardani Jan-ga project attempts to bridge the gaps in the scientific evidence base, respond to recommendations of the Coronial Inquest and address community needs in the Kimberley by co-designing, co-implementing, and co-evaluating with the local community members a strengths-based, evidence-informed, culturally secure, adaptive, EAL program to build local Aboriginal young people’s SEWB skills and help youth establish a solid connection to self, community, and country.

Design

Yawardani Jan-ga is an implementation-science project. The project design emerged after extensive consultation and engagement with community members and local services in the Kimberley region of Western Australis (WA) [92] and includes Participatory Action Research (PAR) [102] and phenomenological approaches [103] to capture the distinctive experiences of participants enrolled in the EAL intervention and the local communities where the intervention is implemented [104]. These methodologies offer flexible yet structured approaches to build the faith and trust necessary for collaboration and partnership and integrate local communities’ and services’ experiences and expertise [56,104,105]. Yawardani Jan-ga project adopts a co-design approach from design planning to implementation and evaluation. This approach ensures that the experiences, values, and worldviews of Aboriginal people (including children and young people) are at the core while facilitating the pooling and coordination of community resources [95].

Ethics and identified risks

Continued successful engagement with community members, Aboriginal leaders and local services will be critical for the success of the Yawardani Jan-ga project. Aboriginal leadership will ensure this project is culturally secure from conception to dissemination. This includes methods for measuring impact among participants. For example, data collection processes have been selected to minimise distress by acknowledging potential participants’ ’high-risk’ profiles. Similarly, the planning and outcomes of the EAL Intervention are based on neurodevelopmental concepts, and our approach is trauma and culturally informed.

Two documents produced by the National Health and Medical Research Council of Australia underpin the design of this research: Ethical Conduct in Research with Aboriginal and Torres Strait Islander Peoples and Communities: Guidelines for Researchers and Stakeholders [106] and Keeping Research on Track II: A companion document to Ethical conduct in research with Aboriginal and Torres Strait Peoples and Communities: Guidelines for researchers and stakeholders [107].

Ethical approval for this research has been granted by the WA Aboriginal Health Ethics Committee [Reference: 926] and the Kimberley Aboriginal Health Planning Forum, Research and Evaluation Subcommittee [Reference: 2019–007], The Department of Education, Government of Western Australia [Reference: D20/0184973], The Catholic Education Western Australia [Reference: RP2019/36] and The Western Australia Police Force [Reference: T539]. Refer ST3. Animal ethics for using horses in this research has been sought from Murdoch University’s Animal Ethics Committee [Permit No. T3404/22]. The protocol is prospectively registered with the Australian New Zealand Clinical Trials Registry [ACTRN12619001675112; Universal Trial Number: U1111-1241-7349]. We acknowledge the COVID-19 context in which this project is being implemented.

Community involvement and methodological engagement

Acknowledging the power and knowledge in Aboriginal communities, the overarching approach to Yawardani Jan-ga is Aboriginal leadership and methodological involvement through its investigators, governance, EAL-intervention development, implementation and evaluation structures [108]. A Cultural Advisory Group governs Yawardani Jan-ga with representation from Elders across five cultural blocs [109].

The Cultural Advisory Group ensures that Aboriginal experiences, values, and worldviews remain at Yawardani Jan-ga’s core. Additionally, working groups of Content Experts, Local Services, and Youth Leadership will be established, with nominated members from each group to inform a Translation Working Group. Guided by the Cultural Advisory Group, the Translation Working Group will assist in developing culturally responsive evaluation processes, frameworks, and strategies for translating findings into embedded practice and sustainable community partnerships.

The Translation Working Group comprises 10–12 members from Kimberley, Broome Regional and Derby Aboriginal Medical Services, headspace, Kimberley Police District Office, Catholic Education Broome Office, and the Western Australian (WA) Education Department Broome Office, as well as community members (youth and Elders).

The Translation Working Group allows community members, youth, local services, and content experts to respectfully work together, share and learn while building solid connections. This multi-level community involvement in Yawardani Jan-ga will ensure that Aboriginal people not only support the SEWB of young people in their communities but also make a significant contribution to the research process, including guiding how to implement the EAL program, informing how SEWB is expressed and manifests in Aboriginal children and young people, and how to monitor progress among Yawardani Jan-ga participants over time (follow-up). Ongoing stakeholder and community consultation processes are well established in Broome and Halls Creek and safeguard community readiness in both sites and high-quality input into the delivery planning. In Broome, for example, a local referral network akin to a ’no wrong door’ approach has been set up to intervene early and prevent the decline of wellbeing of Aboriginal youth (S3 Fig). This means Aboriginal children and young people who need diverse levels of SEWB support for various reasons, including bullying, trauma, exposure to domestic violence or substance use, can be referred to Yawardani Jan-ga. Sources of referral can include WA Police and Juvenile Justice; Youth services such as the Police and Community Youth Centres and Alive and Kicking Goals; Aboriginal community-controlled health services: Broome Regional Aboriginal Medical Service, Derby Aboriginal Health Service and Kimberley Aboriginal Medical Service; Mental health services such as Headspace and Kimberley Mental Health and Drug Services Child and Adolescent Health Service (Broome and Derby); and the Department of Education and Catholic Education primary and high schools.

Yawardani Jan-ga EAL intervention development

The Yawardani Jan-ga EAL intervention builds on an earlier EAL program called ’Nguudu Barndimanmanha’ (Horses making good) that targeted the SEWB of Aboriginal young people with additional needs, living in the MidWest region of WA, namely, Geraldton city (Fig 2) [66]. The ’Nguudu Barndimanmanha’ EAL program incorporated EPI Horse Wisdom Program elements to thematically organise sessions [59,66]. The ’Nguudu Barndimanmanha’ EAL team partnered with multiple service providers in the Geraldton community, including the Department of Child Protection, local primary and high schools, and the Regional Aboriginal Medical Service and was accessed by 270 Aboriginal young people aged 6–26 years, in blocks of 6–10 weeks over one calendar year. Parents and teachers reported improvements in self-regulation, self-awareness and socialisation skills. Feedback from young people demonstrated the feasibility, acceptability, cultural appropriateness and preference of EAL over room-based interventions previously experienced by the participants [66]. The Yawardani Jan-ga EAL program scales up its predecessor to more systematically and rigorously evaluate the impact of EAL on the SEWB needs of Aboriginal children and young people aged 6–26 years across several Kimberley sites. It also measures whether EAL intervention effects are sustained after young people complete their regular EAL sessions.

Theoretical underpinnings of the Yawardani Jan-ga EAL program

Yawardani Jan-ga EAL is a trauma-informed, recovery-oriented, culturally secure program underpinned by Aboriginal knowledge, concepts, and bioecological (collective) view of health theories of child development [56,110–113]. Similar to its predecessor, the Yawardani Jan-ga EAL sessions thematically draw from the Equine Psychotherapy Institute’s (EPI) Horse Wisdom Program [59], the neuroscience of attachment [84], the Neuro-sequential Model of Therapeutics (NMT) [19,20] and the Six Rs of Positive Development [114].

The Neuro-sequential Model of Therapeutics (NMT) outlines how trauma affects brain regions sequentially, beginning with the lower, more primitive parts of the brain (e.g., brainstem) and moving to higher, more complex areas (e.g., cortex). In line with the NMT, session order has been carefully planned to enable sequential resourcing in a manner that replicates neural organisation and development (ST1) [19,20]. Activity content is built around repeated somatosensory regulatory experiences (e.g. repeated brushing of horses) in a relationally enriched environment (e.g., building trusting and healthy connections with horses and EAL-practitioners) that allow emotions to become less threatening and overwhelming, leading to emotional and behavioural change. As participants achieve greater regulation and relational security, activities that stimulate higher brain functions are introduced. These include problem-solving tasks with the horses, such as navigating obstacle courses, which engage the cortex and enhance executive functioning. Emphasis is placed on post-activity reflections facilitated by highly skilled Aboriginal EAL practitioners, with dialogue focusing on reflecting on the horse’s nonverbal communication or biofeedback.

The Six Rs of Positive Development—relationship, repetition, regulation, respect, reward, and routines—are foundational principles for fostering adaptation and recovery in trauma-informed care [115]. These principles are operationalised through specific horse-assisted activities in the Horse Wisdom Program context. For instance, building a trusting relationship with the horse and the EAL practitioner can provide a safe and secure environment for participants (relationship). Repetitive, rhythmic activities, such as grooming or leading the horse, can help regulate the nervous system and promote a sense of calm (repetition and regulation). Ensuring that interactions with the horse are respectful and acknowledging each participant’s efforts can foster mutual respect and self-esteem (respect and reward). Finally, establishing consistent routines in the sessions can create a predictable and safe therapeutic environment (routines).

The equine psychotherapy institute (EPI) partnership with the Yawardani Jan-ga EAL program

Yawardani Jan-ga EAL program places a cultural lens on the EPI Horse-Wisdom Program [59] and other elements, such as the EPI Theory of Change, where horses are included in the experiential learning process as potential change agents. Similarities can be found with the four pillars of EPI practice methodology, including:

1. Phenomenology and the Phenomenological Method of Inquiry [116];
2. Humanistic, Experiential, and Relationally oriented Psychotherapy [58,117–119];
3. Dialogic or I-Thou relating [120]; and
4. Awareness and Mindfulness [121].

Yawardani Jan-ga EAL session plan and delivery

Addressing the Yawardani Jan-ga Project’s Objectives

• Objective 1: Grow and build the capacity and confidence of the local Aboriginal Equine-Assisted Learning (EAL) workforce and build research capacity across Kimberley communities to address the SEWB needs of Aboriginal children and young people.

To address Objective 1, the Yawarandi Jan-ga project embodies two significant capacity-building opportunities for the communities where the EAL program is implemented. First is the opportunity to develop and provide employment for a workforce of front-line EAL practitioners able to deliver culturally safe early intervention for emotional and behavioural concerns. The second is the opportunity to develop and provide employment and career opportunities for Aboriginal researchers beyond this project.

Sampling

Primary Participants Given the high truancy rates, cumulative risk factors and mobility of the families across the implementation sites in the Kimberley, it is estimated that over the five years of the project, approximately 600–700 young people will be invited to engage with the project. This represents approximately 10%-13% of the total Aboriginal population aged 6–26 years in the Kimberley. This estimate considers the staggered implementation of Yawardani Jan-ga across sites and the five weeks, ten weeks, 3-month, 6-month and 12-month follow-up data collection points for each participant.

Secondary Participants: Purposive sampling will be used to recruit parents/caregivers of primary participants, referrer staff from local services and EAL practitioners employed by Yawardani Jan-ga to deliver the program across sites.

Recruitment

Primary and Secondary Participants: Recruitment of primary participants will occur every ten weeks and coincide with the commencement of the school term. The first recruitment commenced in February 2020 and will continue until December 1, 2024. Participants will be generally enrolled in one ’block’ of EAL intervention, with each ’block’ corresponding to a school term in the academic timetable. Whilst enrolled in the intervention, participants attend weekly EAL sessions to achieve the desired intervention outcomes. However, a key feature of EAL is its flexibility in being personalised or adapted to meet the specific needs of each young person.

Potential participants can be referred to Yawardani Jan-ga by staff from local organisations in Broome and Halls Creek (e.g., schools, youth service, medical services, Aboriginal community-controlled health services, judicial system, police) using a study-specific referral form. Recruitment packs (containing poster, flyer, referral form, participant information and consent forms) will be distributed through the referral network.

Data collection schedule.

Please refer to S3 Fig, for an overview of the open-door participant flow and data collection schedule and Table 1 below for an overview of the data collected.

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Table 1. Nature of the data collected at each process.

https://doi.org/10.1371/journal.pone.0312389.t001

• Objective 3: Evaluate the implementation and impact of the Yawardani Jan-ga EAL project on SEWB and life skills and plan for its sustainability if found effective.

Using a Participatory Research Approach, Yawardani Jan-ga will be qualitatively led in its evaluation and instrument development activities [102,128,129]. Inherent in the Participatory Research Approach is that participants are not simply considered subjects from whom data are collected; the focus is not on collecting clearly defined outcomes or outputs. Rather, participants, their families, and the community are considered active research agents in the research process who possess valuable knowledge and experiences to offer Yawardani Jan-ga on the expression, experience, manifestations and consequences of poor SEWB and life skills in the communities in which they live [102,128,129].

Qualitative methods will be used to understand how participants perceive, feel, process, and create meaning from their experience in the program. Methods employed will include observation, interviews, focus groups, drawings or paintings, and methods that use technology to capture experiences, such as photography, video, and voice recording. This ensures that data collection methods are appropriate for community involvement and engagement for Aboriginal children and young people who may not respond to talk-based data collection. The contextual units of analysis will include the Yawardani Jan-ga EAL program, participants, and the dyadic horse-human interaction. Data will be gathered through multiple and diverse sources, including the client file; interviews with participants, parents/carers, and referrers; minutes and/or transcripts from meetings and consultations with different community groups (Advisory and Steering groups); project documentation; and community information sessions.

Qualitative data analysis will follow the descriptive phenomenology method of inquiry (130). In this context, Colaizzi’s phenomenological approach will be used to provide knowledge about aspects of a young person’s world that cannot be accessed by observation alone, and it, therefore, has implications for understanding SEWB as experienced by young Aboriginal people [103,130,131]. While analysing qualitative data from the initial cohorts of participants, an inductive approach to coding will be adopted to remain open to unexpected insights and themes. In subsequent cohorts, a mixture of inductive and deductive approaches to coding will be used, and themes will be compared across cohorts in an iterative process. At least two Aboriginal research team members will undertake coding and thematic analysis. Congruence and agreement of coding and thematic analysis will be checked using intra-rater and inter-rater reliability indices [132]. We will follow the Consolidated criteria for reporting qualitative research (COREQ) checklist for interviews and focus groups to report the findings of the research [133] (See Supplementary Section, ST2: COREQ 32-item checklist). Qualitative data will be used to:

• Evaluate whether program activities are implemented as intended (process/implementation evaluation).
• Evaluate the impact of the Yawardani Jan-ga EAL program by dose (i.e. how much and which sections of the program) on individual participants from different perspectives (e.g., self, parent/carer, referrer) (Impact evaluation).
• Guide the development and/or adaptation of two instruments that accurately capture important SEWB skills in Aboriginal children and young people.

Process/Implementation Evaluation: Gaining a comprehensive understanding of how the Yawarandi Jan-ga intervention is operationalised in the field will allow for the continuous improvement of EAL intervention and inform the development of broader programs seeking to promote the SEWB of Aboriginal youth and enable sustainability. To evaluate the implementation of Yawarandi Jan-ga EAL, assumptions will be developed describing how the intervention works (using a logic model) and how these informed the selection of research questions and methods [134]. A process evaluation framework developed for evaluating and translating evidence into real-world settings and successfully used with First Nations youth will be used [135]. Process evaluation of the EAL intervention will measure the following:

• Readiness of EAL practitioners in implementing the intervention (elaborated in the data sources section below).
• Fidelity and quality of implementation (e.g., What is implemented and how? To what extent was the EAL intervention delivered in accordance with the EAL Practitioner manual?).
• Mechanisms of change (e.g., How does the delivered intervention produce change?).
• Context (e.g., How does context affect implementation and outcomes?. Context includes: Geographic location of implementation (Broome, Halls Creek, Derby) and its implementation logistics, including transportation, infrastructure (presence of a dedicated community liaison person and driver), availability of services and support in each location, and environmental conditions; Community and Social Context: We will explore the impact of community dynamics, social networks, and local leadership at each site on recruitment, uptake and implementation.
• Barriers and enablers across context (Socio-political environment), recruitment (Approaches used to attract participants) and implementation (What was the acceptability and uptake of EAL? and of the project as a whole? How well did the project link with referring in and referring out services?).
• Reach (The proportion of the intended target audience who participated in the intervention) and dose (the number and which of EAL sessions were delivered).
• What improvements and future recommendations have been made by participants, parents/ carers, referring agencies, EAL practitioners, and stakeholders regarding how the project/ EAL is run? What were the barriers and enablers to success (i.e., the referral process working, young people staying engaged in EAL)?

Sustainability planning of the Yawardani Jan-ga project should it be found to be effective

If the intervention is successful, the last year of the project will focus on transitioning Yawardani Jan-ga from a research project to a sustainable, routine SEWB service. Success will be determined using multi-modal data collection approaches that measure: (i) Success in attending the initial dose of 10 sessions using attendance records; (ii) The proportion of referrers who report the intervention was beneficial for the participants at 3, 6, and 12 months; and (iii) The combination of subjective reports (collected from referrers at 3, 6, and 12 months) and improvements in the proposed equine-human interaction measure (that is being developed retrospectively using data), retention rates, engagement levels, or qualitative feedback on participants’ experiences.

During this phase, the focus will be on consolidating service-related mechanisms trialled throughout the project (e.g., contracts, agreements, intervention provision) to enable EAL to be provided as part of routine SEWB programs within health, education and other non-health related services across the Kimberley. Yawardani Jan-ga will seek full-service integration through negotiating service agreements in each site with project partners (e.g., police, schools, Aboriginal Medical Services), including training and employment paths for current and future EAL-practitioners and securing a host organisation to manage the maintenance of horses and facilities.