A SUMMARY OF THE ARTICLE: HEALING OF THE CANOE:PRELIMINARY RESULTS OF A CULTURALLY GROUNDED INTERVENTION TO PREVENT SUBSTANCE ABUSE AND PROMOTE TRIBAL IDENTITY FOR NATIVE YOUTH IN TWO PACIFIC NORTHWEST TRIBE (DONOVAN ET AL.,2015) PRESENTED BY PHILIP DANQUAH, MSW, ASW

1. A S U M M A R Y O F T H E A R T I C L E :
H E A L I N G O F T H E C A N O E : P R E L I M I N A R Y R E S U LT S O F A
C U LT U R A L LY G R O U N D E D I N T E R V E N T I O N T O P R E V E N T
S U B S TA N C E A B U S E A N D P R O M O T E T R I B A L I D E N T I T Y F O R
N AT I V E Y O U T H I N T W O PA C I F I C N O R T H W E S T T R I B E
( D O N O VA N E T A L . , 2 0 1 5 )
P R E S E N T E D B Y P H I L I P D A N Q U A H , M S W, A S W

2. COMMUNITY BASED AND TRIBAL PARTICIPATORY RESEARCH (CBPR/TPR)
APPROACHES
• Academic- tribal partnership between
University of Washington Alcohol and Drug Abuse Institute (ADAI) and
Pacific- Northwest reservation-based tribes
• The Suquamish
• Port Gamble S’Klallam Tribes
Purpose
To develop a culturally grounded social skills intervention to promote increased cultural belonging and
prevent substance abuse among youth.
Outcomes
•This led to the development of a community-informed, culturally grounded intervention to promote a
sense of cultural belonging and to prevent substance abuse among tribal youth.
•The transfer of the process to a second tribal community, to demonstrate replicability of the
development and adaptation process and generalizability of the intervention.
(Donovan et al.,2015)

3. COMMUNITY BASED AND TRIBAL PARTICIPATORY RESEARCH (CBPR/TPR)
APPROACHES
HEALING OF THE CANOE:
• Participation in the intervention – Canoe journey as a metaphor for life, was associated
with
– increased hope,
– optimism,
– self-efficacy
– reduced substance use
– higher levels of cultural identity,
– knowledge about alcohol
– drugs among high school-age tribal youth
• Problem of interest: Substance abuse and its related negative health and social
consequences

4. AMERICAN INDIAN AND ALASKAN NATIVE POPULATION DYNAMICS
AI/AN population dynamics
– 1.7% of the overall population
– AI/AN demonstrate resilience, strength, and endurance despite centuries of pf postcolonial
efforts to eradicate and assimilate them.
– Alarming rates of health disparities and inequalities
– Lower life expectancy that is 4.2 years less than all races in the United States
– Made fewer advances towards healthy people 2010 objectives
– Lack of adequate, let alone effective and cultural appropriate services available to AI/AN
• Substance use and abuse among the AI/AN youth are priority concerns
– Alcohol and drug use at an earlier age
– Capacity to consume at high frequencies and quantity
– Disproportionate higher levels of associated negative consequences
– Relatively young age of many AI/ANs (median age of 29 years as compared to 37.2 years of the
entire national population)
(Donovan et al.,2015)

5. AMERICAN INDIAN AND ALASKAN NATIVE POPULATION DYNAMICS
Statistics - In comparison with national average
 Alcohol – 17.5 % (AI/AN), 16% (National average)
 Marijuana (13.8 % (AI/AN), 6% (National average)
 Pain Medication (6.1% (AI/AN), 3.3% (National average)
Associated Negative Health Consequences:
– Suicide, comorbid mental health disorders, school dropout, delinquency, reduced academic
performance, diabetes, injuries, fetal alcohol spectrum disorder, poverty, cancer, and heart disease.
Causal Research:
– Historical trauma as a contributing factor to substance abuse and mental health challenges among
AI/ANs.
– Removal of AI/AN children to boarding schools
– Theft of land
– Disruption of culture
– Loss of language and traditional practices
– Resulting grief has been associated with increased vulnerability to mental health and substance abuse
issues for AI/ANs.
(Donovan et al.,2015)

6. EMPIRICAL EVIDENCE
• Evidence shows the following are important for preventing substance use and abuse,
suicide and significant behavioral health issues:
– Cultural identity (i.e., ones’ sense of belonging to an ethnic group, defined by cultural heritage,
shared values, traditions, and practices and often language.
– Cultural continuity (i.e., the transmission of core cultural beliefs, values, and traditions across
generations)
– Feeling connected to one’s tribe and community
Therefore: Community-based and culturally grounded programs can be considered as the most
effective strategy.
(Donovan et al.,2015)

7. COMMUNITY BASED AND TRIBAL PARTICIPATORY RESEARCH (CBPR/TPR)
– Addresses the gap
– Communities participate as collaborators and researchers in the identification of issue of
concern, strengths to address the issues and desired outcomes, analysis and interpretation of
data, and effective dissemination of findings.
– Community driven, culturally grounded prevention interventions, that are derived from the
beliefs and values of a given tribe or culture.
– CBPR/TPR appears to be more acceptable and potential more effective for AI/AN youth than
Evidence Based Practices (EBAs) developed with non-native populations.
(Donovan et al.,2015)

8. COMMUNITY BASED AND TRIBAL PARTICIPATORY RESEARCH (CBPR/TPR)
APPROACHES
HEALING OF THE CANOE
Approaches
• Meetings with ADAI research staff, Native American staff, Suquamish Wellness Program
Director and staff, tribal leaders, and Elders, and Suquamish Cultural Co-operative
• Programs are consistent with the tribal sovereignty, culture, and values
• National Institute on Minority health and health Disparities (NIMHD) issued a call for
applications focusing on the use of CBPR approaches
• Suquamish Tribe and ADAI researchers jointly decided to apply for a grant to support the
development of a culturally grounded substance abuse prevention program
• Tribal and university-based personnel shared the responsibilities of a variety of areas,
including the grant application process, the proposed project leadership, and the research
team membership
• Developed an intervention that blends cognitive–behavioral life skills with culturally
grounded, tribal-specific teachings, practices and values that targeted both the prevention
of substance use/abuse and the promotion of cultural identity and belonging among the
youth.

9. COMMUNITY BASED AND TRIBAL PARTICIPATORY RESEARCH (CBPR/TPR)
APPROACHES
HEALING OF THE CANOE
• Phase 1
– Partnership development
– Needs and resources assessment with the Suquamish Tribe
• Community and Indian Health Service describes alcohol and substance abuse as the number one
health problem among the population.
– Intervention development and Piloting with the Suquamish Tribe
– Feasibility piloting with the Suquamish Tribe
• Phase 11
– Extended the partnership to the Port Bamble S’ Klallam to replicate the development process
and involved the evaluation of the convention in the two communities.
o Intervention implementation with the Suquamish tribe
o Intervention Extension to Port Bamble S’ Klallam tribe (PGST)
o Workshop Implementation of Intervention with Suquamish and PGST
(Donovan et al.,2015)

10. COMMUNITY BASED AND TRIBAL PARTICIPATORY RESEARCH (CBPR/TPR)
APPROACHES
HEALING OF THE CANOE
• Recruitment Procedures
– Newsletters, social media, fliers in youth programs and personal contact
• Measures:
– Cultural Identification and Participation in Cultural Activities,
– Hope/Optimism/ Self-Efficacy
– Substance Use
– Substance Abuse Knowledge
– Assessment Administration Schedule
• Analysis & Design: Suquamish High School: Non-parametric using Friedman’s Two Way Analysis
• Suquamish/PGST workshops: Quasi experimental design, Non-parametric analysis. Using Mann-
Whitney –U statistics
(Donovan et al.,2015)

11. COMMUNITY BASED AND TRIBAL PARTICIPATORY RESEARCH (CBPR/TPR)
APPROACHES
HEALING OF THE CANOE
Conclusion:
The transfer of the process to a second tribal community, to demonstrate replicability of the
development and adaptation process and generalizability of the intervention.
Questions
• Do you think they could have done things in a different manner ?
• Why do you think that EBP that works in other communities does not work in AI/AN communities ?
• What is happening in current AI/AN communities? Ponder
– Current services and Evidence Based Practices (EBPs) are often viewed with distrust AI/AN communities.
– Little evidence that they are effective for AI/ANs
– Many AI/ANs view research with suspicion and mistrust.
(Donovan et al.,2015)

12. REFERENCE
• Donovan, Dennis M, Thomas, Lisa Rey, Sigo, Robin Little Wing, Price, Laura, Lonczak,
Heather, Lawrence, Nigel, . . . Bagley, Lenora. (2015). Healing of the canoe: Preliminary
results of a culturally tailored intervention to prevent substance abuse and promote tribal
identity for Native youth in two Pacific Northwest tribes. American Indian and Alaska Native
Mental Health Research (Online), 22(1), 42-76.

13. THANK YOU