Promoting the wellness of urban Aboriginal youth and families in BC
Caitlin O’Reilly, Trixie Ling, Tammy Stubley, Dr. Indrani Margolin, Sheila Lewis, Amanda Swoboda, Sandy Brunton, and Fernando Polanco
Reprinted from "Wellness" issue of Visions Journal, 2013, 7 (4), pp. 23-25
Aboriginal people are the youngest and fastest-growing segment of the Canadian population and experience disproportionately high rates of mental health challenges, particularly depression, substance use and suicide.1 In response to this, the Canadian Mental Health Association (CMHA) BC Division and the BC Association of Aboriginal Friendship Centres, an umbrella organization representing Aboriginal Friendship Centres across British Columbia, have formed a partnership to pilot a community-led mental health promotion project. Connecting the Dots aims to promote the wellness of urban Aboriginal youth and families in BC. About 70% of Aboriginal people live off-reserves and a growing number of Aboriginal people now live in urban centres, but barriers can occur between Aboriginal services and health services in these centres.2 This points to the importance of wellness efforts among this group.
The project was piloted in Kelowna in 2009 in conjunction with the local Friendship Centre and CMHA Kelowna branch. In 2011, the project expanded to Quesnel and Port Alberni through the support of local Friendship Centres and CMHA branches. CTD is funded by the Public Health Agency of Canada* until 2015.
Communities that Care
To promote mental wellness among young urban Aboriginal people, Connecting the Dots is implementing and adapting a model known as Communities that Care in three BC communities. Communities that Care is an evidence-based, five-phase American model used to prevent youth problem behaviours and, more recently, to prevent depression and anxiety.3 The model brings together community members from various sectors—including service providers, local government, law enforcement and school representatives—to administer a youth survey. The survey collects data on social and individual risk and protective factors that influence problem behaviours or mental health. After interpreting the survey results, community representatives implement strategies, programs and policies to support and encourage protective factors and to reduce and eliminate risk factors. For example, if availability of drugs and alcohol was identified as a major risk factor, community members would strive to implement programs and policies to reduce the availability of these substances.
Using Communities that Care to Promote Social and Mental Dimensions of Wellness
Wellness is often conceptualized as a multi-dimensional sense of well-being, involving a balance between emotional, spiritual, physical, mental and social components.4 Wellness is a crucial concept for the mental health community, given that wellness facilitates positive mental health. One of the benefits of using the Communities that Care model as a means of promoting wellness is that poor mental health is not treated as an issue that occurs in isolation. Rather, the model acknowledges the influence that social dimensions of wellness (such as supportive schools, families, neighbourhoods, peers and communities) may have on mental wellness. Through the survey, the model helps communities measure and address such social factors. The model also promotes the idea that developing social networks capable of promoting wellness is a collective community responsibility. Through the multi-phase process, Communities that Care brings the whole community together to improve social dimensions of wellness.
The Communities that Care process brings together community members across different sectors to collaborate, share resources, and work together to promote urban Aboriginal wellness. This emphasis on partnership and collaboration within Communities that Care is particularly important, as Connecting the Dots seeks to promote wellness specifically for urban Aboriginal youth and families. Unfortunately, gaps often exist between mainstream services and urban Aboriginal services, which can result in challenges for Aboriginal community members seeking to access social supports and improve wellness. This points to the importance of collaboration.
Adapting Communities that Care for Aboriginal Wellness
The Communities that Care model provides a template through the youth survey that can help communities measure and promote multiple social determinants of wellness. However, this process is linear and focuses on social factors, so it may not capture a holistic understanding of health and wellness. The Connecting the Dots team has found tha adaptation to Communities that Care is necessary to help ensure that the model is aligned with a multi-dimensional understanding of wellness and mental health. This is particularly important in Aboriginal communities. We have learned that wellness is often conceptualized holistically and mental wellness is seen as influenced by both spiritual and cultural dimensions of wellness and by the historical context of colonization.
In order to measure and address a holistic perspective on wellness, Connecting the Dots is adapting the Communities that Care model. One ongoing adaptation has been the consideration of factors that influence Aboriginal mental health not typically included in Communities that Care or measured through the youth survey. Specifically, the team is working to explore protective factors including cultural identity, Aboriginal spirituality, and self-determination. Risk factors identified as important determinants of Aboriginal wellness include racism, loss of culture, historical trauma through residential school legacy, and the high volume of urban Aboriginal youth in the child welfare system. This part of the adaptation process ensures that risk and protective factors are culturally relevant to Aboriginal communities.
Additional data collection: Focus groups and Photovoice
To explore this broader and more holistic range of influences on urban Aboriginal wellness, we are adding two other data collection methods in addition to youth surveys: focus groups and “Photovoice.”5 Focus groups, which bring groups of people together to talk and share knowledge, are being conducted in each community with service providers, Aboriginal educators, parents, and urban Aboriginal youth. The goal of the focus groups is to help us understand the diverse factors that impact urban Aboriginal wellness from an Aboriginal perspective. In Kelowna, the coordinators use Photovoice by gathering groups of Aboriginal youth, providing them with cameras, and asking them to take pictures of and talk about challenges and strengths they see in their community. Through Photovoice, Aboriginal youth are co-researchers and are empowered to identify needs in the community. These additional methods of collecting knowledge about experiences mean that Connecting the Dots is better equipped to understand and address the contextual factors that influence wellness for urban Aboriginal youth.
To learn more about Connecting the Dots, visit www.cmha.bc.ca/connectingthedots.
To explore Kelowna’s Photovoice project, visit www.cmha.bc.ca/files/Photovoice/index.html.
Cultural safety and cultural competency
In using and adapting Communities that Care for the urban Aboriginal community, two important considerations in striving to promote wellness have been to work to ensure the process is culturally safe and to promote cultural competency. Aboriginal people are among the most studied populations in the world. Research with these groups has rarely been to their benefit and has often been imposed on Aboriginal communities.6 We do not want to reproduce this problematic relationship. To help make both the research and community development process culturally safe—or feel safe and respectful to the Aboriginal community involved—Connecting the Dots has prioritized leadership by and for Aboriginal people. With this in mind, each of the communities has provided leadership from the local Aboriginal Friendship Centre and strived to meaningfully involve the broader Aboriginal community. For instance, in Quesnel, a Guiding Circle of Aboriginal Elders is leading and supporting the project.
In addition to striving for a safe and respectful process, cultural competency workshops have been important at the community level. These workshops raise awareness among non-Aboriginal community members of the history of colonization and how to work respectfully with Aboriginal people. Many Connecting the Dots team members have identified racism and colonization as critical factors influencing wellness among urban Aboriginal people, as well as a lack of awareness among community members of how this context influences Aboriginal wellness. To address this and to build relationships between Aboriginal and non-Aboriginal, the coordinators in Kelowna, Port Alberni and Quesnel have held cultural competency workshops.
Ultimately, as we adapt Communities that Care and strive to promote wellness for urban Aboriginal youth and families, it is crucial to consider and measure the range of influences on wellness, to promote cultural competency, and to work to ensure the process is culturally safe and led by the urban Aboriginal community.
*The views expressed in this article do not necessarily represent the views of the Public Health Agency of Canada.
About the authors
Caitlin O’Reilly and Trixie Ling, CMHA BC
Tammy Stubley and Dr. Indrani Margolin, UNBC
Sheila Lewis, Ki-Low-Na Friendship Society
Amanda Swoboda, CMHA Kelowna
Sandy Brunton, Quesnel Tillicum Society
Fernando Polanco, BC Association of Aboriginal Friendship Centres
O’Reilly, C. (n.d.). The Connecting the Dots Manual. Vancouver, BC: Canadian Mental Health Association - BC Division. 2010.cmha.bc.ca/files/CTDMANUALApril26.pdf.
Flynn, R.J. (2008). Communities That Care: A Comprehensive System for Youth Prevention and Promotion, and Canadian Applications to Date. IPC Review, 2, 83-106.
Government of Canada. (2006). Aboriginal mental health and well-being. In The human face of mental health and mental illness in Canada (Chapter 12). Ottawa: Minister of Public Works and Government Services Canada. www.phac-aspc.gc.ca/publicat/human-humain06/index-eng.php.
Greenberg, J.S. (1985). Health and Wellness: A Conceptual Differentiation. Journal of School Health, 55(10), 403-406.
Wang, C. & Burris, M.A. (1997). Photovoice: Concept, methodology, and use for participatory needs assessment. Health Education and Behaviour, 24(3), 369-387.
Tuhiwai Smith, L. (1999). Decolonizing methodologies: Research and indigenous peoples. Dunedin: University of Otago Press.