Creating a safe space for First Nations youth to share their pain.

INTRODUCTION: Indigenous children and youth may be quiet about the way they express their pain and hurt which is in contrast to how health professionals are trained to assess it. OBJECTIVES: The aim was to understand how youth from 4 First Nation communities express pain using narratives and art-based methods to inform culturally appropriate assessment and treatment. METHODS: This qualitative investigation used a community-based participatory action methodology to recruit 42 youth between 8 and 17 years of age to share their perspectives of pain using ethnographic techniques including a Talking Circle followed by a painting workshop. Physical pain perspectives were prominent in circle conversations, but emotional pain, overlapping with physical, mental, and spiritual pain perspectives, was more evident through paintings. Art themes include causes of pain and coping strategies, providing a view into the pain and hurt youth may experience. Youth were more comfortable expressing emotional and mental pain through their artwork, not sharing verbally in conversation. RESULTS: Circle sessions and artwork data were themed using the Indigenous Medicine Wheel. Content of the circle conversations centered on physical pain, whereas paintings depicted mainly emotional pain (eg, crying or loneliness; 74% n = 31) with some overlap with physical pain (eg, injuries; 54%), mental pain (eg, coping strategies; 31%), and spiritual pain (eg, cultural symbols; 30%). Common threads included hiding pain, resilience, tribal consciousness, persistent pain, and loneliness. CONCLUSION: Once a safe space was created for First Nation youth, they provided a complex, culturally based understanding of the pain and coping experience from both an individual and community perspective. These engaging, culturally sensitive research methods provide direction for health providers regarding the importance of creating a safe space for young people to share their perspectives.

Drawing helps children to talk about their presenting problems during a mental health assessment.

When children require mental health services, clinicians need to conduct assessments that are developmentally sensitive and that include the child's point of view. Drawing is a popular tool that is commonly used in clinical settings. Research on drawing in experimental settings has confirmed that the opportunity to draw while talking increases the amount of verbal information that children report during an interview. The present research examined whether drawing also facilitates children's self reports during a mental health assessment. A total of 33 5-12-year-old children were asked either to draw and tell about their presenting problem or to tell only. Children who drew and told provided twice as much verbal information as children who told only. Further, interviewers in the draw and tell condition used a greater number of minimal responses than did interviewers in the tell only condition. These data have important implications for clinical practice.