First and foremost, it is important to note that Inuit and non-Inuit participants spoke at times of similar experiences but also referred to very distinct perceptions and expectations. As will be observable below non-Inuit tended to speak about the many of the challenges in engaging youth and families and although the described the interest in speaking with extended family and other community members their practices rarely integrated more than the parents. On the other hand, Inuit recognized certain challenges but also put forth many ideas of how to transform approaches and services. Their focus on `how to move forward` was striking. Moreover, Inuit spoke much less of the services per se, even if they themselves worked within the services. They were more descriptive of the roles and ways in which community can support families and children.
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. Inuit and non-Inuit voices are shared through-out the results.
I) Commonly described interventions
In this section, we outline the most commonly described social interventions with youth and families. As mentioned above, service providers spoke predominantly of the difficulties engaging youth and families in services. We describe 1) the various actors discussed by participants and their perceived roles, and 2) their locations and movements between locations.
1) Actors and their perceived roles
Five core groups of actors emerged as essential partners with different roles and responsibilities for effectively providing services to youth and their families: a) service providers; b) youth; c) parents; d) extended families; e) the community.
Service providers. Service providers are described as having to share information with other professionals. They are seen as having to communicate with parents in order to obtain consent to offer services to youth who are under the age of 14. Service providers feel that they often take the first steps in initiating contact and follow-up.
Youth. Service providers do not describe youth as having a particular role or responsibility. Youth are often described for their willingness to receive services, their behaviours, symptoms and family contexts.
Parents. Service providers describe parental involvement as essential in the service delivery process. Parents are sometimes described as potential coordinators of services. A non-Inuit doctor explains that parents can have a beneficial impact on the continuity and coherence of services as they can relay information from one service to another:
“What goes best in paediatrics is when the parents are able to take on the role of kind of coordinating the care, it's really when it goes well. Yeah, for coordinating and also for speaking for the child. Like, “You sent me for that specialist but that wasn't the one I needed. What I needed was this”. So when there's that kind of empowerment and ability, then those really go best”.
Service providers also described how parents can support professionals in finding solutions for youth. A non-Inuit teacher offers an example:
“The parents came in for a meeting and we discussed the plan with the parents and [they] gave us their feedback about how it (the plan) would affect their children and some ideas were put forward”.
Extended family: Service providers described the role of extended family members as support systems for parents when they are not physically or emotionally available. In fact, extended family is considered the first placement option when children must be removed from the immediate family environment. A non-Inuit Crown attorney emphasized how extended family can also be a source of information for service providers:
“Family members will get involved most of the time, to help to find a solution for the child to be protected. Maybe they’ll take the child home and then this way the parents will maybe get a break for a while because sometimes it's difficult for them. And family members will also help me understand the situation a little bit better by giving me input.”
Community Finally, service providers often described “community” as a necessary and needed collaborator for effective care and more specifically for prevention. Service providers spoke of their desire to have community members guide their work and “mobilize” around health and social issues. An Inuk driver for the clinic spoke about the supporting role that community must play for a young girl with behavioural issues:
“She needs hope. How do we give hope? It's a community thing so we just need the people now to be better role models. We need to do our best and hope that she does her best, and that the community speaks to her and we need to hope that everyone will do their best (to help).”
The words of an Inuk participant explain how communities can take on this leadership role:
“There needs to be almost like a mission statement for the community. Like what, what do we want this community to be, what is it right now, where do we want to go with it. If we want to leave it status quo, by all means that is your right. But if we want to make it a little bit better, if we want to change it, if we’re not happy with the way it is, then let’s do something about it. And, that can’t just be from outside people coming from different universities and research and all, so it needs to come from the community members.”
These words also serve as a reminder that research might be a tool, but ultimately the process needs to be in the hands of Inuit.
Within commonly described interventions, these five groups of actors are reported as having distinct yet highly connected roles and responsibilities: In order for the service provider to work with the youth they must interact with parents; for parents to be supportive towards their children and youth, service providers feel that they need support from extended friends and family, who is turn require the support of community. However, services providers rarely describe interactions with extended family or with community representatives or organisations.
2) Locations and movements
The physical locations of services and of those seeking services played an important role in service provider narratives about the role of participation in care. Children and youth often met with service providers inside organisations such as youth protection offices, nursing stations, and schools. Parents were at times described as partners within the services, although mostly described as being difficult to reach and outside of services.
Service providers used a variety of action verbs including go to, come to, send, and call that imply the need for movement when speaking of their attempts to collaborate with families and communities. Service providers generally described their movements and actions towards families and youth as attempts to invite youth and parents to come see them, or asking parents for consent to work with the youth. They describe using email, letters, and phone calls, or at times going directly to their homes. However, they also spoke of feeling uneasy going to peoples’ home, especially if they know that the family has difficult psychosocial dynamics. At times they will ask a colleague from another service to accompany them. They describe the movements and actions from services towards community to sometimes include individual consultations with particular members of the community, such as the mayor or an elder.
Regarding youth and families, very rarely do service providers speak of active steps taken by youth towards services. Instead, youth were described as being “picked up” by service providers
“But of their own will? Would youth come consult themselves? Teens? Because they aren’t doing well? No! The same person explains that youth will be brought to services during a suicidal episode, and according to her perceptions at least three quarters of these youth will not continue the proposed follow-up. Similarly, an Inuk rehabilitation officer explains: The parents usually they don't call me, when I meet them it’s because their son or daughter has been arrested, and then that's when they're going to say “can you help my child, can you try to convince him to listen to me, going back to school….`.
Generally speaking, youth seem to be understood as passive agents within health and social service interactions. Many non-Inuit service providers place a stronger emphasis on the role of parents. While the importance and potential of other actors such as extended family and community are recognized by service providers, there seems to be a disconnect between the locations of services and the locations of actors, and questions about how agency and who is moving towards whom are perceived.
II) Challenges to and within encounters
Service providers’ narratives about patient involvement in care emphasized two inter-related challenges to making connections with youth and families: 1) Challenges that inhibit the use of services by youth and families (as understood by service providers); and 2) Challenges that impact service providers’ ability and desire to go towards youth, families and communities.
1) Inhibitors to going towards services, according to service providers
In this section we identify four broad factors that influence families’ use and perception of services: a) colonialism; b) service provider’s attitudes; c) fear, stigma and discomfort; d) limited service mandates.
Colonialism. For Inuit participants, historical considerations were more prominent in their explanation of difficult encounters. They spoke of the impact of forced sedentarism on families as well as the trauma carried on from generation to generation. I think that many parents have issues that they never healed from when they were young. I think it was passed from generation to generation starting with the years where Inuit were forced to be sedentary.
Only a few non-Inuit participants spoke of how colonial histories influence how families might interact with services.
A non-Inuit nurse explained the irony of the colonial situation that Inuit must contend with:
“They lived in igloos and they had their traditional way of life, and then we came in and said we're gonna give you those villages and we're gonna kill your dogs. We're gonna force a different kind of food on you and we're gonna basically manage you the way we want to. Then we're gonna put you in schools, where a lot of you are gonna get it and abused and whatnot. Then suddenly we're in 2014 and we're asking: How come you guys are not taking care of you own life?”
This nurse described a feeling of frustration and disempowerment in the larger social context where Inuit families are asked to trust services and mobilize healthcare plans made within a colonial system.
Service provider attitudes. Both Inuit and non-Inuit participants feel that service providers’ attitudes influence whether or not services are deemed acceptable by youth and families. Some participants described negative, and at times hostile, attitudes amongst their colleagues who act in ways that enact or reinforce colonial relations. These discriminatory attitudes can directly influence families’ abilities to trust the services. An Inuk parent described the discrimination that their family experienced, being told by a doctor that if they missed an appointment for their child who was dealing with an important medical condition that the nursing station would contact youth protection services. After denouncing the doctor, the parents never heard back from her. These experiences of discrimination fuel existing mistrust.
A non-Inuit family doctor at the hospital described some of the judgmental attitudes that she has observed among her colleagues, which she believes may impact families’ comfort in using services:
“I find there are lots of people who judge quickly (…) Like, my child is half Inuk and she says that when she goes to the hospital, if she is with me, she sees a difference in how she is treated. When she isn’t with me, she says that they don’t always treat her nicely. I feel there can be discrimination.”
Some participants also felt that certain service providers interpret and label behaviours as `cultural ways,` rather than truly attempting to understand the uniqueness of a person, and the complexities and contexts within which individual actions take place.
“Some workers make conclusions like, “ahhh it's because of their culture, she can't tell me this or she can't talk.” I don't know what it is but with the whole White and Inuit… I'm so over it. That's enough (blaming culture). It's the 21st century - we're gonna work together or we're not? It's time to work together, everybody. Stop blaming culture.
Indeed, these statements are not uncommon in Nunavik; non-Inuit workers feel frustrated not being able to connect with Inuit families. Interpreting these challenges as cultural differences removes any possibilities of transforming one’s own practice, or of understanding tensions in a different light.
Families’ fear of services, stigma associated with service use, and feelings of discomfort. Some non-Inuit service providers feel that families might see services as a form of punishment rather than as a source of support. They also feel that for some parents, seeking help through services can be stigmatizing within their community. Other parents may fear service providers taking away their children or the police getting involved in their family life. A non-Inuit child psychiatrist gave an example of a family dealing with this fear:
“The mother was very traumatized by the DYP (Department of Youth Protection), so she will stay away from the `medical` (services) as much as possible; basically all that is `White`. It's a shame because the children… they (families) need help, they have a lot of learning difficulties and then they go to look for help. Sometimes a mother accepts, then she withdraws because she is so afraid (…) she remains scared that her children will all be removed again.”
A non-Inuit social worker described how parents might feel guilty when a service provider or teacher approaches them with a situation concerning their child, which can lead to distancing themselves from the service providers:
“Well, if there is any [problem], there is tension with the family. If your child is not doing well at school, the parent feels guilty about everything, and then they close down.”
A non-Inuit crisis center coordinator felt that families might fear being judged by other community members by accessing particular services, for example, related to mental health.
Inuit workers remind us that in and of itself being a youth can hinder the desire and ability to get help. This position is then compounded by the fact that workers are mostly non-Inuit individuals that youth do not know and therefore feel even less comfortable seeking help or opening up. A participant says: “They close up because the workers are from another culture, they keep it all in. They need to let it out. It just explodes.”
Service mandates. Several service providers also described how different understandings of the role and mandate of the services could impact how patients access and use services. A non-Inuit mental health nurse shared how he responded to a situation when a youth misunderstood the role of his youth protection worker:
“Often they don’t understand. Like for example, I was following a youth under DYP. The youth verbalised that he hated his DYP worker but he didn’t understand her role at all, what she was doing for him. Sometimes I spent time with him, telling him: Listen she wants what is best for you, she is there to ensure this, that and that. She wants to help you go back to school.”
An Inuk worker explains that there may be services and activities within the community for youth and families but that if people do not know about these activities and do not understand why, and where they are taking place then people will not attend. Using community radio as a means of communication as well as direct invitations are encouraged by participants.
From the perspectives of service providers, these factors that inhibit families’ use of services, including colonial histories, service provider attitudes, families fear of services, and misunderstandings about service provision mandates, create barriers from families ‘moving towards’ or accessing services. At the same time, a range of factors also inhibit how service providers engage with youth and families.
2) Factors that influence service providers’ ability and desire to go towards youth, families and communities
Service providers identified six factors that constrain them from reaching out to and engaging with youth and families: a) Parental consent; b) lack of resources within the community; c) language; d) culture; e) mismatched timing; f) challenges of being from the community.
Parental consent. Participants spoke of legal challenges to truly engaging youth and families in service provision. In order to provide services to youth under 14, parental consent is legally required. Consent is also required to share information with other service providers. Service providers described a strained dynamic where they either feel dependent on parents until they either receive consent to provide services to youth (or instead chose to use the institutional power of youth protection services to oblige service provision. A non-Inuit social worker from the nursing station, who also worked at a local school, described the challenges to obtaining parental consent:
“I always try to get consent from parents, especially when the youth is under 14 and well, sometimes they refuse. You cut the grass under my feet, I can’t do anything. Sometimes I work in collaboration with DYP and then they might be able to get a consent from parents after trying very hard. I have to send a paper, they have to sign it, and then I never see the parents. They sign, I have the paper, we invite parents to come meet, again with pressure from the youth protection and often the parents won’t show up.”
Consent is essential in order to ensure parents are decision-makers in a process of care for their children however consent requirements seem to construct and formalize particular types of relationships between service providers and families.
Lack of resources within the community. Service providers perceived a lack of resources as a challenge to setting up alternative services that would better respond to people’s needs, for example, related to emergency housing, in-community alcohol and drug rehabilitation services, psychotherapy, and financial assistance. One non-Inuit youth protection worker, a specialist in clinical activities, explained how the lack of resources for children who are signalled under youth protection directly impacts the chain and quality of services that health workers can provide for youth:
“There is a lot of placement and there are very specific protocols and frameworks on when to put a child in and what to try, how to do it, and how to prioritize and what to do with it… The law can be rigid. But here, unfortunately, we do not have foster families. So we end up placing [youth] in places that are not necessarily better, or place with Whites who will eventually go one day. And I do not judge, but that's it anyway. So we take children, we take them away [from their families] and they lose all contact because the Whites who speak Inuktitut are not many.”
Service providers, like this youth protection worker, described feeling frustrated and discouraged that they do not have more adequate resources to develop/implement comprehensive solutions/plans that better meet the needs of the youth and family they work with.
Similarly, Inuit workers who describe feeling irritated with the types of services offered in their community explain that the nature of services is greatly influenced by the low number of human resources compared to the needs. An Inuk service provider explained:
“But another thing too is that I totally know and understand what their situation is about how overwhelmed [non-Inuit workers] are, but you know a lot of the times is that they don’t set themselves up for success either. I just know for a fact that all these people are so overwhelmed because there’s a giant work load as soon as they come in to work and it’s hard for them to keep up. It’s like everyone is just thrown under the bus. So, there’s no time for them to think about prevention, they don’t have the time to think about counselling, they don’t have time to just do recreational activities.”
Language. Non-Inuit participants identified language as a major impediment to developing positive interactions with families. Communication challenges seem to create frustrations for both service providers and family members who feel that their exchanges are limited when they would like to go further. A non-Inuit psychoeducator explained:
“One of the problems I have, it's Inuktitut. I do not speak Inuktitut, because the problem I have is when you have young people, when you get into the emotions, it's all in Inuktitut. They spit it to you and you would have to understand what is said. There are young people who know I do not speak Inuktitut, but sometimes I get a sentencein Inuktitut and they are discouraged that they do not know how to say it in French or in English.”
Non-Inuit service providers rarely speak Inuktitut. At times they will have learned a few basic words. Moreover, for many service providers English is a second language. In these cases, both the family and the worker are exchanging in a second language. This is challenging in any situation, but particularly tedious when speaking about emotions and relationships. As will be described below, language is yet another reason for non-Inuit workers to work in collaboration with Inuit workers or other community members.
Culture. Some participants spoke of the ambivalence and complexities related to non-Inuit learning about and from Inuit culture. On one hand, some participants remarked that these efforts may be perceived as a form of respect. On the other hand, participants suggested that these efforts can also be perceived as “wanting to be Inuit.” Participants described how community members can limit non-Inuit access to cultural activities, and general interactions with these individuals if they are perceived as not being authentic in their attempts to learn, or if they are view as attempting to appropriate traditional activities. A non-Inuit nurse explained:
“There are some (non-Inuit) who will be able to speak Inuktitut (…) They always come up with Inuktitut sentences in the meetings. Then Inuit will tell me: damn they annoy us (...). But it was only after a few years that I started hearing that. In the beginning you think `I have to become like that, I have to`. But now, collaboration for me ... It's about being yourself.”
Cultural challenges also emerge when people have different and often incompatible expectations. A non-Inuit social worker offered examples like school teachers expecting youth to attend classes every day and all day and social workers hoping youth attend prevention sessions on a regular basis, whereas families might feel that activities such as hunting, camping or staying at home are most helpful for the youth.
Inuit participants spoke of the importance of cultural sensitivity training for non-Inuit workers and the interest of integrating Inuit and non-Inuit workers in the same training so as to ensure shared learning and the ease of working together.
Mismatched timing. From the perspectives of service providers, families use services at times and in ways that are inconsistent with the way services are delivered. Indeed, service providers report that families often ask for help when they are in a precarious situation. However, because of the lack of resources, families often only receive help when the situation becomes critical. A planning officer at Youth and Family Services described the situation of a family who had been asking youth protection services for support because they were concerned that their teenager was engaging in drug use and sexualized behaviors, yet they did not receive any services. In a moment of crisis, one family member hit the teenager. Youth protection services then got involved and placed the child in foster care. In another example shared by an intervention worker, a parent called the police to ask for help to deal with their teenager who was heavily intoxicated. Yet the police did not see themselves as having a mandate or a role in this situation. In these two examples, families reached out for help but could not access these services at the moments they were needed the most.
Furthermore, many service providers described their impression that in times of crisis, families expected services to take charge of a situation and of their children, relegating their parental responsibilities entirely. A non-Inuit psychiatrist described how youth can end up hospitalised alone in Montreal:
“Sometimes, youth that are hospitalised, their parents don’t come to see them. We have to run after the parents. The social services try to reach the parents. The youth is a minor and doesn’t have family around. We have extended family who might be there a bit and that is really helpful. Or else, they end up alone.”
In a contrasting example, a non-Inuit social worker explained how families might show up in times of crisis:
“People call when they are having a big issue, big distress, crises, they are really upset. They aren’t able to keep their child, not able to keep their elderly parent, or not able to deal with alcohol problems of a family member. It’s pretty much what we deal with. Yes, we offer support, but it stops there. Because if people don’t take things into their own hands, well the problem just starts all over again. Me, I try to show the cycle of dependence. I try to show ways out, ways of affirming oneself, how to face our own problems.”
Family members may seek services on different occasions or may stay at home feeling that the resources are not helpful. If the situation spirals into a crisis, families may either feel the need to go back for support or end up forcefully receiving court-ordered services. This spiral has multiple repercussions. In the moment when services are offered or available, the family may have already fallen into feelings of hopelessness and disengagement towards the situation.
Service providers spoke of feeling frustrated when situations ended in crisis when they thought that the crisis could have been prevented. This frustration was at times accentuated by service provider attitudes that stereotypes about Inuit. For example, a non-Inuit service worker articulate the belief that Inuit are not `prevention oriented`:
“In general, health services are very well received by the population. Typically, the Inuit population is a population that lives from day to day. So when we talk about curative health care, yes they are engaged, they come to seek this care. Less when we talk about prevention, it is not necessarily a population that will be compliant with prevention programs or come for their medical appointments. If it is beautiful that day, they will go fishing and then hunt. They will not come to their appointments. Then I say that we are not adapted to this reality.”
These stereotypes and frustrations may be felt and heard by other service providers as well as by the families who may feel judged or misunderstood. An Inuit elder explained the challenges of navigating obscure bureaucracies and of having a genuine community voice within services:
“Even if we meet and talk and say what we need as a people, there are too many other things that influence decision-making, things we cannot see. So in the end we don’t feel heard, we don’t feel understood. What is the point?”
Mismatched timings between the moments when services are needed (before breaking point) the moments when services are offered (at the breaking point), as well as the tendency towards generalization, seems to impact both service providers’ and families’ perceptions of one another, limiting their ability to truly collaborate towards a common goal.
Working and being from the community. Both Inuit and non-Inuit workers speak of the challenge that Inuit workers face working in their own community. Working with youth and parents who are also relatives or neighbors can be socially and professionally complicated. Inuit workers feel that they should be offered counselling and guidance in their work to help deal with these realities. They feel that the lack of social support and counselling is an inhibitor to their ability to consistently provide the care they would want to offer to their community. An Inuk worker explains:
“You know what, I worked out of passion, out of love and I did this for my community. I felt like I was making a positive impact, and then my friend (also working for community services) said, ‘it wasn’t worth being shut-out (by community member) for 15$ an hour.’ It wasn’t worth family disowning them, or not feeling safe to go in public. I swear it blows my mind… after I was at the TRC [Truth and Reconciliation Commission] last year, I felt and saw how really deep everything is, and how my generation and a little bit older, are affected. I have suggested in the past to have counselling, a counsellor for the counsellors. That or intercommunity counselling. Like, let’s say I’m a social worker in this community, I’m having a really hard time [and] I don’t feel like I’m being welcomed by my community. I need to be able to speak to someone about it.”
Both Inuit and non-Inuit service providers describe a range of factors that affect their ability and desire to moving youth and families. Service providers might speak to each actor but rarely together and services providers and family members occupy distinct spaces within the community making it difficult to meet. From seemingly procedural factors such as the bureaucracy around consent, miscommunications around language, and mismatched timing around when services are requested or needed and ultimately offered, to deeper structural issues related to a lack of resources within communities and culture, each of these areas represent barriers or hurdles to youth and family participation, as perceived by service providers.
III) Building on strengths
Despite the multiple challenges above, many Inuit participants and a few non-Inuit service providers described successful encounters with youth and families as well as specific ingredients or approaches that they felt would lead to more positive and meaningful participation of youth, families and communities. We organized these success factors around 5 categories: a) developing trusting relationships; b) informal encounters; c) reaching out to extended family and community; d) responding to the right needs; e) attitude and care from service providers. Here, it is important to note that Inuit participants specifically spoke of trusting relationships and the role of community members in supporting the wellbeing of youth. Inuit also speak of ways of training non-Inuit service providers to improve cultural awareness and attitudes. Inuit workers, who are also parents and community members receiving services go beyond their disappointments with the current situation and see possibilities for transforming approaches and structures of care. Here we integrate Inuit and non-Inuit perspectives to reflect on ways of learning from positive experiences and building on existing strengths always basing the categories around what Inuit within this study and past studies suggest should be done to improve care.
Developing trusting relationships. Non-Inuit participants spoke of service providers who have lived in a community for many years and who have established a trusting relationship with families. They felt that when this was the case, families would mobilize in their care and proactively seek help. A non-Inuit child psychiatrist described how her ongoing relationship with and commitment to the community helps build trust and collaboration:
“I've been there for a few years. [Families are] starting to recognize me, they greet me. Then they'll come to the airport and then they'll tell me "you know my daughter, such, such thing". It is in the long term that the relationship is established and then the collaboration is done”.
After having received training from an Indigenous organisation, a non-Inuit nurse reflected on what she learned through the training:
“Often when Inuit go towards services, it’s because they are in crisis and they just don’t have any other choice. But, would they really just go when they are in crisis if they felt that they had strong trusting relationships and if services were adapted? I don’t think so because I know people who have good relationships with workers and they don’t just go when they are in crisis.”
When a relationship has been difficult to establish with a patient or family, some service providers spoke of building on another service provider's trusting relationship by asking the colleague to speak with the family for them or to accompany them in their meeting with the family. This approach was particularly relevant with Inuit colleagues. For example, an Inuk youth protection worker describes how she has collaborated with her non-Inuit colleagues:
“Literally for every intervention. I heard so many [of my colleagues], like “it's impossible to get to this mother, it's impossible to go to this house” ‘cause they are alone, you know? Like, we discussed before, you should have an Inuk with you every time you go to someone's house. So I follow to people's houses just to go translate and it usually works.”
Another Inuit psychosocial worker described playing a similar role:
“When I was in charge of this service, we had caseloads and we had waiting lists and everything. But we could work much faster and quicker with Inuit families because we're Inuit. I had an assistant who was also Inuit, and elderly experienced people working with us as community workers and going to visit families and knocking on doors and working with the police. So it was much more community-oriented.”
Community involvement and Informal encounters Inuit workers wished that non-Inuit workers be more involved in the community to get to know the families and create that trust that is essential for clinical care.
“Because for me in my mind, as a front-line worker and a community member, the way a community member will see a front line worker is only through when there is a crisis. So a front line worker in the community member is a crisis intervener and then it’s not always positive. So i would always love them to be more involved in the community. It can be by volunteering, you know, coming in to our recreation facility and volunteering and you know, play soccer, or you know be a part of a sports team.”
Non-Inuit participants who described positive collaborations with families spoke of using informal
approaches such as “having an open door to just come and meet”. A non-Inuit social worker described what this open door could potentially look like:
“There’s got to be an open door. You know, I was even discussing with a couple of the local staff in the school - how cool would it be if once a month, we just had like an open-door night for a few hours? Like, not parent-teacher night, not talking about report cards… we are not discussing the academics. Just come and meet the teacher. Come have a coffee, relax, you know? It doesn’t have to be fancy, it doesn’t have to be organised. The idea that the teacher is not this scary entity that sits in a classroom, right? That we are human beings and we’re just here to help your kids.”
A non-Inuit teacher explained that he tends to spend a lot of time within the community, at events and just walking around chatting with people:
“I guess it's also about being in the community a fair amount, so I am very close with a lot of parents. Like, I know them on a social basis. And I'll talk to them about their kids at those points, too. I think it helps sometimes.”
Reaching out to extended family and community. Working with extended family members such as grandparents, aunts and uncles, and cousins as well as key members of the community can also help service providers connect with the family and youth. A non-Inuit general practitioner explained:
“[The] times I've seen beautiful interventions were often [with] the grandparents who know the children well, and the grandparents really have a respect here from young offenders. I think it's often them who have a lever to try to reason youth and talk to them about more emotional things.”
A non-Inuit psychiatrist explained the particular involvement of extended family in Nunavik:
“I find that compared to the south, the extended families really get very involved with patients (…) Aunts, cousins, there is really this sense of family that goes beyond the nuclear family. And generally it goes pretty well with them when they see that we are interested in them, that their opinions count, that we are soliciting them for that, when we thank them for their support for example. They are often really pleased. They have a collaborative mindset”.
A few participants spoke of these types of consultations, yet admitted only seeking this wider community engagement once or twice during their time in the north. More frequently, service providers encouraged patients to consult extended family as well as members of the clergy. A non-Inuit public health agent explains:
“When I started working in my two regular villages, I went to see the Mayor of each community to ask what he saw, as a leader, what were the main problems. And what he thought could be done to adapt service more to their culture. I did it at the very beginning of my practice. I was well received each time. The Mayors were very grateful. But after that, I never did it again”.
On a more individual basis, a program manager, a planning officer and a school director described trying to “go towards community” as a way of learning from community and integrating the environment they live and work in. They spoke of attempting to learn Inuktitut or trying traditional activities, going on the land, participating in community activities, and integrating themselves into the community.
These efforts are consistent with what an Inuk participant explains how workers can be pro-active in their support to families going directly to their homes and actively looking for solutions with the family:
“.I have been trying to volunteer like a workshop, like to train parents by doing home visits, just teach them the basic needs and what they need at home. It's a lot of fun because it's a lot of interactions and some parents they don't know what to do so it would be fun to have home visits. Talk about what kind of support they need, not judgemental.”
Attitude and care. Finally, participants spoke of how attitudes of respect and care for families can allow for positive interventions built on trust. A non-Inuit doctor explained the importance of recognizing the role that families play in patient care:
“To feel that [service providers are] interested in what [families] have to say, that their opinion counts, that they have been asked for that, that they are thanked for the support they give for the patient, for example. They are often very happy with that”.
In the quotation below, a non-Inuit psychosocial worker recounted the story of a foster family and youth protection agent who respected the importance of the mother in the child’s life, despite her challenges:
“The baby is placed in foster care in the South, but this foster family is so available and open. They text [the mother] and they talk to each other every day [on] Facebook, so that the mother can keep a link with [her] baby, [her] daughter who is 2 years old. But this foster family there, so available. Then the social worker who works with her, she is very aware about the reality of First Nations, the importance of maintaining links, culture.
While messaging through social media is certainly a limited form of contact, in the very difficult situation of foster care, where many parents often lose contact with their children completely, this commitment to the Inuit mother is felt as being important for the service provider.
Rethinking the role of community Inuit workers who participated in the study spoke mostly of the role of community in supporting youth and families. They spoke of community members with life experience building trusting relationships with youth to teach them. They also spoke of the importance of spaces and activities in the community where youth and families can come together with workers to do cultural activities and spend quality time together. This is seen as the foundation for wellness and to create connections with people who can offer clinical help. An Inuk complaints commissioner gave the example of a community kitchen:
“There is a community kitchen that happens every Monday, Wednesday, Friday. Three times a week, going on here at school for the whole family. Sometimes I bring my children and then you can bring your children; they have animators for the children. I think little things like that can help relationships between parents and young people.”