Indigenous Land-Based Healing Programs in Canada: A Scoping Review Prepared for: Hotıì ts’eeda and NWT Recreation and Parks Association August 2019 About this publication Hotıì ts’eeda is a research support centre for community members, organizations and researchers involved in Northwest Territories health and health research. It is funded by the Canadian Institutes of Health Research under their Strategy for Patient-Oriented Research. The organization is hosted by the Tłı̨chǫ Government and supported by a partnership of NWT governments and organizations. To learn more about Hotıì ts’eeda, visit nwtspor.ca. The NWT Recreation and Parks Association works with communities across the NWT to promote recreation by supporting leaders, communities, and partners through training, advocacy, and networking.To learn more about the NWT Recreation and Parks Association, visit nwtrpa.org For more information about this literature review, contact Hotıì ts’eeda at communications@ nwtspor.ca. Acknowledgements This report was prepared for Hotıì ts’eeda and the NWT Parks and Recreation Association by Crystal Milligan (University of Toronto). 1 2 Background Others still have called for health professionals to develop a basic understanding of the cultures and Colonization of the lands now known as Canada ways of knowing that underlie Indigenous health is widely acknowledged as the primary source practices (17,18), which encompass land-based of ill health among First Nations, Inuit and Métis approaches to healing. peoples (1–6). Residential schools, reserves and other colonial systems undermined Indigenous This paper presents the findings of a scoping peoples’ abilities to live healthy lives by severing review that aimed to determine and describe what their ties with their cultures and ancestral lands is known in academic and grey literatures about (1) and disrupting the social foundations upon Indigenous land-based healing programs in Canada. which their societies were built (3). Contemporary A scoping review was well-suited to this aim symptoms of colonization include inequitable given the intent to map concepts in the literature systems that place Indigenous peoples in a and provide an overview of the range of current position of disadvantage and reinforce cycles evidence and activities (19). Following established of trauma and poor health outcomes (5,7). methodology (20), this review contributes to the Furthermore, a general failure among Canadian evidence base for Indigenous land-based healing health and social services systems to recognize programs in Canada by synthesizing knowledge Indigenous knowledges, ways of knowing and and pointing toward future directions in research. cultures contributes to health policies and services that are culturally unsafe and do little to address The term ‘Indigenous’ is used throughout this Indigenous peoples’ wholistic health needs (8). paper to collectively refer to First Nations, Inuit and Métis peoples. This collective term The most appropriate mechanism and site of acknowledges similarities in First Nations, Inuit and healing for Indigenous peoples are perhaps the Métis experiences with colonization and facilitates lands from which they were forcibly displaced ease of reading. It is not intended to deny the (9). Relationship with the land has forever been diversity in cultures, practices or histories among a core aspect of health and healing in Indigenous these peoples. On the contrary, this paper aims to communities (10–12), and being on the land support a conceptualization of Indigenous healing is therefore key to restoring one’s connection as an expression of the richly diverse knowledges, with traditional health knowledge and ultimately identities and values among First Nations, Inuit finding means to heal (4,13,14). Yet there are and Métis peoples (21,22). Wherever possible, very few published studies or even evaluations the name according to which an individual or group of land-based healing programs in Canada self-identifies is used. to inform our understanding of their design and implementation. This deficiency is even more conspicuous when considered in light of recognition by the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) of the inherent right of Indigenous peoples worldwide to use their own medicine and health practices (15). This imperative is reinforced by the Truth and Reconciliation Commission (16), which called on Canada to collaborate with Indigenous healers and Elders to make such medicine and healing practices available to Indigenous clients. 3 Methods Americans; Arctic Health Publications Database; and the University of Saskatchewan Indigenous Study design Studies Portal (iPortal). Eight other academic A scoping review was chosen to search for databases or repositories were searched, but and review academic literature and other non- generated no eligible citations. academic information sources in order to synthesize existing knowledge about the design Online search engines used in this review were and implementation of Indigenous land-based Google, Google Scholar and Duck Duck Go. Web healing programs in Canada. The scoping review browser cookies were cleared before beginning is a common method for reviewing literature on a any searches. The review of search results given topic and demonstrating what is known or continued up to five pages after last clicking on not known, helping to inform policy, practice and a relevant item. The websites of 70 Indigenous additional research (20). Designed according to organizations, research centres, universities, methodology established by Arksey and O’Malley news agencies and governments in Canada were (20), the methods and findings of this scoping also reviewed using a combination of Advanced review are reported as per the PRISMA Extension Google, website search bars and browsing. for Scoping Reviews (PRISMA-ScR) (23). An academic health sciences librarian was consulted Eligibility criteria in the planning and development of the study This research sought to identify work based in design and search strategy. empirical research, theory or actual practice that described Indigenous land-based healing Search strategy programs in Canada. Citations had to fulfill the The search strategy included an academic following criteria to be included in this study: database search, search engine queries, targeted • Description of an actual land-based healing website review and reference tracking. Search program(s) led by Indigenous peoples or terms included several combinations, variations organizations or discussion of Indigenous and synonyms of ‘Indigenous,’ ‘land-based,’ healing in connection with the land; ‘healing’ and ‘Canada.’ Terms such as ‘wilderness • Whether it is labelled using ‘healing,’ therapy’ or ‘outdoor behavioural healthcare,’ ‘recovery,’ ‘mental wellness promotion’ or which appeared to be used primarily by non- other similar terms, healing is described Indigenous organizations and mostly returned as part of the program’s mandate, design examples of land-based programs that were not or outcomes; connected with an Indigenous worldview, were not • Inclusion of a Canadian setting(s); and included. • Written in English or French. The initial academic search strategy was developed Citations were excluded if they were dated before for Ovid MEDLINE® using a combination of title, 2000, a date chosen on the basis of preliminary abstract and subject headings in addition to text searches in Scopus that indicated articles related words and then translated for other academic to ‘Indigenous healing’ increased in number after databases. The full search equation for Ovid this year. This also served to limit the number of MEDLINE® is found in Appendix A. Final searches search results that pertained to healing programs with no language or date limits were conducted no longer in operation. between November 19-December 11, 2018 in Ovid MEDLINE®; PsycINFO; CINAHL Plus with Full Study selection and data collation Text; Embase Classic; Bibliography of Native North Before screening began, the eligibility criteria 4 were pilot tested on a preselected list of 10 Using a chart in Excel, data were extracted with citations. A single reviewer reviewed all titles and regard to numerous variables including article abstracts. Where there was not enough or unclear characteristics (e.g., geographic focus, funding information to exclude a citation, the citation was source, document-type); definition of land- included for full-text review. In total, 50 citations based healing; and program description (e.g., were screened in for full-text review against the governance structure, delivery model, clients). eligibility criteria. Six additional citations were For a summary of data abstraction for each specific included at this stage after reviewing the reference Indigenous land-based healing program, see the lists of all citations. This process is illustrated in table in Appendix C. Results were synthesized Figure 1 below. using frequencies and thematic analysis (24). Meta-analysis was not performed. Figure 1: PRISMA flow chart Citations identified through academic databases Citations identified Citations identified (MEDLINE, PsycINFO, CINAHL Plus, Embase, through online through targeted Bibliography of Native North Americans, Arctic search engines website search Health Publications Database, iPortal) (n=28) (n=40) (n=3,462) SEARCH Citations after duplicates removed (n=2,224) Citations screened Citations excluded in (n=50) (n=2,174) SCREENING Citations