Health and Wellness

Imagine if every Indigenous youth in our communities had the tools and knowledge to recognize and respond with resiliency to trauma and stress resulting from the societal, community, and family influences that impact their mental wellness.

More than two-thirds of young adults living with a mental health problem or illness say their symptoms first appeared when they were children (Mental Health Strategy for Canada: A Youth Perspective, 2013). Most Indigenous preadolescence youth have experienced heavy loss or some form of trauma before they enter high school, which can be precursors for mental health struggles in their teenage years if they do not have the tools to successfully navigate these challenges.

A holistic resiliency model for urban Indigenous preadolescent youth that aims to promote mental wellness of urban Indigenous preadolescence youth in Alberta’s Friendship Centre communities using resilience-based intervention. The key intervention methodology uses Indigenous knowledge, cultural activities, and a targeted curriculum addressing colonial-rooted contemporary risk factors impacting the mental wellbeing of Indigenous preadolescent youth. The cultural framework will emphasize the development of internal assets and external resources as the focus for change.

Internal asset development includes: developing healthy social skills and peer relationships, increasing self-esteem for health promoting behaviors and increasing self-confidence, as well as participation in community based activities.

External resource development includes: healthy adult mentorship (i.e. community Elders, traditional and cultural healers, Friendship Centre Staff), increased parental/caregivers skills and knowledge, and providing health promoting settings.

The ultimate goals of this program is to improve social and emotional resilience, decrease risk factors and reduce inequities to promote wellbeing for positive mental wellness.

Target outcomes will include: increased self-esteem, increased coping and competency skills, increased positive supportive familial environment; increased positive peer relationships and communication; increased community connection, increased risk factor protective tools, and increased self-determination.

Filling Our Tipis is using an Indigenous evaluation to measure its impact. Using a model that puts Indigenous epistemology at the center of this Indigenous youth, mental wellness promotion project ensures Indigenous knowledge and wisdom is infused throughout the program and the evaluation process. The program focuses its activities on a Tipi Teaching Curriculum which includes activities such as sharing circles, symbol-based reflection activities, self-awareness medicine wheel activities, and storytelling activities. The Indigenous research and developmental evaluation works in correlation with the program to ensure that Indigenous wisdom and Indigenous evaluative practises are infused in the delivery of the program. And, outcomes can measured while ensuring community and participant safety, and include urban Indigenous mental health and resiliency data collection.

The majority of research and evaluation on Indigenous mental health relates to the mental health of First Nations people living on reserve, Métis Settlements, and Inuit; there is very little mental health information available on Alberta’s Indigenous population who reside in urban and rural centres. In the context of Indigenous people, who experience greater health disparities compared to the general population, mainstream knowledge translation of health evidence has often been inadequate or inappropriate, resulting in limited uptake of the evidence into practice.

In the context of Indigenous research in Canada, it has been suggested that appropriate knowledge translation is about sharing knowledge in ways that are “locally developed and contextualized”. (Estey EA, 2010). For knowledge translation to be effective in the context of Indigenous health, it must be both relevant and valued, and for this, it must resonate with Indigenous ways of knowing and doing. This requires that Indigenous people are effectively and respectfully engaged in all stages of health research. Indigenous ways of knowing can shape ways in which culturally harmonious evaluation can be conducted in Indigenous communities (LaFrance, 2010). Indigenous evaluation needs to incorporate a broad range of standards when assessing what is of value for a community. This program honours knowledge from outside of the western paradigm and broadens the understanding of Indigenous wisdom-seeking practices in health research.

The research and evaluation method for this project embraces the above theory of evaluation and uses the following values of Indigenous evaluation:

• Traditional ways of community reflection and assessing worth: Ceremony, circle process, and relational accountability form the heart of a wisdom-seeking approach.
• Taking ownership and using first voice: As Alberta has a diverse Indigenous population, communities will define the cultural aspects of the intervention. (i.e. Blackfoot teachings, Cree Traditions, or Métis Culture). Taking ownership for defining success and “telling the story” from the perspective of the community’s values and aspirations. Communities can define the standards for telling the program’s story.
• Respecting and inviting Elder knowledge: inclusion of Elders is critical to an Indigenous evaluation framework. They provide the traditions and teachings of an Indigenous world view.
• Understanding the role of time: Evaluation in the Western sense of measuring within a discrete timeframe will generally fall short of the Indigenous notion of taking time to fully comprehend what has been learned and how it was learned. Also, evaluation begins in the early stages of program implementation to fully engage the staff, community, and youth.
• A sense of becoming: the concept of historical trauma as a result of cultural repression, the need to heal and work toward individual and community wellness. Within this context, evaluation is valued when it reflects community values and contributes to learning related to cultural renewal and revitalization.
• Centrality of community and family: Indigenous people’s family and community are core elements of one’s personal identity. This also incorporates the framework of the resiliency program model of internal and external resources.

In Canada, approximately 74% of Indigenous people reside in an urban setting. In Alberta, Indigenous people make up approximately 6.5% of Alberta’s entire population. However, Indigenous people have not benefitted equally as their non-Indigenous counterparts from the medical advances in cancer prevention and care. Urban Indigenous people experience numerous systemic barriers and social determinants regarding healthcare. Partially due to lack of access and culturally appropriate services, there is a tendency towards higher rates of cervical cancer in women, and of lung cancer in men and women in the Indigenous population. Indigenous communities are also disproportionately affected by cancers related to smoking, which in itself is a major risk factor for a number of other cancers and related to infections. By working together and meaningfully engaging Indigenous people in their healthcare, we can combat health inequalities and improve outcomes.

In many instances, Friendship Centres are known as that respectful bridge that helps lead urban Indigenous people to timely, appropriate services without judgment or stigma. This initiative, called Circle of Life, seeks to reduce the incidence of cancer and related risk factors by completing an in-depth community environmental scan of two different communities (one rural and one urban}, develop associated programming in the two Friendship Centre communities, and compile an in-depth report on cancer prevention and the urban Indigenous community based on the findings of the scan and the in-community initiative.

The objectives of this project are:

• Community engagement: Establishment of community circles to increase local awareness, knowledge, and to explore potential community-specific responses to cancer prevention, and reducing risk factors for cancer.
• Awareness: Inform urban Indigenous community members within the two Friendship Centre communities and provide awareness of available cancer prevention, screening services and risk factor. Community organizations, service delivery providers, and other partners will be aware of culturally sensitive approaches to working with the urban Indigenous population and the barriers they face in accessing much needed services. Overall, community understanding.
• Navigation support: Establish two navigation staff, one in each partner Friendship Centre. Navigation staff provide Friendship Centre community outreach and relationship building for all regional services providers, cancer screening and prevention programs and services and the establishment of referral processes.
• Data collection: Tracking and reporting of monthly referrals made through non-identifying markers; document and share through online means all relevant service providers, cancer screening and prevention services located within the Friendship Centre community. Data for each community to be used for an evaluation of the initiative.

Alberta’s Cancer Plan to 2030 strongly indicates cancer prevention, screening, early detection, and cancer journey support as key elements for reducing the economic and social impact of cancer on Albertans. Rising incidence, lower survival rates, lower screening rates, and later diagnosis among Indigenous peoples is indicative of growing inequity and disparity between Indigenous and non-Indigenous peoples. As the largest urban Indigenous service delivery mechanism in Alberta with more than 300,000 points of service annually, Friendship Centres are well positioned to prevent cancer as well as support community members journeying through cancer in ways that are self-determined by urban Indigenous communities.

Through self-determined strategies in two Friendship Centre communities, our two-year Circle of Life initiative sought to reduce cancer incidence and related risk factors at the same time as providing culturally safe navigation support to community members and their families journeying through cancer. As the first cancer specific project involving the ANFCA and Friendship Centres, Circle of Life established a foundation for continued work. We hope to action the needs and recommendations expressed by our Elders, youth, and Friendship Centres through respectful and reciprocal relationships where the self-determination of urban Indigenous peoples is acknowledged and honoured.

A finding of the Circle of Life project was that there is a lack of resources to support urban Indigenous peoples along the cancer screening journey. To help fill this gap, and with the guidance and knowledge of our Elders, youth, Friendship Centres, and in partnership with the Alberta Cancer Screening Programs, we developed three ‘Cancer Screening Pathways’ for breast, colorectal and cervical screening. The goal of these ‘Cancer Screening Pathways’ is to provide Friendship Centre communities with information on the process of cancer screening so that community members understand and feel safe and empowered in taking a preventative action in their journey of wellness.

• Breast Cancer Screening Pathway
• Cervical Cancer Screening Pathway
• Colorectal Cancer Screening Pathway

Here are some other resources to support Friendship Centre communities with cancer prevention and along the cancer journey:

• Alberta Indigenous Virtual Care Clinic (AIVCC)
  • You can call the AIVCC to make a same-day appointment with a doctor to discuss your healthcare needs, including with cancer screening. They can help support you with referrals, follow-up, and explaining your test results.
  • You can access the AIVCC even if you already have a healthcare provider. For example, if you do not feel safe with your healthcare provider or if you feel like they did not take your concerns seriously, you can call the AIVCC.
  • https://aivcc.ca/
• Indigenous Cancer Patient Navigators, Alberta Health Services
  • You can contact the Indigenous Cancer Patient Navigator for your area at any point along your cancer journey. They can help you navigate the healthcare system with cultural safety. You do not need a referral.
  • If you are located south of Red Deer, call 403-476-2763
  • If you are located in and/or north of Red Deer, call 780-432-8747
  • https://www.albertahealthservices.ca/cancer/Page16319.aspx
• Guide to Cancer Care in Alberta For Newly Diagnosed Indigenous Peoples
  • https://www.albertahealthservices.ca/assets/info/cca/if-cca-guide-to-cancer-for-indigenous-people.pdf

In an effort to respond to the growing crisis of opioid deaths, ANFCA and four of its member Friendship Centres located in highly opioid-impacted communities (Edmonton, Grande Prairie, Calgary and Lethbridge) have formed culturally-appropriate channels to identify, inform, support and where possible, mitigate rates of incidence of negative opioid interactions in the urban Indigenous community.

In many instances, Friendship Centres are known as that respectful bridge that helps lead urban Indigenous people in timely, appropriate services without judgement or stigma.

Néya Napew Na Muton (a Cree phrase) that translates to “I Am a Kind Man”, is a program that was created to provide an opportunity for communities to engage men and youth in raising awareness, broaden understanding of violence against women, and supporting men to come together and to end violence. At a time when violence is invading whole communities, “I Am a Kind Man” reminds us that violence has never been part of Indigenous culture.

The program provides a supportive, holistic model for community healing. Néya Napew Na Muton recognizes the challenges Indigenous men face as a result of colonization and historical trauma and encourages them to reconnect with their traditional roles within families and communities.

Néya Napew Na Muton embraces the Seven Sacred Teachings that show us how to live in harmony with creation through wisdom, love, respect, bravery, honesty, humility, and truth. It is designed to offer men a safe place to begin to understand their roles and responsibilities toward ending violence.

The overall purpose of the Néya Napew Na Muton program is to engage men and youth of our communities to speak out against all forms of abuse towards Indigenous women.

Program Objectives

1. To reclaim and revitalize men’s responsibility to end violence against Indigenous women;
2. To ensure access to indigenous cultural values and increase understanding of traditional roles and responsibilities based on local Indigenous knowledge;
3. To increase resilience by empowering men to acknowledge and resolve trauma;
4. To improve men’s well-being and foster community wellness.

* The term men/man shall refer to any individual who identifies as a man throughout stages of the life cycle.

The story begins…

On an early 2011 August morning, an Aboriginal man named Paul Lacerte and his daughter Raven were hunting moose near the infamous Highway of Tears, a section of highway between Prince George and Prince Rupert, BC, where dozens of women have gone missing or been found murdered.  They had brought down a moose that would help feed the family for the winter and provide a moose hide for cultural purposes. As the daughter was skinning the moose her father started thinking…They were so near the highway that has brought so much sorrow to the communities along its endless miles, here with his young daughter who deserved a life free of violence…That’s when the idea sprang to life!  What if they used the moose hide to inspire men to become involved in the movement to end violence towards Aboriginal women and children?  Together with family and friends they cut up the moose hide into small squares and started the Moose Hide Campaign.

Where we are now….

Now, more than 6 years later, over 750,000 squares of moose hide have been distributed and the Moose Hide Campaign has spread to communities and organizations across Canada.  Local campaigns have started in government offices, in colleges and universities, on First Nations reserves, in Aboriginal Friendship Centres, in community organizations, and within individual families.

In Victoria and in communities across Canada, men have held a Moose Hide gathering in February to stand up against violence towards women and children and to spread the campaign.  Over the past 6 years, during the annual Gathering, elected members of the legislatures of British Columbia, Alberta and the Northwest Territories have stood in solidarity with the Moose Hide campaign by wearing the Moose hide square while the House was in session.