Int J Ment Health Addiction (2010) 8:135–144 DOI 10.1007/s11469-010-9272-7
Commentary: Indigenous Health Special Issue Lil Tonmyr & Cindy Blackstock
Published online: 2 April 2010 # Canadian Government 2010
Abstract This commentary highlights indigenous public health research from a special issue of the International Journal of Mental Health and Addiction dealing with child maltreatment, mental health, substance abuse and gambling. We focus on the emerging and growing research movement in Indigenous research through three important themes: 1) worldview and ethics; 2) culturally based research methods; and 3) the need to research both the sources and symptoms of disadvantage. The articles in this issue are then framed within a public health approach (surveillance, identification of risk and protective factors, intervention–evaluation and implementation). Keywords Indigenous health . Child maltreatment . Mental health . Substance use . Gambling . Public health . Ethics This special issue highlights Indigenous public health research in the areas of child maltreatment, mental health, substance use, and gambling. The selected articles address public health concerns in Indigenous communities located in Canada, Aotearoa/New Zealand and the United States and are intended to contribute to an international discourse on Indigenous public health research and policy. The United Nations suggests that there are over 300 million Indigenous peoples living in 70 countries around the world (UNICEF 2003). The diversity of Indigenous peoples means that readers must be cautious about importing knowledge from these articles to other Indigenous communities without meaningful engagement. The best definitions of being Indigenous hinge on self-identification as an Indigenous person or as a group. Despite this
L. Tonmyr (*) Injury and Child Maltreatment Section, Health Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Canada e-mail:
[email protected] C. Blackstock First Nations Child & Family Caring Society of Canada, Ottawa, Canada e-mail:
[email protected]
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diversity, there are some shared elements among Indigenous peoples: 1) valuing communal rights and relationships; 2) viewing reality within expansive concepts of time; 3) believing in an interconnected reality; 4) appreciating spirituality and wonder; 5) situating the preservation of human and environmental life across generations as a personal and leading responsibility; and 6) connecting to the land (Blackstock 2007). The United Nations (2009) has noted that Indigenous peoples over the world are experiencing higher rates of health problems and lower quality of life regardless of the wealth of their country of origin. Historically, very little health research was conducted that was respectful and responsive to the concerns of Indigenous peoples (Royal Commission on Aboriginal Peoples 1996). This is changing as Indigenous peoples and scholars are asserting the need for health research to provide culturally based solutions. This issue provides a snapshot of this emerging, and growing, research movement. In this commentary we identify three important themes in Indigenous research: 1) worldview and ethics 2) culturally based research methods and 3) the need to research both the sources and symptoms of disadvantage. We then position the articles in this edition within a public health framework.
Worldview and Ethics There is a growing movement to legitimize Indigenous health knowledge within research circles that have long privileged western knowledge. There is a growing recognition that ontology in western research limits the questions it can effectively address. Thus there is an exploration how Indigenous ontology can augment research options (Blackstock 2009). In general, western and Indigenous ontology drive very different research approaches. For instance, western cultures, and research, significantly bracket concepts of time (a longitudinal study of over 20 years is rare) and prefer individual rights. Thus health research is often focused on this generation, rarely the next. Indigenous peoples believe that health must be informed by more expansive concepts of time. The seven generations concept, for example, suggests that health information must survey ancestral knowledge going back at least seven generations and consider the impacts on seven future generations. The preference for collective rights means that although individual health is important, the survival of the cultural group across generations is more important, driving health to be explored within collective terms (Blackstock 2009). There is a growing literature rooted in Indigenous ontology and Indigenous research institutes are increasing in number. For example, Smith (1999) documents a Maori perspective on de-colonizing research, Blackstock (2010) presents an Indigenous theory of social work to address structural risks, Kovach (2009) describes how Indigenous research methodologies can be applied, and as shown in Table 1 there are growing numbers of Indigenous research ethical guidelines and health research centres. Table 1 Examples of Ethical Guidelines for Indigenous Research 1 Touchstones of Hope principles developed by Aboriginal peoples in Canada and Native American and Alaskan Native peoples in the United States (Blackstock et al. 2006), 2 Ownership, control, access and possession principles [OCAP] (Schnarch 2004), the Canadian Institute for Health Research (2007) guidelines on research with Aboriginal peoples, 3 Maori ethical frameworks (Rangahau 2010) 4 Aboriginal and Torres Strait Islanders health information in Australia (Todd et al. 2000).
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In addition, increasing numbers of Indigenous communities are developing their own ethics review boards. Community based ethics reviews should be viewed as an essential pre-requisite to conducting research in communities where they exist. This may require researchers to participate in multiple ethics reviews which should increase quality and utility of the research. These research policies and review panels stress that Indigenous peoples should meaningfully participate in developing research questions, methods and dissemination strategies that are responsive to their needs, culture and contexts.
Research Methods Some authors in this edition suggest that the strength and shape of Indigenous selfidentification may vary with context, time (multi-generational impacts of colonization) (Ebbett and Clarke 2010) and Indigenous peoples’ worldview (e.g., Mushquash et al. 2010). Research may include qualitative or quantitative methods as long as they are enveloped in Indigenous worldviews and research requirements. Isaak and colleagues (2010) provide an illustration of the challenges of conducting research in culturally diverse First Nations on suicide, a sensitive issue. Their article describes the importance of situating research methods within the context of the community and of judging their cultural and contextual validity accordingly. They note that discussing suicide in collective settings during their research created unanticipated emotional impacts for group members and was discontinued as a research method. At first blush, a focus group may seem culturally appropriate given the value of groups, but this article demonstrates why it is important to interpret culture within particular research contexts. Thomas et al. (2010) describe the importance of research collaboration in achieving the most relevant outcomes for Indigenous communities.
Sources and Symptoms of Systemic Disadvantage Many of the poor health outcomes experienced by Indigenous peoples are driven by structural issues that are often outside the personal domain for change (Blackstock 2009; United Nations 2009). Indigenous health researchers often wrestle with the tension between individual needs versus structural risks driving the problems. It is critical to explore both but limited financial and human resources available fetter the ability of many. This tension is illustrated in several articles. Some explore the causes of disadvantage whilst others focus on the manifestation at the personal, family and community levels. Health disadvantage among Indigenous peoples worldwide (United Nations 2009) provides an opportunity to collaborate internationally to inform local solutions at the structural and individual levels (de Leeuw et al. 2010). The increasing development of international Indigenous health collectives and projects (e.g., the Permanent Forum on Indigenous Issues, the World Health Organization or the Pan American Health Organization) demonstrates this growing trend. In this next section we summarize the articles in this edition by nesting the themes of 1) worldview and ethics 2) culturally based research methods and 3) the need to research both the sources and symptoms of disadvantage within the public health approach.
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Public Health Approach (PHA) The PHA provides a useful tool to address various public health issues in four different steps: 1) surveillance (what are the trend, scope and pattern of the problems?) 2) identification of risk and protective factors (what influences the likelihood of occurrence of the problems?) 3) intervention-evaluation (what works?) and 4) implementation (how do you do it?) (Potter et al. 1998; MacMillan 2000). These categories are all important to PHA and the articles in this edition touch on aspects of the approach. Recently, Indigenous concepts of public health policy (Loppie-Reading and Wien 2009) and theoretical models that incorporate holistic concepts of public health and determinants of health have begun to emerge (Blackstock 2009). It is important to underscore that although a useful framework, PHA is imbued with western worldviews and thus should be critically analyzed before being applied wholesale to Indigenous peoples and knowledges. For example, a public health model does not fully appreciate the multi-generational concepts of time or holistic health such as spirituality as essential facets of personal and collective well-being. For detailed discussion see Blackstock (2009). However, given the broad recognition of PHA and its integration of the principles of an interconnected reality and holism that are so important to Indigenous worldviews it is used in this article as a useful, but not exclusive, way to draw connections between the articles in this edition.
Surveillance Epidemiologic surveillance is the ongoing systematic collection, analysis and interpretation of health data for the use in the planning, implementation and evaluation of public health practice (Thacker and Berkelman 1988). It is crucial to understand the magnitude of a problem over time. Surveillance data are useful for planning, implementation and evaluation of public health practice and advocacy work. Indigenous ethical surveillance/research guidelines stress that monitoring of health matters should reflect the communities’ priorities. There are many challenges in collecting surveillance data. One of the difficulties is explored by Noel et al. (2010) in a study from the Mi’kmaq in Nova Scotia, Canada. The authors used Rutgers Alcohol Problem Index, an instrument developed with non-Indigenous populations. They examined the cross-cultural validity of alcohol assessment and cut-off points among First Nations adolescents. They concluded that the tool was reliable and valid in identifying substance abuse problems for First Nations adolescents from the communities they studied. The authors point out how First Nations youth and adults differ, and how Indigenous and non Indigenous peoples differ. Non-Indigenous knowledge may be applicable to the Indigenous context; however, first of all research needs to be conducted to establish utility and direct refinement. Understanding these differences is important for contrasting Western science with Indigenous knowledge and approaches. Lavallée and Poole (2010) indicate that mental health has to be seen in the broader context of physical, spiritual and emotional health. Many of these negative circumstances may be part of an experience of colonization. For example, the removal of children from their families and placement in often distant schools or missions intended to assimilate Indigenous children operated in several countries. In Canada the program was called the residential schools and operated for well over 100 years, in the United States they were often called boarding schools and in Australia it is termed the Stolen Generation. The harm arising from the schools was so significant that the Prime Ministers of Australia and Canada apologized to Indigenous peoples (Harper 2008; United
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Nations 2009). Residential school programs and other oppressive aspects of colonization continue to impact on Indigenous peoples today. The negative consequences of the unnecessary removal of children has eroded Indigenous cultures and languages and set in play personal and communal inter-generational trauma. For example Indigenous children continue to be removed at disproportionate rates by child welfare and this has been linked to the historical experiences of colonization and residential schools (de Leeuw et al. 2010; Australian Institute of Health and Welfare 2008; SNAICC 2007; United States Department of Health and Human Services 2006; Trocmé et al. 2004). To be able to monitor these children’s experiences and other concerns, surveillance data are crucial in order to avoid making yesterday’s mistakes tomorrow’s destiny. One promising example of a surveillance activity that is generally well respected by Indigenous peoples is the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS). This effort is a collaborative initiative between First Nation communities, different orders of government, researchers, social service providers and advocacy groups. CIS is an ongoing surveillance system that tracks child maltreatment investigations from referral to case disposition (Trocmé et al. 2005). The Indigenous participation has increased with each cycle, from three to 22 self-governed child and family service agencies. First Nations representatives participate on a committee guiding the overall study and there is a parallel committee composed of First Nations that oversees the First Nations portion, ensuring adherence to Indigenous ethics protocols and augmenting relevance of variables (Tonmyr et al. 2009). Questions were added regarding child’s Indigenous status, caregiver or grandparent attended residential school, band housing, and referral to alternative dispute resolution program (e.g., Indigenous circle). Several First Nations relevant analyses have also been conducted to assist in policy development. For instance, CIS data have been the foundation on which to document and challenge discrepancies in funding between First Nations and non-Indigenous agencies (Auditor General of Canada 2008; Blackstock 2008). Evidence-based advocacy can use surveillance data to provide context for the promotion of policies based on human rights principles (Tonmyr and Jack 2010), such as Jordan’s Principle. This is a child first principle for resolving intergovernmental jurisdictional disputes that inhibit Indigenous children from accessing government services on the same terms as other children. In Australia there is the very important longitudinal study on Indigenous children known as Footprints in Time that provides important information on the cultural safety and wellbeing of Indigenous children and families (Australian Government, Department of Families, Communities and Indigenous Affairs 2010). This growing trend of working respectfully with Indigenous communities to collect meaningful and useful data should be promoted.
Identification of Risk and Protective Factors The determinants of a given health issue are multi-faceted. The importance of understanding the historical context and current environment in moving forward cannot be underestimated. There are encouraging patterns regarding some determinants of health. For instance, communities with a higher degree of self-determination, i.e. control of education, health, policing, have been found to be healthier than those with little or no control (Chandler and Lalonde 1998; Cornell and Kalt 1992). Identification of the factors resulting in health problems is often a challenging task, particularly if the factors are structural in nature and there is inadequate literature to draw
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upon. Another challenge is that health research often continues to be driven by nonIndigenous samples or small samples of Indigenous peoples, or generalized across Indigenous populations. Two articles in this edition provide an illustration of how researchers are surveying the limited literature on problem gambling in Indigenous communities to try to identify the factors that are particularly deserving of further research. Dion et al. (2010) provide an example of the difficulties of reviewing the literature linking childhood trauma and problem gambling, predominated by non-Indigenous studies, to explore possible links between sexual abuse and problem gambling amongst Aboriginal peoples in Canada. The second article compares gambling to smoking and alcohol, in terms of the negative consequences for the individual and for the environment (Dyall 2010). In the identification of determinants of health we need to focus on protective and risk factors that can assist in designing effective interventions. Traditionally, research focus has often been on deficits. But, Zahradnik et al. (2010) highlight how resiliency moderated the relationship between childhood maltreatment and later posttraumatic stress symptoms. Resiliency merits more research to help identify processes that can support better outcomes for Indigenous children, youth, and families.
Intervention-evaluation From the discipline of epidemiological we know the importance of randomised control trials to evaluate the efficacy of proposed interventions. Recently, Indigenous writers have begun to explore how Indigenous research models can address interrelated and multigenerational phenomena that may not be easily explored using gold standard western methods such as the randomised control trial (Kovach 2009; Blackstock 2009). For example, Mushquash and colleagues (2010) provide a methodology for developing early intervention for Indigenous at-risk youth while upholding traditional values and wisdom. The importance of developing culturally valid ways of testing the efficacy of interventions cannot be over-stated. Western research techniques should not be dismissed out of hand but rather should again be evaluated within the context of the Indigenous communities of interest and the research aim.
Implementation The last step of PHA is the implementation of policies that have strong research foundation and have been evaluated. Solutions to public health concerns are multi-faceted. To find Table 2 Interventions Depicted in this Issue 1 Crooks et al. (2010) describe a strength-based school program for First Nations youth that provides culturally appropriate possibilities to construct healthy relationships and leadership skills with the goal of increasing youth engagement. This is achieved through peer mentoring, a credit-based academic course and transition conferences for grade eight students. 2 Dyall and Marama (2010) address the importance of advocating for culturally appropriate health services for Maori in New Zealand. 3 Isaak and colleagues (2010) explore community based suicide prevention research in remote on reserve First Nations communities. 4 Niccols et al. (2010) account for the needs of mothers and children within their Indigenous context when they discuss a substance abuse program.
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these solutions we need to return to cultural roots and traditions. In this issue, several promising practices are depicted (see Table 2) although ongoing evaluation is still needed to determine their reliability and longitudinal effects. Surveillance data can assist in measuring changes at a global level. Other interventions have not been formally evaluated. The substance abuse interventions range from identification to treatment. To better target intervention, two articles addressed motivations for problematic alcohol consumption. Several of the articles remind us of the importance of understanding interventions today, though a cultural and historical lens as well as research evidence. Lavallée and Poole (2010) note the interdependence between mental health and the historical and contemporary experiences of Indigenous peoples. Similarly two authors try to understand drinking behaviour by appreciating different cultural concepts of health and by noting differences among Maori. For example, although more Maori binge drank than non-Maori, they were also more likely not to drink at all. Maori with strong traditional identification do not drink at all or drink to ease the pain of loss of identification (Ebbett and Clarke 2010; Clarke and Ebbett 2010). Research needs to examine sub-populations within Indigenous samples to help identify differential experience and factors contributing to differential experience within Indigenous communities or groups. This helps build the theoretical base for effective intervention development and evaluation.
Moving Forward Worldview and Ethics In depth exploration of ontological differences is essential in Indigenous health research in several ways. An understanding of ontology helps ensure proper methods are used and research impacts are maximized. This may include: 1) collaboration between university based ethics boards and Indigenous peoples in their region to develop ethics review standards that are consistent with the culture, context and needs of Indigenous peoples 2) integration of Indigenous research principles into the research process 3) participation of Indigenous experts participating on university ethics review panels 4) coordinating community and university ethics review processes 5) including Indigenous people in authorship as in this issue and 6) ensuring that reviewers, guest editors and the invited commentary includes Indigenous peoples as in this issue. Culturally Based Research Methods The poor health outcomes experienced by Indigenous peoples worldwide clearly demonstrate the need for sustainable and meaningful support for Indigenous health research. To that end, we applaud the International Journal of Mental Health and Addiction for hosting this special edition to profile Indigenous health and we encourage this journal and others to contribute to the sharing of Indigenous health knowledge as a matter of practice. Other issues could further share methodological innovation and learning across research projects using Indigenous research methods and western research methods enveloped within Indigenous worldviews and ethical standards. We also underscore the importance of policies and practices affecting Indigenous peoples being informed by excellent research that includes relevant study questions, methods (particularly samples) and dissemination techniques. In this light, it is important to understand that while there are similarities across Indigenous communities it is absolutely
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important to avoid pan-Indigenous research that fails to recognize differences within and between Indigenous peoples whenever possible. When pan-Indigenous research is conducted it is crucial to state reliability limitations. It is also essential that research institutions engage with the Indigenous community to rebuke the western centrism that can discourage Indigenous research knowledge sharing and building. This includes positioning Indigenous, other cultural and western knowledge on equal footing. This would mean threading Indigenous research throughout universities and research centers while respectfully exploring the utility of Indigenous knowledge and methods for the benefit of all peoples. We chose to position this commentary within PHA since it is directed to protection, prevention and improvement of health for all people through collective action (Last 2001). Indigenous research methods make an important contribution in expanding the western range of methodological options for studying health problems within a holistic and interconnected environment that as in PHA, includes structural risks. There is a critical need for research that links structural risks (i.e., poverty, discrimination, resource inequality) with the manifestation of health issues at individual and community levels.
Conclusion As the United Nations (2009) has noted, Indigenous peoples around the world experience disproportionately poor health outcomes. Although western knowledge in health has had some benefits, it has not been sufficient to redress the significant gaps in life chances. We applaud the increasing publication of Indigenous theory, knowledge and approaches to public health. The introduction of new ways of thinking about Indigenous peoples’ health holds real potential to inform new approaches that meaningfully improve the safety and well being of Indigenous peoples and can also inform public health more broadly. The methodological assumption in conducting work in Indigenous communities should be community partnerships both in terms of ontology, governance and participation. An Indigenous framework ensuring capacity building using inter- and trans-disciplinary methods need to be used. References Auditor General of Canada (2008). First Nations Child and Family Services Program—Indian and Northern Affairs Canada. 2008 May: Report of the Auditor General of Canada. Retrieved May 31, 2008 from http://www.oagbvg.gc.ca/internet/English/aud_ch_oag_200805_04_e_30700.html#hd3a. Australian Government, Department of Families, Communities and Indigenous Affairs (2010). Footprints in Time. Retrieved January 30, 2010 from http://www.fahcsia.gov.au/sa/indigenous/progserv/families/lsic/ Pages/default.aspx. Australian Institute of Health and Welfare. (2008). Child protection Australia 2006–07. Child welfare series no. 43. Cat. no. CWS 31. Canberra: AIHW. Blackstock, C. (2007). The breath of life versus the embodiment of life: Indigenous knowledge and western social work. World Indigenous Nation’s Higher Education Consortium Journal, 67–79. Blackstock, C. (2008). Reconciliation means not saying sorry twice: Lessons from child welfare in Canada. In M. B. Castellano, L. Archibald, & M. DeGagné (Eds.), The Aboriginal Healing Foundation. From truth to reconciliation, transforming the legacy of residential schools. Ottawa: Aboriginal Healing Foundation. Blackstock, C. (2009). Why addressing the over-representation of First Nations children in care requires new theoretical approaches based on First Nations ontology. Journal of Social Work Values and Ethics, 6(3). Retrieved February 01, 2010 from http://www.socialworker.com/jswve/content/blogcategory/22/69/.
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Blackstock, C. (2010). The emergence of the breath of life theory. Journal of Social Work Values and Ethics. Blackstock, C., Cross, T., Brown, I., George, J., & Formsma, J. (2006). Reconciliation in child welfare: Touchstones of hope for indigenous children, youth and families. Ottawa: First Nations Child and Family Caring Society of Canada. Canadian Institutes of Health Research. (2007). CIHR guidelines for health research involving Aboriginal Peoples. Ottawa: Canadian Institutes of Health Research. Chandler, M., & Lalonde, C. (1998). Cultural continuity as a hedge against suicide in Canada’s First Nations. Trans-cultural Psychiatry, 35(2), 191–219. Clarke, D., & Ebbett, E. (2010). Maori identification, drinking motivation and mental health. International Journal of Mental Health and Addiction. Cornell, S., & Kalt, J. (1992). Reloading the dice: Improving the chances for economic development on American Indian researvations. In S. Cornell & J. P. Kalt (Eds.), What can tribes do? Strategies and institution in American Indian economic development (pp. 1–59). Los Angeles: American Indian Studies Centre. Crooks, C. V., Chiodo, D., Thomas, D., & Hughes, R. (2010). Strengths-based programming for First Nations youth in Schools: Building engagement through healthy relationships & leadership skills. International Journal of Mental Health and Addiction. de Leeuw, S., Greenwood, M., & Cameron, E. (2010). Deviant constructions: How governments preserve colonial narratives of addictions & poor mental health to intervene into the lives of Indigenous children and families in Canada. International Journal of Mental Health and Addiction. Dion, J., Collin-Vézina, D., de la Sablonière, M., Philippe-Labbé, M.-P., & Giffard, T. (2010). An exploration of the connection between child sexual abuse & gambling in aboriginal communities. International Journal of Mental Health and Addiction. Dyall, L. (2010). Gambling: A poison chalice for Indigenous peoples’. International Journal of Mental Health and Addiction. Dyall, L., & Marama, M. (2010). Health advocacy—Counting the costs. International Journal of Mental Health and Addiction. Ebbett, E., & Clarke, D. (2010). Maori Identification, alcohol behaviour and mental health: a review. International Journal of Mental Health and Addiction. Harper, S. (2008). Statement of Apology on behalf of Canadians for the Indian residential school system. Retrieved September 28, 2009 from http://www.ainc-inac.gc.ca/ai/rqpi/apo/index-eng.asp. Isaak, C. A., Campeau, M., Katz, L. Y., Enns, M. W., Elias, B., Sareen, J., et al. (2010). Community-based suicide prevention research in remote on-reserve First Nations communities. International Journal of Mental Health and Addiction. Kovach, M. (2009). Indigenous methodologies, characteristics, conversations and contexts. Toronto: University of Toronto Press. Last, J. (2001). A dictionary of epidemiology (4th ed.). New York: Oxford University Press. Lavallée, L. F., & Poole, J. M. (2010). Beyond recovery: Colonization, health and healing for Indigenous people in Canada. International Journal of Mental Health and Addiction. Loppie-Reading, C., & Wien, F. (2009). Health inequalities and social determinants of Aboriginal Peoples’ health. Prince George: National Collaborating Centre for Aboriginal Health. MacMillan, H. L. (2000). Child maltreatment: what we know in the year 2000. Canadian Journal of Psychiatry, 45, 702–709. Mushquash, C. J., Comeau, M. N., McLeod, B. D., & Stewart, S. H. (2010). A four-stage method for developing early interventions for alcohol among aboriginal adolescents. International Journal of Mental Health and Addiction. Niccols, A., Dell, C. A., & Clarke, S. (2010). Treatment issues for aboriginal mothers with substance use problems and their children. International Journal of Mental Health and Addiction. Noel, M., O’Connor, R. M., Boudreau, B., Musquash, C. J., Comeau, M. N., Stevens, D., et al. (2010). The Rutgers Alcohol Problem Index (RAPI): A comparison of cut-points in First Nations Mi’kmaq and nonaboriginal adolescents in rural Nova Scotia. International Journal of Mental Health and Addiction. Potter, L. B., Rosenber, M. L., & Hammond, W. R. (1998). Suicide in youth: a public health framework. Journal of the American Academy of Child and Adolescent Psychiatry., 37(5), 484–487. Rangahau. Maori ethical frameworks. Retrieved February 01, 2010 from http://www.rangahau.co.nz/ethics/166/. Royal Commission on Aboriginal Peoples [RCAP]. (1996). Report of the Royal Commission on Aboriginal Peoples. Ottawa: Indian and Northern Affairs Canada. Schnarch, B. (2004). Ownership, control, access and possession or self determination applied to research. Ottawa: National Aboriginal Health Organization. Smith, L. (1999). Decolonizing methodologies; research and Indigenous peoples. London: Zed Books Limited.
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SNAICC. (2007). Through Black Eyes: a handbook to protect children from the impact of family violence and child abuse. North Fitzroy: SNAICC. Thacker, S. B., & Berkelman, R. L. (1988). Public health surveillance in the United Sates. Epidemiologic Reviews, 10, 164–190. Thomas, L. R., Donovan, D. M., & Sigo, R. L. W. (2010). Identifying community needs and resources in a native community; A research partnership in the Pacific Northwest. International Journal of Mental Health and Addiction. Todd, A. L., Frommer, M. S., Bailey, S., & Daniels, J. L. (2000). Collecting and using Aboriginal health information in New South Wales. Australian and New Zealand Journal of Public Health, 24(4), 378–381. Tonmyr, L., & Jack S. (2010). Media Analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect. Child Welfare, 89(1), 81–101. Tonmyr, L., Jack, S., Brooks, S., Kennedy, B., & Dudding, P. (2009). Utilization of the Canadian Incidence Study of Reported Child Abuse and Neglect in First Nations child welfare agencies in Ontario. First People Child and Family Review, 4(1), 38–46. Trocmé, N., Knoke, D., & Blackstock, C. (2004). Pathways to the overrepresentation of Aboriginal children in Canada’s Child Welfare System. Social Service Review, 78(4), 577–600. Trocmé, N., Fallon, B., MacLaurin, B., Daciuk, J., Felstiner, C., Black, T., et al. (2005). Canadian incidence study of reported child abuse and neglect-2003: Major findings. Ottawa: Minister of Public Works and Government Services Canada. United Nations. (2009). State of the world’s indigenous peoples. New York: United Nations. United Nations Children’s Fund [UNICEF] (2003). Innocenti Digest No.11: Ensuring the Rights of Indigenous Children. Florence: Innocenti Research Centre & UNICEF. United States Department of Health and Human Services. (2006). Child maltreatment 2004. Washington: United States Government Printing House. Zahradnik, M., Stewart, S. H., O’Connor, R. M., Stevens, D., Ungar, M., & Wekerle, C. (2010). Resilience moderates the relationship between exposure to violence and post-traumatic re-experiencing in Mi’kmaq youth. International Journal of Mental Health and Addiction.
