Clinical Strategies to Develop Connections, Promote Health and Address Pain From the Perspectives of Indigenous Youth, Elders, and Clinicians

Despite the challenges facing Indigenous youth and their communities due to historical and contemporary institutionalised racism in Canada, communities are drawing on the richness of their own histories to reassert their cultural heritage. Doing so supports mental health outcomes of young people in particular, as highlighted in a compelling body of research. The question facing many communities, however, is how they can facilitate such child and youth engagement in order to support related positive mental health outcomes. This article reports on findings from a Participatory Action Research (PAR) study conducted in a First Nations community in Unama'ki (Cape Breton), Atlantic Canada. The study, Spaces & Places, was a partnership between the community-based mental health service provider (Eskasoni Mental Health Services, EMHS), eight community youth (14-18 years old), and a team of academics. Situated within a resilience framework, the team explored the ways in which the community facilitated, or restricted, youth civic and cultural engagement. Foregrounded against a strong legacy of cultural reassertion within the community, findings highlight the core resilience-promoting resources that support positive youth development. Additionally, findings demonstrate how these resources provide meaningful support for youth because of the way in which they are intertwined with one another. Furthermore, cultural engagement is underpinned by the Two-eyed Seeing model, supporting youth to integrate their own culture with settler culture in ways that work best for them. Findings support community-based service structures, and underscore the importance of community resilience in the effective support of Indigenous children and youth.

Tight budgets complicate Canadian health research reforms

Objective To evaluate opinions and perceptions around managing mental health and the relevance of available mental health applications (apps) for Indigenous youth populations by surveying values of Indigenous service providers and youth samples in a regional area, in order to better target online mental health information. Method Participants were 15 Indigenous youths (6 males, 9 females) with a mean (SD) age of 16.93 (2.37), and 30 Indigenous service providers (6 males, 24 females) with a mean age (SD) of 34.59 (12.26). Participants were recruited through a Queensland regional Indigenous community organisation, and given a face-to-face survey, (developed with Indigenous community members) during a social event. The survey asked how participants improve their mental health, their knowledge of current Indigenous mental health applications, and their perceived importance of values presented in those applications. Results Although Indigenous youth were not familiar with existing mental health apps, overall, participants agreed with the values presented in available mental health apps. Compared to Indigenous youth, service providers overall perceived presented values as significantly more important, and specifically found ‘Nature in the design’, ‘Themes of strength’, and ‘Themes of community’ to be most important. Regarding content, service providers and youth had different strategies for bolstering mental health with Indigenous sports stars the least popular in both groups. There were no statistical gender differences in thematic importance for bolstering mental health. Conclusions Mental health applications are little utilised by Indigenous youth so awareness needs to increase. In addition, these are viewed differently between service providers and youth. This may have relevance for uptake and usage of these apps within the mental health service delivery.

Introduction: The climate crisis significantly and disproportionately impacts Indigenous Peoples across Turtle Island, and worldwide. Some major issues faced are threats to reserve lands, food sovereignty, and traditional employment. The harms caused by climate change have been uniquely placed on Indigenous youth as both the future and current caretakers and land defenders of Turtle Island, impacting the mental health of our youth. Yet, their perspectives are rarely included in scholarly literature, research, or decision-making on environmental policy.Purpose: This article outlines findings from initial pilot phases of a climate crisis research project regarding the perspectives of Indigenous youth on the impacts of the climate crisis on their mental health and recommendations for service providers.Methodology: The findings outline themes and perspectives from Talking Circles with youth and Elders, as well as the development of a play created and performed in collaboration with an Indigenous theatre expert and our community partner, 2-Spirited People of the 1st Nations, in Toronto. Additionally, a quantitative survey was conducted to gather audience feedback on the performance.Results: 4 qualitative themes emerged: anxiety, fear and powerlessness; finding voice & using voice; autonomy & decolonization in government; education, educating & training youth. Audience feedback was mainly positive, impactful and inspiring. 6 main recommendations for policy and service delivery shifts were also acquired.Conclusion: This research responds to the emergent need for the inclusion and empowerment of Indigenous youth voices on the ongoing climate crisis and investigates its impacts on Indigenous youth mental health. Overall, the study had a positive impact on Indigenous youth mental health, with future research underway. Recommendations for programming and policy changes provided to continue supporting positive Indigenous youth mental health and wellness.

This article focuses on the work of cultural and language maintenance and fortification with Indigenous youth populations. Here, the idea of work represents two strands of thought: first, research that is partnered with Indigenous youth-serving institutions and that prioritizes Indigenous youth perspectives; and second, the work of cultural and linguistic engagement that is often taken for granted as part of the sociocultural fabric of Indigenous communities where youth are active participants. By highlighting a study with Pueblo Indian youth in the southwestern United States, we aim to build on the counter-narrative frameworks of other educational scholars and community-based researchers in order to offer alternative approaches towards understanding how Indigenous youth can and do participate in representing themselves as cultural and language agents of change. Arriving at this realization requires several key steps, including deconstructing dominant assumptions, holding ourselves accountable for interrogating and revisiting our own biases, and ultimately committing to long-term research and support with Indigenous youth. As such, we offer empirical evidence that contradicts universal discourse of Indigenous peoples and youth as victims at risk. Instead, we focus on the ways in which Indigenous youth demonstrate both tentative and bold fortification of key elements in their Indigenous identities and illustrate promise in contribution to multiple levels of policy development to address their communities’ most urgent needs and goals.

According to estimates, the prevalence of various forms of neurodivergence is much higher among musicians than in the general population. Despite this fact, we know very little about the lived experiences of neurodivergent (ND) musicians in professional settings, such as educational institutions and places of employment. The lack of information leads to a lack of understanding, appropriate support, and inclusion of ND personnel in these spaces; therefore, it is crucial to gather accurate information directly from the population. A Participatory Action Research (PAR) study was planned and organised by ND musicians, which consisted of an in-person event and online follow-up conversations, where members of the community (ND musicians, music educators, music researchers, and neurotypical allies) were invited to discuss various aspects of their vocational education and professional lives. In alignment with the guiding principles of PAR, all participants were invited to contribute to the outputs to ensure their autonomy and utilise their unique expertise to the fullest. Given the quantity and richness of the data and the limited space, detailed discussions about the findings will be published separately. Here, we opted to focus on the methodological approach and procedure to provide a template for using PAR with adult ND communities.

This research extends and explores two key concepts. First, cultural preservation is important to Indigenous health and wellbeing. Second, when Indigenous youth spend quality time (whether online or offline) on issues pertaining to their identity and sense of self, that time can be key to preserving Indigenous cultures. This research project was an exploratory study carried out using a variety of research methods, including online surveys, semistructured interviews, and open ended storytelling engagements. In this study, youth ages 15 to 24 years interacted with one another in online and offline spaces, which in some cases served as culturally safe wellbeing sites where their self-esteem increased, especially if they were mentored by Indigenous peers and adults. This study found out that Indigenous youth are active social media users and engage in all kinds of activities including self presentation, social connections, cultural activities, and advocacy. The risks and benefits of using social media for identity expression and cultural engagement were identified, but some youth were noted to require supports to engage safely on social media to derive maximum benefits. The interdisciplinary nature of the research merges concepts, theories, and ideas from First Nations Studies, Sociology, Community Health, and Media Studies. This project embraced methodologies employed in these various disciplines but used a Two-Eyed Seeing framework as a tool to ensure cohesiveness in the research and respect for Indigenous cultures and cultural protocols. The research ultimately unfolded using lenses of both Indigenous and nonIndigenous worldviews, which I believe contributed greatly to the richness of the findings.

In Canada, diabetes is 3 to 5 times more common among Aboriginal people than in the general population. Women with a diagnosis of gestational diabetes mellitus have an increased risk of developing glucose intolerance later in life, with almost half developing type II diabetes within 15 years. A participatory action research study using a Two-Eyed Seeing approach was conducted. Conversational interviews with 9 Mi'kmaq women who experienced gestational diabetes mellitus and talking circles were held. Hermeneutic phenomenology was used for data analysis. Themes included life-altering experience; barriers limiting access to health care; social support during pregnancy; and feeling compelled to take action.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has affected the hospital experience for patients, visitors, and staff. To understand clinician perspectives on adaptations to end-of-life care for dying patients and their families during the pandemic. Mixed-methods embedded study. (ClinicalTrials.gov: NCT04602520). 3 acute care medical units in a tertiary care hospital from 16 March to 1 July 2020. 45 dying patients, 45 family members, and 45 clinicians. During the pandemic, clinicians continued an existing practice of collating personal information about dying patients and "what matters most," eliciting wishes, and implementing acts of compassion. Themes from semistructured clinician interviews that were summarized with representative quotations. Many barriers to end-of-life care arose because of infection control practices that mandated visiting restrictions and personal protective equipment, with attendant practical and psychological consequences. During hospitalization, family visits inside or outside the patient's room were possible for 36 patients (80.0%); 13 patients (28.9%) had virtual visits with a relative or friend. At the time of death, 20 patients (44.4%) had a family member at the bedside. Clinicians endeavored to prevent unmarked deaths by adopting advocacy roles to "fill the gap" of absent family and by initiating new and established ways to connect patients and relatives. Absence of clinician symptom or wellness metrics; a single-center design. Clinicians expressed their humanity through several intentional practices to preserve personalized, compassionate end-of-life care for dying hospitalized patients during the SARS-CoV-2 pandemic. Canadian Institutes of Health Research and Canadian Critical Care Trials Group Research Coordinator Fund.

IntroductionThe term “two-eyed seeing” is spreading across North America as a concept for explanatory pluralism. The concept was brought into academic science by Albert Marshall, a M’iqmaq from Nova, Scotia, Canada. It speaks to the idea that indigenous knowledge is an equally valid way of conceptualizing a phenomenon as is contemporary science. Marshall’s famous example compares a traditional M’iqmaq story about the origins of the large tides in the Bay of Fundy with contemporary oceanographic geology findings and simulations.ObjectivesWe wanted to explore how this two-eyed seeing model could be applied to mental health to facilitate a dialogue between psychiatry and traditional cultural healers.MethodsWe reviewed the existing literature on two-eyed seeing within mental health care using PubMed, IndexMedicus, OneSearch, and Google Scholar. We presented a course on two-eyed seeing for indigenous mental health services and two-eyed seeing for addressing trauma in indigenous communities and surveyed the participants about the two-eyed seeing concept. We offered this course primarily to providers within indigenous communities and also for other interested counsellors.ResultsParticipants in our trainings were enthusiastic about the role of two-eyed seeing for improving communication among indigenous providers and patients and non-indigenous providers. Most indigenous counselors had not heard of two-eyed seeing and were quite enthusiastic about its affirming nature and how it gave them a basis for dialogue with non-indigenous practitioners.ConclusionsTwo-eyed seeing allows a rich dialogue between European-derived practitioners and indigenous people that enabls each to appreciate the other’s perspectives, leading to greater cooperation and collaborative treatment.DisclosureNo significant relationships.

Indigenous youth in settler nations are susceptible to poor mental health due to complex intergenerational systemic inequities. Research has shown benefits of cultural connectedness for improving mental health; however, there are few studies which have evaluated the impact of culturally relevant mental health interventions, particularly among Indigenous youth. The purpose of this study is to assess the impact of a culturally-responsive, land-based, active living initiative on the mental health of Indigenous youth. This quasi-experimental qualitative study is part of Smart Indigenous Youth (SIY), a mixed-methods 5-year longitudinal digital citizen science initiative. SIY embeds culturally responsive, land-based active living programs into the curricula of high schools in rural Indigenous communities in the western Canadian province of Saskatchewan. In year-1 (Winter 2019), 76 Indigenous youth citizen scientists (13-18 years) from 2 schools participated in the study. At the beginning of the term, each school initiated separate 4-month land-based active living programs specific to their culture, community, geography, and language (Cree and Saulteaux). Before and after the term, focus groups were conducted with the 2 Youth Citizen Scientist Councils, which included students from both participating schools. This study includes data from focus groups of one participating school, with 11 youth citizen scientists (5 boys, 6 girls). Focus group data were transcribed and analyzed by two independent reviewers using Nvivo to identify themes and subthemes. Both reviewers discussed their thematic analysis to reach consensus about final findings. Baseline focus group analyses (before land-based programming) revealed themes demonstrating the importance of Indigenous culture, identity, history, and language. Youth emphasized the impact of loss of language and culture, the importance of being a helper, and the necessity of intergenerational knowledge transfer. Follow-up focus group analyses (post land-based programming) indicated that cultural school programming led to students expressing positive mental health benefits, increased interest in ceremonies, increased participation in physical activity, and greater knowledge of culture, identity, and ceremonial protocol. This novel qualitative quasi-experimental study offers a window into the future of upstream interventions in partnership with Indigenous communities, where Indigenous youth can be engaged in real-time via their digital devices, while participating in culturally-sensitive, land-based school programming that promotes culture, identity, and mental health.

BackgroundIndigenous people experience significant poor oral health outcomes and poorer access to oral health care in comparison to the general population. The integration of oral health care with primary health care has been highlighted to be effective in addressing these oral health disparities. Scoping studies are an increasingly popular approach to reviewing health research evidence. Two-eyed seeing is an approach for both Western and Indigenous knowledge to come together to aid understanding and solve problems. Thus, the two-eyed seeing theoretical framework advocates viewing the world with one eye focused on Indigenous knowledge and the other eye on Western knowledge. This scoping review was conducted to systematically map the available integrated primary oral health care programs and their outcomes in these communities using the two-eyed seeing concept.MethodsThis scoping review followed Arksey and O’Malley’s five-stage framework and its methodological advancement by Levac et al. A literature search with defined eligibility criteria was performed via several electronic databases, non-indexed Indigenous journals, Indigenous health organizational websites, and grey literature. The charted data was classified, analyzed, and reported using numeral summary and qualitative content analysis. The two-eyed seeing concept guided the interpretation and synthesis of the evidence on approaches and outcomes.ResultsA total of 29 publications describing 30 programs conducted in Australia and North America from 1972 to 2019 were included in the final analysis. The following four program categories emerged from the analysis: oral health promotion and prevention programs (n = 13), comprehensive dental services (n = 13), fly in, fly out dental services (n = 3), and teledentistry (n = 1). Biomedical approaches for integrated primary oral health care were leadership and governance, administration and funding, capacity building, infrastructure and technology, team work, and evidence-based practice. Indigenous approaches included the vision for holistic health, culturally appropriate services, community engagement, shared responsibility, and cultural safety. The program outcomes were identified for biological, mental, and emotional dimensions of oral health; however, measurement of the spiritual dimension was missing.ConclusionOur results suggest that a multiple integrated primary oral health care approach with a particular focus on Indigenous culture seems to be efficient and relevant in improving Indigenous oral health.

Christine A. Walsh is an Assistant Professor of Social Work at the University of Calgary. Her research interests include the examination of violence across the lifespan, child maltreatment, intimate partner violence and elder abuse, and participatory action research and communitybased research with populations affected by issues of poverty or violence. Jenny Ploeg is an Associate Professor at the School of Nursing of McMaster University. Her research interests include qualitative and quantitative research related to high-risk elderly persons and their care-givers. Dr Ploeg holds a CIHR/St Joseph’s Healthcare Hamilton investigator award. Lynne Lohfeld is an Assistant Professor in the Department of Clinical Epidemiology and Biostatistics at McMaster University, as well as a faculty member in the Program for Educational Research and Development (PERD), and an associate member of the Department of Family Medicine and the School of Geography and Life Sciences, also at McMaster University. Her research interests include aging and health, qualitative research, community-based participatory action research, ethics and programme evaluation. Jaclyn Horne is a Masters of Social Work student at the University of Calgary. Her research interest is in gerontology, with focuses on driving cessation, dementia, care-giver burden, longterm care seniors’ housing and elder abuse. Dr Harriet MacMillan—a member of the Offord Centre for Child Studies—is a psychiatrist and pediatrician conducting research on the epidemiology of violence against children and women. She is a Professor in the Departments of Psychiatry and Behavioural Neurosciences, and Pediatrics at McMaster University and holds the David R. (Dan) Offord Chair in Child Studies. Daniel Lai is Professor of Social Work and Alberta Heritage Health Scholar at the University of Calgary. His research interest is in gerontology and social work with older adults, with special focus on health, well-being and culture in the aging population. He was the Social Policy and Practice Section Editor of the Canadian Journal on Aging. Currently, Daniel is also on the Institute Advisory Board of the Institute of Aging of the Canadian Institutes of Health Research.

Informed consent is based on communication, requiring language to convey meanings and ensure understandings. The purpose of this study was to investigate the use of language in informed consent documents used in the genetics research funded by Canadian Institutes of Health Research and Genome Canada. Consent documents were requested from the principal investigators in a recent round of funding. A qualitative content analysis was performed, supported by NVivo7™. Potential barriers to informed consent were identified, including language that was vague and variable, words with both technical and common meanings, novel phrases without clear meaning, a lack of definitions, and common concepts that assume new definitions in genetics research. However, we noted that difficulties in comprehension were often obscured because the words used were generally simple and familiar. We conclude that language gaps between researcher and potential research participants may unintentionally impair comprehension and ultimately impair informed consent in genomics research.

ABSTRACTWhile research demonstrates that Indigenous youth experience higher levels of obesity-related chronic disease compared to non-Indigenous youth throughout Canada, few studies consult Indigenous youth for their perspectives on how to address barriers to active lifestyles. This paper examines the constraints that urban Indigenous youth encounter in accessing physical activity and sport programmes in three Canadian cities. Researchers used a community-based participatory methodological approach that included volunteering and talking circles to gain the perspectives of 41 Indigenous youth who were recruited from urban health organisations and local high schools. Despite the differing socio-cultural contexts throughout urban centres in Canada, Indigenous youth face similar constraints in accessing physical activity and sport programmes. These findings indicate that any changes to public policies to improve community health outcomes and access issues for urban Indigenous youth need to consider the broader national contexts as well as the multiple constraints that influence their participation experiences.