Vicky Thomas wasn’t keen when she learned she would be using a new digital health tool called WelTel in her outreach work with Indigenous youths and adults struggling with the impacts of intergenerational trauma.
She thought it would involve a lot of extra work with little payoff. But over a decade later, the WelTel mHealth platform is an essential part of her job.
“It’s proven to be much easier to use than I ever imagined it could be, and ended up being this incredible tool to help people stay connected,” says Thomas, co-ordinator of the Cedar Project, a long-term cohort study involving about 800 participants across British Columbia that explore show historical and lifetime traumas affect health in First Nations communities.
Initiated in 2003, the Cedar Project examines the increased vulnerability to HIV, hepatitis C and other health challenges experienced by Indigenous people who use drugs. The Cedar Project was the first to demonstrate direct links between having a parent who attended residential school and risk for HIV and hep C infection, sexual assault and suicide.
WelTel has been a Cedar Project collaborator since 2012. A paper describing some of their recent work together, published in the July 2020 issue of JMIR (theJournal of Medical Internet Research), concluded that weekly two-way texting using mobile phones was an effective way to support connections and strengthen relationships that are critical to health and well-being.
The collaboration has continued through the COVID-19pandemic. In mid-2020, researchers with the Cedar Project and UBC’s School of Population and Public Health received funding from the Canadian Institutes of Health Research (CIHR) and the Michael Smith Foundation for Health Research to investigate the pandemic’s impacts on at-risk Indigenous people and how mHealth technology can help mitigate and manage those impacts.
“It’s about building a relationship with each person,” Thomas says. “The Cedar Project was the first to show the multigenerational impact of residential schools, and it’s giving a voice to all those young people who need to be heard.”
Thomas says using the WelTel platform has helped the Cedar Project succeed “beyond our wildest dreams” because it fits with Indigenous perspectives on health — a holistic view that includes physical, emotional and spiritual wellness — and it supports participants by helping them stay connected with people in their community who genuinely care about their well-being.
Here’s how: Each Monday, a text message asking, “How’s it going?” is automatically sent to participants through the WelTel mHealth platform. Responses are colour-coded to the level of attention required, and case managers follow up accordingly. On Wednesday, those who have not replied receive an additional text asking if they are ok. By Friday, case managers attempt to call those who still have not responded to the text messages.
“It’s really important for our peeps to feel as safe as they can,” she says. “They can text and share as much as they want, or nothing at all. One of our members never answers the texts just so they’ll get that follow-up phone call on Friday.”
While the response to WelTel from Cedar Project members has been enthusiastic since Day 1, the platform has been essential keeping the lines of communication open during the pandemic when in-person support services were no longer available. Maintaining those relationships is crucial, especially for people with serious trust issues due to the impacts of trauma and addiction that are the ongoing legacy of Canada’s residential school system.
“We all have that history,” Vicky says. “I’m lucky that I didn’t go to residential school, but my mom went for 15 years. It’s amazing how forgiving she is. Her voice of love and forgiveness and compassion is what keeps me going every day. She’s my hero.”