Inuit Futures and Development Study

MAIN OBJECTIVE

The main objective of the project is to support young people from Nunavik who are experiencing suicidal behaviours reengage with life. Part of this involves helping them dare care, experience agency, imagining a future and reconnecting. This research project, led by Dre Gómez-Carrillo Castro of the MUHC, has four components: art to prevent suicide, mentoring to inspire a community building space and project funds to dare care and experience agency.

Support from the Pediatric Research Foundation will help kick-start the project by providing funds for coordination between the four components and for liaison between the stakeholders and the graduate students responsible for participatory monitoring evaluation activities, including stakeholder consultation, participant feedback, evaluation quality assurance and outcome analysis.

PROJECT CONTEXT

Inuit are the fastest-growing population in Canada. The suicide rate for youth is 11 times higher than for non-Inuit children. These children are three times more likely to be in the care of youth protection services than any other community in Quebec.

The Future for Inuit Youth project is a four-pronged intervention aimed at promoting the projection of young people into the future by picking them up where they are at and helping them to re-engage in life through individual and community development.

This project stems from the experiences of a child and adolescent psychiatrist in Nunavik and builds on insights from “Unlocking a different future” – an independent report of the “Project Future” by the Centre for Mental Health1. The project’s scope also falls within Canada’s Youth Policy commitment, the message of Inspiring Healthy Futures2 and the vision behind Minnie’s Hope Social Pediatrics Centre.

An Inuit advisory group and consultation with Inuit artists, elders and youth will guide the process throughout. At the same time, this will provide the basis for long-term youth

engagement. The project will also consult and involve local social services, community nurses, youth councils and family homes.

Currently, most of the project’s components are based in Inukjuak, but expansion to other communities and partnership with Cree communities is possible through collaboration with the Montreal Children’s Hospital Northern Program (Dr. Mauger, psychiatry, and Dr. Morel, pediatrics).

The 4 strands combine: Art to prevent suicide, mentoring to inspire, a community building space and project funds to dare care.

STRAND 1 : THE HEALINGS OF ARTS

Art and skills based suicide prevention program inspired by AIRY^TM3

The arts program emerged as a response to needs and opportunities identified by one of the child psychiatrists providing care in Nunavik in her regular practice at the Inuulitsivik Health Centre and inspired by informal conversations within the communities, artists, and other health practitioners.

“We encounter youth in fragile states and precarious psychosocial situations. When supported and stabilized, they dare to start engaging and investing in themselves, to explore interests and to start caring about something again”.

The arts – stone carving, beading, sketching, film, photography, rapping, throat singing to name a few help youth process and deal with complex trauma and allow them to develop a sense of self, regain their agency and, with support, remain engaged and have something to care about and invest themselves in.

This is a key process in moving away from traumatic disengagement from life and central to regaining the wish to live and develop perspectives for the future. It is also a way of finding a voice and express what words may fail one to convey.

Disengagement as a reaction to neglect, chronic disappointment and complex trauma in context of historical and colonial legacies can contributes to boredom, and loss of attachment and meaning to life, which can in turn prompt risk taking behaviours and increase the risk for suicidal behaviours.

Supporting youth in projecting a future for themselves and being motivated by the present, to dream and voice their hopes is key to suicide prevention. This kind of child and youth development requires proactive support and access to resources. Encouraging and fostering a future orientation and a present engagement with concrete action also increases resilience and perseverance. It helps youth care and regain a sense of agency.

STRAND 2 : MENTORING MINDS

Connecting Inuit youth art with indigenous artists to foster future self-projection and inspiration.

This component conceived as mentoring by Inuit artists will be co-developed with Inuit artists and the projects advisory council.

Encouraging and fostering a future orientation with concrete action increases resilience and perseverance. This opens the way to expanding their imaginations, so they move from ‘daring to hope’ to a sustained projection of their future selves pursuing a path of their choice. It helps youth care about their future and envision themselves as contributing to their community.

An artist-mentoring component helps youth explore their talents, which contributes to self-esteem and identity development, thereby addressing major issues that often underly mental health concerns, fosters resilience and encourages community building around the arts for underprivileged youth, while also supporting rising Inuit talent.

The mentorship program emerged as a response to needs identified by one of the child psychiatrists in her regular practice at the Inuulitsivik Health Centre. Youth in fragile states and precarious psychosocial situations may dare to dream and look to the future with hope, once supported and stabilized. This development needs to be supported proactively.

STRAND 3 : ADAPTATION AND IMPLEMENTATION OF TREE OF LIFE INTERVENTION IN INUIT COMMUNITIES

Art studio will be open after school hours for program participants to continue to work on their art in a communal space and offering opportunities for collaboration and sharing around their art making. Youth enrolled in the art-based suicide prevention program will be able to come the art studio at their leisure, which will create a sense of open access support community.

To engage youth not enrolled in the art-based suicide prevention program we will also offer group participation in the Tree of Life at the Art Studio space.

is a psychosocial support tool based on narrative therapy, originally developed in East and Southern Africa to help vulnerable children. Drawing on the metaphor of a tree, taken from Zimbabwean folklore and collective narrative practice, the ToL supports groups and communities to overcome difficult life experiences. We will train community stakeholders as ToL facilitators to help implement the culturally adapted version of the ToL intervention in multiple contexts.

This program will be piloted and then delivered at Minnie’s Hope, and potentially at the Kuujjuarapik Group Home and Inukjuak Girls Unit in collaboration with corresponding stakeholders and community workers. There is existing funding of $15,550 to support the adaptation of the “Tree of Life” Program to Inuit youth context, starting with Kuujjuaraapik/Whapmagoostui (Nord-du Québec).

STRAND 4 : DARE TO DREAM

Helping youth access the resources to pursue the interests, activities or training of their choice to strengthen their sense of agency, foster peer support groups and support youth stabilization in times of crises.

This 4th strand aims to provide the funds to support youth access to the leisure and training resources of their choice.

The team will work with the youth council, social services, the community nurse, community workers, Family House and school to identify individual and small group needs and wishes. Given the social structural reality of the northern communities, especially in context of COVID, youth have often not been able to access leisure and skill training that responds to their interests. Small group activities are often beneficial to counter exclusion, loneliness/social withdrawal, bullying, group suicidal pacts, and grief.

These include taking underserved youth camping/hunting and having the flexibility of offering stimulating workshops brought to their community, such as film making/editing, stone carving, writing/poetry, bike repair, illustration/design, theatre/dance, throat singing, music making, etc.

A modest budget would allow to personalize activities to individual youth or groups of youth that are at risk due to ongoing traumatic experiences in the community.

This will facilitate peer-support group building, youth stabilization and future orientation. A collaboration with Vélo Quebec and Wapikoni Mobile is in progress.

ENGAGEMENT OF THE COMMUNITY

The community will be actively engaged through a youth council, consultation with elders, Inuit artist, Inuit cultural center (Avataq) and by hiring local youth workers, that can be trained in service delivery. Benefits are direct for program participants but also as a creative hub creation in the community, that can inspire and induce a snowball effect, as well as contributing to community strengthening. In addition, what makes this project stand-out is that it is an in-the-field intervention program led by a doctor with feet-on-the-ground. Careful consideration was given to local communities, their psychosocial realities and the structural and systemic constraints that are in need of concrete solutions. Community will benefit by having youth engaged in life, with a future imaginary, improved sense of agency and empowered for community building and local activism hopefully leading to waves of sustainable social and economical empowerment, and a reduction in suicidal behaviour and rates as a reflection of increased well-being

YOUNG PEOPLE IMPACTED

Focus will be on youth (12–21-year-olds) who present suicidal behaviour broadly construed. Program will run in age-appropriate groups. Ultimately, it aims to promote the projection of young people into the future by picking them up where they are at and helping them to reengage in life through individual and community development. For the initial launching of the project in Inukjuak we envision

Number of people will have to be assessed depending on the project evolution. Objective is to focus initially on one community and expand to nearby communities as it goes.

We can expect the initial project to offer support to 6-8 youth per group, with 3 groups running in parallel for 6 months, so after 1.5 years a minimum of 54 youth may have completed the program, through issues with attrition needs to be considered. The project will be expanded to other communities at a later stage following positive results of participatory monitoring-evaluation phase. We will use “The most significant change (MSC) technique4 which is a method used for the monitoring and evaluating of complex development interventions.

MEASURES OF SUCCESS – OUTCOMES MEASURES

In collaboration with the AIRYTM founder, we will use the following outcome measures in addition to the measures suggested by our advirosy board and consultation process.

• individual suicide risk scores which include environmental stressors, access to lethal means, previous attempt history
• self-reported suicidality, numerical scale 0-10
• psychological drivers and interpersonal suicide risk factors, measure by a scale 0-10. This includes level of stress, emotional pain, urges to self-harm, or engage in destructive behaviour, feelings of hopelessness, self-hate, burdensomeness and lack of belonging. As well as a few measures based on cultural adaptation including boredom and irritability.

TIMEFRAMES

We estimate a 3 to 5 years research-intervention project phase, once the project gets the funds to kick start.

We will start in Inukjuak running 3 groups of 6-8 children in parallel that will go for 6 months. The initial program monitoring and evaluation will last 1.5 years. The results from the monitoring and evaluation feedback into the project to optimise the intervention and structure. The reality of project development in this remote Inuit community needs to be considered, the advantages and challenges are very different from large urban centers, for one everything takes more time to realize, especially hiring qualified personnel