Sociology Mind
2013. Vol.3, No.2, 123-130
Published Online April 2013 in SciRes (
Copyright © 2013 SciRes. 123
Adapting Communities That Care in Urban Aboriginal
Communities in British Columbia: An Interim Evaluation
Tammy Stubley, Indrani Margolin, Marcela Rojas
School of Social Work, University of Northern British Columbia, Prince George, Canada
Received January 11th, 2013; revised February 19th, 2013; accepted March 2nd, 2013
Copyright © 2013 Tammy Stubley et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
A considerable amount of research has been conducted on Aboriginal mental health and health promotion.
However, implementation and impacts of culturally relevant health promotion strategies have not been
equally addressed. This article provides an interim evaluation of Connecting the Dots, an innovative pro-
ject designed to support and promote the mental health of Aboriginal youth and families in urban areas in
British Columbia. Connecting the Dots adapted the Communities that Care (CTC) model, a prevention
planning program promoting positive youth development and reducing risk factors that predict youth’s
future involvement in problem behaviors. This article devotes specific attention to the necessitated adap-
tations of the CTC model to promote cultural relevancy in urban Aboriginal communities. Evaluation
findings suggest that Aboriginal communities can successfully adopt mainstream evidence-based pro-
gramming, provided that programs permit adaptations to meet the communities’ needs. For urban Abo-
riginal communities, programs must be re-conceptualized so that the linear, western delivery model is
transformed to a holistic and circular implementation approach congruent with Aboriginal worldviews. In
the Connecting the Dots project, inclusion of traditional Aboriginal practices and key Aboriginal repre-
sentatives were among the most well received model adaptations. Evaluation participants reported that the
adaptations made to the CTC framework have been critical to sustainability.
Keywords: Aboriginal; Community; Health Promotion; Mental Health; Prevention; Urban; Youth
Connecting the Dots (CTD) is an innovative project designed
to support and promote the mental health of Aboriginal youth
and families in urban areas through the mobilization of com-
munity resources and by tackling identified risk and protective
factors. The project is federally funded by the Public Health
Agency of Canada (PHAC) and is spearheaded at the provincial
level by the Canadian Mental Health Association BC Division
(CMHA BC) and the British Columbia Association of Abo-
riginal Friendship Centres (BCAAFC). It is locally imple-
mented through Friendship Centres and CMHA branches in
three British Columbia urban Aboriginal communities: Kelowna,
Port Alberni, and Quesnel.
The foundational purpose of the CTD project is to adapt the
Communities that Care model to an urban Aboriginal Canadian
context, ultimately addressing the mental health of young urban
Aboriginal families. Communities that Care (CTC) is a preven-
tion planning program based on two approaches to prevention
science: promoting positive youth development and reducing
risk factors that predict youth’s future involvement in problem
behaviors (Flynn, 2008).
In 2010, the first phase of funding for the CTD project com-
menced in Kelowna, the first of three urban Aboriginal com-
munities in British Columbia (BC) to pilot CTD. The second
phase of CTD commenced following the approval of funding
for an additional four years. Subsequently, in 2011, two addi-
tional urban Aboriginal communities embraced CTD, imple-
menting the project in Port Alberni and Quesnel.
This article devotes specific attention to the necessitated ad-
aptations of the CTC model to promote relevancy in urban
Aboriginal communities. The implementation of cultural prac-
tices is one of the driving forces of the CTC model. It engages
community partners in a comprehensive manner to combat the
societal concerns that are faced by several Aboriginal commu-
nities. The challenges and successes of the CTD adaptation of
the CTC model will be explored. The CTD program holds great
potential to impact societal concerns such as dysfunctional
behaviors among children and youth. Ultimately, the adapta-
tions of the CTC model encourage collaborative relations with
the urban Aboriginal communities, which in turn will assist
with unraveling the societal problems they face.
One of the remarkable features of the CTD project is the in-
novative nature of the partnership between CMHA BC and
BCAAFC. Linking Aboriginal service providers with the men-
tal health sector dismantles silos. Subscribing to a cooperative
and collective professional practice that conceives new ways of
knowing and has the benefit of value exchange is a founda-
tional change. In other words, this partnership creates pathways
across various sectors and among these organizations, including
the affiliated Friendship Centres and CMHA BC branches.
At the provincial level the CMHA BC Division is the spon-
soring association of the joint venture, but decision-making
occurs in collaboration between the organization s. The BCAAFC,
an Aboriginal umbrella organization, serves 25 Friendship
Centres throughout the province of British Columbia (British
Columbia Association of Aboriginal Friendship Centres, 2012).
The BCAAFC possesses a wealth of knowledge and expertise
working with urban Aboriginal people. The Friendship Centres
provide a number of quality services to Aboriginal communities
including services related to employment, substance use, family
support, legal services, and cultural retention. Although each
center is as unique as the community it serves, the communities
are united by a common bond: to improve the quality of life for
Canadian Aboriginal people and, most importantly, to protect
and preserve Aboriginal culture for the benefit of all Canadians.
Similarly, the CMHA BC Division and member branches
have extensive knowledge in promoting mental health. CMHA
is a charitable association that promotes the mental health of all
and supports the resiliency and recovery of people experiencing
mental illness through public education, community-based re-
search, and influence on public policy, and in addition provides
direct services and support. CMHA BC Division has provided
more than 55 years of service to British Columbians and is the
umbrella organization for a network of 19 CMHA branches
across British Columbia (Canadian Mental Health Association,
In sum, the CTD project offers an urban Aboriginal Canadian
context adaptation of the prevention program planning model
known as Communities that Care (CTC). The project reaps the
expertise of two reputable organizations in developing visions,
strategies, and concrete tools to improve the mental health of
urban Aboriginal people—and BC is home to the second-
largest Aboriginal population in the country (BC Stats, 2006).
The project builds on the mandates, core competencies and
values of the two main partners, the Canadian Mental Health
Association BC Division (CMHA BC) and the BC Association
of Aboriginal Friendship Centres (BCAAFC).
Communities That Care
CTD is a multi-year, multi-site research and community de-
velopment project utilizing the Communities that Care (CTC)
model, which was developed by Drs. J. David Hawkins and
Richard Catalano at the University of Washington in Seattle.
CTC is a prevention planning program grounded in research
from a variety of fields, including public health, psychology,
education, sociology, social work, criminology, medicine, and
organizational development. By extension, this model serves as
a medium for improved interdisciplinary discourse. In other
words, it is clear that the CTC model crosses several disciplines,
which inevitably can foster communication for improved out-
comes. CTC’s trademark is the reinforcement of positive pre-
dictors of health that shield and prevent youth from misconduct,
leading to the absence of negative outcomes such as violence,
substance use, delinquency, teen pregnancy, high school drop-
out, and mental health issues (Flynn, 2008).
CTC is a linear process designed to assess risk and protective
factors of mental health. Based on three decades of scientific
research including longitudinal studies carried out in North
America, Europe and New Zealand, CTC founders identified
themes in the data collected that revealed risk and protective
factors that reliably forecast youth’s future involvement in
problem behaviors (Flynn, 2008). The CTC model is a collabo-
rative, community-driven process that consists of five phases:
getting started; organizing, introducing, involving; developing a
community profile; creating a community action plan; and im-
plementing and evaluating the community action plan (Flynn,
2008). A number of methods are used to recruit community
members, including information meetings, email, community
forums, word of mouth, and snowball technique. Through a
collaborative approach, CTC engages all areas of the commu-
nity, extending from school representatives to law enforcement,
to city and business leaders, to faith community members, to
youth and health professionals, all of whom share a unity of
purpose: promoting healthy outcomes for youth. The core value
of CTC is that behaviors can be influenced by addressing cer-
tain factors which either increase the risk of youth becoming
engaged in delinquency or guard against involvement (Hawkins,
Catalano Jr., & Miller, 1992).
Before turning to the CTD project let’s first review the lit-
erature on integrated approaches to service delivery in mental
health for Canadian Aboriginal populations to learn whether
any common themes exist in the approaches and results of pre-
vious projects with Aboriginal communities.
Literature Review
A great deal of research is available on the topics of Abo-
riginal mental health and health promotion. However, the im-
plementation and impact of culturally relevant health promotion
strategies is not equally addressed. Studies of health promotion
strategies such as the Communities that Care (CTC) model fail
to provide tangible examples of culturally relevant adaptations.
This paper seeks to explore these topics by examining available
literature on Aboriginal mental health, health promotion, and
CTC, while considering how these areas of interest have served
to inform the CTC cultural adaptation model known as Con-
necting the Dots (CTD).
Aboriginal Mental Health
The concept of Aboriginal mental health has been discussed
in scholarship on such topics as the basis for knowledge con-
cerning Aboriginal mental health and multidisciplinary per-
spectives on Aboriginal mental health (Kirmayer & Valaskakis,
2009). Kirmayer and Valaskakis (2009) compilation of multi-
disciplinary perspectives on Aboriginal mental health provides
the reader with an opportunity to explore the various social,
economic, and political issues affecting the health and well-
being of Aboriginal people in Canada. McCormick’s chapter,
“Aboriginal Approaches to Counselling” (Kirmayer & Valaskakis,
2009: pp. 337-354), depicts innovations in counseling ap-
proaches to working with Aboriginal populations. McCormick
succinctly captures the essence of a well-informed and consci-
entious journey towards culturally competent practice. The chap-
ter’s content also serves to validate integrated approaches to
promoting the health and well-being of Aboriginal clients. The
author’s assertion that additional research is needed to further
establish the value and impact of both traditional and main-
stream approaches serves as a challenge to the professional
community to extend the body of knowledge in this area.
Other chapters explore factors influencing Aboriginal health
and well-being, including Aboriginal worldviews, spirituality,
tradition, and culture. The role of mainstream mental health
methodologies and traditional healing practices in supporting
the mental health of Aboriginal clients is also considered. The
efficacy of amalgamating mainstream and traditional appro ach es
Copyright © 2013 SciRes.
is discussed, giving consideration to their applications within
the context of multiple counseling scenarios, including sex
abuse, career/vocational, suicide, and substance abuse (Kir-
mayer & Valaskakis, 2009).
The histories, worldviews, and needs of Aboriginal popula-
tions have prompted acknowledgment in multiple fields of re-
search and practice of the importance of developing and im-
plementing services that reflect the uniqueness of Aboriginal
culture. The development of Aboriginally relevant counseling
methods is reflected in recent research efforts, such as Limb
and Hodge’s (2011) contemplation of the therapeutic imple-
mentation of spiritual ecograms, a unique assessment tool that
incorporates the fundamental aspects of a genogram, with addi-
tional consideration given to past and present functioning,
while considering the physical and spiritual aspects of the self.
Walker, Cromarty, Kelly, and St Pierre-Hansen (2009) offer
a recent Canadian example of culturally competent service
delivery in addressing the health needs of Aboriginal popula-
tions. Their introduction provides a helpful review of Aborigi-
nal perspectives on well-being and healing, allowing the reader
to better understand the difference between Aboriginal and
mainstream perspectives. The comparative review provides
particular insight into how integrated methods complement and
strengthen the individual components while promoting im-
proved client outcomes. The authors’ discussion of existential-
ism and its homogenous roots in both mainstream and tradi-
tional ideologies concerning the search for meaning facilitates
the consideration of not just the differences, but also the impor-
tant similarities between the two belief systems.
Health Promotion
Various scholarly inquiries have been undertaken into the
conceptualization and applicability of health promotion. These
efforts have sought to discern the epistemological origins of
health promotion strategies and their impact on communities
and individuals. Several scholarly efforts have contributed to
this body of knowledge (O’Neil, Pederson, Dupéré, & Rootman,
2007; Rice, 2011).
The concept of health promotion is explored in Wendy
Rice’s Health promotion through an equity lens: Approaches,
problems and solutions (2011). The author contends that global
disparities in health equities have prompted a shift towards a
more holistic, preventative approach to the delivery of health
services. Additional assertions are made concerning traditional
methods for addressing health-related concerns, which have
been limited in their efficacy because of approaches that as-
sume a disease management, reactive stance that fails to con-
sider preventative measures for promoting health.
Yet another significant limitation in traditional methods is
inequality in the delivery of health services, including in acces-
sibility and quality of care for marginalized populations. Rice
(2011) further asserts that traditional approaches are limited by
their failure to adopt ecological methodologies. Ecological
methods are described as processes that foster inclusive and
holistic supports and interventions that consider the individual
within the context of his or her local and global environments.
Health promotion strategies are believed to support this eco-
logical approach while seeking to effect change at various lev-
els, including research, policy, and service delivery (Rice,
Rice reinforces the assertion that health promotion efforts
support means of action that acknowledge the individual as a
complex being who is not isolated from his or her environment.
Further credence is given to a conceptualization of health pro-
motion as a process empowering individuals to gain a better
understanding of the factors that have a direct impact on their
health and to better equip them to improve their state of
well-being. Rice’s analysis effectively conveys the value of
health promotion strategies in supporting communities to take a
localized stake in the improvement of structural supports and
resources while promoting individual buy-in and accountabil-
Health promotion’s ecological approach was the focus of
O’Neil et al., Health promotion in Canada: Critical perspec-
tives (2007). The authors describe the ecological approach to
health as a framework of action that considers the complexities
of the systems that influence the overall health and well-being
of individuals. These systems encompass micro, mezzo, and
macro level transactions. Transactions may include environ-
mental, community, and global factors. Furthermore, the eco-
logical approach to health promotion is said to foster a social
ecological stance on “the social, organizational, and cultural
components of the environment” (O’Neil et al., 2007: p. 49).
The O’Neil et al. (2007) examination of the ecological ap-
proach to health promotion complements the existing body of
knowledge on this topic and enhances understanding of health
promotion’s epistemological foundation. It is this foundation
that gives further credibility to health promotion as a holistic
approach to improving health and well-being. The inclusion of
specific examples of the application of this approach would
have served to strengthen the authors’ stance. Furthermore, a
comparative analysis of health promotion approaches and tradi-
tional methods would have supported understanding and appre-
ciation of the merits of the model of choice.
The Communities That Care Approach
In his 2008 publication “Communities that Care: A compre-
hensive system for youth prevention and promotion, and Cana-
dian applications to date,” Robert J. Flynn explores the theo-
retical basis of Communities that Care (CTC) and its applica-
tions within the Canadian context. Flynn references the sys-
tem’s creators, Hawkins and Catalano Jr. (2002), and outlines
their description of CTC as a functional approach that supports
communities in strategizing the prevention of widespread acute
behavioral trends among children and adolescents. The Social
Development Model is identified as the theoretical foundation
for CTC. Key health prevention principles, such as guided mo-
bilization, multiple levels of intervention, and high fidelity, are
a foundation for the CTC approach. Community readiness,
training, and technical supports are described as key factors in
determining the successful implementation of CTC.
Data are collected via a survey tool, designed especially for
CTC to assist in gathering pertinent information from the se-
lected population, typically comprised of children and youth
actively enrolled in the public school system, and with a focus
on risk and protective factors as determinants of acute behav-
ioral trends among children and adolescents. The information
collected is intended to inform and guide the community in
selecting the most suitable evidence-based policies and pro-
gramming. In addition, the CTC approach relies on a multiple-
phase strategy of five distinct stages: community readiness,
community mobilization, data collection, findings review, and
Copyright © 2013 SciRes. 125
action plan implementation. Flynn (2008) further explains that
a milestones and benchmark tool is utilized to determine the
fidelity with which the CTC phases are implemented. Mile-
stones are the community goals, while benchmarks are de-
scribed as the actions the community assumes to meet these
Flynn (2008) then describes the results of the CTC evalua-
tion process. The reliability and validity of the youth survey
tool are considered. The implementation of CTC in the State of
Washington is reviewed, with emphasis given to the long-term
impact on target communities. The data revealed improved
inter-agency collaboration and coordination of services, en-
hanced community stakeholder involvement, improved access
to educational opportunities, better adapted prevention strate-
gies, and reduction in service duplication. The author gives
additional consideration to CTC implementation outcomes in
Pennsylvania, with stakeholder involvement, prevention know-
ledge, coalition function, community readiness, and barriers
identified as key domains of measurability. Overall, the project
has been effective throughout its target communities in reduc-
ing risk factors and acute behavioral trends among juvenile
populations (Flynn, 2008).
Flynn’s (2008) examination of CTC concludes with a review
of approach implementations in Canada to date. Squamish,
British Columbia, is identified as the first Canadian community
to implement CTC. Described as a successful example of CTC
implementation and sustainability, Squamish is regarded as a
valuable source of information and support for other CTC tar-
get communities. Flynn goes on to describe his personal in-
volvement in the implementation of CTC in three Ontario com-
munities, including adapted variations of the approach. He con-
cludes by giving consideration to the successes and shortcom-
ings of CTC in the Canadian context.
The article provides a detailed review of the origins, the
theoretical foundation, and impact of the CTC approach in the
United States and Canada. Flynn (2008) provides the reader
with the opportunity to learn about CTC and to consider the
implications of implementing this approach at both the local
and national levels. While the author’s scope provides a com-
prehensive overview of CTC, little information is provided on
the types of and reasoning behind the adaptations to the CTC
approach in Canada. Flynn’s title implies that CTC implemen-
tation within the Canadian context will be the focus of the re-
view, but he provides little more than a quick overview of
Canada’s experience with the program. The intent of the pre-
sent article is to contribute to the body of knowledge available
on Canada’s experience with the CTC model and to address the
neglected issue of culturally relevant adaptation of CTC. In
providing a more detailed analysis of a specific impleme ntation
of CTC in the Canadian context and in assessing the challenges
and benefits of adapting CTC to Aboriginal approaches, this
article furthers the development of models for health promotion
in Aboriginal communities.
Connecting the Dots: A CTC Adaptation for
Urban Aboriginal Communities
Health promotion initiatives support holistic and prevention-
focused approaches to the delivery of health care. These holistic
processes coincide with traditional Aboriginal approaches to
health and healing. CTC is a public health strategy that embod-
ies health promotion priorities such as community engagement
and development. CTD is a recent CTC adaptation supporting a
community development approach that promotes culturally
relevant ways to engage the Aboriginal community in promot-
ing the health and well-being of its members, while being cog-
nizant of Aboriginal worldviews and priorities. In its integra-
tion of the holistic tenets of health promotion and traditional
Aboriginal approaches to healing, CTD offers an exciting op-
portunity to develop culturally relevant health promotion
strategies in Canada.
The CTD Methodology
CTC seeks to mobilize multiple social supports within the
community to promote surroundings that foster positive mental
health. The CTD project recruits and retains leadership by and
for Aboriginal people. Aboriginal people are among the most
studied populations in the world, and research with these
groups has rarely been to their benefit (Smith, 1999). Moreover,
historical research conducted on Indigenous peoples was based
on factors that were not ethically sound, further perpetuating
colonial power (Cochran et al., 2008). Therefore, it is crucial to
adapt the CTC model, where necessitated, to cultivate cultural
relevancy, practical success and, most importantly, Aboriginal
community investment. In the absence of Aboriginal support
and participation the program will not be effective, deflating its
The teams endorsing the CTD project are cognizant of the
impact of past research and they are hyper-vigilant to this sen-
sitivity, ensuring a balance of culture, purpose, and ethics. CTD
members recognize the value and importance of the project’s
aim, which drives the team to produce a promising foundation
rooted in cultural awareness and safety—embracing the voice
and expertise of the urban Aboriginal communities.
The CTD project applies a promising methodology informed
by qualitative inquiry and guided by a Participatory Action
Research (PAR) framework to mental health promotion focused
on young Aboriginal families. CTD was designed to be highly
collaborative, relevant, and empowering for all members in-
volved. Involvement beyond a single community organization
has the potential to impact those at greatest risk (Johnson,
1986). CTD clearly connects several organizations, which is
extremely useful as it sheds insight on the problem of youth
CTD is based on collaborative practice, relationship building,
and information exchange achieved via community engagement,
which led to community meetings to discuss barriers and part-
nerships, and to gain a better understanding of the community.
The local project coordinators invested an enormous amount of
energy in order to cultivate the relationships. Information ex-
change occurred with other CTC projects in British Columbia
in order to facilitate best practice sharing and dialogue about
how to overcome challenges. Because of bridging of well-
known community access points with key informants, services
that were well known to others in the community have now
become common knowledge to the key informants.
In the initial phases of CTC, one of the CTD teams advo-
cated for an adaptation in the intervention training. Initially, an
external, non-Aboriginal CTC trainer provided the training for
the local community members. On closer inspection, it was
agreed that it was essential for the training to be delivered from
an Aboriginal perspective, by individuals with a lived experi-
ence and passion for Aboriginal ways of knowing. Subse-
Copyright © 2013 SciRes.
quently, the team contracted with Aboriginal CTC trainers from
In addition to the hiring of Aboriginal trainers, one of the
communities created an Elders’ Guiding Circle to assist with
the sharing of knowledge, traditions, and teachings. Prayer time
at all project-related functions is another example of honoring
Aboriginal traditions. Furthermore, the CTC survey questions
were revised to make them more culturally applicable and rele-
vant to the community. Conformity was reached in regards to
developing cultural competency through formalized training
and adopting project structural standards that reflect Aboriginal
The CTD team developed “storytelling templates” to facili-
tate communication among key personnel and local partners
while utilizing Indigenous methodologies. The written stories
captured monthly through a storytelling template highlighted
the project activities and tasks completed by the target commu-
nity, and were reported on a quarterly basis. Some of the pro-
ject activities were key leader training, recruitment of board
members, workshops, building relationships with diverse com-
munity partners and, in addition, the building of relationships
between mainstream mental health services and the urban Abo-
riginal community. The storytelling format was meant to reflect
the integration of traditional Aboriginal perspectives and values
with mainstream evaluation methodologies. The documents
were reviewed and served to substantiate the adaptations of the
model and triangulated information from interviews.
Evaluation of CTD
Evaluation Process
This paper explores the adaptations of a mainstream evi-
dence-based model (CTC) implemented in three Aboriginal
communities in British Columbia, focusing specifically on the
findings from Phases I and II during the period 2009-2012. The
evaluation process was guided by the project’s research ques-
tions and objectives. The overall research question for this
evaluation is:
How effective is Communities that Care as a model to im-
prove the mental health of urban Aboriginal youth in Can-
The following has been identified as the secondary research
What adaptations to the CTC model are required to improve
its efficacy with urban Aboriginal communities in Canada?
Data Collection Methods
Evaluation focused on the analysis of information gathered
through semi-structured interviews and storytelling templates.
The process of arranging the CTD evaluation interviews and
obtaining interviews with key participants relied on the efforts
and expertise of local project coordinators. A purposeful sam-
ple was applied for the evaluation of the pilot studies. Participa-
tion in the interview evaluation of the CTC process was com-
pletely voluntary. Individual and dyadic interviews were con-
ducted utilizing a semi-structured format. The semi-structured
interview approach was adopted to allow for a rich dialogue,
granting the interviewee the flexibility to explore their thoughts
and feelings concerning the project. This technique allows for
greater flexibility to make adjustments in order to accommodate
the participant’s needs and to support the disclosure of difficult
and at times emotional information (Selltiz, Jahoda, Deutsch, &
Stuart, 1967). A semi-structured interview allows the inter-
viewer and respondents to engage in a formal process that is
guided by a set of questions to be addressed yet permits the
inclusion of free-flow dialogue, allowing for a more thorough
understanding of the subject matter (Cohen & Crabtree, 2008).
Interviews were guided by open-ended interview questions,
which allowed the interviewers to maintain a balance between
flexibility and cont rol.
The provincial Project Liaisons, local Project Managers,
Project Coordinators and Administrators, and Key Leader/
Community Board members were interviewed. All interviews
were recorded and later transcribed. Face-to-face interviews
were the preferred approach, although geographic and schedul-
ing limitations required additional flexibility resulting in some
of the interviews being conducted via teleconference. Interview
participants were provided with an Information Letter and
Consent Form. Twenty-five interviews were completed among
all three pi lot sites.
Evaluation Meth o dology
A Participatory Action Research (PAR) framework was em-
ployed to assess the work of the CTD project. PAR is a means
of bridging the gap between researchers and stakeholders
through collaborative endeavors that inform all aspects of the
research process. PAR promotes a greater level of participation
and influence by stakeholders, as compared to more traditional
research processes (Turnbull, Friesen, & Ramirez, 1998). This
attractive feature resonated with the CTD team, as it is congru-
ent with Aboriginal approaches. The CTD team collaborated
closely with all participants involved during all phases of the
evaluation process.
The evaluation process was also guided by exploratory and
descriptive research approaches. The exploratory research ap-
proach is concerned with increasing knowledge about a rela-
tively unknown topic (Singleton & Straits, 2005). The descrip-
tive research approach seeks to describe a phenomenon through
a systemic and precise approach to data gathering (Singleton &
Straits, 2005). One of these tactics is the interview approach
discussed earlier, which provided a better opportunity to con-
sider the soundness of the information being gathered, by al-
lowing the observer the opportunity to study the circumstances
in which responses are provided. These qualities supported the
decision to adopt semi-structured process interviews as the
primary data-gathering tool.
A Thematic Content Analysis (TCA) approach will be
adopted and applied in the examination of research findings.
TCA is described as a “descriptive presentation of qualitative
data” (Anderson, 2007: p. 1). TCA supports the depiction of
themes, as identified within the research data. TCA is believed
to provide an objective approach to data analysis (Anderson,
2007). Furthermore, thematic analysis offers an adaptable me-
thod for recognizing, studying, and exposing patterns contained
in the data (Braun & Clarke, 2006: p. 79).
Thematic analysis of the data collected from the semi-struc-
tured interviews and the storytelling templates yielded a wealth
of insight concerning the project’s efforts, successes, challenges,
and overall progress. Interviews were conducted with the fol-
Copyright © 2013 SciRes. 127
lowing members: the Provincial Project Liaisons, Local Man-
agers, Local Coordinators, administrative staff, and Community
Board members. In addition, a document review of the quar-
terly storytelling templates was conducted. The themes will be
structured in accordance with the overarching goals of the pro-
To initiate and sustain a long-term partnership between
CMHA and Friendship Centres.
To improve urban Aboriginal mental health.
To adapt the Communities that Care model in an urban
Aboriginal context.
After the data were analyzed, several themes emerged. The
following section provides a summary of the following themes:
Collaboration, Partnership, and Relationships; Cultural Aware-
ness and Adaptations; Personal and Professional Lessons
Learned; and Challenges, Barriers, and Time.
Collaboration, Partnership, and Relationships
The provincial partnership is described as progressing in
mutually identified areas of interest, including collaborative
practice, relationship building, and information exchange. In
regards to successes, organizational information exchange has
fostered improved common understanding, establishing the
successful integration of traditional Aboriginal approaches and
mainstream mental health principles. The CTD project has
paved the way for CMHA BC and BCAAFC, as they were not
formally affiliated in a working relationship of this nature. This
type of success and growth creates a ripple effect, uniting many
service providers and community members in an effort to sup-
port Aboriginal youth. As one Local Manager stated, “Con-
necting the Dots is exceptional in that it links the non-Abo-
riginal community and the urban Aboriginal population”. In
describing the evolution of the partnership between the two
provincial organizations, there was consensus among all of the
participants that a key aspect of the process is that of “building
relationships” and “building trust”. The Local Managers for the
project had an abundance of information to share on trust and
partnership building. A Local Manager artic u la ted:
I think what’s unique is that it’s forced two agencies that
definitely had a relationship, but now it’s forced us to
work together. Each partnership like this helps strengthen
the position of trust in terms of the people working at our
agency. This project has expande d our organizatio nal view-
point, and you’re right, it’s the community viewpoint.
All of the respondents expressed satisfaction that the project
is starting from a place where there are very limited services
available for urban Aboriginal youth in terms of mental health.
Acknowledging that this is a deficit within the communities
promotes great discussion and the generation of ideas. A Pro-
vincial Project Liaison commented: “I really want this to be
something tha t the community has ownership over. I want eve-
ryone to honor and respect everything that they come to the
table with, and I feel like that’s been very successful.”
Jamieson et al. (2012) describe ten essential principles when
conducting research with Indigenous communities, including
creating an “open and transparent relationship with key com-
munity groups” (Jamieson et al., 2012: p. 16). This type of
communication is the spirit of the Connecting the Dots project.
Relationship building is an effective method for improving the
community’s capacity to understand Aboriginal mental health
(Jamieson et al., 2012).
One of the most meaningful contributions of this partnership
is the bridging of well-known community access points with
key informants. The CTD’s partnership framework has “raised
awareness” and has facilitated a rich discussion regarding men-
tal health in the Aboriginal context. A Community Board
Member reports that the partnership established has generated
the conception of a “collective group energy,” which fuels ideas
and moves action forward. Bringing “people together with a
clear purpose” was described as yet another example of suc-
cessful collaboration. The project has successfully facilitated
the process of people working and consulting together to sup-
port the youth in their community. Not surprisingly, the data
reflect the project’s focus, driven by such ingredients as col-
laboration, partnership, and relationship building in all three
sites in British Columbia.
Cultural and Awarenes s Adaptation s
The project adaptation successes were described by program
participants as localized efforts to adapt the CTC model to the
unique needs of each of the target communities, while adhering
to the principal objectives of the project. Comments from the
participants revealed that cultural awareness is fundamental in
terms of the project’s sustainability. This discovery has signifi-
cant implications for the CTC model, ultimately making adap-
tations crucial to meet Aboriginal communities’ needs.
Jamieson et al. (2012) attest that “flexibility in study imple-
mentation while maintaining scientific rigour” (p. 17) may be
necessary based on the needs of the community. Participants
identified the adaptation of the model’s training component
from a “linear” form of delivery to a more “circular” approach
as an example of a provincial level success. This distinction is
important for several reasons: the inclusion of Aboriginal train-
ers strengthened the connection to the community, and the
trainers highlighted the efficacy of the model as they shared
personal successes a bout societal problems that were addressed
in their own communities with the application of this model. As
well, the curriculum was taught in a fashion that was comple-
mentary and congruent with the learning needs of the commu-
nities. One Local Coordinator reported:
Taking this model and applying it with a very distinct
population and also what hasn’t been done a whole lot
particularly in Canada is looking at the mental health as-
pect of what can communities do in terms of promoting
mental health… It is innovative. I definitely can see the
connection with innovation strategy... It’s a golden op-
portunity right now... CMHA [can] really deepen our un-
derstanding, our breadth of knowledge about this popula-
tion of urban Aboriginal people who in many ways seem
to be invisible…there’s a lot of assumptions about Abo-
riginal people...
Project participants also celebrate the fact that all three sites
hold a contract with two Aboriginal women from Oregon, one
of them one of the original certified CTC trainers involved with
the University of Washington in the first CTC research trials in
the United States.
The process of promoting cultural competency has reportedly
been enhanced through online access to educational opportuni-
ties. One of the Community Board members articulated:
Copyright © 2013 SciRes.
The project is described as “culturally driven”. The pro-
ject’s approach to promoting cultural knowledge and skill
is described as “very respectful to Aboriginal people”.
The development of cultural knowledge is reportedly sup-
ported by the project’s networking opportunities. The
project’s positive, welcoming, and organized approach
reportedly fosters a safe environment in which to explore
In summary, the inclusion of traditional Aboriginal practices,
such as the Elders’ Guiding Circle and talking circles, and the
revisions of the survey are described as some of the ways in
which the project has been adapted in order to meet the needs
of the Aboriginal communities. As the project progresses
through the various phases of the CTC model it provides an
opportunity to make additional adaptations that embrace the
needs of the community while maintaining fidelity.
Challenges, Barriers, and Time
Evidence-based programming is a key aspect of the CTD
model and one that is limited in capturing cultural relevancy.
Ensuring “fidelity while implementing adaptations” is a pri-
mary challenge, according to one of the provincial Project Li-
aisons. The cultural component is fundamental to sustainability.
Both Provincial Proje c t L i aisons agreed that this is an important
factor. For example, as one Provincial Project Liaison asked:
How do you maintain fidelity so that you can still have
successful outcomes but also have a sustainable project
that the community buys into in the long term so that once
funding is over, the community is able to continue it….
So that’s one of the major things that PHAC is looking at,
so how do you navigate the implementation quality gap?
It should also be mentioned that during the initial phases of
the project it was discovered that there was a lack of consis-
tency in the level of knowledge and skill set concerning cultural
competence, which later proved to be a significant challenge.
Local Coordinators revealed an interesting finding, explaining
that, “urban Aboriginal people have no problem accessing ser-
vices”. One Local Coordinator argued that people move from
the reserve to the urban environment to improve their life situa-
tions. So, she continued,
The problem isn’t for them accessing service but the peo-
ple who are offering those services are providing chal-
lenges…. Because they’re not aware of what the history is
or why maybe a person can’t provide a birth date or social
insurance number or a fixed address.
The cultural competency component, one of the greatest con-
tributions this project has made to the communities, in part
grew out of this barrier. One of the lessons learned early on was
the importance of focusing on cultural awareness and how it
impacts the target population group. With this recognition the
coordinators were driven to create cultural competence for
other agencies to ensure their practices are culturally sensitive.
This was not part of the Communities that Care framework, but
it was beneficial to the project and the community to raise cul-
tural awareness across agencies. Hence, many training events
occurred with an overwhelming response from community
partners. As a result of the feedback, it was clear that many
participants left with a new level of cultural awareness. Chang-
ing the training from the CTC model’s “linear” form of delivery
to a more “circular” approach was provided as an example of
successful adaptation. The up side to this challenge is that
front-line service providers are afforded the opportunity to look
at their practices and reflect on how they can ensure urban
Aboriginal clients receive their services and how the service
providers can be of aid while simultaneously meeting funder
requirements of demographics. It was clear in the data that the
project coordinators are instrumental in opening up that dia-
logue and helping service providers become more proficient in
cultural competency through ongoing dialogue, community
engagement, and education opportunities.
Another hurdle the project must tackle is overcoming skepti-
cism and mistrust derived from a history of programming
aimed at effecting significant change in Aboriginal communi-
ties but often resulting in disappointing outcomes for the com-
munity. Additional challenges faced are issues of inclusion,
tokenism, trust, and ambivalence on the part of the Aboriginal
community. There is no denying that these issues were born of
previous unethical research that was conducted among Abo-
riginal people. Aboriginal people have been submissive sub-
jects rather than “participants”, leading to “misinterpretations”
as their voices were absent and an atmosphere was not created
for possible modification of the data (Holmes, Stewart, Garrow,
Anderson, & Thorpe, 2002: p. 1268). Often conflict arises be-
tween traditional Aboriginal perspectives and mainstream ide-
ologies, speci fically concerni ng time sensi tivity in lieu of ma in-
stream time-lines and priorities. Participants identified work-
load issues, pressures, a nd scheduling restrictions as barriers to
participating i n the project.
According to the information collected throughout the
evaluation process, the overall findings show that partnerships
between the agencies and individual relationships are deepen-
ing and that this cohesion is resulting in creative and effective
completion of the tasks and activities of the Communities that
Care model. All participants expressed an enormous amount of
appreciation, respect, and support for each role and member
involved in the project. The project has brought together two
provincial organizations and has the potential to bring organi-
zations together on a national scale in the future. In Kelowna,
Quesnel and Port Alberni, it has linked together the non-Abo-
riginal community and the urban Aboriginal population in an
unprecedented way. The inclusion of traditional Aboriginal
practices and key Aboriginal representatives were among the
most well received model adaptations. Interview participants
reported that the adaptations made to the CTC framework have
been critical to sustainability. Current structural supports appear
to be an essential aspect of the project’s ongoing success.
Findings from the evaluation suggest that mainstream evi-
dence-based programming can be successfully adopted by ur-
ban Aboriginal communities, with the strong caveat that pro-
grams must permit adaptations to meet the communities’ needs.
To execute an evidence-based program powered by a “one size
fits all” approach is inadequate for urban Aboriginal communi-
ties. Essentially, such programs require re-conceptualization to
transform a linear, western delivery model to a holistic and
circular implementation approach, which is congruent with
Aboriginal world views. Using a qualitative approach such as
PAR provides a platform for work with the communities. It
Copyright © 2013 SciRes. 129
Copyright © 2013 SciRes.
stimulates reflection and ongoing assessment of the successes
and challenges, and it provides a venue to problem solve. Fur-
thermore, the model presents as an effective medium for im-
proved interdisciplinary discourse, while offering promising
potential towards impacting societal concerns, such as dysfunc-
tional behaviors among children and adolescents. In addition,
by examining the adaptations in the context of the CTC model,
PAR addresses whether the intended actions compromise fidel-
ity. Overall, these findings support a strong foundation to
maintain efficient continuance towards the completion of the
current phase of the project. The Evaluators are confident that
this project can succeed with ongoing consultation with Com-
munity that Care experts, coupled with strong knowledge and
practices that support and honor Indigenous peoples.
First and foremost, we would like to honour and acknowl-
edge all the First Nations territories upon which this project
occurred. We are very thankful to the Canadian Mental Health
Association (CMHA), BC Division and the BC Association of
Aboriginal Centres for the implementation of this project
through the local Friendship Centres and CMHA branches in
three British Columbian urban Abori gina l Communities: Kelowna,
Port Alberni and Quesnel. The authors wish to express their
gratitude to the Provincial Project Liaisons, Trixie Ling and
Fernando Polanco who offered support throughout the project.
Special thanks to the Local Project Managers Trevor Barnes,
Sandy Brunton, Bob Hargreaves, Cyndi Stevens, Shelagh
Turner and Cam Martin for their guidance. Deepest gratitude is
also due to the Local Project Coordinators Sheila Lewis,
Amanda Swoboda, Lanny Kipling, Michelle March, Diandra
Jurkic-Wells, and Shan Jacob Ross. Without their knowledge
and commitment the project would have not been successful
thus far. Finally, an honourable mention goes to the community
participants known as the Key Leaders and the Community
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