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.
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.
This is a preview of subscription content, access via your institution.
Notes
The term “Indigenous” is an inclusive and international term to describe individuals and collectives who consider themselves as being related to and/or having historical continuity with “First Peoples,” whose civilizations in what is now known as Canada, the United States, the Americas, the Pacific Islands, New Zealand, Australia, Asia, and Africa predate those of subsequent invading or colonizing populations. There is no universal definition of Indigenous peoples, but we chose to use this this term over the 1982 Canadian Constitution Act definition, which includes “Indian, Inuit, and Métis.”
References
Aboriginal Standing Committee on Housing and Homelessness. (2012). Plan to end aboriginal homelessness. Calgary AB.
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.
Allan, B., & Smylie, J. (2015). First peoples, second class treatment.
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.
Bear Paw Legal. (2016). Wahkohtowin: Cree Natural Law.
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.
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.
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.
City of Toronto. (2013). Street needs assessment 2013 results. Toronto.
Crabtree, B. F., & Millar, W. L. (1999). The dance of interpretation. In Doing qualitative research (2nd ed., pp. 127–143). Thousand Oaks: Sage Publications.
Environics Institute. (2010). Urban aboriginal peoples study. Toronto.
Environics Instute. (2010). Urban aboriginal peoples study: Toronto report. Toronto.
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.
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.
First Nations Information Governance Centre. (2014). Ownership, control, access and possession (OCAP™): The path to First Nations information governance.
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.
Kovach, M. (2009). Indigenous methodologies. University of Toronto Press.
Kovach, M. (2010). Conversational method in indigenous research. First Peoples Child and Family Review, 5(1), 40–48.
Lafrance, J., & Nichols, R. (2010). Reframing evaluation: defining an Indignous evaluation framework. The Canadian Journal of Program Evaluation, 23(2), 13–31.
Linklater, R. (2014). Decolonizing trauma work: indigenous stories and strategies. Fernwood Publishing.
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.
McCaskill, D., FitzMaurice, K., & Cidro, J. (2011). Toronto aboriginal research project: final report. Toronto.
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.
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.
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.
Parkdale Queen West Community Health Centre. (2018). Retrieved from https://pqwchc.org/about-us/who-we-are/overview/. Accessed 19 Feb 2019.
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.
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.
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.
Shah, C. P., Klair, R., & Reeves, A. (2008). Early death among members of Toronto’s aboriginal community: walking in their shoes (Vol. 43). Toronto.
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.
Smith, L. (2012). Decolonizing methodologies: research and indigenous peoples (2nd ed.). Zed Books Ltd..
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.
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.
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..
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.
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.
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.
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.
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.
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/.
Toronto West End Agencies. (2015). Premature death meeting may 12 2015 - summary notes.
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.
Truth and Reconciliation Commission of Canada. (2015b). Truth and Reconciliation Commission of Canada: calls to action.
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.
Well Living House, & Seventh Generation Midwives Toronto. (2018). Our health counts Toronto fact sheet: housing and mobility. Toronto.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Firestone, M., Syrette, J., Jourdain, T. et al. “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. Can J Public Health 110, 404–413 (2019). https://doi.org/10.17269/s41997-019-00192-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.17269/s41997-019-00192-6