Development and evaluation of a culturally woven transdiagnostic group intervention for First Nation children

Abstract

The Truth and Reconciliation Commission of Canada has identified a need to address disproportionate levels of mental health needs among First Nation children while integrating Indigenous Knowledge. This research program worked with a community organization to develop and evaluate a mental health treatment that brought together cultural teachings and practices with clinical psychology strategies to address mental health needs of First Nation children. Study 1 assessed lived experiences and needs for future treatments using semi-structured interviews that brought together perspectives from children who previously received treatment (n = 7), caregivers (n = 7), and cultural and community workers (n = 12) including treatment providers, Elders, Cultural Knowledge Keepers, and organization managers. Theoretical thematic analysis was used to identify themes among transcripts. Informants endorsed primarily cognitive and behavioural strategies as being helpful, a need to take time in developing a meaningful relationship, individualization of treatment, and ensuring that treatments are engaging and hands-on. These findings were integrated with a systematic review of 24 studies (study 2) that identified psychoeducation, emotional awareness, cognitive strategies, opposite action, and problem solving as commonly embedded into successful transdiagnostic treatments for children. Results were synthesized into a draft treatment manual, and a team of cultural workers including an Elder and four Knowledge Keepers identified how to embed culture into the pilot treatment. Study 3 included a pilot treatment delivered to five children, aged 7- to 11-years, over five days as a summer-camp style intervention. Following the treatment a quantitative evaluation demonstrated relative stability in externalizing, internalizing, behavioural symptoms, and adaptive skills scores on the BASC-PRS, as well as relative stability on the BASC-SRP school problems, internalizing, inattention/hyperactivity, emotional symptoms index, and personal adjustment scores, with some changes in the expected directions. Reliable change indices were non-significant for pre- and post-treatment changes on the PRS and SRP. Interviews with the children post-pilot revealed high engagement, appreciation of cultural interventions, and improvements in emotional awareness and regulation strategies. This process of treatment development provides a detailed depiction of how Two-Eyed Seeing can be implementing in developing mental health services within community organizations for First Nation children. The evaluation provides guidance for the treatment to be further developed and refined to meet the needs of youth in the community.