NATO’ WE HO WIN: Final Report
Introduction
nato’ we ho win is an innovative intervention program which addresses the mental and physical health women who have experienced intimate partner violence (IPV) and self-identify as Indigenous. nato’ we ho win (pronounced “natawayhowin”) is a Cree word that can be translated as “the art of self-healing.” The program consists of trauma-and-violence-informed artistic and cultural programming. Participants engage in cultural and creative activities to increase stress management skills, social support networks, and knowledge of traditional Indigenous culture, and to address health and social issues related to IPV.
Financial and in-kind contributions
nato’ we ho win was supported through the Public Health Agency of Canada’s investment Supporting the Health of Survivors of Family Violence (contribution #1617-HQ-000035). The Public Health Agency of Canada provided $637,602.00 from October 2016 to March 2021. Program space for nato’ we ho win groups was provided in-kind by the Moose Jaw Art Museum and Gallery and, the University of Regina in the Nanatawihowikamik Healing Lodge and Wellness Clinic. In-kind contributions were also provided by the research team and PATHS.
Partners and collaborators
Provincial Association of Transition Houses and Services of Saskatchewan (PATHS) member agencies (domestic violence shelters and services) and other organizations that serve victims/survivors of IPV in Regina, Moose Jaw, and Prince Albert provided connections to professionals to serve in the domestic violence advocate role, shared information about the program and referred clients, and were available to provide additional support or information to program participants, as needed.
Dr. JoLee Sasakamoose provided guidance on Indigenous research methodology, hired research assistants for the project, and collaborated on knowledge translation. Dr. R. Nicholas Carleton provided guidance on the quantitative methodology, quantitative data analysis, and collaborated on knowledge translation.
Background
The rate of police-reported IPV in Saskatchewan is consistently over double the national rate. Data from Statistics Canada indicates Indigenous women are three times more likely than non-Indigenous women to experience IPV than non-Indigenous women and tend to experience more severe forms of IPV than non- Indigenous women. Approximately 16% of women in Saskatchewan are Indigenous; however, in a single year (2019- 2020) the majority (75%) of women who accessed Saskatchewan’s domestic violence shelters were Indigenous. Indigenous women who seek support at domestic violence services have often experienced multiple traumatic events. including physical, sexual, emotional, psychological, spiritual, and financial abuse. For many Indigenous survivors, the impact of IPV is exacerbated by trauma related to Canada’s history of colonization and residential schools.
Our goal was to develop a trauma-and-violence-informed intervention that would be beneficial for Indigenous women who had experienced IPV. Existing research indicated the positive impacts of arts, as well as cultural programming, as interventions for survivors of violence and trauma. The goal of nato’ we ho win was to combine these two approaches to create an effective cultural and arts-based intervention for Indigenous women who had experienced IPV. Our hope that was reconnecting Indigenous women with their cultural knowledge and spiritual beliefs in a group setting would build resiliency, develop support systems, and improve overall health and well-being.
Key activities and outputs
Program development
nato’ we ho win was centered in ceremony, designed and developed by Barbara Frazer, an Indigenous Knowledge Educator. nato’ we ho win was informed by Indigenous Knowledge Keepers, Norma Rabbitskin and Willie Ermine. nato’ we ho win consists of 3-hour weekly group sessions, for thirteen weeks, to reflect the Grandmother Teachings for each of the thirteen moons in a year. The intervention was designed to be easily replicated in other communities and contexts and encourages the use of local languages, teachings, materials and art forms.
Program delivery
nato’ we ho win was piloted in Moose Jaw March- May, 2017. The groups then ran concurrently in three communities (Moose Jaw, Regina, and Prince Albert) three times each—Fall 2017, Winter 2018, and Fall 2018.
There are three team members present at every group session—the facilitator, an Elder, and a domestic violence advocate (DVA). The Elders begin each session with prayer, offer cultural teachings, and are available to offer support and guidance. DVAs manage logistical matters (including conducting intakes, communicating with participants between sessions, and arranging transportation), assist participants with safety planning, and provide referrals or support. During the nine groups conducted in Saskatchewan, DVAs also assisted with research data collection. Transportation, childcare, and a meal were provided each week.
Self-care activities with a focus on empowerment, holistic connectedness, and circle sharing were included alongside arts-based projects. Artistic activities included mural painting, visual journaling, and Indigenous hand-building including sewing, beading, and using traditional medicines to make tea and salve. Indigenous protocols such as prayer, smudging, and offerings of tobacco were integral to the process.
Partners and collaborators
Partners include PATHS member agencies, Indigenous Knowledge Keepers (Barbara Frazer, Norma Rabbitskin, and Willie Ermine) and Dr. JoLee Sasakamoose and Dr. R. Nicholas Carleton from the University of Regina. Project teams in Prince Albert, Moose Jaw, and Regina communities consisted of Elders, Facilitators/Artists, Domestic Violence Advocates, Childminding Organizers, additional childminders, and individuals who assisted with food preparation. Research assistants in each community collected data.
Intervention research
Research was conducted, with the participants of nine groups in Saskatchewan, to evaluate the effect of participation in nato’ we ho win on Indigenous women’s sense of well-being. Research consisted of self- report questionnaires completed by participants at intake (prior to beginning nato’ we ho win), after completing the intervention (week 12), and one year after completion of nato’ we ho win. An evaluation, which included questions about the length of the intervention and supports offered, such as childcare and transportation, was completed by women at week 12. Focus groups, conducted in a sharing circle format, took place at week 12 and one year after completion.
Self-report questionnaires included demographic questions and several validated measures of well-being (experience of IPV, post- traumatic stress, depression, generalized anxiety, quality of life, personal agency, interpersonal agency, resilience, connectedness, and post-traumatic growth). Focus group questions inquired how women felt about their emotional, spiritual, mental, physical well-being before and after participating in nato’ we ho win. One year later, we asked women if they had continued to engage in cultural and creative activities and if they felt like they were able to maintain positive changes since completing nato’ we ho win.
Research results
Quantitative results, using several validated measures of well-being, indicate that, overall, iskwêwak (Cree, translated as “women”) reported increases in resilience, personal agency, connectedness, and post- traumatic growth from intake to one year after completing nato’ we ho win. Participants reported statistically significant decreases in their self-reported anxiety and depression from intake to one year later.
In the program evaluation, participants were asked how valuable they found the program. On a scale of 1 to 10, 86% rated the value 8 or higher, with the majority selecting 10. An open-ended question asked participants what parts of this program they found to be the most valuable. Participants described cultural teachings, art activities, sharing circles, and social connections. The majority (90%) of participants who completed the evaluation stated that they would recommend nato’ we ho win to others.
In the sharing circles, iskwêwak shared several ways that teachings and practices they learned and skills that they developed in nato’ we ho win helped them to be more resilient. Participants maintained these skills and practices after completion of the intervention. Overall, iskwêwak reported feeling happier and experiencing a more positive outlook. They expressed an improved sense of balance and clarity in their lives and reported improved self-care practices and improved management of their daily routines.
“I'm glad I came here. I came to these groups, to be around other Native people. And learn the culture and practicing it. It makes me feel better. It makes me feel whole again. And it helps every day, I take care of the kids, I go to school, and I'm able to handle stresses…”
The support and skills gained in nato’ we ho win helped iskwêwak to feel more independent, which was a protective factor for living free from violence. iskwêwak reported that they felt they now had the strength and support to avoid returning to partners who had been abusive and to focus on themselves without searching for a new intimate relationship.
“Being in the group now has helped me see I'm not alone and that we're all at different stages in our lives, and it does make life bearable. There are some issues that happened during the group, and being here really, really, really helped me emotionally and mentally to let go of that and have a safe circle where you can share that information, and feel supported, so I do feel a lot better being in the group.”
Participants also spoke about improvements in self-management and daily routines. Specifically, iskwêwak spoke of “balance” and discussed taking care of their physical health, including eating regularly and eating healthier foods. iskwêwak also described improved sleep routines and how they found it easier to get out of bed in the morning. It became easier to care for children. Several participants reported quitting or reducing substance use. It also emerged that the cultural and expressive arts activities and sharing circles within the groups did not only benefit the women participants, but their children. iskwêwak reported increased parenting efficacy and positive relationships with their children and shared that they planned to pass the skills learned in nato’ we ho win on to their children.
Developing healthy and supportive relationships with other women was another central theme. The social connections established through sharing within the group helped iskwêwak to overcome isolation, facilitate healthy boundaries, and develop a sense of community. Participants described establishing trust and enjoying the positive social connections in the group and in some cases, relationships that were built were maintained beyond the completion of nato’ we ho win. While participating in nato’ we ho win, many iskwêwak were introduced to Indigenous cultural teachings and practices for the first time. Participants described how these teachings instilled in them a source of pride and strength. They also gained strength from spiritual practices, such as smudging and praying, and incorporated these practices into their lives at home. These practices enriched participants’ sense of stability.
iskwêwak spoke positively of the various artistic and handbuilding activities that were part of the various nato’ we ho win groups. In addition, some participants reported that while they found learning new skills to be challenging, it ultimately led to them increasing their patience and bringing about self-awareness in a new area.
“It taught me patience, and taught me that I can make something beautiful just from my hands.”
Art activities helped iskwêwak to relax and increase feelings of calm in their lives. Some iskwêwak also reported that cultural artistic activities, such as beading, provided a positive activity to fill their free time at home, where they may have previously turned to negative coping strategies. Participants spoke of their desire to continue engaging in creative practices and to teach these skills to others.
Knowledge translation
1 - Program Manual with Facilitator Guide
6- Videos
4 - Conference Presentations
2 - Webinars
4 - Poster Presentations
3 - Research Reports
6 - Media articles
Project outcomes
Our research results provide initial evidence that nato’ we ho win was effective for supporting the healing of a sample of Indigenous women who had experienced IPV and adds to the body of knowledge demonstrating the importance of cultural interventions and of programming that centres on the teachings of Indigenous Knowledge Keepers and Elders. nato’ we ho win was designed as a short-term intervention to assist Indigenous women in building resilience and healing from IPV. Results of our research indicate that this goal was met. This being said, many participants expressed that they wished for the group to continue. The women spoke of the support they received from the other women and the intervention team (facilitator, Elder, and domestic violence advocate). It is clear that opportunities to build community, connect with their culture, and engage in creative activities can assist Indigenous women who have experienced IPV to build resilience and heal from trauma.
Next steps
The current project produced several valuable results. The program manual and facilitator’s guide are now available for organizations and communities who would like to deliver nato’ we ho win. The intervention can be adapted to fit the facilitator, Elder, and community’s teachings and ways of healing. Team members are currently working to share the manual and guide, as well as research results, throughout a variety of avenues so that this information can be of assistance to others who would like to facilitate nato’ we ho win.
Continuation of nato’ we ho win
After nato’ we ho win concluded, participants and intervention team members from the Moose Jaw nato’ we ho win group continued to meet, engaging in cultural teachings, beadwork, and social support. This group of women beaded traditional capes, which were displayed at the Moose Jaw Art Gallery in February 2020. A second show, in October 2020, featured more work from this group of women.
Dr. JoLee Sasakamoose is currently working to adapt the nato’ we ho win model of care for delivery with a group of Indigenous women undergoing treatment for Hepatitis C.
It is our hope that nato’ we ho win will continue, in some form, in the communities in Saskatchewan where it was initially delivered. We also hope it will continue to adapted in different communities and cultural contexts.
