Rethinking early intervention therapy with Indigenous communities and families in northern British Columbia

Early intervention therapy (EIT) programs for children with developmental challenges and disabilities have been shown to be highly beneficial for young children (0-5 years) in the wider Canadian population. However, EIT programs are consistently significantly under-utilized by Indigenous communities and families. Indigenous parents and community stakeholder perspectives on EIT are largely absent in current literature, and Indigenous communities are often not consulted on how these programs are delivered. 

Dr. Gerlach’s research will generate new knowledge aimed at improving the health, development, and quality of life of Indigenous children with developmental challenges and disabilities. The research will take place in northern BC, where there are a large number of rural/remote First Nations and urban Indigenous communities. This study builds on Dr. Gerlach’s extensive experience working with Indigenous communities, organizations, and families as an early intervention occupational therapist and community researcher. The methodology has been developed in close collaboration with research impact partners, including community stakeholders, the First Nations Health Authority, the Ministry of Children & Family Development, and child development centers in the northern region. 

A local Indigenous advisory circle will be formed to guide the research process, and sources such as policy documents and interviews with key policy stakeholders will provide insight into how funding, policy, and organizational factors influence Indigenous parents and children’s access to and use of EIT services. The results of Dr. Gerlach’s research will inform the creation of EIT practices and policies that are responsive to the realities, strengths, and needs of Indigenous families and children living in rural and remote communities in northern BC. The findings will also be shared with a wide audience through community forums, policy briefs, and publications.

This research has national and international relevance at practice and policy levels. BC has an opportunity to take a leadership role in this emerging field of research and in the implementation of Jordan’s Principle, which is focused on achieving health equity for all Indigenous children regardless of where they live. 

Understanding health equity and resource development (UnHEARD): New tools for assessing the health equity implications of unconventional natural gas development on rural and remote communities in northern British Columbia

Resource extraction and development activities are the primary drivers of social and economic development for communities across northern Canada, and therefore are significant determinants of community well-being. However, there is growing global recognition that the benefits of resource development are not distributed evenly across the supply chain, and that new tools are required to understand how anthropogenic changes in the natural environment affect population health.

This study uses the case of unconventional natural gas development in northern BC’s rural and remote communities to enhance the scientific understanding between resource development pathways and human health. BC is currently preparing for the rapid development of its natural gas reserves in conjunction with other diverse forms of land use and development (e.g. forestry, mining, industrial agriculture, etc.). However, the health impacts of rapid industrial growth are not well understood, and differences will be abound between gas extracting regions in the northeast of the province, gas transportation corridors through the northern interior, and gas exporting communities on the northwest coast.

In seeking to contextualize health impacts associated with resource development across the supply chain, this research will work to develop a new health equity impact assessment tool that is rooted in international best practices to explicate the intersections between ecosystems, the boom and bust cycle of resource-dependent towns and regions, and the resulting impacts on human health which are often overlooked in existing provincial environmental assessment and cumulative effects assessment protocols. Indeed, an explicit focus on health equity is a purposeful way to understand how health impacts are distributed across time and geographic space related to rapid resource development, thereby giving voice to health issues that often go UnHEARD during project permitting and planning. This work will involve the integration of a variety of data types to track changes in the distribution of health outcomes over time, and enable the identification of programs and protocols capable of mitigating associated health risks. Accordingly, this research will inform provincial regulatory processes through an expanded understanding of environmental disturbance as a context for health promotion, while assisting regional stakeholders in minimizing harmful impacts of industrial activities on community and worker health.

Mirrored integrated patient practitioner journey mapping for addressing persistent health inequities lived by Aboriginal people in Northern British Columbia

Aboriginal people in northern BC live with persistent health service inequities. This research asks:

  1. What is the current character of the interface between health provision institutions and Aboriginal communities in the rapidly evolving social, cultural and political climate?
  2. In the diverse landscape of Aboriginal communities, what are the common gaps in health services and programs, and how can they be addressed in a holistic way to renew the health and well-being of Aboriginal people and communities?     

Research design heavily incorporating Indigenous methodologies, ways of knowing, and decolonizing methodologies will be used to develop a model for integrated health and a well-being journey mapping integrating both sides of the patient/practitioner interface with specific attention to:

  • Socio-cultural determinants of health.
  • The specific context of Aboriginal communities in urban, rural and remote northern BC.
  • Attention to applied methodologies and Knowledge To Action (KTA), Aboriginal KT (AKT), and integrated Knowledge Translation (iKT) strategies.

This work will:

  • Describe the nature of the current paradigm shift in health services and program provision for Aboriginal communities and identify emerging streams of new vision and work to improve their health and wellbeing.
  • Identify and explore community-driven mechanisms to renew trust at the community-institutional interface and to expand access to culturally safer programs in Aboriginal communities.

Health, Creative Arts, and Northern Communities

With the highest rates of premature mortality at 3.71/1,000 people, the Northern Health Authority has the lowest health status in BC. Dr. Sarah de Leeuw’s research seeks to address this issue by examining how creative arts and the humanities can help resolve health inequities experienced by Indigenous and non-Indigenous people in northern BC.

To do this, she will draw on her previous research as well as growing global evidence that shows how medical humanities and health-based creative arts can enhance well-being. She will also look at how social determinants of health frameworks can explain health disparities.

She will lead a team of northern BC community advisors, health researchers, and medical/health science students. The team will develop and deploy multi-disciplinary creative methods and methodologies to harness, document, translate, and disseminate existing northern strengths – especially First Nations’ – as a population health and wellness initiative.

Her research will:

  • Advance new methods, approaches, and models – anchored in creative arts and social determinants of health frameworks – that produce and translate innovative ways of addressing health inequities.
  • Promote rural, northern and First Nations communities through the creative arts as places where health service providers want to live and work.
  • Use creative arts to increase interest by locals – particularly First Nations – to pursue health and medical education and training within the region and to then stay in the region.
  • Encourage multi-disciplinary cross-community collaborations.
  • Augment northern health education curricula (nursing, social work, medicine, community health) with accessible, targeted, and affecting knowledge.
  • Circulate strengths-based evidence about populations in the Northern Health Authority – especially First Nations – beyond the borders of the health authority with the intent of encouraging southern, urban, and non-Indigenous British Columbians to feel vested in the wellness of BC’s northern populations.

Global view of pre-mRNA splicing in Saccharomyces cerevisiae

Proteins, the molecules that carry out most cellular functions, are synthesized according to information contained in DNA sequences. Converting information from DNA into a protein requires an intermediate step in which the DNA sequence is copied into a molecule called mRNA. In humans, there is an essential biochemical process called pre-mRNA splicing, in which certain (non-coding) portions of the sequence are removed and the remaining protein-coding portions are joined together to form a template for protein synthesis. This is a complex process with multiple steps, and even small errors can be dangerous. Many diseases, such as some cancers, Alzheimer’s disease, and Parkinson’s syndrome, can be attributed to defects in the pre-mRNA splicing machinery. Perhaps due to the complexity and requirement for absolute precision in splicing, the molecular machine that carries out splicing – termed the spliceosome – is enormous. For both humans and yeast, its components number well over 100. However, several splicing proteins likely remain unidentified. A thorough understanding of splicing will require a complete inventory of its parts. Paul Kahlke is identifying novel splicing factors in yeast, which serves as a laboratory model for human splicing. His objective is to uncover previously unknown splicing factors and to determine whether existing candidate proteins are indeed integral to splicing. His studies take a whole genome approach, testing many genes one by one to see which ones are involved in splicing. By screening a large number of genes, Kahlke hopes to identify several new splicing factors and gain insight into the function of known pre-mRNA splicing factors.

Structure and RNA-cleaving function of apurinic/apyrimidinic endonuclease 1 (APE1)

Cancer occurs when cells won’t stop growing. The source of this malfunction is often an alteration in DNA, the genetic instructions for making different proteins inside a cell. To make proteins, a gene is copied out from the DNA into a molecule called mRNA. The mRNA travels out of the cell nucleus and into the cytoplasm, where its genetic instructions are used as a template for synthesizing proteins. C-myc mRNA serves as a template for synthesizing the c-Myc protein. This protein plays fundamental roles in regulating growth, differentiation, and cell death in virtually all mammalian cells, and it is implicated in diverse human cancers. In fact, it has been estimated that c-Myc dysfunction contributes to one-seventh of all cancer deaths. One way that cells regulate their level of proteins is by destroying mRNA in the cytoplasm by chemically cutting, or cleaving, its molecular structure. Recently, the enzyme APE1 was discovered to cleave c-myc mRNA. This opens the potential for using APE1 to reduce or eliminate levels of c-Myc protein in the cytoplasm as a potential treatment for cancer. Wan Kim is exploring the function of APE1 as an mRNA destroyer. He is identifying the key amino acids and mechanisms APE1 uses to cleave c-myc mRNA, and determining whether the enzyme cleaves any other types of mRNA. Kim hopes to generate valuable insights into how APE1 can degrade c-myc mRNA and influence gene expression. Also, the study will provide useful information on the potential design of novel approaches in cancer treatment.

The mechanism of U4/U6 Di-small nuclear ribonucleoprotein formation: a modification/interference analysis

Proteins, the molecules that carry out many cellular functions, are synthesized according to information contained in DNA sequences. Converting information from DNA into a protein requires an intermediate step in which the DNA sequence is copied into a molecule called RNA. In humans there is an essential biochemical process called RNA splicing, in which non-coding portions of the sequence are removed and the remaining protein-coding portions are joined together to form a template for protein synthesis. Ninety percent of human genes are subject to splicing, so it is not surprising that errors in this process have been linked to a wide array of diseases, including retinitis pigmentosa, spinal muscular atrophy, cystic fibrosis, myotonic dystrophy, Alzheimer’s disease and cancer. Splicing is catalyzed by the spliceosome, a large and dynamic complex that consists primarily of five small nuclear ribonucleoproteins (snRNPs) designated U1, U2, U4, U5, and U6. During spliceosome assembly, the snRNPs interact with each other in a step-wise, ordered way. One of the first steps in assembly involves U4 and U6 pairing to form a particle called the U4/U6 di-snRNP. Although the di-snRNP complex is essential for spliceosome assembly and function, the mechanism by which it forms is poorly understood. Tara Wong is investigating the process by which U4 and U6 undergo essential conformational changes necessary for spliceosome assembly. She is using chemical modification/interference experiments to determine how free U4 and free U6 snRNPs interact to form the U4/U6 di-snRNP. This knowledge will be fundamental to understanding spliceosome assembly and function, and should ultimately lead to a better understanding, and treatment of splicing related diseases.

Workplace Traumatic Exposure Team

One of the most serious effects of occupational stress is mental illness — a prominent health issue in terms of both financial and human costs. It is estimated that mental injury claims are approximately 50 per cent more costly than physical injury claims, since workers with a mental injury are typically absent from work longer than those with a physical injury. Post traumatic stress disorder (PTSD) and anxiety disorder are the most significant mental injuries originating in the workplace. The majority of workers will encounter an emotionally traumatic work event at some point in their career. Despite the negative implications for the worker and for society, workplace traumatic exposure has not yet been extensively studied in BC. This award supports the development of a team consisting of researchers at UNBC and UBC who are working to pool their individual expertise in workplace traumatic exposure. The team will develop their research around description/understanding, prevention, remediation and policy/knowledge translation.

Dissection of Prp24 Functional Domains using Molecular Beacons

Pre-mRNA splicing is a critical step in the process by which genes direct the production of proteins. While there are many aspects of this process we do not yet understand, it is clear that splicing must be incredibly accurate. Errors can result in a number of devastating diseases, including myotonic dystrophy, spinal muscular atrophy and retinitis pigmentosa, which results in blindness. Splicing errors have also been linked to the growth of malignant tumours and the development of cystic fibrosis and Alzheimer’s disease. Amy Hayduk’s research at the Rader Lab at the University of Northern British Columbia is directed at understanding the mechanisms that make up the process. Specifically, she is using molecular beacons to study the roles of the four RNA recognition motifs of the protein Prp24. This work builds upon original research conducted by Hayduk involving a novel application of molecular beacon technology to RNA detection. By analyzing the degree of impairment in the activity of Prp24 resulting from specific gene mutations, her work will help explain the molecular interactions through which pre-mRNA splicing is accomplished. By contributing to a more precise understanding of the intricate sequence of molecular interactions that constitutes pre-mRNA splicing, this research will assist with the development of strategies for treating diseases that arise from defects in splicing.

Who works in rural areas?: Experiences and characteristics shared by long term health care professionals working in rural areas of Northern British Columbia

The recruitment and retention of health care professionals is one of the most pressing challenges facing the Canadian health care system today. BC is competing with the rest of the world to recruit and retain physiotherapists, pharmacists, X-ray technicians, socials workers and other health care professionals. This challenge is even more prevalent for rural and northern BC communities seeking talented professionals. Candice Roberge is researching the experiences and personal characteristics shared by health care professionals who successfully make a career of working in rural, northern BC communities. Her study will provide insight into the kind of people that need to be trained to meet the health care needs of rural BC. With her findings she hopes to assist health authorities target their recruitment strategies towards health professionals who will thrive on the lifestyle and the unique rewards of providing health services in small-town BC. In addition, her research strives to improve health care services and accessibility to services for individuals living in rural BC.