This Article Summary is part of our CanFASD Connect Top Articles Summary Series. Over the next several months, we will be bringing you summaries of all the recent research papers from our list of the Top FASD Articles of 2019. This is an overview of a recent research paper called Collaborative Action on Fetal Alcohol Spectrum Disorder Prevention: Principles for Enacting the Truth and Reconciliation Commission Call to Action #33.

Background:

Colonization has a negative impact on many traditional Indigenous practices related to pregnancy, mothering and healthcare in their communities. The Indian Act, the residential school system, child welfare practices, and systemic violence against women have damaged traditional approaches to Indigenous peoples’ health and wellness.

In 2008, the Truth and Reconciliation Commission of Canada (TRC) was created to respond to the decades of trauma Indigenous peoples in Canada have experienced. Fetal alcohol spectrum disorder (FASD) prevention was identified as health priority in Indigenous communities and was included in the TRC’s 2015 report under the “Call to Action #33”.

In 2017, in response to the TRC Call to Action #33, a framework outlining eight principles (or “tenets”) for FASD prevention in Indigenous communities was developed collaboratively by and with Indigenous and non-Indigenous peoples. It was called The Consensus Statement: Eight tenets for Enacting the Truth and Reconciliation Commission’s Call to Action #33.

The researchers of this study use data collected from two collaborative meetings, previous reports, the Consensus Statement, and phone and interview conversations to highlight how important these 8 tenets are to Indigenous-led FASD prevention efforts.

Main Findings:

• Tenet 1: Centering Prevention around Indigenous Knowledge and Wellness

FASD prevention efforts should be guided by the concept of wellness and the principles of land, lineage, and language. Nimi Icinohabi (Our Way of Life) and LIVE (Living Indigenous Values Everyday) are two projects initiated by the Alexis Nakota Sioux Nation that demonstrate this principle.

• Tenet 2: Using a Social and Structural Determinants of Health Lens

FASD prevention initiatives should go beyond individual behavior to focus on ways to support the wellness and healing of women, as well as their families and communities.  The Circle of Life Mentorship Program operating in Terrace, B.C. on the Tsimshian Territory demonstrates this principle, creating safe and supportive environments for the individual, their family, and their support networks.

• Tenet 3: Highlighting Relationships

FASD prevention programs need to understand and support the role that external relationships with Elders, community members, and extended family members play in child development. The Innu Care Approach, developed by two Innu First Nations in Labrador, embodies this principle. At its core, the approach is about healing a nation and investing in children to ensure healthy and thriving Innu people, communities, and culture.

• Tenet #4: Community-Based and Community-Driven

Indigenous peoples and nations are distinct and diverse. FASD prevention programs have to build on the interest, needs, wisdom, language, and knowledge of a specific community and its members. For the Skidegate Health Centre on Haida Gwaii Island, B.C., it is essential that their work is community-driven and relationship-based to meet their clients where they’re at.

• Tenet #5: Provision of Wraparound Support and Holistic Services

Holistic and wraparound supports involve coordination and collaboration with other supports and services in the community to meet the complex needs of the women and their families. In urban centers, these supports can be offered through outreach or “one-stop shop” drop-in programs like the Manito Ikwe Kagiikwe (The Mothering Project) in Winnipeg, Manitoba.

• Tenet #6: Adopting a Life Course Approach

In FASD prevention, a life course approach re-centers services around Indigenous worldviews and recognizes pregnancy and childbirth as a sacred part of the life cycle. It connects individuals to their culture, promotes positive parenting, and reinforces the role of the community and family in raising children. An example is the Stó:l­o Family Empowerment Team, which is a culturally safe, relationship-first program for Indigenous women in urban and rural areas.

• Tenet #7: Models Supporting Resiliency for Women, Families, and Communities

Fostering resiliency includes implementing strengths-based approaches, such as programs built with Indigenous culture at their foundation. The Lakeland Centre for FASD fulfils this principle by offering community-driven supports within First Nation and Métis communities in Alberta that are focused on resiliency and encourage skill building, cultural teaching, healthy pregnancies, and healthy parenting.

• Tenet #8: Ensuring Long-Term Sustainable Funding and Research

Current research methods need to be decolonized so that community-held knowledge, languages, and cultures are incorporated into the research process. Priority areas in research have to be identified by Indigenous communities and groups and funders have to recognize the full scope of work needed to deliver Indigenous-led comprehensive FASD programs to make sure the work is well-funded and sustained.

Recommendations:

• To address the Call to Action #33, we need to shift our thinking away from the Western Medical model of treating alcohol and substance use to look at wellness as a whole, recognizing the impact social and economic factors can have on health
• FASD prevention in Indigenous communities should look at the social, political, and cultural reasons alcohol use during pregnancy, rather than focusing on educating about the dangers of drinking during pregnancy.
• There is a need for strengths-based approaches to FASD prevention that focuses on culture and relationships as the foundation that individuals, families, and communities can build on.
• Researchers should ensure that supporting and creating opportunities for collaboration is a priority, as expertise is fostered by building relationships and sharing knowledge. Indigenous FASD research should be co-developed, interdisciplinary, and reconciliatory.

Authors: Lindsay Wolfson, Nancy Poole, Melody Morton Ninomiya, Deborah Rutman, Sherry Letendre, Toni Winterhoff, Catherine Finney, Elizabeth Carlson, Michelle Prouty, Audrey McFarlane, Lia Ruttan, Lisa Murphy, Carmen Stewart, Lisa Lawley and Tammy Rowan

Journal: International Journal of Environmental Research of Public Health

Date: May 7, 2019

Read the full article (available open access)