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“I feel safe just coming here because there are other Native brothers and sisters”: findings from a community-based evaluation of the Niiwin Wendaanimak Four Winds Wellness Program

  • Michelle FirestoneEmail author
  • Jessica Syrette
  • Tessa Jourdain
  • Vivian Recollet
  • Janet Smylie
Qualitative Research
  • 64 Downloads

Abstract

Background

Urban Indigenous populations in Canada are steadily growing and represent diverse and culturally vibrant communities. Disparities between Indigenous and non-Indigenous peoples’ experiences of the social determinants of health are a growing concern. Under the guidance of the West End Aboriginal Advisory Council (WEAAC), Parkdale Queen West Community Health Centre (PQWCHC) launched the Niiwin Wendaanimak Four Winds Wellness Program that seeks to enhance health and community services for homeless and at-risk Indigenous populations in Toronto.

Objectives

A process evaluation was carried out to (1) assess the collaborative service delivery model; (2) identify service gaps and issues for homeless and at-risk Indigenous populations; and (3) develop recommendations for how non-Indigenous organizations can provide culturally responsive services for Indigenous populations.

Methods

In consultation with the WEAAC, a thematic analysis of qualitative data collected from 2 focus groups with community members who access the Niiwin Wendaanimak program and 17 key informant interviews with staff and peers was conducted.

Results

The Niiwin Wendaanimak program bridges teachings of inclusivity and the practice of harm reduction to create a non-judgemental space where community members’ dignity and autonomy is respected. Strengths of the program include Indigenous leadership and access to activities that promote wellness and community building.

Conclusions

As a non-Indigenous service provider, PQWCHC is meeting the needs of homeless and at-risk Indigenous populations in Toronto. Program strengths, system gaps, and challenges including policy recommendations were identified.

Keywords

Indigenous population Program evaluation Cultural safety Harm reduction 

Résumé

Contexte

Les populations autochtones du Canada sont en croissance constante et constituent des communautés diversifiées et culturellement dynamiques. Les disparités entre l’expérience des déterminants sociaux de la santé chez les Autochtones et les non-Autochtones inquiètent de plus en plus. Sous l’impulsion du conseil consultatif autochtone West End Aboriginal Advisory Council (WEAAC), le centre de santé communautaire Parkdale Queen West (PQWCHC) a lancé un programme de mieux-être, Niiwin Wendaanimak Four Winds, en vue d’améliorer les services de santé et les services collectifs offerts aux populations autochtones sans abri et vulnérables de Toronto.

Objectifs

Une évaluation des processus a été menée pour: 1) analyser le modèle concerté de prestation de services; 2) repérer les lacunes et les problèmes de l’offre de services touchant les populations autochtones sans abri et vulnérables; et 3) formuler des recommandations pour que des organismes non autochtones puissent offrir des services adaptés à la réalité culturelle des populations autochtones.

Méthode

En consultation avec le WEAAC, une analyse thématique des données qualitatives recueillies à la faveur de 2 groupes de discussion avec des membres de la communauté inscrits au programme Niiwin Wendaanimak et de 17 entretiens avec des informateurs (employés et pairs) a été menée.

Résultats

Le programme Niiwin Wendaanimak établit un rapprochement entre les enseignements de l’inclusivité et les démarches de réduction des méfaits afin d’aménager un espace non critique où la dignité et l’autonomie des membres de la communauté sont respectées. Les forces du programme sont ses instances dirigeantes autochtones et l’accès qu’il offre à des activités favorisant le mieux-être et la solidarité sociale.

Conclusions

Bien qu’il soit un fournisseur de services non autochtone, le centre PQWCHC répond aux besoins des populations autochtones sans abri et vulnérables de Toronto. Les forces du programme, les lacunes du système et des recommandations de principe ont été déterminées.

Mots-clés

Autochtones Évaluation de programme Sécurisation culturelle Réduction des méfaits 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. Aboriginal Standing Committee on Housing and Homelessness. (2012). Plan to end aboriginal homelessness. Calgary AB.Google Scholar
  2. Acting Medical Officer of Health. (2017). Toronto overdose action plan: prevention and response. Retrieved from https://www.toronto.ca/legdocs/mmis/2017/hl/bgrd/backgroundfile-101780.pdf.
  3. Allan, B., & Smylie, J. (2015). First peoples, second class treatment.Google Scholar
  4. Ball, J., & Janyst, P. (2014). Enacting research ethics in partnerships with indigenous communities in Canada: “Do it in a Good Way.”. Journal of Emperical Research on Human Research Ethics: An International Journal, 3(2), 33–51.  https://doi.org/10.1525/jer.2008.3.2.33.CrossRefGoogle Scholar
  5. Bear Paw Legal. (2016). Wahkohtowin: Cree Natural Law.Google Scholar
  6. Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2(1), 1–9.  https://doi.org/10.1186/1748-5908-2-40.CrossRefGoogle Scholar
  7. Cavino, H. M. (2013). Across the colonial divide: conversations about evaluation in indigenous contexts. American Journal of Evaluation, 34, 339–355.  https://doi.org/10.1177/1098214013489338.CrossRefGoogle Scholar
  8. Churchill, M. (2015). Defining and evaluation cultural safety at seventh generation midwives Toronto: exploring urban indigenous women’s perspectives on culturally safe maternity care. Lakehead Univeristy.Google Scholar
  9. City of Toronto. (2013). Street needs assessment 2013 results. Toronto.Google Scholar
  10. Crabtree, B. F., & Millar, W. L. (1999). The dance of interpretation. In Doing qualitative research (2nd ed., pp. 127–143). Thousand Oaks: Sage Publications.Google Scholar
  11. Environics Institute. (2010). Urban aboriginal peoples study. Toronto.Google Scholar
  12. Environics Instute. (2010). Urban aboriginal peoples study: Toronto report. Toronto.Google Scholar
  13. Estey, E., Kmetic, A., & Reading, J. (2008). Knowledge translation in the context of aboriginal health. The Canadian Journal of Nursing Research, 40(2), 24–39 Retrieved from http://myaccess.library.utoronto.ca/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2010030518&site=ehost-live.Google Scholar
  14. Firestone, M., Smylie, J. K., Maracle, S., Spiller, M., & O’Campo, P. (2014). Unmasking health determinants and health outcomes for urban First Nations using respondent-driven sampling. BMJ Open, 4(7), e004978.  https://doi.org/10.1136/bmjopen-2014-004978.CrossRefPubMedCentralGoogle Scholar
  15. First Nations Information Governance Centre. (2014). Ownership, control, access and possession (OCAP™): The path to First Nations information governance.Google Scholar
  16. Indian and Northern Affairs. (1996). Report of the Royal Commission on Aboriginal Peoples (RCAP). Retrieved from http://www.ainc-inac.gc.ca/ch/rcap/sg/cg_e.html.
  17. Kovach, M. (2009). Indigenous methodologies. University of Toronto Press.Google Scholar
  18. Kovach, M. (2010). Conversational method in indigenous research. First Peoples Child and Family Review, 5(1), 40–48.Google Scholar
  19. Lafrance, J., & Nichols, R. (2010). Reframing evaluation: defining an Indignous evaluation framework. The Canadian Journal of Program Evaluation, 23(2), 13–31.Google Scholar
  20. Linklater, R. (2014). Decolonizing trauma work: indigenous stories and strategies. Fernwood Publishing.Google Scholar
  21. Loppie Reading, C., & Wien, F. (2009). Health inequalities and social determinants of aboriginal peoples ’ health. Retrieved from http://www.nccah-ccnsa.ca/docs/socialdeterminates/nccah-loppie-wien_report.pdf.
  22. McCaskill, D., FitzMaurice, K., & Cidro, J. (2011). Toronto aboriginal research project: final report. Toronto.Google Scholar
  23. Moore, G., Audrey, S., Barker, M., Bonell, C., Hardeman, W., Moore, L., … Baird, J. (2014). Process evaluation of complex interventions: UK Medical Research Council (MRC) guidance.Google Scholar
  24. Moore, G. F., Audrey, S., Barker, M., Bond, L., Bonell, C., Hardeman, W., et al. (2015). Process evaluation of complex interventions: Medical Research Council guidance. BMJ, 350(mar19 6), h1258.  https://doi.org/10.1136/bmj.h1258.CrossRefPubMedCentralGoogle Scholar
  25. O’Reilly-Scanlon, K., Crowe, C., & Weenie, A. (2004). Pathways to understanding: “Wahkohtowin” as a research methodology. McGill Journal of Education, 39(1994), 29–44 Retrieved from http://search.proquest.com/docview/202694315?accountid=14771.Google Scholar
  26. Parkdale Queen West Community Health Centre. (2018). Retrieved from https://pqwchc.org/about-us/who-we-are/overview/. Accessed 19 Feb 2019.
  27. Rotondi, M. A., O’Campo, P., O’Brien, K., Firestone, M., Wolfe, S. H., Bourgeois, C., & Smylie, J. K. (2017). Our Health counts Toronto: Using respondent-driven sampling to unmask census undercounts of an urban indigenous population in Toronto, Canada. BMJ Open, 7(12), e018936.  https://doi.org/10.1136/bmjopen-2017-018936.CrossRefPubMedCentralGoogle Scholar
  28. Rowan, M., Poole, N., Shea, B., Gone, J. P., Mykota, D., Farag, M., et al. (2014). Cultural interventions to treat addictions in indigenous populations: findings from a scoping study. Substance Abuse Treatment, Prevention, and Policy, 9(1), 34.  https://doi.org/10.1186/1747-597X-9-34.CrossRefPubMedCentralGoogle Scholar
  29. Schnarch, B., & First Nations Centre, N. A. H. O. (2004). Ownership, control, access, and possession (OCAP) or self-determination applied to research: A critical analysis of contemporary first nations research and some options for first nations communities. Journal of Aboriginal Health, 1(1), 80–95.Google Scholar
  30. Shah, C. P., Klair, R., & Reeves, A. (2008). Early death among members of Toronto’s aboriginal community: walking in their shoes (Vol. 43). Toronto.Google Scholar
  31. Smith, D., Varcoe, C., & Edwards, N. (2005). Turning around the intergenerational impact of residential schools on Aboriginal people: implications for health policy and practice. The Canadian Journal of Nursing Research, 37(4), 38–60 Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med5&AN=16541818.Google Scholar
  32. Smith, L. (2012). Decolonizing methodologies: research and indigenous peoples (2nd ed.). Zed Books Ltd..Google Scholar
  33. Smylie, J. (2011). Knowledge translation in context: Indigenous, policy, and community settings. In B. J. R. Leadbeater, E. M. Banister, & E. A. Marshall (Eds.), Knowledge translation in community-based research and social policy contexts. University of Toronto Press Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=cat02447a&AN=smh.a8348296&site=eds-live.
  34. Smylie, J., Firestone, M., Cochran, L., Prince, C., Maracle, S., Morley, M., et al. (2011a). Our health counts urban aboriginal health database research project: community report first nations adults and children. City of Hamilton.Google Scholar
  35. Smylie, J. K., & Firestone, M. (2016). The health of aboriginal peoples. In D. Raphael (Ed.), Social determinants of health: Canadian perspectives (3rd ed., pp. 434–466). Toronto: Canadian Scholars Press Inc..Google Scholar
  36. Smylie, J. K., Snyder, M., Allan, B., Booth, S., & Senese, L. (2013). Gathering and applying reproductive, maternity, and family health information to support aboriginal maternity services in the GTA: aboriginal health data collection – aboriginal community engagement project summary report. Toronto.Google Scholar
  37. Smylie, J., Kaplan-Myrth, N., & McShane, K. (2009). Indigenous knowledge translation: baseline findings in a qualitative study of the pathways of health knowledge in three indigenous communities in Canada. Health Promotion Practice, 10(3), 436–446.  https://doi.org/10.1177/1524839907307993.CrossRefGoogle Scholar
  38. Smylie, J., Kirst, M., McShane, K., Firestone, M., Wolfe, S., & O’Campo, P. (2016). Understanding the role of indigenous community participation in indigenous prenatal and infant-toddler health promotion programs in Canada: a realist review. Social Science & Medicine, 150, 128–143.  https://doi.org/10.1016/j.socscimed.2015.12.019.CrossRefGoogle Scholar
  39. Smylie, J., Lofters, A., Firestone, M., O’Campo, P., & Campo, P. O. (2011b). Population-based data and community empowerment. In P. O’Campo & J. R. Dunn (Eds.), Rethinking social epidemiology: towards a science of change (pp. 67–92). Toronto: Springer Netherlands.  https://doi.org/10.1007/978-94-007-2138-8.Google Scholar
  40. Thistle, J. A. (2017). Definition of indigenous homelessness in Canada. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=azh&AN=44845164&site=ehost-live.
  41. Toronto Public Health. (2018). Monitoring deaths of people experiencing homelessness. Retrieved January 29, 2018, from https://www.toronto.ca/community-people/health-wellness-care/health-inspections-monitoring/monitoring-deaths-of-homeless-people/.
  42. Toronto West End Agencies. (2015). Premature death meeting may 12 2015 - summary notes.Google Scholar
  43. Truth and Reconciliation Commission of Canada. (2015a). Honouring the truth, reconciling for the future. Retrieved from http://www.trc.ca/websites/trcinstitution/index.php?p=3.
  44. Truth and Reconciliation Commission of Canada. (2015b). Truth and Reconciliation Commission of Canada: calls to action.Google Scholar
  45. Well Living House. (2017). Well Living House. Retrieved August 11, 2016, from http://www.welllivinghouse.com/wp-content/uploads/2018/04/QWCTCHC_FourWinds_Evaluation_11_9_17_FINAL2.pdf.
  46. Well Living House, & Seventh Generation Midwives Toronto. (2018). Our health counts Toronto fact sheet: housing and mobility. Toronto.Google Scholar

Copyright information

© The Canadian Public Health Association 2019

Authors and Affiliations

  1. 1.Well Living House, Centre for Urban Health Solutions (C-UHS)St. Michael’s HospitalTorontoCanada
  2. 2.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  3. 3.Parkdale Queen West Central Toronto Community Health CentreTorontoCanada

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