Program Overview

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Program Introduction

Listening to One Another to Grow Strong (LTOA) is a community-driven and culturally-adapted program for Indigenous families. The program originates out of a collaboration between First Nations communities in British Columbia, Manitoba, Ontario and Quebec and research teams based out of McGill University, the University of Lincoln, Nebraska and the University of Manitoba. Our program takes root in the principle that family wellbeing is a cornerstone of individual and community wellness. For that reason, each session includes activities for the family as a whole—for instance, meals, discussions and games—as well as separate activities designed specifically for youth and adults. 

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Throughout these activities, families work their way through a range of themes, from community history and pride, to emotional regulation, bullying, problematic substance use, and more. Taken together, the sessions contribute to a comprehensive vision of positive mental health, meaning that wellbeing is maintained or achieved through a supportive, strength-based approach. LTOA empowers youth and adults to become more resilient and self-confident, take pride in their identities, and develop effective help-seeking behaviours. Beyond the specific skills promoted in the program, LTOA creates an environment where youth, caretakers and elders engage one another directly, stimulating good family communication skills and strengthening intergenerational bonds. LTOA is more than a band-aid program that reacts to crisis situations—it fosters wellbeing proactively to empower communities to become strong and healthy before mental health crises emerge.

Our Indigenous community partners are involved in every stage of this participatory action research project. These partners contribute to the cultural adaptation of program materials, the recruitment of participants, the training of facilitators, the delivery of the program, the evaluation of the program's effectiveness and the dissemination of knowledge. In the current phase of our project, Indigenous staff at regional health organizations coordinate the program in their respective First Nations, and Indigenous community members are employed as facilitators and co-facilitators in their home communities.

Program Objectives

Our research team's agenda extends beyond the development and implementation of an innovative culturally-based, family-centred mental health promotion program for Aboriginal youth living in rural and remote communities. Reflecting a broader vision of implementation research, our team strives to:

  • Develop and document the process of the intervention's cultural adaptation and local implementation;
  • Evaluate the impact of the intervention on indicators of mental health and well being among youth and their families;
  • Identify the enabling factors, active ingredients, and possible mechanisms underlying the effectiveness of the intervention program; and
  • Establish a knowledge exchange and support network that can sustain the intervention over the long term and allow its translation to other Aboriginal communities and settings.

​Cultural Adaptation

The process of cultural adaptation is a defining feature of our project. It allows the generic version of our intervention to transform into a program that reflects strengths and values of our Indigenous partners, and allows our content to address the specific needs identified by our participating communities. By placing a strong emphasis on cultural adaptation, we affirm culture as an important determinant of health and wellbeing. Program adaptations range from superficial modifications, like translations of the program name and session titles, to in-depth revisions that foreground the stories, values, symbols, traditions and practices of our collaborating communities.  We've designed our program to be highly flexible, therefore communities may integrate as much cultural material as they deem appropriate, as long as the program retains its fidelity to core objectives. 

The process of cultural adaptation unfolds as follows:

• A partnership is formed between our research team and an Indigenous health/social organization that services one or several Indigenous communities

• The Indigenous health/social organization assembles a steering committee—made up of community elders, leaders and knowledge holders—to guide the cultural adaptation process. The steering committee receives all the program materials and, over the course of several workshops, adapts the materials to their satisfaction.

• In collaboration with the research team, changes to the program material are verified through an iterative process, to ensure that the program retains core elements of the evidence-based curriculum.

• Our research team formats all changes to the program materials into relevant documents; the facilitator's manual, and youth and adult booklets.

• The steering committee reviews the formatted materials and approves them for use in their communities.

• Partnered First Nations deliver the culturally adapted materials and generate comments that feed back into revisions to the program curriculum.

• Throughout the entire adaptation process, we work with local agencies, social service providers, band government, and schools to identify community organizations who would be interested in sustaining the program.

For more information, please see our extended page on Cultural Adaptation.

Program Delivery

Before delivering the program in a community, local facilitators receive in-depth training on the program materials, as well as their roles and responsibilities as project collaborators. With the assistance of an Elder and—session depending, a guest speaker—facilitators take responsibility for the delivery of the 14-session program. Coordinators employed at a regional Indigenous health or social centre provide advice and support to facilitators throughout the program delivery. Since the sessions usually begin in the early evening, our program provides dinner when participants arrive. A communal meal helps create a welcoming environment that is conducive to communication. Sessions take place once or twice a week (occasionally on weekends, depending on local preference) between October and April.

For more information, please see our extended page on Delivery.

Research

Research is a fundamental component of the developmental process of LTOA. All communities that deliver our program are also research partners by virtue of their involvement with our project. Participation in our research process is straight-forward for youth and adults: before the first session and after the last session, all participants fill out an anonymous survey. We designed the survey to measure changes in different aspects of participants social, emotional and psychological wellbeing from the first to the last session, as well as to explore the quality of participants' experiences in the program. Research data is then aggregated and analyzed at our research unit at McGill University. We keep all of our data securely stored and uphold high standards of privacy. Before publishing our findings, we engage our collaborators in a consultation process to ensure that all parties feel accurately represented by our interpretations of the data. 

Our research team is at the service our partnered communities and offers data analysis services to any community that would like to explore specific hypotheses about their data.

Beyond the collection of survey data, we frequently invite program collaborators—facilitators, coordinators and elders—to regional or national meetings to collect qualitative information on their experiences as collaborators on the project. In conversation with our partners, our research team develops an understanding of the aspects the program that are particularly effective and enjoyable, and the components of the program that are in need of improvement.

For more information, please see our extended page on Evaluation.

Results

We are not yet in a position to share findings: our agreement to consult communities before disseminating results precludes our presenting detailed results to the public at this point in time. Thus, until a later stage of our research process, we are only able to present quantitative findings, as well as participant and collaborator testimonies. We regret not being able to share our quantitative findings, but we have a strong commitment to our agreement with our collaborating communities, and, as a research team, we are acutely aware of protocol transgressions carried out by other researchers working with Indigenous communities. Moreover, we believe that our data stands to be enriched by the interpretative perspectives that emerge out of the community consultation process.

In our final analysis, we intend to evaluate three broad categories of outcomes:

1.     The research process, including partnerships, cultural adaptations,  and program implementations

2.     The program, including goals, cultural materials, delivery timelines, program procedures, and community fit

3.     The outcomes of the program, including changes in wellbeing measured at the individual, family and community levels
 

More on the Project Overview

Follow the links below for full pages dedicated to different aspects of the project overview:

School Program

Session-by-session Breakdown

Program History

Current and Future Directions

Program Related Publications