8 Informed Approach to Disclosures of Abuse and Healing

Daniel A. Afram and Amber Miners

The authors are located in Iqaluit, Nunavut but their respective work covers the Qikiqtaaluk region of Nunavut.

Consistent with other remote Indigenous communities, social work in Nunavut has many unique challenges and limitations. The current chapter aims to explore and understand approaches to these challenges, through the introduction of a case study highlighting common realities across Nunavut. We will further describe several practice approaches and competencies in navigating the case study. As social workers, we must understand the historical and social complexities of Inuit populations to consider any approach or intervention in the provision of service. It is our hope that the introduction of Inuit history and its context will enrich your approach to care within our region. We introduce and explain the Child Advocacy Centre (CAC) model, which works within the Inuit Qaujimajatuqangit (IQ) principles. We will also explain the Umingmak CAC and how its introduction has changed the response to childhood trauma within our jurisdiction, and allowed for more inter-departmental communication and collaboration. This change has ultimately shifted the response to care of our most vulnerable children and adolescents in our community.

This chapter will review Inuit history, values, community response to supporting children and adolescents with disclosures, as well as challenges, barriers and interventions. Although the content may seem extensive, we recognize that it may still not feel complete in capturing the complexity of social work in Nunavut. As a future social worker, you need to immerse yourself in the content while maintaining a critical lens of the larger impact of colonialism on service provision. The chapter might also illicit certain reactions based on your own social location and your beliefs about how service delivery should look or be implemented. If you find yourself challenged at certain moments, manage the discomfort as you are able and then return to the chapter when you are ready.

Learning Objectives

This chapter will focus on the following elements that will serve to inform the learning objectives:

  • Historical context of Inuit in the Arctic
  • Inuit societal values
  • Community response to care
  • Child Advocacy Centres
  • Multidisciplinary teams
  • Ethical considerations
  • Barriers and challenges

Inuit history from pre-colonialism to current realities will be reviewed. We acknowledge that we are not Inuit and do not represent Inuit. We write about Inuit culture and heritage only to assist in the description of unique social work practice in our location. We encourage you to look to Inuit organizations and individuals for further information on this subject. Our intention is to provide some foundational understanding relating to themes of distrust in service provision caused by colonialism. Inuit societal values will be explored in the context of resilience and the sustaining of Inuit traditions. Inuit societal values are integral to policy enactment and subsequently service provision. The review of values will add another layer of learning about the strength of Inuit. As an emerging social worker, your understanding of a community response to care is integral to service provision. At times, you may feel disconnected from the theory as realities of practice crystalize; you are encouraged to challenge your learning during this process. We will review community response to care in our Inuit community and the complexity of service provision. Child Advocacy Centres (CAC) have been transformative in many communities with respect to service provision for children and adolescents who have disclosed distinct forms of maltreatment. Therefore, we will review the history of CACs and the impact in communities, particularly Nunavut.

A part of Inuit societal values relates to working together for a common good. This value is explored through a discussion about working in multidisciplinary teams. As social workers we are actively confronted with ethical dilemmas, and these can be unique in remote communities such as Nunavut where your neighbour might also be your client. Attention to ethical considerations in small communities will be explored. We will conclude our learning by discussing barriers and challenges experienced by social workers in Nunavut. In particular, the section will highlight some of the progress relating to service delivery but will also review a call to action in highlighting the challenges ahead. Prior to our learning on Inuit history, to provide additional context to social work in Nunavut, please review the case study of Jessica, which will guide this chapter.

Case Study of Jessica

This fictitious case study of Jessica will focus on the realities of remote communities, such as service pathways for those located in Nunavut. The authors aim to highlight specific challenges faced as a result of this context.

Jessica is a 10-year-old Inuk girl who is currently in grade 5 in Kinngait, Nunavut. Jessica has three younger siblings and resides with them and her mother (Tapisa) within a multigenerational household that is owned by her Uncle (Jamesie); there are 11 people residing in the three bedroom home. Tapisa has a history of alcohol dependence but in the past year has focused on her personal healing. The former partner (Peter) of Tapisa died by suicide when Jessica was 5 years old.

A couple of years ago, Tapisa started working as a machine operator for a mining company. Tapisa works in another fly-in community on a three week rotation and then is home for three weeks. During the time Tapisa is away working, Jessica and her siblings are cared for by extended family members within the home.

During a recent outburst in the home by Jessica, Tapisa took her daughter aside to help regulate her. Jessica disclosed to her mother that she was being sexually abused by one of her uncles during the period that Tapisa was working at the mining company. Jessica pointed to pain in her vaginal area. Tapisa was very shocked and emotional with her daughter. Tapisa reassured her daughter that she was safe, thanked her for telling her, and assured her that she would deal with it.

Tapisa took Jessica to the Community Health Centre (clinic in the community) where a nurse examined her. Based on the examination and disclosure, a decision was made to fly Jessica to Iqaluit, Nunavut, for additional medical attention and support. Iqaluit has the only hospital in the region. Prior to leaving, Child Protection became involved, in addition to the Royal Canadian Mounted Police (RCMP) being notified of the disclosure.

Jessica and her mother had two hours to get ready before the plane came. Tapisa ran home to get a couple of personal items for her daughter before the arrival of the medevac (emergency medical flight). Typically, Jessica would have been placed on a regularly scheduled flight, but she had already missed the flight for that day and the next one was not scheduled for another two days. Based on the time sensitivity of examining Jessica and collecting evidence, a decision was made to travel by medevac. Jessica’s siblings had to stay with extended family in the home while Tapisa and Jessica were away in Iqaluit.  We encourage you to keep this case study in mind when reviewing the next section on Inuit history.

Inuit History

Many Inuit reside in small communities in four northern regions of Canada (Inuit Nunangat) including: Inuvialuit (NWT); Nunatsiavut (Newfoundland and Labrador); Nunavik (Quebec); and Nunavut. About 80 percent of Inuit reside across 51 communities within Nunangat (Inuit Tapiriit Kanatami, 2011). Inuit Nunangat encompasses about 35 percent of Canada’s landmass and 50 percent of its coastline (Inuit Tapiriit Kanatami, 2011). According to Inuit Tapiriit Kanatami, it is reported that about 60 percent of Inuit report speaking Inuktut (the Inuit language), and 76 percent of Inuit in Nunavut have Inuktitut as their mother tongue (Government of Canada, 2017). The focus of our chapter will primarily be Nunavummiut (Inuit residing in Nunavut) residing in the Qikiqtaaluq region of Nunavut. The Qikiqtaaluq region consists of 13 fly-in communities.

Pre-Colonialism with Qallunaat (Non-Inuit, Particularly of European Descent)

Consistent with all Indigenous groups at the time, Inuit had a thriving, holistic society and actively met their needs through economic, social organization, and spiritual connections. The economic connections centred on the power of Inuit to meet basic needs of food, shelter and clothing (Arctic Children and Youth Foundation [ACYF], 2018). Within traditional Inuit society and harsh climates, Inuit sustained themselves in their diet by hunting, harvesting and eating all of the animal—this provided a significant source of nutrients and needed sustenance. According to Inuit Tapiriit Kanatami (2011), social organization related to how Inuit organized their relationships with each other (e.g. gender roles, communication protocols, education, leadership, governance, dealing with wrongdoers, etc.) and it was intentional and practiced. The social organization allowed Inuit to have control and agency in day-to-day life. Spiritual practices revolved around the way that Inuit explained their existence through ideas of higher powers, rules of life, relationship with the natural world, and individuals acting as intermediaries with the spiritual world. There are several key historical events that greatly impacted upon the lives of Inuit, primarily colonialism.

1800s-Early 1900s

Whalers began to come to the area from England, Scotland and the United States, as products such as whale bones for corsets, and whale oil were in high demand (ACYF, 2018). Unlike explorers who were just passing through, whalers visited yearly and therefore had a bigger impact on the life of Inuit. According to the Qikiqtani Inuit Association (2013), whalers drew on Inuit knowledge; they employed, traded with, and socialized with Inuit. The relationship between whalers and Inuit introduced regular trade for things like flour, tobacco, textiles, and other metal tools; music such as square dancing (which Inuit still practice today); and social relationships, including babies born from unions between whalers and Inuit (Qikiqtani Inuit Association, 2013).

The first Hudson Bay Company (HBC) trading post was established in Kimmirut in 1912. This expanded to 100 trading posts in the North West Territories (NWT), although not all were HBC. Due to the influence of the trading posts, Inuit started hunting for trade, not just for food, and people grew more dependent on trade goods such as flour and tobacco. This shift caused families to become more individualistic throughout the North, and is seen as the beginning of the use of “money” for Inuit populations (ACYF, 2018). Inuit became dependent, then, on both money and goods, and when these were in low supply, they turned to government services for support.

Canadian Government and RCMP Impact on Inuit

The Royal Canadian Mounted Police (RCMP) initially came to the north in response to threats to Canadian Arctic sovereignty (American and European traders) in the early 1900s. RCMP began travelling to northern communities to enforce Canadian law. In traditional Inuit society, a system was already in place to deal with individuals who were out of line within the group: those who were troublemakers or who caused threats to others (Karetak, 2013). At that time, decisions would be made by Elders, hunters or the whole camp, for the betterment of the camp, and for the good of the group as a whole. This traditional justice worked for the unique lifestyles of Inuit. Increased confusion was created for Inuit with the involvement of RCMP and the new and unfamiliar ways of the Canadian justice system.

Relocation

At the time of the Cold War, many countries fought for sovereignty to claim the North, and Canada sent the military to the North to claim the land. The federal government moved, through forced relocation, the “Canadian Indians” (Inuit) further north in order to claim that land (Inuit Tapiriit Kanatami, 2004; Inuit Tapiriit Kanatami, 2011). At first, Inuit that moved from the Qikiqtaaluk region to higher latitudes (Grise Fiord) understood that they could return to their home communities if they chose. However, this return did not happen. Other relocations occurred with Inuit from northern Quebec, and many suffered greatly and/or died. Extreme weather, and distinct hunting patterns in the unfamiliar territory was the cause. The relocations created artificial settlements, which then turned into communities. On August 18, 2010 in Inukjuak, Nunavik, John Duncan, who was the Minister of Indian Affairs and Northern Development at the time, apologized on behalf of the Government of Canada for the relocation of Inuit to the High Arctic (Government of Canada, 2010).

 

Figure 1

Apology Statute in Grise Fiord

Note. Picture of Apology Statute in Grise Fiord one of the most northern communities in the Arctic. Photo by Sarah Clark taken on June 16, 2020.
Tuberculosis in the North 1940s – 1960s

Around 1946, thousands of Inuit across the Canadian North suffered a severe outbreak of tuberculosis (TB). This occurred because of the increase in contact with people from southern Canada and the American military who were stationed in the North. The Canadian government sent a coast guard ship called the C.D. Howe to screen Inuit in the North. Members of the settlements were forced to board the ship and be screened for this and other diseases. However, any individual found to have any signs of TB was not allowed to get off the ship. In this way, children, women, and men of all ages were taken away from their families, and many never returned. The majority of Inuit did not speak English, and the southerners did not speak Inuktut, which affected communication. Inuit would spend an average of two and half years in the hospital due to the tuberculosis outbreak, and during this time, many who had left as children had forgotten their language and crucial survival skills. Most importantly, many individuals had missed out on valuable time with family. Some families to this day do not know the whereabouts of their members who died in TB sanitoriums (Olofsson et al., 2008). As a result, many Inuit lost their traditional connection to land and culture. At one point, one in every seven Inuit were in treatment in the south. By 1970, the long-term hospital treatments slowed the epidemic, but Inuit continue to suffer from TB. On March 8 2019, Prime Minister Justin Trudeau apologized to Inuit for the deliberate mistreatment of Inuit with TB; he committed funding towards travel costs for families who knew where their relatives were buried in addition to funding for marking graves and creating plaques (Government of Canada, 2019).

Residential & Federal Day Schools

Prior to colonialism, Inuit had their own way of educating their children. Because Inuit did not have a writing system, children learned through hands-on experiential learning and oral traditions, including the sharing of legends and stories teaching lessons. Residential schools began in the late 1940s for Inuit, and the children were sent away from their families to attend the schools in places far from their home. If Inuit refused to let their children attend, they would not receive or be eligible for the Federal Family Allowance program—this was the first universal welfare program for families. While attending the school, many children were physically, sexually and mentally abused, could not speak their mother tongue nor were allowed to engage in Inuit practices. The separation of children from their parents during these events severely-affected family attachments, ways of knowing, language, knowledge, communication and the foundation of Inuit kinship society (Healey, 2016). Throughout these atrocities, it was maintained that the schools were present to benefit Aboriginal communities (Macionis & Gerber, 2005). By 1964, 75 percent of Inuit children and youth aged six to 15 were enrolled in the schools (Pauktuutit Inuit Women’s Association of Canada, 2007). The children who attended the residential schools lost their identity in many ways. The last residential school in Canada closed in 1996; however, the intergenerational trauma from attending residential school continues today. In 2008, then-Prime Minister Stephen Harper apologized to the victims of residential schools on behalf of the Canadian Government (Government of Canada, 2008).

Dog Slaughter

Dogs played an important role for survival for Inuit (i.e. hunting, travel and protection). In the 1950s and 1960s, it is estimated that 20,000 sled dogs were killed (Qikiqtani Inuit Association, 2013). The slaughter happened all across the Arctic yet was not known as a common occurrence because communities were spread apart, and communication was limited. An Inuit family coming into a town might have had their dog team slaughtered in order to force them to stay in the community. Elders have mentioned that this slaughter could also have been orchestrated to assist the Hudson Bay company (HBC) to sell their skidoos (Qikiqtani Inuit Association, 2013). Eventually, the skidoos replaced sled dogs, and Inuit started living in the communities rather than in small outpost camps. Traditionally, family groups would move to where the hunting was plentiful, but being forced to stay in one area meant that hunting was often less plentiful. Distrust towards the RCMP also began to emerge during this period. On August 14, 2019, then Minister of Crown-Indigenous Relations and Northern Affairs, Carolyn Bennett, apologized on behalf of the government of Canada for colonial practices imposed on Inuit, including sled dog killings—as well as the forced relocations and family separations—to the Qikiqtani Inuit (an Inuit organization representing the Qikiqtaaluk region) (Government of Canada, 2021).

 

Figure 2

Training Dog Team in Iqaluit, Nunavut

Note. Picture of Laura Pia Churchill training with her dog team in Iqaluit, Nunavut. Erik Boomer, taken on April 12, 2019.
1970s to the Formation of Nunavut

Over the past century, Inuit have been attempting to regain their culture and identity through the work and advocacy of a multitude of local and national level organizations. The organization towards self-government is one example, and organizations that led that process included: 1971 Indian Brother of the NWT; 1971 Inuit Tapirisat of Canada (currently Inuit Tapariit Kanatami); 1972 Inuit Cultural Institute established; and 1981 Inuit Broadcasting Corporation. At present, Inuit Tapariit Kanatami is recognized as the national voice for Inuit of Canada. The role of Inuit Tapiriit Kanatami since its inception has been to support and advance Inuit right to self-determination and self-governance. Through coordination of Inuit Tapiriit Kanatami and its national committees, Inuit were able to secure inclusion of section 35 into the Canadian Constitution Act of 1982, which affirms First Nation, Metis and Inuit rights (Inuit Tapiriit Kanatami, 2004). Inuit Tapariit Kanatami represents four Inuit land claims organizations in Inuit Nunangat and include: Inuvialuit Regional Corporation, Makivvik Corporation, Nunavut Tunngavik Incorporated, and the Nunatsiavut Government.

The Nunavut Land Claims Agreement (NLCA) is a landmark agreement with the federal government, which divided the NWT and created a new territory called “Nunavut.” Nunavut has 28 communities that cover 20 percent of Canada’s landmass and three time zones. Nunavut is separated into three regions (Kitikmeot, Kivaliq and Qikiqtaaluk). It came into being on April 1, 1999. The Legislature began with 19 Members of the Legislative Assembly (MLAs). The government is a consensus government, working for agreement among all its members and respecting Inuit Qaujimajatuqangit (IQ) values (Government of Nunavut, 2007).

The incorporation of Inuit Qaujimajatuqangit (IQ) values into every aspect of modern-day practices within Nunavut exists to maintain and enrich the cultural heritage of Inuit. IQ values are therefore central to Inuit way of living and self-determination. The following IQ values are not only integral to the way of being in Nunavut but also encompass service provisions provision and the delivery.

Inuit Qaujimajatuqangit (IQ values)
  1. Inuuqatigiitsiarniq: Respecting others, relationships, and caring for people:
  2. Tunnaganariq: Fostering good spirits by being open, welcoming, and inclusive:
  3. Pijitsirniq: Serving and providing for family and/or community
  4. Aajiiqatigiinniq: Decision making through discussion and consensus
  5. Pilimmaksarniq/Pijariuqsarniq: Development of skills through observation, mentoring, practice, and effort
  6. Piliriqatigiinniq/Ikajuqtigiinniq: Working together for a common cause.
  7. Qanuqtuurniq: Being innovative and resourceful (i.e. in solving problems)
  8. Avatittinnik Kamatsiarniq: Respect and care for the land, animals and the environment

(Government of Nunavut, 2007)

 

The incorporation of IQ values into service mandates and programming is helping shift the way systems respond in supporting individuals and families within Nunavut. The complex history of Inuit reviewed in the previous section of this chapter has resulted in the impact of intergenerational trauma. Intergenerational or historical trauma refers to trauma experienced by past generations that continues to have an impact on descendants (Crawford, 2013). In many Indigenous communities, such as Nunavut, the presence and impact of intergenerational trauma is commonplace. In recognizing this intergenerational trauma, several initiatives and groups have been working towards a model of service delivery to the most vulnerable segments of the population. The incorporation of IQ values is central to providing appropriate provision of care, as it recognizes the importance of Inuit principles in addressing historical harm. As we transition to our case study, it is important to be mindful of the themes and concepts learned in the previous sections. The application of the previous learning will aid in our perspective with respect to providing care and support to the fictional young Jessica and her family.

Community Response to Care

In this section of the chapter, we will describe the local approach and support given to children and families like those identified in the case study. In the previous section we learned of the history of Inuit through colonialism and the role of national organizations in elevating Inuit voices. Furthermore, the introduction and incorporation of IQ values into programs and services is gradually changing the relationships that community members have to these services. For example, the initial contact for Jessica, following her disclosure, is important as her connection would not have been possible without services explicitly embracing IQ values. Rooted in IQ values is the Surusinut Ikajuqtigiit protocol. The application of this protocol in Nunavut has been able to shift how service providers support the most vulnerable children and adolescents in the community.

Surusinut Ikajuqtigiit (A Group Helping Children)

Based on generations of mistrust from governmental services and entities, forming meaningful relationships is crucial in remote communities such as Nunavut. Traditionally, the basis of strong relationships in Inuit culture has typically related to connection to family, friends and community with a level of equity. The sustained resilience of many Inuit can be attributed to horizontal ties, by which individuals have equal membership and there is reciprocity and cooperation. Vertical ties are relationships in which a member has greater standing with respect to authority, knowledge and wisdom (Brown, 2020). Increasingly, as southerners and governments use vertical ties in their relationship to Nunavut, the sense of belonging and acceptance for Nunavummiut becomes revoked. Vertical ties can be instrumental in some aspects of social work practice; however, when the power balance misaligns, it can become detrimental to the culture, values, and rhythm of the community. Therefore, any collaboration must adhere to traditional community principles as a priority, and must be both reflective and reflexive of generational harm inflicted on individuals and communities by southerners. As social workers, we need to be mindful of the distinction between horizontal and vertical ties. An equitable relationship at the horizontal level can eventually inform the expertise that may be sought at the vertical level.

The creation of Surusinut Ikajuqtigiit (SI) policy as led by governmental departments in Nunavut, is based on the eight IQ values identified earlier in this chapter. Surusinut Ikajuqtigiit recognizes the importance of collaboration (Piliriqatigiinniq—working together for a common cause) within the care provided to the most vulnerable populations. The policy was achieved through active collaboration with governmental organizations who are normally responsible for the care, safety, and education of children and adolescents. The collaboration between these governmental departments, non-governmental organizations, and Elders responding to the needs of the child/adolescent and family is the foundation of SI by protecting children and ensuring that their voices are heard. SI emphasizes the need for multi-disciplinary approaches, collaborative and responsive practices, promotion of child-centred and strength-based investigations, and support services to children and youth. Without the collaboration of community members and important policies as laid out in SI, the creation of coordinated services such as Child Advocacy Centres would not exist (Government of Nunavut, 2020).

The incorporation of SI and IQ values are examples of appropriate connection between horizontal and vertical ties. If there had not been significant engagement and relationship building at the horizontal level, it would be very difficult for the community to have embraced other systems. Similarly, the creation and success of Child Advocacy Centres (CACs) is attributed to an appreciation of ties. Without one service provider willing to acknowledge their limitations to another organization with mutual interests, services would be fragmented, and would not take into account the best interest of an individual or community.

Child and Youth Advocacy Centres

Child Advocacy Centres (CACs) or Child and Youth Advocacy Centres (CYACs) exist in support of children and youth who have experienced different forms of abuse/maltreatment (Hickey, 2015). CACs/CYACs provide child-centred environments for the person receiving support. Although the CAC model may have variations across regions, it is recognized as an overall best practice model of care for response to child/adolescent abuse (Bertrand et al., 2018). The Centres are created out of a need to improve disjointed service collaboration and lack of child-centred processes, which inevitably causes more trauma to a child after abuse/maltreatment. As highlighted in Table 1, CAC/CYACs have been shown to have many short- and long-term benefits (Bertrand et. al., 2018; Herbert & Bromfield, 2016).

 

Table 1

Benefits of CACs

Short Term Benefits Long Term Benefits
  • Increased mental health services and referrals

  • Increased access to medical consultations

  • Improved client satisfaction and supports for all parties

  • Reduced number of interviews

  • Increased data collection

  • Decrease impact of Adverse Childhood Experiences (ACES)

  • Decrease incidences of risky health-related behaviours

  • Decrease impact of systemic trauma

  • Resources dedicated to improving response, community outreach

  • Increased understanding of big picture

Note. Adapted from Herbert and Bromfield, 2016.

CACs in Nunavut

It is reported that child abuse and maltreatment rates in Nunavut are approximately 10 times that of the national average (Representative of Children and Youth, 2019). The stark difference in these rates has resulted in a demonstrated need for improved service coordination in Nunavut to support children and adolescents. Based on a community needs assessment, it was determined that a CAC would provide supports using a child-centered, culturally-relevant response to young Nunavummiut (people residing within Nunavut) who have experienced child abuse and neglect (Qaujigiartiit Health Research Centre, 2010). The embracing of a CAC in Nunavut was encouraged through service partners in the creation of the SI.

With the non-governmental organization (NGO) Arctic Children and Youth Foundation (ACYF) as lead, the following organizations and departments were involved in the collaboration: Justice, Health, Education, Child and Family Services, the RCMP, and Nunavut Tunngavik Incorporated (NTI). These organizations signed a memorandum of understanding (MOU). An MOU is an agreement between distinct parties with mutually-accepted expectations. The expectation was the commitment of the highlighted parties to create a CAC in Nunavut where children and their families can feel safe and comfortable to access support.

The Umingmak Centre became operational in 2019 in Iqaluit, Nunavut. Since opening, the Umingmak Centre has provided services and resources to children and families where there have been disclosures or suspicions of crime relating to abuse (i.e. exposure to significant caregiver violence, death and homicide, sexual abuse, neglect and physical abuse). The Centre uses best practice in child abuse investigations, assessment, support and treatment by coordinating with its service partners (e.g. RCMP, Child and Family Services, Pediatricians, Justice, Education and allied community members).

Umingmak is the Inuktitut word for muskox. Umingmaks are known to be very protective of their young. When a young umingmak is in danger, the adults create a protective barrier around them to shield them from harm. The analogy of protection is rooted in the purpose of the centre and community values around caring for vulnerable children and adolescents.

 

Figure 3

Umingmak Centre

Note. The images show the various components of the Umingmak Centre. Photos taken by Kaity Inookee and Emma Akulukjuk-Hackett on September 18, 2021.

The Umingmak Centre has highly skilled professionals who provide quality service through a trauma informed lens with children/adolescents and their families.

Roles at the Centre

To help describe how a CAC works, and how it might serve the needs of someone like Jessica in our case study, we will describe the role of each member of the team at the CAC.

Child/Adolescent Advocates at the Umingmak Centre are responsible for supporting children/adolescents, and their non-offending caregivers with age specific trauma informed support. Advocates are the main point of contact for children and non-offending caregivers.  They are ultimate service and system navigators following the completion of the interview or investigative process and are a source of psychoeducation to families and children/adolescents.

The role of the Trauma and Inuit-trained Counsellors at the Centre is to support families, children/adolescents through trauma-informed information and supports. Counselling can occur in the context of individual, family and group formats. Given the disruptive nature of trauma in a family setting, family therapy allows individuals to incorporate the various available resources. With cultural and individual family considerations, family therapy can include whoever the child/adolescent views as a supportive person. Counselling can be tailored to individual needs.

The Umingmak Centre works closely with local Pediatricians. The role of the pediatrician is to provide clinical support in the investigative process, and to complete a forensic examination (collect DNA samples from child/adolescent for testing and provide essential medical care). Pediatricians also provide reassurance examination for cases where there has been a historical disclosure (disclosure that occurred outside clinical limits for examination). They also meet with the child/adolescent and their non-offending caregiver as needed in order to provide follow-up care. The Centre works closely with specially trained RCMP Interviewers in child/adolescent cases of maltreatment called the Specialized Investigation Team (SIT). The SIT was formed in 2019 as part of the Nunavut RCMP V Division. The SIT is focused on assisting and conducting investigation of sexual crimes involving children and adolescents across the territory of Nunavut. The officers will typically conduct their interview in plain civilian clothing to reduce stress and intimidation possibly triggered by the uniform. For many children/adolescents who have been interviewed at the Centre, it is typically the first time seeing an officer in civilian clothing. The interviewer’s role is to acquire as much information relating to the disclosure as possible in order to determine if a charge can be made.

The role of the Child Protection Worker is essential to the investigative process of the particular allegation/charge, and ongoing after that time as needed, to ensure the safety of the child/adolescent. Protection Workers are also known as Social Workers within Nunavut. A Protection Worker will typically bring the family to the Centre, observe the interview for further interventions and as support to the family. Simultaneously observing the interview eliminates the need for further interviews which might be distressing or retraumatizing.

Case Study and Multidisciplinary Care

Now that we have reviewed the history of Inuit in Nunavut and the CAC model, we can look at how this multidisciplinary care would look for Jessica from our case study. We will review the steps and process of investigation typically followed in Nunavut, as well as the start of healing for Jessica and her family. We learned earlier that the creation of the Surusinut Ikajuqtigiit (SI) policy was to encourage collaboration following disclosures of abuse. Disclosures of childhood sexual abuse within Nunavut typically are received through Child Protection Services and the RCMP. As part of the SI, there is an emphasis on the importance of community partners ensuring that their efforts to protect children from abuse are integrated, effective, and culturally appropriate.

Each of the smaller communities in Nunavut has a Community Health Centre (CHC). Community Health Centres provide a variety of health services (i.e. emergency, pre-and post-natal, immunizations, public health, counselling, mental health and etc.) and are typically supported by community members and nurses. In the Qikiqtaaluk region, physicians typically fly into the community on a rotational basis every few weeks. Nursing staff connect with physicians via phone or email (depending on urgency) to best support clients locally. For more complicated or urgent cases, the individual is flown to Iqaluit via scheduled flights or medevac (air ambulance).

In this fictitious case of Jessica, her disclosure activated different reporting agencies within her community of Kinngait. Upon being examined by the Community Health Nurse (CHN) at the Health Centre, the CHN had to contact Child Protection Services as part of her Duty to Report, as well as the RCMP. As we have previously learned, Child Protection is responsible for the safety of the child/adolescent and will determine if the child needs protection, whereas the RCMP investigates to determine if criminal charges are to be laid.

Due to the time sensitivity in the case of Jessica, the CHN sought direction from the physician who was on call in Iqaluit. Based on the physician consultation, the decision was made to have Jessica flown to Iqaluit for further care. A full investigation was not possible in the community due to the timing of the scheduled plane arrival, so both Child Protection Services and the RCMP made sure to connect with counterparts in Iqaluit.

Jessica Arrives in Iqaluit

In the case study focusing on Jessica, arrangements were made with Child Protection Services to provide the family with transportation at the airport. As the flight arrived late, the Child Protection Worker ensured that the family was taken to the local medical hotel/boarding home for individuals and families visiting Iqaluit for medical care. Arrangements were subsequently made with Jessica and her mother to be picked up in the morning to come to the Umingmak Centre.

Upon arriving at the Umingmak Centre, Jessica and her mother Tapisa were welcomed by the Advocate who is Inuk (singular for Inuit). At the onset of the therapeutic relationship, the Advocate typically provides a tour of the Centre to the child/adolescent and their non-offending caregiver, as was the case for Jessica and Tapisa. The Advocate reinforces the existing supports and highlights that the Centre is dedicated in building community relationships and resources to help families throughout the journey from disclosure to healing.

Often country food (food that is local to Inuit) and beverages are offered and shared during this time, which is consistent with Inuit culture. The experience can at times be quite overwhelming for non-offending caregivers as many caregivers are flooded with emotions about their own past traumatic experiences. As we learned earlier in this chapter, the impact of intergenerational trauma is pervasive within northern communities. Being in supportive spaces like the Centre can at times result in many caregivers disclosing their own experience of abuse (typically sexual maltreatment) during the introduction meeting with their child/adolescent. Caregivers of children/youth involved with the Umingmak centre have been universally thankful for the existence of services through the Centre for their child/adolescent, but often talk about the contrast in the potential impact that the Centre’s existence would have had within their own adult lives and healing had it existed for them during their childhood. As needed, the Centre typically connect caregivers to an Inuit Trained Trauma Counsellor.

Specialized Investigative Team (SIT)

Jessica was introduced to two female members of the RCMP SIT who conducted her interview. Typically, one will lead the interview and the other will monitor the interview in another room along with the Child Protection Worker. Jessica is bilingual (fluent in Inuktitut and English), but preferred to be interviewed in English, and therefore was interviewed by an English-speaking interviewer. In the event that Jessica was unilingual in Inuktitut, an RCMP member fluent in Inuktitut would have taken the lead on the interview, or an interpreter would have been provided. In Nunavut, there have been significant recognition for the need to train additional RCMP officers who are fluent in Inuktut.

Medical Examination

Jessica was then introduced to the pediatrician. The pediatrician spent time with Jessica and her mother prior to the exam, to allow them to feel comfortable and ask questions. The clinic room is child friendly and is similar to any other clinical exam room in a community health centre or hospital setting. The pediatrician provided a medical assessment, which in this case included a forensic examination and obtaining forensic evidence with a sexual assault evidence kit (SAEK). The specifics around evidence collection were provided by the forensic interview that was completed. With consent, Jessica’s mother was present for the entire examination.

Case Review

Following the interview with Jessica, the SIT members met with the pediatrician to review their respective interviews and assessments. In this case, there were significant findings by the pediatrician during the examination. It was also helpful that Tapisa kept Jessica’s clothing from the sexual assault which was then sent out for testing. The majority of sexual assault evidence collection is sent to Manitoba to the RCMP national forensic lab for testing. During this review, the SIT lead investigator also confirmed that Jessica gave a disclosure, which resulted in her uncle being arrested and charged.

Following this discussion, the SIT members, pediatrician and advocate met with Tapisa and Jessica to inform them about next steps. Tapisa became emotional after learning about the disclosure and medical findings. Tapisa expressed worries about being evicted from the familial home as it is owned by her brother (the alleged perpetrator). The team offered reassurance that the support received by Jessica would be a big factor in determining the positive healing journey ahead for her. Victims of sexual abuse have better treatment outcomes if they feel believed by the person they disclose to (Humphreys, 1992; Vaplon, 2015). Tapisa was offered additional support through the Inuk Trained Counsellor and also met with the Child Protection Worker to develop a safety plan.

At this point, an exploration of a treatment plan was reviewed with the multidisciplinary team at the Centre. Typically, for cases within the Qikiqtaaluk region, interdepartmental collaboration occurs and families are supported to travel and have ongoing support in their home community (i.e. Mental Health Nurse, Outreach Worker, Wellness Counsellor and in some cases an Elder).

In the case of Jessica, following the immediate arrest of the uncle, Tapisa, Jessica and their family were evicted from the home. This created an emergency situation of homelessness. According to Inuit Tapiriit Kanatami (2014), about 39 per cent of Inuit in Inuit Nunangat live in overcrowded homes compared to four percent of all Canadians. The significant disparity can create additional stressors and pressures for families fleeing violence. In the case of Jessica, the Protection Worker was able to make arrangements to have Tapisa and her children brought to Iqaluit for emergency housing. Nunavut operates family violence shelters in each of the three regions.

Healing Considerations

The deleterious long-term impact of child maltreatment and trauma for children/adolescents often manifests in the breakdown of family systems and poor psychosocial outcomes (Buss et al., 2015). Within treatment, the goal is recovery for the individual, family and caregivers. At the Umingmak Centre, individual trauma counselling is available for children and youth who meet criteria for counselling along with their non-offending caregivers. The treatment program provides principles of trauma-informed practice which emphasizes: trust, safety, choice and control. The goals of the programs are to reduce the negative impacts of abuse, trauma, and maltreatment while fostering resilience. Each client’s treatment plan is created collaboratively with the client and the multidisciplinary team, as the ultimate goal is to allow the child to heal holistically in the domain of the physical, developmental, cultural and spiritual self.

Being believed by a non-offending caregiver, following disclosure of abuse, can at times be transformational for the child/adolescent providing the disclosure (Bolen & Lamb, 2004; Humphreys, 1992). Simply, within the therapeutic process, non-offending caregivers possess the ability to play an essential role in supporting their child/adolescent through traumatic disclosures and subsequently the experience itself. In keeping with the importance of familial relationships among Inuit, there is active mobilization of the child’s support systems. The additional recognition of the non-offending caregivers highlighting their own historical and sometimes active traumas, can at times complicate the healing journey for the family, particularly the child/adolescent (Manion et al., 1996). The complexities of supporting the family system through a culturally-centric approach in helping members of the family heal in their recovery journey, specifically focusing on the challenges facing the non-offending caregivers and their respective traumas, is quite significant. The role of the Inuit Trained Trauma Counsellors assists in making this work successful.

Multidisciplinary teams can be incredibly helpful for families such as Jessica’s in navigating their healing journey through the linking of services and resources available within the community. Although, discussion and actions coming from these teams’ meetings will look different for every child/family, the collaboration of partners remains essential in better understanding and meeting the needs of each child.

The well-being of children is impossible to separate from the well-being of their caregivers and others within their community (McKenzie et al., 1995). Within the literature it is well understood that non-offending caregiver support typically has four major dimensions: believing the child, protecting the child, emotionally supporting the child, and obtaining resources for the child (Priebe & Göran, 2008). The shame associated with sexual abuse is at times amplified in remote communities such as Nunavut. As the child/adolescent moves through their trauma healing, the objective is to create new narratives which will empower them to reconnect with previous joys and normalcy within their lives and community. Part of this reconnection centres around family and strengthening the bond associated with same. In collaboration with the family, the Centre is actively finding ways of incorporating traditional healing (i.e. on the land programming) to increase the reconnection for the child/adolescent. Additionally, part of the healing includes increasing the child/adolescent’s cultural identity through mentorship with the Inuit Advocates at the Centre. For Jessica this includes learning about her own Inuit history through the experience of running a dog team or being part of therapeutic groups with peers who have had similar experiences.

 

Figure 4

Being on the Land

Note. Healing incorporates the replenishing aspects of being on the land with clients regardless of season. Photo taken in the summer months of August 2020 by Kylie Aglukark.

Levels of Social Work Practice in Nunavut

Now that we have described a case scenario, we will dissect the levels of social work practices in Nunavut, while keeping this case in mind.

At the micro level, it is important to recognize some of the barriers that individuals and families have to services. Clients like Jessica and her family received a variety of supports including individual, family and group therapy that was individualized to their specific needs. Within this work, clients are actively referred to other services within the community in order to achieve their full potential and healing needs. The involvement or exclusion of families within the therapeutic relationship at the micro level can also instill or breakdown further issues at this level. Being a social worker within a remote community such as Iqaluit is more than simply providing service and linking people to services. The role and responsibility has many important considerations, especially when working with vulnerable populations. Social workers need to be mindful of the generations of harm and the perpetual continuation of this within systems. More importantly the level of power and trust at the micro level needs to be respected and recognized when navigating larger systems with families.

As social workers, our work with clients at the meso practice level typically involves participation in working groups and advocacy towards achieving equitable services within the community. An example of this includes the formation of the Arctic Child and Youth Foundation (ACYF), which was founded by community leaders such as the current Governor General of Canada, Mary Simon. In 2003, along with other community members, Mary Simon created the organization ACYF to support children and youth of Nunavut to navigate their quickly changing world from the traditional Inuit way of life. About a decade later, the prevalence of childhood sexual abuse was becoming even more apparent, and leading community members created a working group to address this important issue. The first Child Advocacy Centre (CAC) in Nunavut is an example of the gradual grassroots movements to address community issues at the meso level. Families, like Jessica’s, are able to receive coordinated services as a result of organization at the meso level.

Similar to the working group in the meso system, it took a couple of community leaders to focus on changes at the macro practice level. As a result of their efforts over the past two decades, changes have occurred at the political level by having a Memorandum of Understanding (MOU) created within all the departments in Nunavut who are responsible for the well-being of children, such as Education, Health, Justice, Child and Family Services, the RCMP, and Nunavut Tunngavik Incorporated (NTI). The support of leaders from these departments for this MOU has allowed the opportunity for there to be a focus on children and adolescents in Nunavut to receive the coordinated, consistent care they deserve with respect to adverse experiences such as abuse and maltreatment. The opening and subsequent success of the Umingmak Centre has also encouraged governmental and non-governmental funders to create a second CAC within the Kitikmeot region of Nunavut.

Without the advocacy of social workers, allied professionals and community members doing individual and family interventions and then shinning a light to the important and prevalent issue of child abuse, there would have been no working groups, political will and data collection to support the need of a transformative approach to addressing child abuse in Nunavut. The collaboration of these leaders would not have been possible without the ability to contextualize the issue of abuse and the manifestation of it as evidenced by significant harm inflicted on the community following colonization. Community members actively recognized the impact of the historical harm and transformed it through an adherence to Inuit Qaujimajatuqangit (IQ) values, working collaboratively across sectors for the betterment and future of the most vulnerable populations.

Ethical Considerations for Working in the North

The urban metaphor of being neutral and understanding of a culture does not capture the knowledge and history that must be acquired prior to working within a northern community setting such as Nunavut. There is a strong foundation of culture and experience in each community that requires respect from southern workers. Without the provisions outlined in social work codes of ethics, the manner in which professionals conduct themselves could adversely affect not only the worker but the type of work done with vulnerable clients and their families. An adherence to regulated bodies such as a college of social work, can ensure that the work is being guided with the best interests of our clients, especially in marginalized and vulnerable communities in Nunavut. In stating this, our clients are left at a disadvantage when we engage in the work without any accountability through connection with a regulated body. Currently, in Nunavut, there is no mandate to be part of a college of social workers, which can lead to concerns especially when the individual is a new graduate. Ideally, a competent social worker is guided by legislation so that they are better able to work within those parameters or possibly challenge policies. When practitioners do not have a professional college to belong to, this can create issues with appropriate checks and balances, which can leave the client in a situation with limited recourse if ethical violations occur. In remote communities such as Nunavut, having a professional college affiliation is essential when considering the history of harm.

Although professional membership is not mandatory, many social work practitioners in Nunavut have opted to be part of the Association of Social Workers in Northern Canada (ASWNC). The ASWNC represents social workers in the Yukon, Northwest Territories and Nunavut. The aim of the Association is to provide support to social workers through professional development and representation at the territorial and national level. The values in the Code of Ethics adhered to by ASWNC follows that of the Canadian Association of Social Workers (2005), which includes: respect for the inherent dignity and worth of persons; pursuit of social justice; service to humanity; integrity in professional practice; confidentiality in professional practice; and competence in professional practice.

The issues that arise in northern social work practice include practicing beyond our competence, dual relationships, having too much access to information, and limited supervision. An additional issue is professional drift which can occur in northern communities where a social worker can abandon the purpose associated with the profession in place of roles associated with other disciplines. The role of a regulatory body would be to ameliorate the emergence of such issues by keeping social workers within the boundaries of their profession. Although there is no regulatory body within Nunavut, practitioners are still morally obliged to uphold these standards and adhere to these boundaries through membership involvement and appropriate supervision.  When practicing in northern and remote communities, the lack of resources or “experts” within communities can result in many social workers engaging in work that is normally outside their expertise, or a practicing social worker might align oneself with the practice of other professionals within the community (Schmidt, 2009). For instance, a social worker might be asked to assist with a role outside their usual scope, simply due to a shortage of staff. Although well intentioned, this alignment may lead to service and care that is not client centred. Social workers who embrace these additional roles for the sake of resource scarcity also risk denying clients their right to feel empowered. Due to the nature of social work practice in the north, we are also privy to more details of our clients’ personal lives, as we are neighbours with our clients; we see them at the grocery store and at the hockey rink. This familiarity is not the case in other geographical settings. Truly, the combination of these factors places us in various ethical predicaments.

For social workers in northern practice, appropriate supervision is essential in ensuring that the described challenges are avoided. In balancing a client’s right to self-determination along with an ethical dilemma, the role of a culturally-diverse multidisciplinary team is even more important in all decision-making processes.

As social workers, our professional knowledge, insight and experience allow clients to work with us and hopefully trust us.  If barriers exist to us upholding that professionalism, this may impact our ability and growth as a social worker, which in turn will negatively impact clients. Any regulatory body for our professional code of ethics is a reference point that allows us to do the work that we are intended to do within this helping profession. Furthermore, our removal from this process, or lack of acknowledgement of the historical context, would be harmful not only to our therapeutic relationships but also to the growth experienced by our clients.

Challenges and Barriers

Geography poses the most significant barrier to families and their ability to access professionals, including social workers. Finances for physical travel are obvious, but the latent barriers geography poses for families are perhaps more dangerous to meaningful access. The implications of Jessica and her caregiver travelling some distance for care outside her home community are significant. Without access to childcare, families with a child/adolescent in need of medical practitioner care, as well as care from allied professionals (including social workers) at a Child Advocacy Centre (CAC) may be forced to choose between accompanying the child to the CAC and leaving remaining children in non-ideal child care arrangements or in the temporary care of a child welfare agency. In addition to child care issues, accessing care may mean parents are forced to choose between taking unpaid leave from work and forgoing wages needed to feed and house their families. As social workers in remote communities, we need to be aware of these realities, as they provide essential context to any client intervention and goal setting. Awareness of these realities also ensures that we manage our expectations of our clients by not asking too much of them.

The reality of the case of Jessica highlights many inequities that continue to exist for victims of child abuse and family violence. Limited availability of resources typically means that the victim has to relocate in order to access support. In some instances, the abuse is maintained and perpetrated as the victim(s) are unable to leave, and there are no emergency resources within the community. The daunting reality faced by families like Jessica’s present additional stressors and systemic barriers for families in their healing. In this situation, following the disclosure, Jessica had to travel out of her home community for additional care and supports. Jessica also learned that, as a result of her disclosure, she and her mother were no longer welcomed in the familial home. As the family considered these new changes, Jessica and her siblings also had to consider changes to their home environment, social life and emotional supports. Tapisa also has to be able to navigate new employment and support systems for herself and her family.

The challenges facing the child/adolescent in a remote community in Canada are evident and need to be acknowledged. Southern social workers in remote communities such as Nunavut need to understand the barriers in place and how these barriers may affect children and families. This understanding will help social workers and allied professionals in connecting and supporting families successfully at the micro/meso/macro levels. As seen by the progression of grassroots organizations, no social worker or medical practitioner is going to change the world overnight. Rather, the role is to understand and chip away at the challenges that have been cemented through generations of trauma and wrong-doing. Understanding the community, knowing the families and their challenges, understanding the available resources and the lack of resources facing families, and listening to concerns is crucial to transformational and meaningful change.

In addition to understanding children/adolescents, their families, and the communities from which they come, it is extremely important that social workers from the south operate from the perspective of diligently making connections and knowing what resources are locally available. Whether it is the Community Health Nurse (CHN), the Child Protection Worker, a community justice worker, a government representative, or an Elder, such individuals will understand family dynamics, relationships, and any existing trauma far more than someone operating from a stand-alone place of “expertise.”

Conclusion

Inuit have lived in the Arctic region for over 5000 years and are the original inhabitants (Inuit Tapiriit Kanatami, 2004). Prior to colonization, Inuit resided in small, family-based camps, and were nomadic, travelling seasonally on the land for hunting, fishing and gathering all their food and resources. To survive the harsh climate, Inuit typically depended on each other to meet their basic physical needs (i.e. food and shelter). Established values sustained families throughout these hardships, and the resilience of Inuit has sustained them over the years. The role of Inuit Qaujimajatuqangit (IQ) values have also been instrumental in the maintenance of culture and identity. Furthermore, the incorporation of IQ values in policies and organizations has proved beneficial in the lives of Inuit, but this is an active process and practice, especially for southerners working in Nunavut with children/adolescents and their respective families.

As professionals working in remote communities such as Nunavut, it is our duty to be informed about the histories and oppressions experienced by our clients. The deleterious long-term impact of child maltreatment and trauma for children/adolescents often manifests in the breakdown of family systems and poor psychosocial outcomes (Buss et al., 2015). The discovery of a child experiencing severe maltreatment can cause trauma to each family member, and can have serious implications for the lives of all family members. How a parent responds to a child disclosing abuse can also have a dramatic influence on the child. In a territory such as Nunavut, with a well-documented history of intergenerational trauma, social and physical inequalities, the impact of a disclosure in the family is typically experienced differently in that the dynamic shift can be significant (Representative for Children and Youth, 2019). Multidisciplinary teams can play a significant role in the healing of families, especially when the team is representative of the uniqueness of the community and its needs.

Based on the two decades of commitment towards the realization of the first CAC in Nunavut, it is easy to appreciate the complexity and challenges of historical harm. The Umingmak Centre plays the vital role of supporting children/adolescents with disclosures of abuse (e.g., sexual, physical, neglect and exposure to violence). The multidisciplinary approach is rooted in recognition of cultural perspectives and understanding of the initial disclosure and healing journey. Based on the uniqueness of the remote community, services available to the children and their respective families are fostered and enriched from a cultural perspective by creating allies within the community along with fostering service partnerships.

In supporting a child/adolescent in their healing, family involvement must be central to the child/adolescent’s overall recovery. Childhood sexual abuse is relational by nature, and therefore the importance of aligning with families to foster further healing through social learning and corrective narratives has the potential to sustain wellness within families. Increased connection and support is key to increased family empowerment, healing, safety, sense of self and resilience, and reduced generational transmission of trauma response.

Activities and Assignments
  • If you were to start planning to open a CAC in a northern community close to where you are now, whom would you speak to first, and what would be your priorities in planning? Apply the concepts of micro/meso/macro to your answer.
  • You are starting a new job in Kugluktuk, Nunavut as a social worker. You have recently graduated and are very keen. What do you expect will be your three biggest challenges, and how might you overcome those challenges?
  • As part of your self-care, you have joined an extracurricular activity playing frisbee. One of your teammates is a parent of a family that you are involved with at work. How would you navigate this interaction?
  • A caregiver you are supporting informs you that she is worried about a case conference at their child’s school. How would you apply the Surusinut Ikajuqtigiit in this situation to ease her worries about the meeting?
  • This chapter highlighted the many challenges experienced by Jessica in leaving her home community to receive service. As the social worker helping the family with their transition to their new community, which IQ values will you apply to guide this process?

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Rural and Northern Social Work Practice: Canadian Perspectives by Daniel A. Afram and Amber Miners is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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