Completed Theses

Intergenerational trauma among Indigenous peoples in Canada is identified as an ongoing detrimental outcome of Canadian colonialism. Both adverse childhood experiences (ACEs) and substance use problems appear to be difficulties perpetuating intergenerational trauma among this population. While it is known that ACEs increase risk for a multitude of poor mental and physical health outcomes, the underlying mechanisms are less clear. Executive functions (EFs) may be one plausible mechanism linking ACEs to substance use difficulties, as EFs are both affected by chronic stress during childhood and are associated with poor outcomes later in life. This community-based research project was driven by Indigenous partnership who wanted to better understand how ACEs are implicated in the substance use difficulties their clients are facing. With this in mind, the goal of this study was to examine the interrelationships between ACEs, EF, and substance use outcomes among clients at an Indigenous substance use treatment program in Northwestern Ontario. To do this, 80 participants completed self-report questionnaires at two time points while in treatment. Ultimately, the number of ACEs experienced did not predict EF difficulties. However, family substance use predicted difficulties across all EFs and severity of neglect predicted difficulties in working memory specifically. ACEs did not predict age of first alcohol or cannabis use, though this relationship approached statistical significance. More than half of the sample demonstrated clinically significant post-traumatic stress disorder symptoms, which were both associated with number of past ACEs and predicted EF difficulties seen within the sample. Ultimately, this study serves as a preliminary step toward better understanding the link between ACEs and EFs among Indigenous adults with substance use difficulties, providing a knowledge base for future prevention, intervention, and research pursuits.

Experiencing adversity during childhood can disrupt typical childhood development and consequently affect health outcomes throughout the lifespan (Norman et al., 2012). Ongoing research has identified that ten specific Adverse Childhood Experiences (ACES) have been associated with pervasive longitudinal health outcomes and the presence of chronic diseases such as cardiovascular disease and diabetes in adult populations. Although many of these relationships have been established within non-Indigenous populations, minimal research exists that has described similar outcomes for Indigenous populations. Indigenous populations in Canada experience increased health disparities when compared to non-Indigenous populations, such as increased rates of mental health concerns, higher prevalence of some diseases and chronic health conditions, and overall have poorer access to social determinants of health that may help mitigate these concerns (Statistics Canada, 2018). Life experiences related to childhood adversity experienced over time can also influence mental and physical health outcomes across generations. To better understand these relationships within Indigenous populations, the First Nations ACE study examined ACE scores in a First Nations population seeking substance use treatment, including participant-reported ACEs and health outcomes of parents and grandparents using a community-based participatory approach. Regression models assessed the relationship among ACE scores and subsequent health outcomes reported by 141 individuals in an on-reserve residential treatment program. Higher reported ACE scores were significantly associated with an increased number of health concerns, although odds ratios of increase rates of specific diseases were not significant. Parent and grandparent ACEs and residential school attendance were not significantly related to increased health concerns by participants, although were associated with parenting difficulties. Participants and staff involved with the First Nations ACE Study reported positive experiences with this research, and staff members reporting satisfaction with the CBPR practices embedded within the study.

Canada’s First Nations population experiences elevated rates of opioid use and negative opioidrelated consequences. These rates stem from the long history of colonization that First Nations populations have faced, which has resulted in unique treatment access barriers and a need for culturally and contextually relevant treatment. The purpose of this study was to longitudinally evaluate the first on-reserve methadone maintenance therapy program in Canada through both client questionnaires and staff interviews. Forty-nine clients (mean age of 40, 51% female, 100% First Nations identification) and 11 staff members of the program participated in this study. Overall, clients noted self-improvement; improved quality of life, housing condition, employment status, and family support; and decreases in symptoms of anxiety and depression, overall psychological and physical distress, and drug use and high-risk behaviours. Qualitatively, clients spoke positively of the treatment centre and noted challenges of the program. Staff noted their primary goal as seeing clients become substance free and they also spoke about the importance of the community’s support of the program. Staff noted challenges with funding and reported a desire to see the program continue to help the community until everyone is healed. Overall, the results of the evaluation were positive and show that the program is succeeding in the eyes of the clients and the staff.

The purpose of this project was to create, implement, and evaluate a tool designed to measure the wellbeing of First Nations children in the Robinson Superior Treaty Area. This project followed a community-based participatory research approach and was overseen by a research advisory made up of employees from the partner organization. Interviews were conducted with community members in the Robinson Superior Treaty Area and analyzed to identify indicators of wellbeing for children. This analysis was utilized to generate items for a pilot version of the measure. This pilot version was administered by two mental health intake workers to the parents and caregivers of 91 children who were seen through intake for service at Dilico Anishinabek Family Care, along with the Child and Adolescent Needs and Strengths measure (Lyons et al. 2003). Following piloting, interview with the mental health intake workers, and measure refinement, a principal component analysis was conducted and three factors emerged: General Wellbeing, Traditional Activities, and Social Engagement. This measure represents one of few created and validated for use specifically with a First Nations population and aligns with the literature regarding the importance of engagement in traditional activities and understanding of culture for the wellbeing of Indigenous people.

Heavy alcohol and marijuana use are common in undergraduates and are associated with numerous use-related problems, whether one drug is consumed on its on (i.e., monodrug use) or if two or more are taken together at the same time (i.e., polydrug use). Several personality traits (i.e., anxiety sensitivity, sensation seeking, impulsivity, and hopelessness) are known to differentially relate to alcohol and marijuana use. Further, the literature suggests that substance use motives (i.e., enhancement, coping, social, and conformity) and depressive symptoms are associated with mono- and polydrug use. Study 1 (N = 361) investigated the relationship between heavy episodic drinking (HED), personality traits, and motives and found that each personality trait at Wave 1 was differentially related to motives for drinking at Wave 2. However, only coping-anxiety, coping-depression, and enhancement motives predicted HED (i.e., five or more drinks for men, or four or more drinks for women, during one occasion). Hopelessness and anxiety sensitivity predicted depressive symptoms, athough depressive symptoms, in turn, did not predict HED. Study 2 (N = 57) investigated personality traits and motives associated with one form of polydrug use known as simultaneous polydrug use (i.e., use at the same time or in close temporal proximity). Results revealed that hopelessness was the only personality trait to predict a motive for simultaneous polydrug use (i.e., coping-depression motives). No motives were predictive of simultaneous polydrug use. Both hopelessness and anxiety sensitivity were predictive of depressive symptoms. In summary, individuals who engage in either mono- or simultaneous polydrug use may be more likely to have sensation seeking as a prominent personality trait. Those who specifically engage in the simultaneous polydrug use of alcohol and marijuana may also be more likely to endorse different personality traits and motives for use than monodrug users.

Alcohol is a widely used substance among university students. There are several measures that are used to assess the consequences of alcohol consumption. However, current instruments fail to capture several behavioural consequences established in literature. Negative consequences missing from existing measures are related to sexual behaviour, suicidal and non-suicidal self-injury, and criminal and delinquent behaviour. In addition to negative consequences, positive consequences have been neglected from these measures. The goal of this research was to develop a new measure that addresses these gaps. In Study One, items from current and widely used measures in research and clinical applications, as well as newly developed items, were administered to a sample of undergraduate students. Factor analysis and item performance indices (e.g., item to total scale correlations, item variance, relationship to desirable responding) were used to construct a new scale. In Study Two, the new scale was administered to assess indices of reliability and validity. Although many of the new behavioural consequences (e.g., suicidality, eating behaviours, and aggression) were eliminated from the scale through empirical methods of item retention, the final scale was found to perform well across nearly all indices; there was strong evidence of construct, concurrent, and convergent validity. The final scale was comprised of positive and negative consequences, with an index for valence ratings.

Conduct disorder involves violations of the rights of others and/or conflict with authority figures or societal norms and may include bullying, theft, or other serious antisocial behaviours (American Psychiatric Association, 2013). Due to historic discriminatory policies and intergenerational traumas, Indigenous youth are more likely to be exposed to risk factors for conduct disorder (Bombay et al., 2014; Greenfield et al., 2017). Early intervention is the best way to prevent negative future outcomes, including future incarceration, for these children (Baskin-Sommers et al., 2016; Dodge et al., 2015). The Stop Now and Plan (SNAP) program is a well-established early intervention for children with conduct-related behaviours (Augimeri, Walsh, & Slater, 2011; Burke & Loeber, 2015; Pepler et al., 2010). Despite the increased risk of Indigenous youth, this program has rarely been evaluated with Indigenous youth and has never been adapted for First Nations families. The current study tested a culturally and contextually adapted SNAP program for First Nations youth and families. Mixed model regression analysis was used to investigate outcomes before and after SNAP program involvement. Significant improvements in parenting self-efficacy were found within the domains of Control, Discipline and Boundary Setting, and Pressures for specific age groups. Most youth age groups also showed significant decreases in externalizing symptoms, and overall reported symptoms across time points. No significant differences were found between females or males for any TOSPE or CBCL scales. Results are discussed in relation to prior research outcomes with non-Indigenous youth and families with considerations for future research.

First Nations youth are one of the fastest growing demographics in Canada, yet they are more likely to experience adverse health and life circumstances than non-Indigenous Canadians. Developing and implementing appropriate interventions for mental health is a priority area in decreasing this health gap, and requires the incorporation of First Nation models of mental wellness. Mental Wellness for First Nations’ youth is tied to interpersonal and cultural factors such as relationships with caregivers and the greater community, caregiver and/or community access to necessary resources, and cultural identities. Examining these wider sociocultural factors, in combination with youth characteristics and strengths, provides a more comprehensive understanding of how to address mental health needs in First Nation communities. Working in collaboration with a First Nation based community health provider, the Child and Adolescents Needs and Strengths (CANS) assessment was analyzed for 178 First Nation children to identify specific mental health intervention needs and explore predictors of mental health needs. The CANS is a reliable measure that assesses youth mental health needs, caregiver needs, individual strengths, environmental strengths, as well as many other factors. The most commonly reported mental health intervention needs were seen for Anxiety, Mood, Emotional Control, and Adjustment to Trauma. Hierarchical regression identified referents’ age, sex, Functioning, Individual Strengths, and Family/Caregiver Needs and Strengths domain scores as predictive of mental health intervention needs. Age and Functioning domain scores were robust individual predictors of mental health needs across most models, yet sex was not individually predictive in any model.

Organizations offering mental health services are in need of innovative solutions to address a lack of accessibility and availability in service provision. Waitlists for counselling services are long, often forcing those experiencing mental health difficulties to rely on acute care services in the interim. One option, single-session counselling, allows consumers to access services when they need it, as often as they need it. This service model can be integrated into current services to contend with difficulties related to efficiency and accessibility. The current study evaluated a new single-session counselling program offered in an outpatient community mental health clinic in Northwestern Ontario. The majority of participants rated the service favourably, and experienced a decrease in mental health difficulties and associated impairment. Single-session counselling reduced difficulties associated with the presenting problem, and allowed access to services sooner. Continued implementation of this model of care is supported by the current findings. Dissemination of information describing the nature of single-session counselling, as well as outcomes of program evaluations such as the current study, may help to increase acceptance of its integration into ongoing mental health services.

First Nations children are overrepresented in the child welfare system in Canada (Blackstock, 2003). First Nations communities are seeking to improve current service delivery models and create alternative evidence-based strategies. A First Nations child welfare organization has identified priority areas related to reunification and parenting, identify successes and barriers to reunification, and examine service needs. These priorities were addressed with a community-based, participatory model, and guided by a community Research Advisory. Results were analyzed using a blend of grounded theory and thematic analysis techniques. Participants identified the need to place children with extended family or within home communities to facilitate best child outcomes. Improving parental and community capacity was recognized to promote positive reunifications. Successes identified within communities included available supports, such as those that increased empowerment and community capacity. Identified barriers within communities were the lack of culturally appropriate parenting services, hesitancy to obtain available support due to fears of child welfare intervention, and mental health difficulties of community members. Results of this study will be disseminated to communities and used to develop a culturally appropriate parenting program.

The use of alcohol and drugs is a significant issue faced by First Nations communities in Canada, which is accentuated by high rates of mortality and morbidity resulting from opioid use. The frequency of opioid-related emergency room visits and the higher prevalence of illicit prescription drug use disorders in First Nations populations suggest challenges. Methadone maintenance therapy programs are consistently found to be the most effective treatment for opioid dependence; however, due to financial, geographic, and cultural factors, Aboriginal individuals are less likely to initiate methadone maintenance therapy. Cree Nations Treatment Haven is the first on-reserve methadone maintenance therapy program in Canada and the present study aimed to evaluate this program from clients’ perspectives. Results indicated that individuals in treatment with higher rated improvement showed greater engagement, life quality, psychological functioning, physical health, relationships with family and friends, and a more positive opinion of services and less motivation for treatment, psychological distress, problems with alcohol, criminality, employment and life difficulties, and overall risk. Individuals with a more positive opinion of services reported higher engagement and lower motivation. Finally, individuals in treatment reported a decrease in drug use, high-risk, and criminal behaviours, and improvements in housing, employment status, and family support, since admission to the program. Future evaluation would be beneficial to solidify the present findings and clarify the importance of culture in treatment effectiveness.

There is a high level of both heavy episodic drinking and related problems among Canadian undergraduates. Four personality traits and five motives for alcohol consumption place students at risk for experiencing increased levels of alcohol-related problems. Protective behavioural strategies represent a novel, harm reduction approach to ameliorating the negative consequences that individuals experience as a result of their drinking behaviour. In order to explore the relationships between personality traits, motives for drinking, protective behavioural strategies and alcohol-related problems, a 2-wave longitudinal study was conducted to examine two hypotheses: 1) Does PBS use at wave 1 moderate the relationship between personality traits at wave 1 and alcohol outcome at wave 2?, and 2) Does PBS use at wave 1 moderate the relationship between motives for alcohol use at wave 1 and alcohol outcome at wave 2? Results indicated that PBS do not moderate the relationship between any personality traits and problems, but do moderate the relationship between two motives for use (coping with anxiety and coping with depression) and alcohol-related problems, however, relationships did not emerge as predicted. For those who drink to cope with anxiety or depression, increased PBS usage was related to increased alcohol-related problems, demonstrating that PBS may not provide a protective effect at high levels of these drinking motives. Unique aspects of undergraduate lifestyle may impact the usefulness of PBS for this population, and more directive or intensive strategies to reduce related harms may be required.