An holistic approach to promoting resilience and bimaadiziwin among First Nations youth in communities in Northwestern Ontario

Indigenous youth experience many of the same developmental stressors as non-Indigenous youth. Yet, the disproportionate number of Indigenous youth attempting and completing suicide suggests that the behavioural profile associated with suicide differs (Bolton, 2014; MacNeil, 2008), and the prevalence of conditions that place Indigenous youth at risk is greater. Intergenerational trauma, cultural discontinuity, community struggles (poverty, insufficient and inadequate housing, low education and employment, lateral violence), and familial factors emanating from historical and ongoing trauma (poor parenting, substance use, mental health challenges) all contribute to Indigenous youth deaths by suicide (Kirmayer et al., 2007).

Given the range of contributing factors, it should not be surprising that any single approach to suicide prevention is unlikely to have substantial impacts. Knowing where to begin and how to proceed is difficult when so little is known about effective prevention of youth suicide in general, and Indigenous youth suicide more specifically (Harlow et al., 2014; Kutcher et al., 2017). What is known is that sustained and real change requires holistic and culturally appropriate interventions (Bennett et al., 2015; White & Mushquash, 2016). Such a claim is not novel, and is consistent with the conclusions of numerous reports, including the 1995 Royal Commission on Aboriginal Peoples “Choosing Life” report, and the 2017 report of the Standing Committee on Indigenous and Northern Affairs titled “Breaking Point.” The Indigenous Youth Futures Partnership was created with the understanding that if interventions are only mobilized when communities are in crisis, suicide prevention will continue to be an upstream battle. A more effective approach would be to reduce the multitude of risk factors for suicide by providing young people with the strength, self-knowledge, and hopes that promote resilience and empower them on the pathway to bimaadiziwin (a healthy way of life).

Framework guiding the Indigenous Youth Futures Partnership
After several years of partnership-building across disciplines, universities, and sectors working with children and youth in northwestern Ontario, in 2016 the Indigenous Youth Futures Partnership (IYFP) was launched. The IYFP brings together tools and approaches rooted in local Indigenous knowledge and Western science to work together with First Nations communities in the Sioux Lookout First Nations Health Authority (SLFNHA) zone in northwestern Ontario to articulate each community’s vision for the future. This vision will guide the co-development, implementation and evaluation of multiple, interdependent pathways to foster youth resilience and create the conditions for youth to thrive.

The need for an interconnected approach to suicide prevention reflects the IYFP’s early discussions with First Nations youth who pointed to the importance of “being balanced physically, emotionally, mentally, and spiritually,” “having and being a good role model and being a leader”, “community gatherings” and especially “family.” Elders further underscored the need for youth to understand the history of First Nations peoples that has led to their current circumstances. Such an understanding would help youth to appreciate that their difficulties are not about their own shortcomings, or those of their family or community. By recognizing the pervasive effects of colonizing practices and policies, there is a basis for moving forward in the healing process.

As depicted in Figure 1, the IYFP framework takes a systems-based approach to suicide prevention that places youth at the centre, and recognizes the influences of the local community, the institutions that affect how communities operate, and in the values, norms, and social relationships that are at the core of community life. This framework is consistent with theoretical perspectives that argue that resilience operates within the ‘ecosystem’ in which youth reside (Burns, 2014). In line with this, the IYFP approach focuses on activities that target four elements; the order in which they are considered depends on existing community strengths and priorities. The activities are designed to address:

  1. Empowering youth by fostering their hopes and goals for the future, strengthening coping skills, enabling a view of themselves as having something to contribute, and engaging them as decision-makers.
  2. Providing a positive socio-cultural context for youth development, which depends on fostering community resilience (i.e., the capacity to prevail in the face of collective adversity). Community resilience includes a strong cultural identity, a sense of belonging and trust among community members, reconciling differences in worldviews, and adapting to changing environments and the modern world.
  3. Encouraging the aspirations of youth by enabling them to contribute to, and benefit from, the development of their communities. This means having appropriate mentoring, social structures, economic bases, policies, and leadership for effective governance. It also requires that jurisdictional tensions that create resource gaps and service inadequacies need to be addressed.
  4. Finally, local values and traditions are a source of strength, and many communities have retained or are reclaiming traditional teachings, connection to the land, language, and ways of relating to one another. Ensuring youth have a voice in shaping cultural identity and strategies of resistance and empowerment can contribute to their resilience.

In effect, our approach to suicide prevention encourages multiple pathways to youth wellness. It is aligned with various strategies that encourage a culturally relevant, holistic, and community-engaged framework, including the 2015 “First Nations Mental Wellness Continuum Framework” that highlights the need for youth to feel a sense of belonging, purpose, hope, and meaning in life. These factors are key to youths’ capacity to cope with the challenges that they face, and to protect them against depression, despair, and ultimately suicide.

Figure 1. The core elements of the Indigenous Youth Futures Partnership for fostering resilience and bimaadiziwin, and the contexts in which they operate.

How are we doing this?
The focus of the IYFP is on communities in the Sioux Lookout First Nations Health Authority catchment area of the Nishnawbe Aski Nation in northwestern Ontario. This region includes 33 rural and remote fly-in communities that vary in size, accessibility, cultural connections and roots, treaty agreements and resources. They have in common the impacts of colonialist policies, including the effects of Indian Residential Schools. Many of these communities are struggling with youth suicide. In fact, suicide rates for those under 15 in some communities in this region have been identified to be 50 times higher than the national population average (SLFNHA, 2006). In the past year alone, three communities have declared a state of emergency due to suicide clusters among their young people, some of whom were as young as 10 years of age. Each time, the solution adopted is to send in mental health workers who can “treat” those at risk. While calls for more sustained mental health supports that are proportionate to the need deserve to be met, the fact that there is such a dire need points to a social, political, and environmental context that is giving rise to young people viewing suicide as a solution. In recognition of this, SLFNHA established community health and mental health strategies, with a particular focus on children, families, and communities.

The IYFP approach builds on SLFNHA’s community-based strategy called “Raising our Children” by expanding the range of pathways communities can develop to support the healthy development of their young people. In partnering with the IYFP, communities self-identify their concerns and commit to implementing and evaluating actions that promote youth resilience in the face of the stressors they encounter, create an environment that supports youth success and aspirations, and ultimately ensure their mental and physical well-being in order to reduce rates of suicide.

To establish an action plan, the IYFP works together with communities to articulate each community’s vision for the future, and to develop a pathway to achieving this vision. Developing a comprehensive community-led approach to change means that actions are not conducted in isolation, but are part of a systematic integrated approach that builds on community resources and strengths, and can adapt to challenges or obstacles as they are encountered. The role of the IYFP is to facilitate exploration of alternatives not yet considered, and to help identify and leverage resources for sustained implementation. This includes an evaluation framework, with communities defining appropriate measures to evaluate the implementation process and outcomes, and at the same time assess on an ongoing basis progress toward reaching their vision.

Our discussions with communities focus on the goal of promoting youth resilience and wellness, as the ability for communities to openly acknowledge and explicitly address the issue of suicide varies. This might translate into some interventions being framed explicitly as suicide prevention, whereas the same activity in other communities might instead focus on protective conditions, such as returning to cultural traditions. In addition, the activity or program each community chooses to implement to meet its aspirations is decided at the community level. One community might choose to focus on a single activity, and use it as a basis for branching out. For example, a community might set up a youth hockey league. In so doing, youth are able to participate in an activity that promotes leadership and team skills, a sense of belonging, a healthy life style, a social support network, and a way of coping with stress, all of which constitute protective factors in relation to suicide.

Alternatively, a community might build on a series of activities that, once threaded together, creates a well-woven safety net. For example, the community might make the most of youths’ interest in technology by training them to do digital stories. To empower Elders (or promote healing), land-based retreats might be established. These activities might be threaded together with an intergenerational digital storytelling initiative, wherein youth learn from the resilience of their Elders. Modeled after Wexler’s (2011) “Intergenerational Dialogue Exchange and Action,” such an initiative provides an opportunity for youth to gather and share valuable insights into community values, strengths, and relationships, and the digital stories they create can serve as “Hope Kits,” reminding youth of their reasons for living.

In effect, the IYFP adopts a system-based approach to taking actions to promote a positive life for youth. The success of each activity is anticipated to leverage the success of another in a cumulative manner. Much like a traffic circle, the expectation is that a community can enter the circle from a single or multiple points, but irrespective of which or how many entry points are chosen, there is a common understanding of which direction they are going in and the destination they plan to reach.

Critical features
An holistic multi-pronged approach to suicide prevention recognizes the multi-layered world in which youth live. For the IYFP to be successful requires coordination of activities that target each of these layers. In this regard, there are several features of the IYFP that maximize the probability of success in terms of creating the broader conditions that can lessen the factors that place youth at risk for suicide, and that promote youth wellness.

The IYFP approach is aligned with the strategic framework guiding the priorities of SLFNHA, the primary regional partner. This means that we are able to leverage pre-existing resources and strengths, and anchor program development in an organization that has a stable and credible reputation within the region. SLFNHA is mandated to take an holistic approach to the wellbeing of individuals, families, and their communities. This is reflected in its Approaches to Community Wellbeing framework, which takes an integrated, community-engaged approach to physical and mental health programing. “The Approaches to Community Wellbeing” framework was developed through a process of community consultations over several years. A key aspect of the framework concerns “Raising Our Children,” which identifies strategies for positive youth development, building healthy relationships, and ensuring that children are raised in healthy environments – an intrinsically preventative approach to suicide, among other personal wellbeing issues. By building on the “Raising Our Children” aspect of the Community Wellbeing framework, the role of family and the developmental course of youth are incorporated into the IYFP strategy. This alignment ensures that the research and policy advocacy activities of the IYFP reflect the priorities and needs of communities. At the same time, as seen in Figure 2 (GORDON 2.pptx), there are distinctive elements of the IYFP that allow us to support communities to take a more comprehensive youth-focused action strategy.

Figure 2. The relationship between the Indigenous Youth Futures Partnership and the Raising our Children component of SLFNHA’s Approaches to Community Wellbeing framework.

From the outset, youth have been actively engaged in our approach and we continue to seek their voices as programs and goals are shaped. Not only does this mean that the activities and outcomes will be more relevant, but meaningful youth engagement in itself serves a protective role against suicidal ideation and behaviour (Armstrong & Manion, 2015). When youth feel like they are heard, that they belong, and they are engaged in the decision-making and leadership of their community, they have greater cultural pride and perceive a more positive future.

Cultural continuity, and environmental, social, and economic stability are widely cited as essential foundations for the wellbeing of Indigenous peoples and communities. In this regard, promoting youth wellness goes beyond individual risk factors for suicide, to include economic independence and connections to culture and the land (Allen et al., 2014; Phillips et al., 2012). The IYFP includes expertise to address multiple dimensions of a community that one does not always think of as part of a suicide prevention strategy, but do, in fact, influence whether young people feel hope or despair. This includes effective self-governance and administration, resource and economic development, public health, artistic and cultural endeavours, and the health of the land. As communities define their own pathways forward, access to relevant expertise within the partnership can provide the supports that are needed for communities to address the complex challenges and opportunities to build their futures in ways of their own choosing.

Although we are working directly with communities, they operate in a broader context (as noted in Figure 1). For example, many youth must leave their communities to attend high school. This transition is often highly stressful. Many of our partners are well-positioned to support youth as they transition out of their communities, including youth services in Thunder Bay and Sioux Lookout, and schools and educators who are actively engaged in promoting student success and well-being. These partners are key to developing ways of providing a seamless safety net for young people.

An explicit objective of the IYFP is to affect policy at the local, provincial and federal levels. The inequities in funding for Indigenous health, education, and child and family services in Canada are well-documented. The IYFP has committed to raising awareness across levels of government of the need to address these funding gaps, and how to work with communities to reduce the inefficient and ineffective funding distribution and reporting processes, which itself would allow communities to better meet the needs of their youth.

Final comment
As a research endeavor that is taking a systems-based approach to promoting resilience among Indigenous youth, we cannot say on the basis of evidence, yet, that our approach will not be without its challenges. The protective factors that we are putting in place are inherent to youth wellbeing generally, and suicide prevention more specifically. This said, our index of success is unlikely to be rates of death by suicide; although these rates are high within several communities in the region, relatively speaking, death by suicide is still sufficiently rare that variability from one year to another in any given community includes no deaths, even without intervention. Other markers of success will be especially important to us, such as numbers of community members engaging in programs, reductions in reports of school bullying (lateral violence), stronger cultural identity and pride among youth, reports of more positive relationships between Elders and youth, and opportunities for dialogue with policy makers.

By adopting an approach that places youth and their community’s priorities first, collaborating to combine evidence-based input with cultural wisdom, facilitating capacity (building) to develop and implement a community-based action plan and evaluation framework, and concurrently building relationships with those who are in a position to affect policy and program funding, we are hopeful that our approach will bring us that much closer to achieving the sustained resilience and bimaadiziwin for Indigenous youth that encourages them to embrace life. ◉

Janet Gordon is Chief Operating Officer at Sioux Lookout First Nations Health Authority (SLFNHA), and a nurse by training. Originally from Kasabonika Lake First Nation and now a member of Lac Seul First Nation, she has deep roots in the Northern Ontario communities. She led the community consultation process to develop the SLFNHA Community Wellness Framework, and is currently responsible for its implementation.

Kimberly Matheson is the Culture and Gender Mental Health Research Chair jointly held at the Royal Institute of Mental Health Research and Carleton University. She is the project lead of the Indigenous Youth Futures Partnership (IYFP) that is working to bring together Indigenous and western approaches to promote youth resilience and prosperity in First Nations communities in Northwestern Ontario.

Acknowledgements: Thank you to Kaylyn Dixon for designing the figures, and to all of our partners who contributed to the ideas presented in this paper. The Indigenous Youth Futures Partnership is funded by the Social Sciences and Humanities Research Council of Canada. Correspondence should be addressed to Kimberly Matheson, Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6.

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