Culture as Intervention in Addictions Treatment: Appreciating the Evidence within Indigenous Knowledge

Transcription

1 Culture as Intervention in Addictions Treatment: Appreciating the Evidence within Indigenous Knowledge Chiefs of Ontario Health Forum Feb Elder Jim Dumont, Carol Hopkins, Colleen Dell, Peter Menzies & Team

2 WHAT DO WE KNOW? 1. The destructive impacts of colonization on the determinants of First Nations health. 2. The important and strengths-based role of culture in healing from problematic substance use and addictions.

3 1. What are the indicators of client wellness as an outcome of participation in Indigenous traditional cultural interventions while in treatment for problematic substance use? 2. Drawing on this understanding, what is the validity of a culturally competent instrument developed to measure change in wellness among clients in treatment for problematic substance use?

4 In Our Own Words

5 Collecting Understanding Two-Eyed Seeing First Nations knowledge was prioritized throughout the process of synthesizing the information shared by the Treatment Centres

6 The Environmental Scan Sharing the Process Travelling across the country On snowy roads in beautiful landscapes Culturally Grounded Research Local First Nations protocols were followed at each center. How treatment centers looked at their themes Central questions 1. What is wellness from First Nations perspectives? What does it look like? 2. What are the indicators or measures of physical, emotional, mental and spiritual wellness in the treatment program? 3. What are the cultural interventions used by your Treatment Centre to achieve wellness and how do they work in the treatment program? 4. Is there a story of origin/traditional teaching linked to each intervention and if so, where does it come from? 5. When are these cultural interventions not working to achieve and maintain wellness, and why? 6. What are the broader Treatment Centre issues influencing these interventions? Who or what are major factors in this, and why? 7. How can these cultural interventions work better within these influencing factors? Arriving at our framework Elder Jim Dumont shared the Anishinabe Creation story before the 3 day discussions.

7 Indigenous Framework Sharing the Process London ON London calling We met twice as a team with Elder Jim Dumont, Mary Deleary, Carol Hopkins, Virgil Tobias and Laura Hall. Based on Elder Jim Dumont s insights and data analysis a framework emerged Wellness What does it mean to understand wellness and health/wholeness, from our own perspectives as First Nations Peoples? What does a strengths-based approach look like? What are our: Indicators Outcomes Deficits Time Together We sorted through the notes, scrolls, and flip-charts from the Treatment Centre visits. We created charts illustrating the behavioral aspects of a whole and healthy Anishinabe person. Spirit as Hope Physical as Purpose Emotional as Belonging Mental as Meaning How do we define wellness? An example of some commonly used ideas

8 Western Method Approach Sharing the Process The Process Multi-Level First-Order Data Analysis: What Content Exploration Analysis Label shared units of meaning At a Glance Step 1: Shared Units of Meaning during Focus-Group Discussions Wellness Explained Step 3: Explained emphasis of Discussion Second-Order Data Analysis: Description Label and describe shared pattern categories Third-Order Data Analysis: Explanation Conceptually discuss, explain, declare pattern categories How Why Approved notes from 12 different focus group-gatherings Step 1: 13,581 unit nodes captured in total 2,136 unique unit nodes from these Step 2: 52 category nodes from shared patterns Step 3: 4 explanatory pattern categories of Wellness Step 2: Wellness Pattern Categories for Consideration Steps 1 & 2: Emergent approach to meaning creation Step 3: Grounded approach to meaning explanation The Tool The Team N A T I O N Carina A Fiedeldey- Melissa Santoro Greyeyes-Brant L Van Dijk Sheila Grantham Laura Hall F O R U M Special thanks to all participants

9 Scoping Review Approach Sharing the Process *Scoping study approach Stage 1: Identify the research questions. Stage 2: Identify relevant studies. Stage 3: Select studies. Stage 4: Extract information from studies. Stage 5: Collate, summarize, and report results. Stage 6: Consult with stakeholders. (*from Arksey & O Malley, 2010; Levac et al, 2010). Research questions 1) To what extent have cultural interventions been used in Indigenous populations to treat addictions? 2) What is the outcome of cultural interventions on wellness in these contexts? Catching the best articles from a sea of information Netting relevant studies through PICO Population: First Nations, Indigenous, Aboriginals in treatment for problematic substance abuse or addictions treatment. Intervention: Indigenous cultural interventions for addictions and substance abuse, wellness, well being, mental health, mental wellness. Comparison: Not applicable. Outcome: Outcomes are holistic and focus on the dimensions of spiritual, mental, emotional, and physical wellness. The selection process Scientific literature database search N=3908 Abstracts and papers excluded through three stages of screening N=3894 Grey literature database search N=610 Reports excluded through three stages of screening N=605 Final papers included N=14 Final reports included N=5 Final papers and reports included in scoping study N=19

10 DEFINITION OF WELLNESS Wellness is a whole and healthy person expressed through a sense of balance of body, mind, emotion and spirit. Central to wellness is belief in one s connection to language, land, beings of creation, and ancestry, supported by a caring family and environment. The spirit causes us to live, gives us vitality, mobility, purpose and the desire to achieve the highest quality of living in the world. Spiritual well-being is the quality of being alive in a qualitative way. Spirit is central to the primary vision of life and worldview and thereby facilitates hope. Within an Indigenous worldview, being rooted in family, community and within creation as extended family is the foundation of belonging and relationships. At this heart level of one s being, emotional and relational wellbeing is nurtured by ones belonging within interdependent relationship with others and living in relation to creation, including beings in creation. The mind operates in both a rational and intuitive capacity. Mental well-being is the conscious and intelligent drive to know and activate one s being and becoming. Having a reason for being gives meaning to life. The body is the most outer part of our being and is comprised of the most immediate behavioral aspects of our being. Physical wellbeing is that way of behaving and doing that actualizes the intention and desire of the spirit in the world. This and the knowledge that the spirit has something to do in the world generates a sense of purpose, conscious of being part of something that is much greater than they are as an individual.

11 WELLNESS FRAMEWORK Way of Doing Values Family Community

12 Draft List of Cultural Interventions 1. Language 2. Tell Creation story 3. Traditional teachings 4. Ceremonial practice 5. Naming ceremony 6. Give away ceremony 7. Cleansing & Healing ceremony 8. Fasting ceremony 9. Ghostfeast/memorial feast 10. Prayer 11. Dream interpretation 12. Use of natural foods/medicines 13. Use of cultural instruments 14. Singing 15. Dancing 16. Elders (various roles) 17. Cultural Practitioners (various roles) 18. Social/culture 19. Land based activity 20. Hunting/fishing/hide making 21. Storytelling 22. Talking circle 23. Other - teaching prophecies - Teaching protocols - Use of humor - arts/crafts - horse program (horse dance ceremony - Teaching about treaties - medicine gathering - planting - trade/commerce - clan identification

13 DEFINITION OF CULTURE: SUMMARY OF PRIMARY CONCEPTS Although there are many ways by which culture is expressed amongst the various First Nations, there are principal, foundational beliefs and concepts that are commonly held that support a unified definition of Indigenous culture. In what follows are these primary concepts of the Indigenous worldview. 1.The Spirit: The most fundamental feature of the Indigenous worldview is the Spirit. 2.The Circle: the world. The circle, more than any other symbol, is most expressive of the Indigenous view of 3.Harmony and Balance: Desire for harmony is the pre-disposition of all of the created world. Harmony is a central value of the Indigenous worldview, which pre-supposes that all of life consciously cares for one another, and while respecting the individual s autonomy, strives to achieve and maintain an interrelationship that assures quality of life for the collective whole. Balance is a fundamental principle within the way that harmony in interrelationship works. 4. All My Relations. All that is created consciously cares about the harmony and well-being of life; all things are regarded as persons and as relatives. Personhood not only applies to human persons, but plants, trees, animals, rocks, and visible and unseen forces of nature are also considered as persons.

14 14 DRAFT DEFINITION OF CULTURE: SUMMARY OF PRIMARY CONCEPTS 5. Kindness/Caring/Respect Another key to understanding the Indigenous worldview is the recognition of the fundamental precept: the universe cares. The Creator cares for his creation. The Earth cares about her off-spring and all of earth-life. The beings within creation care about each other and about how they relate to one another within the interconnectedness and interdependence of the web of life. 6. Earth Connection: We are all relatives because we have the same Mother. 7. Path of Life Continuum: The experience of living in this world is understood as a journey of the spirit moving progressively through stages that are interconnected and continuous. In the same way, lives are connected inter-generationally as strings of lives connecting us to our ancestors and to those yet unborn. 8. Language: The original language is the most expressive communication of the spirit, emotions, thinking, behaviour and actions of the people. Language is the voice of the culture and therefore the true and most expressive means for the transmission of the original way of life and way of being in the world. Culture is the expression, the life-ways, and the spiritual, psychological, social, material practice of this Indigenous worldview.

15 STRUCTURE OF THE WELLNESS INSTRUMENT The instrument will consist of approx 65 questions for clients and observers, with a balance across all 4 quadrants of the Indigenous Wellness Framework It will be set up to be tested and standardized to report reliable changes over time this means at the beginning, during, end and post treatment We hope to test the instrument with as many treatment centres as possible and with all clients not just the ones who participate in culture. A guidebook will accompany the instrument so there are clear instructions The list of 22 cultural interventions will also accompany the instrument

16 PILOT TEST To register for the pilot test, please contact: or Pilot with clients and observers completing the assessment will take place from July 30 th 2014 to Jan 31, 2015 Please join us in our work to create a pathway of wellness to the future with culture as the foundation

17 Next Steps 1. Complete final stages to draft Wellness Instrument 2. Initiate the pilot 3. Writing for shared learning 4. Monthly newsletter, website, recipe cards

18 F OR MORE INFORMATION, CONTACT: B ARBARA F ORNSSLER PHD R ESEARCH M ANAGER HOS: A BORIGINAL C ULTURE AS INTERVENTION INYURL. COM/ CULT UREASINTERVENTIONRESEARCH O FFICE OF DR. C OLLEEN DELL, DEPARTMENT OF SOCIOLOGY & S CHOOL OF PUBLIC HEALTH 1112 A RTS BUILDING, 9 C AMPUS D RIVE U NIVERSITY OF SASKATCHEWAN SASKATOON SK C ANADA S7N 5A BARB.FORNSSLER@ USASK.CA