Sarah L. Fraser

Changing Rates of Suicide Ideation and Attempts Among Inuit Youth: A Gender-Based Analysis of Risk and Protective Factors

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15-24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross-sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long-term impacts on Inuit youth, as well as exposure to culturally meaningful activities.

Communicating power and resistance: exploring interactions between aboriginal youth and non-aboriginal staff members in a residential child welfare facility

ABSTRACT Aboriginal youth are highly overrepresented within the child welfare system. High-risk youth are often placed in out-of-community residential placements. Such residential placements have been described by some as a continuation of colonial practices. Using communication theory as a conceptual model, we propose a qualitative analysis of micro-interactions that take place between Aboriginal youth and non-Aboriginal workers during the management of high-risk behaviors within a residential program. Three broad categories of interaction emerge from the data: complementary, symmetrical/complementary (where youth show a form of submission despite resistance), and symmetrical (characterized by a power struggle). Despite the diversity of interactions along this symmetrical to complementary continuum, interventions always start and finish in the same fashion. Moreover, the nature of interactions depended mostly on how quickly youth accepted the consequences of their behaviors. We also extracted five categories related to culture, race or context that are perceived as influencing the interactions that take place between staff and youth. The analysis of micro-interactions within clinical, organizational, social and historical contexts points to mechanisms by which asymmetrical power relations may be replicated on a day-to-day basis despite the best intentions of residential workers.

Experience and representations of health and social services in a community of Nunavik

Objectives: The study aims to explore representations and experiences with health and social services in an Inuit community of Nunavik. Methods: A total of 15 semi-structured interviews were conducted with Inuit adults from a community of Northern Quebec. Informal interviews and participatory observation was conducted on six visits over two years. A thematic inductive analysis of data was conducted. Results: Participants’ experiences with care were largely related to the nature of interactions with service providers, and feelings about whether perceived needs were being met. Often these needs were socio-economic. Perceptions of services were based on concepts of trust, privacy and fear of consequences of divulging information, three intrinsically related themes. Conclusions: Reflections must be made on how to address the socio-economic needs of patients and how to go beyond the immediate requests to hear the psychosocial needs that patients might not feel safe to talk about.

Communities being well for family well-being: Exploring the socio-ecological determinants of well-being in an Inuit community of Northern Quebec

Inuit communities of Canada experience many disparities in health and psychosocial context. Research in community psychology has shown associations between such socio-ecological factors and individual well-being. The objective of the study was to explore how community-level determinants of well-being influence family well-being in a northern community of Nunavik, Quebec. A total of 14 participants were interviewed. A thematic inductive analysis was conducted to extract community determinants of family well-being from the data. A system science approach was used to explore the associations between determinants and larger psychosocial dynamics. A community workshop was held to discuss the results and their meaning. A total of 25 determinants were coded, 16 of which were community-level. Community-level stressors were highly interrelated, whereas community supports were generally disconnected and superimposed on narratives of stressors. Participants spoke of desired supports. In their narratives, these supports were connected to a variety of determinants of well-being, suggesting the need to connect, redefine and support existing resources rather than simply add on new ones. We discuss intricate links between family and community well-being in small and geographically isolated communities.

Everyday ethics of participation: a case study of a CBPR in Nunavik:

Introduction: Multiple reports highlight the need for community-based family-oriented prevention services for Aboriginal peoples in order to address important health and social inequalities. Participatory, empowerment-based approaches are generally favoured for these means. Faced with important social issues, in a context of colonisation and complex power dynamics, we question how community members experience participation, as well as the everyday dynamics that take place when attempting to create community-level change. Context: The initial steps of this community-based participatory research (CBPR) took place over a two-year period in a community of Nunavik, a large northern region of the province of Quebec. The objective of the CBPR was to develop a community-driven project aimed at supporting families to be able to keep children within their homes or communities, rather than having to be placed under child welfare services. Method: We participated in, and documented, various group meetings, community workshops, informal reflexive discussions, and formal interviews with community partners to explore their everyday experiences of participation in community-based change. Results: We describe some of the initial actions taken in this project. We describe how certain social and power dynamics infiltrated into the process of participation leading to various tensions, personal and interpersonal experiences and needs. Discussion: We discuss how these experiences led to everyday ethical dilemmas regarding participation. We conclude that although participatory approaches towards community change may be effective, they are also ethically challenging and at times disempowering for those who participate. We describe some of the approaches used to work with these ethical challenges.

What stories to tell? A trilogy of methods used for knowledge exchange in a community-based participatory research project:

Researchers in the field of Aboriginal health generally have a keen interest in ‘participating in change’ to address the ongoing injustices experienced by Aboriginal peoples. Perhaps the most promoted methods for this purpose are those described as Indigenous methods and action research. Criteria of authenticity are generally used to assess the quality of research. In this essay, we reflect on how certain basic principles of action research, more notably ontological authenticity and educative authenticity can penetrate the process of knowledge exchange, creating spaces of ontological contamination and transformation. We reflect on the context of sharing ‘difficult knowledge’, knowledge that is encountered and shared in a post-colonial context of unequal power dynamics. We describe a trilogy of methods used for such knowledge exchange activities with three distinct audiences, and distinct goals. A commonality amongst the three described methods is the ‘unfinished’ and unorganised nature of what is transmitted, requiring the receptor to actively participate in the differentiation and reorganisation of information in a way that makes sense to him/her.