Addressing experiences of trauma within Indigenous-focused substance use residential treatment: a systematic review and environmental scan

Indigenous individuals in Canada disproportionally experience higher rates of substance use concerns. This study examined clinical practices currently implemented with Indigenous-led residential treatment facilities to simultaneously address substance use and post-traumatic stress. A systematic review of relevant literature retrieved published approaches to address these concurrent disorders with Indigenous individuals. This review retrieved 35 sources related to trauma and substance use treatment among Indigenous individuals or communities. Among these sources, all leveraged cultural approaches as a dual treatment for trauma symptoms and substance use. Inconsistent results were reported among those sources (n = 3) who analyzed comparisons with wait-list controls or used randomized-controlled designs. Using culture-as-treatment was elaborated upon in the second goal of this study: an environmental scan of Indigenous-led treatment programs and qualitative interviews with 10 treatment center staff to understand how programs may address both substance use and traumatic symptoms among Indigenous-led substance use treatment centers across Canada. When we searched the websites of these centers, we found that approximately 38% (16 of 43) of treatment centers discussed implementing some form of treatment that addressed trauma symptoms in conjunction with primary substance use. Among the 10 staff participants, all discussed how trauma can impede client success in treatment, and ACE-specific programming is useful within their respective treatment programs. Results showed that when manualized treatments are used, they must be adapted to meet the specific needs of Indigenous communities, and culture-as-treatment is a popular approach among Indigenous-led treatment centers, particularly for addressing trauma symptoms.

Culturally responsive evaluation: A scoping review of the evaluation literature

Evaluators have become increasingly aware of the influence of culture in evaluation, leading to new evaluation approaches that account for the cultural considerations in which evaluations are situated. This scoping review sought to explore how evaluators understand culturally responsive evaluation and identify promising practices. A search of nine evaluation journals yielded 52 articles that were included in this review. Nearly two-thirds of the articles stated that community involvement was essential to culturally responsive evaluation. Power differentials were discussed in almost half of the articles, and the majority used participatory or collaborative approaches to community engagement. Findings from this review suggest that in culturally responsive evaluation, evaluators prioritize community involvement and have an awareness and attentiveness to power differentials. Yet, gaps exist in how culture and evaluation are defined and interpreted, and consequently, inconsistency in how culturally responsive evaluation is practiced.