Community trial evaluating the integration of Indigenous healing practices and a harm reduction approach with principles of seeking safety in an Indigenous residential treatment program in northern Ontario

K A Morin, T N Marsh, C Eshakakogan, J K Eibl, M Spence, G Gauthier, J D Walker, Dean Sayers, Alan Ozawanimke, Brent Bissaillion, D C Marsh, K A Morin, T N Marsh, C Eshakakogan, J K Eibl, M Spence, G Gauthier, J D Walker, Dean Sayers, Alan Ozawanimke, Brent Bissaillion, D C Marsh

Abstract

Objective: Our primary objective was to evaluate how the Indigenous Healing and Seeking Safety (IHSS) model impacted residential addiction treatment program completion rates. Our secondary objective was to evaluate health service use 6 months before and 6 months after residential treatment for clients who attended the program before and after implementing IHSS.

Methods: We observed clients of the Benbowopka Residential Treatment before IHSS implementation (from April 2013 to March 31, 2016) and after IHSS implementation (from January 1, 2018 - March 31, 2020). The program data were linked to health administration data, including the Ontario Health Insurance Plan (OHIP) physician billing, the Registered Persons Database (RPDB), the National Ambulatory Care Reporting System (NACRS), and the Discharge Abstract Database (DAD). Chi-square tests were used to compare patient characteristics in the no-IHSS and IHSS groups. We used logistic regression to estimate the association between IHSS and treatment completion. We used generalized estimating equation (GEE) regression model to evaluate health service use (including primary care visits, ED visits overall and for substance use, hospitalizations and mental health visits), Results: There were 266 patients in the no-IHSS group and 136 in the IHSS group. After adjusting for individual characteristics, we observed that IHSS was associated with increased program completion rates (odds ratio = 1.95, 95% CI 1.02-3.70). There was no significant association between IHSS patients' health service use at time one or time two. Primary care visits time 1: aOR 0.55, 95%CI 0.72-1.13, time 2: aOR 1.13, 95%CI 0.79-1.23; ED visits overall time 1: aOR 0.91, 95%CI 0.67-1.23, time 2: aOR 1.06, 95%CI 0.75-1.50; ED visits for substance use time 1: aOR 0.81, 95%CI 0.47-1.39, time 2: aOR 0.79, 95%CI 0.37-1.54; Hospitalizations time 1: aOR 0.78, 95%CI 0.41-1.47, time 2: aOR 0.76, 95%CI 0.32-1.80; Mental health visits time 1: aOR 0.66, 95%CI 0.46-0.96, time 2: aOR 0.92 95%CI 0.7-1.40.

Conclusions: Our results indicate that IHSS positively influenced program completion but had no significant effect on health service use.

Trial registration: This study was registered with clinicaltrials.gov (identifier number NCT04604574). First registration 10/27/2020.

Keywords: Indigenous health principles; Seeking safety; Substance use disorder; Trauma.

Conflict of interest statement

Dr. David Marsh maintains the following roles: Chief Medical Director at CATC (Canadian Addiction Treatment Center), opioid agonist therapy provider. Dr. Marsh has no ownership stake in the CATC as a stipendiary employee. We do not foresee any conflict of interest as data will be made freely available to the public and the CATC, and the Universities have no ability to prevent publication and dissemination of knowledge. The authors have no conflicts declared.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Project timeline
Fig. 2
Fig. 2
Impact of IHSS versus no-IHSS on health system outcomes 6 months before and 6 months after residential treatment (Odds ratio and 95% confidence intervals)

References

    1. Cote H, Schissel W. Damaged children and broken spirits: a residential school survivor story. In: Schissel B, Brooks C, editors. Marginality & condemnation: an introduction to critical criminology. 2. Black Point: Fernwood; 2008. pp. 220–237.
    1. Marsh TN, Cote-Meek S, Toulouse P, Najavits LM, Young NL. The application of two-eyed seeing decolonizing methodology in qualitative and quantitative research for the treatment of intergenerational trauma and substance use disorders. Int J Qual Methods. 2015;14(4):1–13.
    1. Marsh TN, Young NL, Cote-Meek S, Najavits LM, Toulouse P. Embracing Minobimaadizi, “living the good life”: healing from intergenerational trauma and substance use through indigenous healing and seeking safety. J Addict Res Ther. 2016;7(3).
    1. Poonwassie A, Charter A. Aboriginal worldview of healing: inclusion, blending, and bridging. In: Moodley R, West W, editors. Integrating traditional healing practices into counseling and psychotherapy. Thousand Oaks: Sage; 2005. pp. 15–25.
    1. Duran E. Healing the soul wound: counseling with American Indians and other native peoples. New York: Teacher's College Press; 2006.
    1. Munro A, Allan J, Shakeshaft A, Breen C. “I just feel comfortable out here, there’s something about the place”: staff and client perceptions of a remote Australian Aboriginal drug and alcohol rehabilitation service. Subst Abuse Treat Prev Policy. 2017;12(1):49. doi: 10.1186/s13011-017-0135-0.
    1. Rowan M, Poole N, Shea B, Gone JP, Mykota D, Farag M, et al. Cultural interventions to treat addictions in indigenous populations: findings from a scoping study. Subst Abuse Treat Prev Policy. 2014;9:34. doi: 10.1186/1747-597X-9-34.
    1. Kirmayer LJ, Tait CL, Simpson C. The mental health of Aboriginal peoples in Canada: transformations of identity and community. In: Kirmayer LJ, Valaskakis GG, editors. Healing traditions: the mental health of Aboriginal peoples in Canada. Vancouver: British Columbia, Canada; 2009. pp. 3–35.
    1. Chansonneuve D. Addictive behaviours among Aboriginal people in Canada. Ottawa; 2007.
    1. Hart MA. Indigenous worldviews, knowledge, and research: the development of an Indigenous research paradigm. J Indig Voices Soc Work. 2010;1:1–16.
    1. Brant Castellano M. Ethics of Aboriginal research. J Aborig Health. 2004;1:98–114.
    1. Wilson S. Research is ceremony: indigenous research methods. Winnipeg: Fernwood Publishing; 2008.
    1. Marsh TN, Marsh DC, Ozawagosh J, Ozawagosh F. The sweat lodge ceremony: a healing intervention for intergenerational trauma and substance use. Int Indig Policy J. 2018;9(2).
    1. Martin-Hill D. Traditional medicine in contemporary contexts: protecting and respecting indigenous knowledge and medicine. Ottawa: National Aboriginal Health Organization; 2003.
    1. Allan B, Smylie J, Shing LK. First peoples, second class treatment. Toronto: Well Living House for Wellesley Institute; 2015.
    1. Brave Heart MYH. The historical trauma response among natives and its relationship to substance abuse: a Lakota illustration. In: Phillips NM, editor. Healing and mental health for native Americans: speaking in red. Lanham: AltaMira; 2004. pp. 7–18.
    1. Gone JP. A community-based treatment for native American historical trauma: prospects for evidence-based practice. J Consult Clin Psychol. 2009;77(4):751–762. doi: 10.1037/a0015390.
    1. Marsh TN, Eshakakogan C, Eibl JK, Spence M, Morin KA, Gauthier GJ, et al. A study protocol for a quasi-experimental community trial evaluating the integration of indigenous healing practices and a harm reduction approach with principles of seeking safety in an indigenous residential treatment program in northern Ontario. Harm Reduct J. 2021;18(1):35. doi: 10.1186/s12954-021-00483-7.
    1. Kovach M. Indigenous methodologies: characteristics, conversations, and contexts. Toronto; 2009.
    1. Marsh TN, Marsh DC, Najavits LM. The impact of training indigenous facilitators for a two-eyed seeing research treatment intervention for intergenerational trauma and addiction. Int Indig Policy J. 2020;11(4).
    1. Danto D, Walsh R. Mental health perceptions and practices of a Cree Community in Northern Ontario: a qualitative study. Int J Ment Health Addict. 2017;15(4):725–737. doi: 10.1007/s11469-017-9791-6.
    1. George J, Morton Ninomiya M, Graham K, Bernards S, Wells S. The rationale for developing a programme of services by and for indigenous men in a First Nations community. AlterNative. 2019:1–10.
    1. Linklater R. Women and indigenous religions. Santa Barbara: Preger; 2010. Decolonizing our spirits: cultural knowledge and indigenous healing; pp. 217–232.
    1. Mehl-Madrona L. Coyote medicine: lessons from native American healing. New York: Fireside; 1998.
    1. Menzies P. Aboriginal people with addiction and mental health issues: what health, social service and justice workers need to know. Toronto: CAMH Publications; 2014.
    1. Spittal PM, Craib KJ, Teegee M, Baylis C, Christian WM, Moniruzzaman AK, et al. The Cedar project: prevalence and correlates of HIV infection among young Aboriginal people who use drugs in two Canadian cities. Int J Circumpolar Health. 2007;66(3):226–240. doi: 10.3402/ijch.v66i3.18259.
    1. Smith LT. Decolonizing methodologies: research and indigenous peoples. London: Zed Books; 1999.
    1. Waldram JB. The way of the pipe: Aboriginal spirituality and symbolic healing in Canadian prisons. Peterborough: Broadview; 1997.
    1. Warry W. Unfinished dreams: community healing and the reality of Aboriginal self- government. Toronto: University of Toronto; 1998.
    1. Duran ED, B. Native American postcolonial psychology. Albany: State University of New York; 1995.
    1. Gagne M. The role of dependency and colonialism in generating trauma in First Nations citizens. In: Danieli Y, editor. International handbook of multigenerational legacies of trauma. New York: Plenum; 1998. pp. 355–372.
    1. McCormick RM. Culturally appropriate means and ends of counselling as described by the First Nations people of British Columbia. Int J Adv Couns. 1996;18(3):163–172. doi: 10.1007/BF01407960.
    1. Nan Chiefs call for immediate assistance as the region braces for major health catastrophe [press release]. Nishnawbe Aski Nation News Release; 2012.
    1. Stewart SL. Promoting indigenous mental health: cultural perspectives on healing from native counsellors in Canada. Int J Health Promot Educ. 2008;46(2):12–19. doi: 10.1080/14635240.2008.10708129.
    1. Robbins JA, Dewar J. Traditional indigenous approaches to healing and the modern welfare of traditional knowledge, spirituality and lands: a critical reflection on practices and policies taken from the Canadian indigenous example. Int Indig Policy J. 2011;2(4):2.
    1. Brave Heart MYH. The return to the sacred path: healing the historical trauma and historical unresolved grief response among the Lakota through a psychoeducational group intervention. Smith Coll Stud Soc Work. 1998;68(3):287–305. doi: 10.1080/00377319809517532.
    1. Rojas M, Stubley T. Integrating mainstream mental health approaches and traditional healing practices. A literature review. Adv Soc Sci Res J. 2014;1(1):22–43.
    1. National native alcohol and drug abuse program. Ottawa: Government of Canada. Available from: . Accessed Apr 2021.
    1. Personal Health Information Protection Act, 2004, S.O. 2004, c. 3, Sched. A, (2004).
    1. Villafranca SW, McKellar JD, Trafton JA, Humphreys K. Predictors of retention in methadone programs: a signal detection analysis. Drug Alcohol Depend. 2006;83(3):218–224. doi: 10.1016/j.drugalcdep.2005.11.020.
    1. Peles E, Schreiber S, Adelson M. Factors predicting retention in treatment: 10-year experience of a methadone maintenance treatment (MMT) clinic in Israel. Drug Alcohol Depend. 2006;82(3):211–217. doi: 10.1016/j.drugalcdep.2005.09.004.
    1. Morin KA, Eibl JK, Gauthier G, Rush B, Mushquash C, Lightfoot NE, Marsh DC. A cohort study evaluating the association between concurrent mental disorders, mortality, morbidity, and continuous treatment retention for patients in opioid agonist treatment (OAT) across Ontario, Canada using administrative health data [pre-print] Harm Reduct J. 2020;17(1):1–3. doi: 10.1186/s12954-020-00396-x.
    1. Eibl JK, Gomes T, Martins D, Camacho X, Juurlink DN, Mamdani MM, et al. Evaluating the effectiveness of first-time methadone maintenance therapy across northern, rural, and urban regions of Ontario, Canada. J Addict Med. 2015;9(6):440–446. doi: 10.1097/ADM.0000000000000156.
    1. Martins DGS, Tadrous M, Paterson M, Bandola D, Singh S, Juurlink D, Mamdani M, Gomes T. Opioid use and related adverse events in Ontario. Toronto: Ontario Drug Policy Research Network (ODPRN); 2016.
    1. Hartley D. Rural health disparities, population health, and rural culture. Am J Public Health. 2004;94(10):1675–1678. doi: 10.2105/AJPH.94.10.1675.
    1. Beard JR, Tomaska N, Earnest A, Summerhayes R, Morgan G. Influence of socioeconomic and cultural factors on rural health. Aust J Rural Health. 2009;17(1):10–15. doi: 10.1111/j.1440-1584.2008.01030.x.
    1. Canadian Mental Health Association . Rural and northern community issues in mental health. 2009.
    1. Kulig JC, Williams AM. Health and place in rural Canada. In: Kulig JC, Williams AM, editors. Health in rural Canada. Vancouver: UBC press; 2012.
    1. Statistics Canada . Rural and small town definition. Ottawa: Statistics Canada; 2007.
    1. Brach C, Fraser I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev. 2000;57(Suppl 1):181–217. doi: 10.1177/1077558700057001S09.
    1. Robbins JA, Dewar J. Traditional indigenous approaches to healing and the modern welfare of traditional knowledge, spirituality and lands: a critical reflection on practices and policies taken from the Canadian indigenous example. Int Indig Policy J. 2011;4:1–20.
    1. Marsh TN, Cote-Meek S, Young NL, Toulouse P. Indigenous healing and seeking safety: a blended implementation project for intergenerational trauma and substance use disorders. Int Indig Policy J. 2016;7(2).
    1. Mamakwa S, Kahan M, Kanate D, Kirlew M, Folk D, Cirone S, et al. Evaluation of 6 remote First Nations community-based buprenorphine programs in northwestern Ontario: retrospective study. Can Fam Physician. 2017;63(2):137–145.
    1. Morin KA, Eibl JK, Caswell JM, Rush B, Mushquash C, Lightfoot NE, et al. Evaluating the effectiveness of concurrent opioid agonist treatment and physician-based mental health services for patients with mental disorders in Ontario, Canada. PLoS One. 2020;15(12):e0243317. doi: 10.1371/journal.pone.0243317.
    1. Astals M, Domingo-Salvany A, Buenaventura CC, Tato J, Vazquez JM, Martin-Santos R, et al. Impact of substance dependence and dual diagnosis on the quality of life of heroin users seeking treatment. Subst Use Misuse. 2008;43(5):612–632. doi: 10.1080/10826080701204813.
    1. Bogdanowicz KM, Stewart R, Broadbent M, Hatch SL, Hotopf M, Strang J, et al. Double trouble: psychiatric comorbidity and opioid addiction-all-cause and cause-specific mortality. Drug Alcohol Depend. 2015;148:85–92. doi: 10.1016/j.drugalcdep.2014.12.025.
    1. Hazlett SB, McCarthy ML, Londner MS, Onyike CU. Epidemiology of adult psychiatric visits to US emergency departments. Acad Emerg Med. 2004;11(2):193–195. doi: 10.1111/j.1553-2712.2004.tb01434.x.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel