Two-Eyed Seeing in action: Project extension for community health outcomes - Indigenous chronic pain & substance use.

Background: Indigenous Peoples in Canada experience health disparities, including higher rates of chronic pain. Many report distrust of the health system due to factors such as racial discrimination. A lack of appreciation and respect for Indigenous knowledges further contributes to feelings of alienation. In 2022-2023, we offered the first Project Extension for Community Healthcare Outcomes (Project ECHO) Indigenous Chronic Pain and Substance Use Health (ICP&SU) to health care providers interested in improving chronic pain care with and for Indigenous Peoples in Canada. The program reflects a Two-Eyed Seeing approach weaving together Indigenous and Western approaches to chronic pain and substance use health care. Aims: We describe the development and implementation of Project ECHO ICP&SU. Methods: Following guidance from the project Elder, we use storytelling, centered around the metaphor of weaving, to discuss the conception and implementation of Project ECHO ICP&SU. We also describe our engagement in sharing circles and ceremonies to share stories, knowledges, and lessons learned. Results: With strong Anishinaabe leadership, the program was implemented as intended and reached 121 health care professionals. Lessons learned included an overt recognition of the influence of different structures and institutions on programs and for a culturally safer development and evaluation frameworks for future Project ECHOs to improve care with and for Indigenous Peoples. Conclusions: Project ECHO can be a vehicle to enact Truth and Reconciliation Calls to Action through weaving relationships and knowledges to create culturally safer institutions and practices to improve chronic pain, substance use health, and wellness, with and for Indigenous Peoples.