5. Healing of the Canoe

Background: The Suquamish Tribe is a federally recognized tribe that resides on the Port Madison Indian Reservation in the rural Puget Sound area of Washington state. Of the tribe’s more than 800 members, approximately 350 live on the reservation. The University of Washington’s Alcohol and Drug Abuse Institute and the Suquamish Tribe have a partnership that began when the director of the tribe’s Wellness Program inquired about the possibility of collaborating on the development of culturally relevant interventions on substance abuse in the community. At the same time, NIH’s National Center on Minority Health and Health Disparities had called for three-year planning grants for CBPR with communities to address issues of health disparities. Following approval by the Tribal Council, an application was submitted and subsequently granted. The Healing of the Canoe (HOC) set out to reduce health disparities by (1) conducting assessments of community needs and resources; (2) identifying and prioritizing the health disparities of greatest concern to the community; (3) identifying strengths and resources already in the community that could be used to address concerns; (4) developing appropriate, community-based, and culturally relevant interventions; and (5) pilot testing the interventions.

Methods: The project used CBPR and tribal-based research approaches, the Community Readiness model (Pleasted et al., 2005), interviews with key stakeholders, and focus groups from four populations identified by the Suquamish Cultural Cooperative (SCC) and the researchers: Elders, youth, service providers, and other interested community members recruited through flyers, word of mouth, and personal recommendations.

Results: Key stakeholders and focus group participants identified several behavioral health issues of concern. Of particular concern were prevention of substance abuse among youth and the need for youth to have a sense of tribal identity and a sense of belonging to the community. Participants identified three strengths/resources in their community that they thought would be critical to addressing the areas of concern: the tribal Elders, tribal youth, and Suquamish culture and traditions.

Comments: The findings from this community assessment were used to develop a culturally grounded curriculum for Suquamish youth called “Holding Up Our Youth” that incorporated traditional values, practices, teachings, and stories to promote a sense of tribal identity and of belonging in the community. The result was an intervention that uses the canoe journey as a metaphor, providing youth with the skills needed to navigate through life without being pulled off course by alcohol or drugs, with culture and tradition serving as both anchor and compass (Pleasted et al., 2005; Thomas et al., 2010).

Applications of Principles of Community Engagement: The HOC project, by asking the community to identify its key health issues, demonstrates Principle 4, which states that communities need to “own” the issues, name the problems, identify action areas, plan and implement action strategies, and evaluate outcomes. Principle 7, which emphasizes the need to build on the capacity and assets of the community, is also evident in the project as it sought to identify the strengths and resources within the community. True partnership, as stressed in Principle 5, is evident at both the macro and micro levels in the HOC. A tribe member with a master’s degree in social work is part of the research team and a coinvestigator. Following the completion of stakeholder interviews and focus groups, the HOC submitted a report to the SCC for review, feedback, suggestions, and approval, all in accordance with Principle 8, which states that principal investigators must be prepared to release control to the community. Finally, the foundation that was set by including the Suquamish Tribe in all aspects of the HOC project allowed for continued collaboration over time, in synchrony with Principle 9, long-term commitment by the engaging organization.