Dissecting systemic racism: policies, practices and epistemologies creating racialized systems of care for Indigenous peoples.

In this paper we explore some of the ways systemic racism operates and is maintained within our health and social services. We look at a very specific context, that of Nunavik Quebec, land and home to 13,000 Nunavimmiut, citizens of Quebec and Canada, signatories of the James Bay and Northern Quebec Agreement. We operationalize some of the ways in which policies and practices create and support social hierarchies of knowledges, also called epistemic racism, and how it impacts our ability to offer quality care that Indigenous peoples can trust and use.

On the move: exploring Inuit and non-Inuit health service providers' perspectives about youth, family and community participation in care in Nunavik.

BACKGROUND: Literature about participation in health and social services suggests that youth, and more specifically Indigenous youth, are difficult to engage within health and social services. Youth are less likely to access services or to actively participate in decision-making regarding their personal care. Service providers play a crucial role in engaging youth based on the ways in which they seek, establish, and maintain relationships with youth and their families. The way in which providers engage with youth will depend on various factors including their own perceptions of the roles and relationships of the various people involved in youth's lives. In this article, we analyze health and social service providers' perspectives, experiences and expectations regarding the roles of Indigenous youth, families and community in care settings in Nunavik, Quebec. METHODS: Using a snowball sampling approach, we recruited 58 interview participants (39 non-Inuit and 19 Inuit), including psychiatrists, general practitioners, nurses, social workers, school principals, teachers, student counsellors, representatives of local committees, and police officers. The interviews focused on three broad areas: 1) participants' current and past positions and roles; 2) participants' perceptions of the clientele they work with (youth and their families); and 3) participants' understandings of how collaboration takes place within and between services and the community. We conducted inductive applied thematic analyses and then analyzed the interview transcripts of Inuit and non-Inuit participants separately to explore the similarities and differences in perceptions based on positionality. RESULTS: We organized the findings around three themes: I) the most commonly described interventions, II) different types of challenges to and within participation; and III) what successful participation can look like according to service providers. Participants identified the challenges that families face in moving towards services as well as the challenges that services providers face in moving towards youth and families, including personal, organizational and historical factors. CONCLUSION: We adopt a critical lens to reflect on the key findings in order to tease out points of tension and paradoxes that might hinder the participation of youth and families, specifically in a social context of decolonization and self-governance of services.

Exploring Community Mobilization in Northern Quebec: Motivators, Challenges, and Resilience in Action.

Nunavimmiut (people of the land) are the Indigenous peoples of the northern peninsula of the province of Quebec. Communities of Nunavik and its regional organizations have been making concerted efforts in implementing community-based strategies to support family wellbeing. These community strategies are grounded in many of the values underpinning community psychology: favoring empowerment-oriented approaches, fostering community capacity, and transforming organizational cultures to allow for new modes of interaction, as well as new policies and practices that are grounded in community and culture. Despite the growing support and expectation for community mobilization, there is still very little research on the processes and challenges to such mobilization. In this study, we explored the unique challenges and facilitators to community endeavors in northern Quebec in order to better understand the complex dynamics and the strengths that Inuit build upon. We first used a focused ethnographic approach in the context of a 5-year community mobilization project in Nunavik. We then conducted 12 individual interviews and two small group interviews with Inuit working on community-based wellbeing-oriented mobilization projects in four additional communities. Results expose how sociogeographical realities and colonialism influence the process of community mobilization. They also highlight the values and motivational factors that lead community members to move beyond these influences.

Culturally and contextually adaptive indicators of organizational success: Nunavik, Quebec.

OBJECTIVE: This study aimed to develop a preliminary guide to culturally and contextually relevant indicators to assess community resources in the 14 communities of the Inuit territory of Nunavik, Quebec. METHODS: As part of the Community Component of Qanuilirpitaa? of the 2017 Nunavik Health Survey, data were collected from 354 organizations located across Nunavik. Data were collected via short structured interviews with representatives of the organization. An inductive qualitative analysis was conducted to identify emerging themes describing the contexts that influence organizations, how key informants conceptualized what is a successful resource, and the facilitators and needs to achieving these indicators of success. Inuit partners were involved throughout the project to offer insight and to ascertain its pertinence and validity. RESULTS: Interviews revealed structural and community realities that influenced organizations. Three main indicators were used to describe successes: (1) team efficiency and dynamics; (2) accessibility of the resource; and (3) ability to impact clients and the community. The third indicator was by far the most discussed indicator of success. Participants and leaders offer suggestions as to how to achieve these indicators and advocate for the conditions necessary for organizational sustainability. CONCLUSION: This data-driven framework suggests that the measures of success that are frequently used by funding agencies (e.g., number of people reached, number of activities) may not fully represent the potential of local services in a given community. Indeed, services may be creating job opportunities for Inuit, instilling pride, offering cultural opportunities, and increasing capital (human, economic, health) within the community, all of which are equally important indicators of success that may more adequately further improve the social determinants of health among communities.

RéSUMé: OBJECTIF: Cette étude visait à élaborer un guide préliminaire d'indicateurs culturellement et contextuellement pertinents pour évaluer les ressources communautaires dans les 14 communautés du territoire inuit du Nunavik, au Québec. MéTHODES: Dans le cadre du volet communautaire de Qanuilirpitaa? de l'Enquête sur la santé au Nunavik de 2017, des données ont été recueillies auprès de 354 organisations situées dans tout le Nunavik. Les données ont été collectées via des entretiens courts et structurés avec des représentants de l'organisation. Une analyse qualitative inductive a été menée pour identifier les thèmes émergents décrivant les contextes qui influencent les organisations, la façon dont les informateurs clés ont conceptualisé ce qu'est une ressource réussie, ainsi que les facilitateurs et les besoins pour atteindre ces indicateurs de réussite. Des partenaires inuits ont été impliqués tout au long du projet afin d'offrir leur point de vue et d'en vérifier la pertinence et la validité. RéSULTATS: Les entrevues ont révélé des réalités structurelles et communautaires qui ont influencé les organisations. Trois indicateurs principaux ont été utilisés pour décrire les réussites : 1) l'efficacité et la dynamique de l'équipe; 2) l'accessibilité de la ressource; et 3) la capacité d'avoir un impact sur les clients et la communauté. Le troisième indicateur était de loin le plus discuté des indicateurs de succès. Les participants et les dirigeants offrent des suggestions sur la façon d'atteindre ces indicateurs et plaident en faveur des conditions nécessaires à la durabilité organisationnelle. CONCLUSION: Ce cadre axé sur les données suggère que les mesures de réussite fréquemment utilisées par les organismes de financement (par exemple, le nombre de personnes atteintes, le nombre d'activités) peuvent ne pas représenter pleinement le potentiel des services locaux dans une communauté donnée. En effet, les services peuvent créer des possibilités d'emploi pour les Inuit, susciter la fierté, offrir des possibilités culturelles et accroître le capital (humain, économique, santé) au sein de la communauté, autant d'indicateurs de réussite tout aussi importants qui peuvent contribuer de façon plus adéquate à améliorer les déterminants sociaux de la santé au sein des communautés.

Inuit wellness: A better understanding of the principles that guide actions and an overview of practices.

By imposing non-Inuit ways of doing within households and communities, colonization has created a rift between generations and impacted the transmission of Inuit practices and knowledge. Inuit care-providers continue to support their fellow community members with individual and collective approaches to wellbeing. The objectives and design of the current project were developed with community members who play an active role in mobilization and wellness. Inuit and non-Inuit research assistants conducted 14 individual interviews and 2 group interviews (total of 19 participants) with key informants involved in community wellness work. Then an Elder (third author) shared her knowledge regarding traditional practices. In this study we describe three underlying principles regarding wellness practices as well as five approaches and the mechanisms by which these approaches seem to impact personal and collective wellbeing. This study highlights how Inuit culture and knowledge can support children, family and community wellbeing in the ways of being together and of taking care of each other. The study responds to an expressed desire named by our partners to document Inuit approaches as well as the principles and practices underlying such approaches and how they are related to self-determination.

Review of child maltreatment in immigrant and refugee families.

OBJECTIVES: Study results on child maltreatment based on general population samples cannot be extrapolated with confidence to vulnerable immigrant or refugee families because of the specific characteristics and needs of these families. The aims of this paper are 1) to conduct an evidence review of the prevalence, risk factors and protective factors for child maltreatment in immigrant and refugee populations, and 2) to integrate the evidence in an analytical ecosystemic framework that would guide future research. METHODS: We used a 14-step process based on guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Canadian Collaboration for Immigrant and Refugee Health. We searched major databases from "the oldest date available to July 2014". The eligibility criteria for paper selection included qualitative or quantitative methodologies; papers written in English or French; papers that describe, assess or review prevalence, risk and protection factors for child maltreatment; and a studied population of immigrants or refugees. SYNTHESIS: Twenty-four articles met the criteria for eligibility. The results do not provide evidence that immigrant or refugee children are at higher risk of child maltreatment. However, recently settled immigrants and refugees experience specific risk factors related to their immigration status and to the challenges of settlement in a new country, which may result in high risk of maltreatment. CONCLUSION: Future research must incorporate more immigrant and refugee samples as well as examine, within an ecosystemic framework, the interaction between migratory and cultural factors with regard to the prevalence, consequences and treatment of child maltreatment for the targeted groups.