Product Details

Author Information

Corresponding Author
Colleen Dell
University of Saskatchewan
1109 Arts Building
Saskatoon, SK S7N 5A5
Canada
p: 306 966 5912
f: 306 966 6950
colleen.dell@usask.ca

Authors (listed in order of authorship):
Colleen Dell

Jennifer Kilty

Cathy Fillmore

Sheila Grantham

Tara Lyons

Sharon Clarke

Carol Hopkins

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Allied Health, Public Health, Social Work

What specific topics does your product address?

Community engagement, Cultural competency , Health disparities, Race & health, Substance use, Women's health , Community-based participatory research

Does your product focus on a specific population(s)?

Indigenous/Aboriginal, Women

What methodological approaches were used in the development of your product, or are discussed in your product?

Community-academic partnership, Community-based participatory research , Qualitative research, Interview

What resource type(s) best describe(s) your product?

Best practice , Evidence-based practice, Handout

Application Narrative

1. Please provide a 1600 character abstract describing your product, its intended use and the audiences for which it would be appropriate.*

Our research identifies key skills and traits for service providers working with Aboriginal women that assists them with re-claiming their cultural identity. The "Turtle Finding Fact Sheet: The Role of the Treatment Provider in Aboriginal Women's Healing from Illicit Drug Abuse" was created to disseminate and commence discussion on this initial finding from our community-based research project in Canada. The study overall focussed on the role of identity and stigma in the healing journeys of criminalized Aboriginal women from illicit drug abuse. Our team is committed to sharing its finding with the community from which the information was collected–workers in the National Native Alcohol and Drug Abuse Program (NNADAP). The Fact Sheet is based on a sample of interviews with substance abuse treatment providers, and was verified with women in treatment and who have completed treatment. In recent years, the addictions literature has increased its attention toward the importance of the therapeutic alliance between treatment providers and clients(1), although understanding specific to Aboriginal women remains limited. Identity reclamation is central to women's healing journeys and treatment providers have an influential role. This finding is framed in the fact sheet within the cultural understanding of the Seven Teachings of the Grandfathers(2). The fact sheet (8.5x11) has been distributed to the over 700 NNADAP workers, and is also available at no cost in two poster size formats. It is appropriate for anyone providing services to Aboriginal women requiring addictions treatment.

2. What are the goals of the product?

The goal of the Turtle Finding Fact Sheet is two-fold. First, our team is committed to returning the project findings to the community with whom the information was collected – as stated, workers in the National Native Alcohol and Drug Abuse Program (NNADAP). NNADAP originated in the mid-1970s in Canada and supports a national network of 52 residential treatment centres with approximately 700 treatment beds. It also provides 550 prevention programs with over 700 workers. Program activities are situated in three key categories: prevention activities (e.g., public awareness campaigns), intervention activities (e.g., treatment programming), and aftercare activities (e.g., counselling). In partnership with the National Native Addictions Partnership Foundation, our team was able to share the voices, wisdom, and expertise of treatment providers, alongside women in treatment and women who completed treatment, in an accessible format – a Fact Sheet. It was distributed in the mail to all NNADAP workers during National Native Addictions Awareness Week in November, 2009.

Second, our research team is committed to raising awareness about the specific needs of criminalized Aboriginal women in their healing journeys, in particular how these needs relate to identity and stigma. Our research verified the growing awareness that identity reclamation is central to women's healing journeys, and that this necessarily involves grounding women-specific treatment in an Aboriginal worldview(3). However, there is little available research on treatment for Aboriginal women with substance abuse problems(4), and the availability of culturally-appropriate services is a major concern(5). The fact sheet, with its basis in a cultural framework, is an accessible means for front-line treatment providers to reflect on and discuss the skills and traits identified for them to assist women with understanding how stigma can negatively impact their healing journeys, and how culture can be a protective factor and assist them with re-claiming their identity as Aboriginal women. This is important because at the onset of NNADAP, the programs were founded on conventional, Western approaches to treatment and were limited in Aboriginal understandings of healing and attention to women's issues.

3. Who are the intended audiences or expected users of the product?

Coinciding with the goals of the Turtle Finding Fact Sheet, our target audience is National Native Alcohol and Drug Abuse Program (NNADAP) workers. This ranges from treatment providers working in residential substance abuse programs to front-line prevention workers in urban, rural, and Aboriginal reserve locations. Although our team's goal is specific to NNADAP workers, the fact sheet has proven to be of interest to and appropriate for any service provider offering addictions services to Aboriginal women. We have used the fact sheet in workshops with non-Aboriginal specific service providers, women's violence shelter workers, and correctional and nursing staff, to assist in their understanding of the needs of female Aboriginal clientele.

4. Please provide any special instructions for successful use of the product, if necessary. If your product has been previously published, please provide the appropriate citation below.

The "Turtle Finding Fact Sheet" is available on our website at: ttp://www.addictionresearchchair.com/creating-knowledge/national/cihr-research-project/view-our-findings-through-posters/
When presenting the fact sheet, it would be useful to do so in the context of the project's focus and methodology. A virtual public lecture with this information is available on our website at: http://www.addictionresearchchair.com/creating-knowledge/national/cihr-research-project/read-about-our-findings-through
Our team is currently developing a workshop for women in treatment based on the findings of the project, including an introductory exercise with the Fact Sheet for service providers who will be facilitating the workshop. The facilitator's manual will be available in Spring, 2011.

5. Please describe how your product or the project that resulted in the product builds on a relevant field, discipline or prior work. You may cite the literature and provide a bibliography in the next question if appropriate.

Little is understood about how women's healing is impacted by their views of themselves as a result of multiple stigmas associated with being a drug user, involved in crime and an Aboriginal woman in Canadian society. In response, our team drew upon a combination of academic literature, practice-based expertise, and the wisdom of lived experience. The problematic use of drugs amongst Aboriginal women is a serious health concern in Canada. According to the 2002-03 First Nations Regional Longitudinal Health Survey, although the documented rate of illicit drug use is low (7.3%) among First Nations (9.3% for men, 5.3% for women), it is still more than double the rate of the general Canadian population (3.0%) (6). Aboriginal women also make up a disproportionate percentage of Canada's injection drug use population; between 1998 and 2003, 66.9% of all HIV-positive tests among Aboriginal women were attributable to IDU(7)(8). Aboriginal women, including First Nations, are also over-represented in Canada's criminal justice system, including incarceration at the federal and provincial levels, which is an identified health risk(9)(10).

Current research evidence suggests that the effects of competing role expectations and stigma are harmful, though minimal research exists in the substance abuse(11)(12) and criminal justice fields(13), or that which is specific to Aboriginal women and the gendered function of colonialism(14)(15). A potential contributing factor to healing that has received some degree of empirical attention to date is the role of the service provider. Though limited in number, studies(16, 17, 18) have indicated that a culturally competent therapist with strong interpersonal skills (e.g., ability to forge a therapeutic alliance with the client) is associated with an increase in positive treatment outcomes. Less research attention has been paid to the effects of negative characteristics of program workers (e.g., prejudices and stereotypes) on client healing(19). The impact of the treatment program worker on the client has received even less attention in the literature on women's illicit drug use.

6. Please provide a bibliography for work cited above or in other parts of this application. Provide full references, in the order sited in the text (i.e. according to number order). .

(1) Ilgen M, McKellar J, Moos R, Finney J. Therapeutic alliance and the relationship between motivation and treatment outcomes in patients with alcohol use disorder. Journal of Substance Abuse Treatment 2006,31,2:157-162.
(2) Banai EB. The Mishomis Book: The Voice of the Ojibway. Minnesota: Indian Counutry Press; 1979.
(3) Acoose S, Dell CA. Hear me heal: First Nations women healing from drug abuse. In Herber RW (Ed.). Indigenous Education: Pacific Nations. Saskatchewan: First Nations University of Canada; 2009:1-8.
(4) Public Health Agency of Canada. Workshop on Aboriginal Women and Addictions. Ottawa: First Nations and Inuit Health Branch;2009.
(5) Harding S, Norberg K. New feminist approaches to social science methodologies: An introduction. Signs 2005,30,4:2009-2015.
(6) First Nations Centre. First Nations Regional Longitudinal Health Survey 2002-2003. Results for Adults, Youth and Children Living in First Nations Communities. Ottawa: First Nations Centre; 2005:116.
(7) Barlow, K. Examining HIV/AIDS Among the Aboriginal Population in Canada in the Post-Residential School Era. Ottawa: Aboriginal Healing Foundation, Research Series; 2003.
(8) Public Health Agency of Canada. HIV/AIDS Among Aboriginal Peoples in Canada: A Continuing Concern. HIV/AIDS Epi Update. Ottawa: Public Health Agency of Canada; 2004.
(9) Balfour G, Comack E. Criminalizing Women: Gender and (In)justice in Neo-liberal Times. Halifax: Fernwood Publishing; 2006.
(10) Kilty, JM. Resisting Confined Identities: Women's Strategies of Coping in Prison. Doctoral Dissertation. Burnaby: Simon Fraser University; 2008.
(11) Link B, Struening E, Rahav M, Phelan J, Nuttbrock L. On stigma and its consequences: Evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. Journal of Health and Social Behaviour 1997,28:177-190.
(12) Ridlon F. A Fallen Angel. The Status Insularity of the Female Alcoholic. Toronto: Associated University Press; 1988.
(13) Van Olphen J, Eliason M, Freudenberg N, Barns M. Nowhere to go: How stigma limits the options of female drug users after release from jail. Substance Abuse Treatment, Prevention and Policy 2009,4,10.
(14) Carter S. Capturing Women. The Manipulation of Cultural Imagery in Canada's Prairie West. Montreal: McGill-Queen’s University Press; 1997.
(15) Scott K. Indigenous Canadians. A Substance Use Background Paper. Prepared for the National Native Alcohol and Drug Abuse Program. Ontario; 1992.
(16) Link B, Struening E, Rahav M, Phelan J, Nuttbrock L. On stigma and its consequences: Evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. Journal of Health and Social Behaviour 1997,28:177-190.
(17) Wampold, B. The Great Psychotherapy Debate: Models, Methods, and Findings. USA: Lawrence Erlbaum Associates Inc; 2001.
(18) Ayonrinde, O. Importance of cultural sensitivity in therapeutic transactions: Considerations for healthcare providers. Disease Management & Health Outcomes 2003,11,16:233-248.
(19) Roberts G, Ogborne A. Best Practices - Substance Abuse Treatment and Rehabilitation. Health Canada, Minister of Public Works and Government Services Canada; 1999.
(20) Tickner, J. What is your research program? Some feminist answers to IR's methodological questions. International Studies Quarterly 2005,49:1-21.
(21) Smith, L. Decolonizing Methodologies. Research and Indigenous Peoples. New York: St Martin’s Press; 1999.
(22) Dell CA, Hopkins C, Dell D. Resiliency and holistic inhalant abuse treatment. Journal of Aboriginal Health 2005,1,2:4-12.
(23) Banai EB. The Mishomis Book: The Voice of the Ojibway. Minnesota: Indian Counutry Press; 1979.

7. Please describe the project or body of work from which the submitted product developed. Describe the ways that community and academic/institutional expertise contributed to the project. Pay particular attention to demonstrating the quality or rigor of the work:

• For research-related work, describe (if relevant) study aims, design, sample, measurement instruments, and analysis and interpretation. Discuss how you verified the accuracy of your data.
• For education-related work, describe (if relevant) any needs assessment conducted, learning objectives, educational strategies incorporated, and evaluation of learning.
• For other types of work, discuss how the project was developed and reasons for the methodological choices made.

The AIM of our research project is identified in a two-part research question: What are the experiential paths of Aboriginal women in conflict with the law in the constitution and reconstitution of their self-identity, accounting for associated role expectations and stigma, prior to, during, and following treatment for illicit drug use (defined as the healing journey)? And how do treatment program workers influence women's constitution and reconstitution of their self-identity, and what is the relation to their healing? The "Turtle Finding Fact Sheet" specifically addresses the latter question, focussing on the skills and traits of treatment providers in assisting women on their healing journeys.

The DESIGN of this qualitative, exploratory study is not constructed on hypotheses, but rather on guiding statements that served to initiate the research direction. They are: (1) the lived experiences of adult Aboriginal female illicit drug users in conflict with the law are intimately tied to the constitution of their self-identity. Self-identity influences the women's healing prior to, during, and following drug treatment; (2) drug use is a form of coping and survival rooted in experiences of abuse and violence; and (3) the influence of treatment workers on the lives of women illicit drug users as they undergo treatment affects women's healing outcomes.

Our team collected a SAMPLE of 123 interview discussions over a 12 month period with 65 First Nations, Métis and Inuit women in treatment for illicit drug abuse at 6 NNADAP treatment centres across Canada, and 20 women who completed treatment. Thirty-eight interviews were conducted with NNADAP treatment staff. The large majority of individuals interviewed were First Nations. All of the stories shared were audio recorded and transcribed. The "Turtle Finding Fact Sheet" is based on a single treatment centre sample of 11 staff interviews, complemented with a review of 27 additional interviews at 5 centres and one community agency. The data were analyzed from multiple standpoints (e.g., treatment worker, experiential woman) and the findings verified with all 6 treatment centres participating in the study. Fifty percent of respondents are female and 80% are First Nations; the average age is 49 with the average number of years in their current substance-related position being 10.

The INTERVIEW GUIDE was developed based on our team's intent to respect the rights and experiences of everyone involved in the project. For example, we began our project by documenting the personal healing journeys of three women on our research team. Alongside the academic literature, their healing journeys informed our research in multiple ways, from directing our research focus to the content of our interview guide. The interviews themselves were carried out by Aboriginal women, many of whom had life experiences in the topic area. The interviews were reciprocal in nature, with us offering the women gifts or messages of hope and support to honour their stories, including a comfort blanket and copies of experiential healing stories from women on our team.

In terms of ANALYSIS, the data was organized using NVivo software. Multiple people reviewed the transcripts to identify key themes. Each of the analyses was then read by the same person, alongside the transcripts, and overarching themes were identified. These themes and INTERPRETATIONS were verified with those who did the initial analyses, and were taken back to where the interviews were originally conducted. The findings were likewise shared amongst all team members for feedback, which ensured that individuals with diverse lenses/experiences reviewed the interview data for themes (e.g., outsider knowledge, experiential, cultural, social worker, researchers, transcribers). The preliminary findings were shared as well with a sample of the original people interviewed.

8. Please describe the process of developing the product, including the ways that community and academic/institutional expertise were integrated in the development of this product.

To identify treatment provider skills and traits that asist women with re-claiming their identity, as noted, multiple team members with diverse lenses reviewed the transcripts to identify key themes. The initial reviewers included Aboriginal treatment providers, Elders, students, women who have been in drug treatment, treatment centre directors, academic researchers, community agencies working with criminalized Aboriginal women, Aboriginal and non-Aboriginal research assistants and expert mentors. Each transcript was read by all individuals in order to identify the themes and several team members then worked together to identify the overarching themes. These themes were then verified with those who did the initial analyses, and then were taken back to the treatment centers where the interviews were originally held. A group of treatment providers and research team members produced the initial draft version of the Fact Sheet. This was presented to the entire team for feedback, which in turn was incorporated, and then sent once again to the team for final verification.

It was important to our team that the fact sheet contain information on the skills and traits identified as helpful to women in re-claiming their identity, as well as the research methodology that led to this understanding, including the focus, method, meaning, and proposed next steps for the project. The addictions field is fraught with a diversity of theories and perspectives on healing, many of which are not grounded in best practices. It follows that it was important to our team that it be known how the findings came about - that is through a community-based social scientific process - to establish their credibility and lend to their uptake.

In terms of the multiple voices and the contribution of academics and community members to the project, our collaborative team was spearheaded in 2005 by the National Native Addictions Partnership Foundation (has a mandate to be the national voice advocating for Inuit and First Nations culturally-based addictions services), the Canadian Centre on Substance Abuse (has a legislated mandate to provide national leadership and evidence-informed analysis and advice to mobilize collaborative efforts to reduce alcohol- and other drug-related harms) and Carleton University. The University of Saskatchewan joined as a principal investigator in 2007. Our research team represents a multiplicity of experiences and expertise. Western science does not typically accept people's everyday and work experiences as valid 'knowledge'(20). Similarly, it does not generally work in collaboration with the holders of such knowledge(21). Respect for multiple voices and experiences is foundational to our project. From the project's inception and through each stage of the research process, including the development of the Turtle Finding Fact Sheet, community involvement and partnership has directed our work.

9. Please discuss the significance and impact of your product. In your response, discuss ways your product has added to existing knowledge and benefited the community; ways others may have utilized your product; and any relevant evaluation data about impact, if available. If the impact of the product is not yet known, discuss its potential significance.

The potential academic and community-practice SIGNIFICANCE of the "Turtle Finding Fact Sheet" is considerable. For the most part, literature on the therapeutic alliance is grounded in a Western, mainstream paradigm. Constructing understanding about the skills and traits of the service provider in women's heaing within an Aboriginal worldview, and linking to a cultural understanding of the Teachings of the Seven Grandfathers, is respectful of an Aboriginal perspective of wellness. Wellness is conceptualized within an Aboriginal worldview as the well-being of individuals and their communities, in which understanding an individual apart from her community is not possible. An individual's well-being is understood to be inter-reliant with the wellbeing of the collective (children, family, community, land) and its relation to identity. Aboriginal healing traditions assume an individual is a relational, interdependent entity(22).

We convey during our team's presentations of the project's findings that treatment providers are an important part of a woman's healing journey from illicit drug abuse, as well as being in conflict with the law. Certain skills and traits lead service providers to success in working with Aboriginal women. The eight characteristics of a successful treatment provider in helping an Aboriginal woman heal from drug abuse are reviewed and discussed: empathy, acceptance, inspiration, recognition, communication, care, spirituality, and momentum. Then, drawing on the work of Banai(23), the 7 Teachings of the Grandfathers are illustrated for how they frame the findings. Love, Respect, Bravery, Honesty, Humility, Truth, Wisdom are all explained to be interrelated and threaded through each identified treatment provider skill and trait. According to Banai,
"To cherish knowledge is to know wisdom.
To know love is to know peace.
To honour all of the Creation is to have respect.
Bravery is to face the foe with integrity.
Honesty in facing a situation is to be brave.
Humility is to know yourself as a sacred part of the Creation.
Truth is to know all these things".

Culturally specific research findings that directly address the work of service providers need to be accessible to them. It cannot be assumed that what is written in the area is necessarily accessible to service providers (e.g., limited access to academic journals). Accessible products such as the "Turtle Finding Fact Sheet", are a first step to ensuring IMPACT. In addition to distributing over 2,000 copies of the Fact Sheet, and their availability on-line, our team has presented the Fact Sheet in numerous community discussions and at conferences (e.g., Saskatchewan Regional NNADAP Symposium on Addiction, National Aboriginal Health Conference, National Network on Aboriginal Mental Health Research Annual Meeting, 21st Annual Native Health Research Conference).

Feedback from presentations and dicussions with addictions managers, clinical supervisors, and front-line workers suggest that there is much interest in this work. Feedback was solicited at each of the presentations to date and it has been overwhelmingly positive; "I will definitiely use this in my coulselling", "How wonderful to have something for the female population we work with", "Very informative", "The message of our role as helping professionals is long overdue". With our team's goal being to share the findings and initiate discussion among NNADAP workers and others, disseminating the fact sheet is helping to achieve this.

10. Please describe why you chose the presentation format you did.

For the research findings to have impact, it is necessary that they be accessible. A visual and colourful handout foremost is inviting and not overwhelming for service providers. In the busy workday of a service provider, having a fact sheet that is accessible, easy to comprehend, and to the point is essential to capture their attention. Further, translating the Fact Sheet into a poster format serves as an easy reference point (e.g., hang on wall).

The key reason the "Turtle Findings Fact Sheet" was chosen as the initial venue to share the findings is its accessibility. Part of this accessibility is its visual appeal. For example, the turtle on the fact sheet is culturally relevant as it symbolizes mother earth (i.e., women) and in doing so recognizes the centrality and importance of women’s role in life. Further, the Teachings of the Seven Grandfathers encircle the turtle and the findings of the project. Just as the Seven Teachings cannot be understood as apart from one another, so too must the findings of the study be understood in conjunction with the teachings. The Fact Sheet also identifies the 8 treatment provider skills and traits in a hierarchical ranking that spells RE-CLAIM. A main finding of the project by treatment staff, and verified by the women, is the need for women to re-claim their identity to ward off the harmful effects of stigma and to be able to continue on their healing journeys. It is important to note that the "Turtle Finding Fact Sheet" also contains information on the project focus, methodology, and reference to resources.

11. Please reflect on the strengths and limitations of your product. In what ways did community and academic/institutional collaborators provide feedback and how was such feedback used? Include relevant evaluation data about strengths and limitations if available.

Accessibility is a strength of this project and "The Turtle Finding Fact Sheet"; similarily, the collaborative process in which the fact sheet was developed is a strength. Consistent with the overall research project process, treatment providers, researchers, research assistants and non-governmental decision makers were involved in its construction. The entire research team, including women with lived experience that we interviewed, as well as expert mentors, had an opportunity to contribute their feedback and have it incorporated into the the final version of the fact sheet.

Weaknesses of the product centre on its unknown impact. It has been well-established by our team that there is great interest in the fact sheet, and that there is intention to use it within the field (as relayed at conference presentations and community discussions). However, our team is not aware specifically of the extent to which the fact sheet is being used and how. We also do not know the level of comprehension of its intended meaning and its translation into practice. An evaluation plan alongside our dissemination would have been useful. Given that our team's goal for the fact sheet was to relay knowledge and initiate discussion, we believe we have been successful.

12. Please describe ways that the project resulting in the product involved collaboration that embodied principles of mutual respect, shared work and shared credit. If different, describe ways that the product itself involved collaboration that embodied principles of mutual respect, shared work and shared credit. Have all collaborators on the product been notified of and approved submission of the product to CES4Health.info? If not, why not? Please indicate whether the project resulting in the product was approved by an Institutional Review Board (IRB) and/or community-based review mechanism, if applicable, and provide the name(s) of the IRB/mechanism.

Our team's research project is based on the core concept of RESPECT, as relayed by our Elder, Joyce Paul, in our team's initial meeting in 2005. The concept and practice of respect was filtered throughout the project, ranging from the interview discussion process through to team relationships and the process of relaying our findings.

Our team is national in scope and large in number with over 30 members. We have had several initial findings released from the project (e.g., song, video of the research process, music video, Turtle Finding Fact Sheet), and given the interests and expertise of our various team members, this has dictated the products they have been willing and able to contribute to. In this sense, we have various ways of SHARING THE WORK. The "Turtle Finding Fact Sheet", for example, was drafted by a core group, and shared with the entire team for feedback and validation.

CREDIT IS EQUITABLY SHARED among our team members by no primary author being identified. Many of our team products are sourced for authorship as "The CIHR Project Research Team–Aboriginal Women Drug Users in Conflict with the Law: A Study of the Role of Self-Identity in the Healing Journey". Further, the majority of our academic publications have been authored alphabetically. This is in line with our attempt to address the power imbalance that Western approaches to research have conventionally institutionalized and perpetuated.

All authors of the "Turtle Finding Fact Sheet" have contributed to writing this article. As well, the entire research team was notified of this opportunity and has had the opportunity to participate or respond. All approve of its submission to CES4health.

This research project, in its entirety, has been granted ethics approval by the University of Saskatchewan Human Behviour Research Ethics Review Board. No other Ethics Review Board granting was required by our project partners.