Our case study presents insights from our experiences of “integrating” Indigenous ways of knowing and being into integrated youth services (IYS), a growing Canadian model for offering a range of services to youth aged 11–25. Huddle NorWest, one of Manitoba's IYS hubs, serves a diverse population of youth, with ~30–40% identifying as Indigenous. Recognizing the importance of culturally safe care, Huddle NorWest seeks to understand the factors that contribute to Indigenous youths' comfort in accessing its services. Current engagement strategies include an on-site Indigenous Elder, culturally relevant programming such as beading and ribbon skirt making, and the integration of Indigenous art and teachings throughout the space. As part of its broader commitment to reconciliation, NorWest Co-op Community Health actively supports a Truth and Reconciliation Commission (TRC) Committee and has signed the Winnipeg Indigenous Accord, outlining a three-year action plan to align with the TRC's Calls to Action. Indigenous perspectives are embedded in the organization's governance and advisory structures since 2017, including community and youth advisory councils, half of whom identify as Indigenous. This work reflects an ongoing effort to build trust and provide culturally safe, inclusive services for Indigenous youth, and can inspire other urban IYS serving Indigenous youth.

Introduction

Indigenous youth represent one of the fastest-growing and youngest populations in Canada. Over 41% of Indigenous Peoples are under the age of 25, and the population of First Nations, Inuit and Métis youth aged 15–30 has increased by more than 39% in recent decades (Statistics Canada 2018). This underscores the role of Indigenous young people for community well-being, vitality and cultural revitalization. Indigenous youth health and well-being must be understood within the broader historical, social and political contexts that continue to shape their lives. The enduring impacts of colonization have led to intergenerational traumas, cultural disruption and socio-economic inequities that contribute to disproportionate rates of mental health and substance use concerns among Indigenous youth (Goetz et al. 2023; Radford et al. 2022). These structural determinants intersect with other barriers to care, such as geographic isolation, underfunded services, provider turnover, mistrust of mainstream health systems and the lack of culturally grounded, community-led supports. Despite strengths such as cultural continuity, community resilience and longstanding healing traditions, Indigenous youth continue to encounter service systems that fail to reflect their realities, values and cultures. This is especially true in urban settings, where most Indigenous youth now live (Anderson 2021).

Most mental health problems emerge before the age of 25 (Solmi et al. 2022). With adolescence and young adulthood representing critical periods for many developmental milestones, mental health problems, including anxiety, depression and substance use and other challenges related to transitions to adulthood (e.g., finding housing, employment and educational opportunities), are major contributors to distress and reduced quality of life among young people. These concerns were already rising before the COVID-19 pandemic and have since appeared to amplify (Statistics Canada 2024; Wiens et al. 2020). However, many youths continue to face substantial barriers to receiving timely, appropriate and youth-friendly services and supports. Common barriers include long wait times and fragmented, siloed systems of care. The recognition that traditional mental health systems were ill-equipped to meet the diverse needs of the youth population has fueled efforts to redesign models of care. These efforts have aimed to create services that are accessible and address the multiple and intersecting needs of youth across physical health, mental health, community and educational sectors.

Building on recent service transformation research projects such as the pan-Canadian ACCESS Open Minds network (Iyer et al. 2025; Malla et al. 2019), Canadian jurisdictions have increasingly turned toward the development of Integrated Youth Services (IYS) models (Integrated Youth Services n.d.). IYS aim to consolidate mental health, physical health, substance use, educational and social support services within single, youth-friendly entry points. These hubs are typically co-designed with youth and families to ensure that services are relevant, accessible and responsive to local needs. Currently, all provinces and territories in Canada have implemented or started to develop their own jurisdictional IYS, including Aire ouverte (Quebec), Anchor (Nova Scotia), Becket (Newfoundland), Foundry (British Columbia), Homebase (Saskatchewan), Huddle (Manitoba), Kickstand (Alberta) and Youth Wellness Hubs Ontario (Ontario). Among the key guiding principles of IYS is “cultural safety” and a “wholistic, trauma-informed and harm reduction approach,” with the goal of “support(ing) Indigenous youth” (Pan-Canadian Guidance for Integrated Youth Services 2023). Yet the ways in which cultural safety is operationalized and whether it increases uptake of services by Indigenous youth remain insufficiently documented within IYS hubs.

Given that many Indigenous young people are now in many urban settings, IYS hubs may be serving large numbers of them. Despite this, a gap remains in understanding how IYS models recognize, integrate and meaningfully engage with Indigenous worldviews, cultural practices and community priorities. There have also been a few published reports of the number of Indigenous young people receiving services at urban IYS. Understanding how urban IYS services are being designed to support Indigenous youth and whether there is uptake of their services by Indigenous youth remains a significant priority and the aim of this paper, drawing on lessons from Huddle NorWest.

Huddle NorWest provides an important case for examining how urban IYS can meaningfully engage Indigenous youth, given its location in a city with one of the largest Indigenous populations in Canada and its longstanding community-driven approach.

Context

Winnipeg, Manitoba, is home to one of the highest proportions of Indigenous residents of any large city in Canada. In 2021, there were 91,610 Indigenous Peoples in Winnipeg, representing approximately 12.6% of the city's population, several times higher than in most major Canadian metropolitan areas. Of those, 5.7% (n = 40,340) identified as First Nations, 6.6% (n = 48,455) as Métis and 0.1% (n = 450) as Inuit. Importantly, Winnipeg's Indigenous population is quite young: 60.3% of Indigenous Peoples in Winnipeg were under the age of 35, compared with 42.9% of non-Indigenous Peoples in Winnipeg (Statistics Canada 2023).

NorWest Co-op Community Health is a large, non-profit, community health agency and healthcare co-operative, comprising 150 staff, that provides primary care and community development services to the Inkster neighbourhood in Winnipeg.

NorWest has a history of acting to meet the needs of the community. In 2009, NorWest responded to the increased gang violence in the social housing community of Gilbert Park by seeking funding for a new after-school youth program, which combined recreation and counselling programs that became known as Gilbert Park Going Places. In 2013, NorWest staff were noticing increasing food insecurity. Staff attended a conference and heard about a national movement called Community Food Centres Canada. NorWest leveraged this knowledge to create the NorWest Community Food Centre (CFC). The CFC is a dignified way to meet the food needs of the community by serving healthy meals in a sit-down family style. It also provides food education and advocacy, and now has a community farm in which participants can reclaim land and grow their own food.

In 2017, due to an increased need for youth mental health services, the NorWest Youth Hub came to fruition. The youth hub was originally modelled after the Australian integrated primary youth mental healthcare model, Headspace, which combined elements of mental health help/counselling, employment services, primary care and recreation. The intent was to be a “one-stop-shop” for youth to get their many needs met, including their mental health needs. NorWest also partnered with ACCESS Open Minds (Iyer et al. 2019) to receive training in 2019, collect data (2020–2023) and become a part of ACCESS Open Minds' community of practice.

As the NorWest Youth Hub was thriving in terms of uptake, activities and community acceptability, there were important developments regarding IYS in the province of Manitoba. The Government of Manitoba committed dedicated funding to support the establishment of youth hubs such as NorWest throughout the province. These emerging hubs were backed by a Backbone Team of professionals employed by United Way Winnipeg. In partnership with NorWest, United Way Winnipeg supported five additional sites in their transition to youth hubs, which were subsequently named “Huddle” by youth. In 2022, Huddle NorWest formally joined Manitoba's IYS network.

Each Huddle site offers youth aged 12–29 six core services, including mental health, Indigenous programming, physical and sexual health, peer support, substance use support and social services (see Figure 1).

Partnerships are foundational within the Huddle model. Each Huddle site is supported by a designated lead agency responsible for housing the hub, employing staff and overseeing operational functions. Lead agencies provide critical in-kind support, including management oversight, financial administration and organizational infrastructure, which enables hubs to function efficiently. In the case of Huddle NorWest, NorWest Co-op Community Health serves as the lead agency. Many lead agencies, including Huddle NorWest, deploy staff from other programs to work under the Huddle roof. At NorWest, staff from employment programs, community hosting and Indigenous Elder services contribute to service delivery within Huddle, strengthening the “one roof, one-stop-shop” approach that characterizes IYS.

Beyond operational and staffing support, the lead agency also shapes the hub's strategic and cultural direction. NorWest policies, work culture, staff engagement and overall leadership inform the day-to-day practices of Huddle NorWest. Notably, NorWest's commitment to truth and reconciliation is a key driver of the Indigenous programming offered at Huddle NorWest, informing both program content and the broader ethos of the hub.

A Warm, Welcoming Environment

The service's ability to support Indigenous youth begins with offering a space where all young people feel safe, comfortable and included.

Huddle NorWest has long-prioritized consistently engaging youth and creating spaces that are warm, welcoming and youth-friendly. The site offers food, snacks and refreshments in all its programs and during drop-in hours, along with access to computers, Wi-Fi and video games. These elements help foster an environment that youth enjoy and feel comfortable in. Staff have observed that young people may initially come in for food or Wi-Fi, but gradually open up and seek support. What begins as an informal point of connection can therefore evolve into access to more formal services such as counselling, primary care, housing assistance, employment supports and other services.

For young people living in inadequate or overcrowded housing, NorWest provides a safe and calming space where they can take a break from stressors associated with their home environments. Youth experiencing food insecurity are also encouraged to take food home, an initiative developed in partnership with Manitoba Harvest, a non-profit organization focused on food security and community engagement. The fresh produce offered through programming is often food that youth do not have regular access to. During the summer months, NorWest operated a youth-run fruit and vegetable market; many young people who worked at the market were able to take leftover produce home, further supporting food security.

A central element in creating warm, youth-affirming spaces is NorWest's staff. Hiring practices prioritize individuals who are knowledgeable, committed and genuinely passionate about working with young people. This approach has contributed to strong staff retention, which is essential for youth engagement. Trust and long-term relationships are foundational to youth engagement, and consistent staff presence allows these relationships to develop over time. To further strengthen staff capacity, NorWest is expanding its onboarding and professional development processes to include enhanced training in trauma-informed care and harm reduction. These efforts support the delivery of inclusive, responsive and safe services for all youth who come through their doors. This is particularly relevant for Indigenous youth, many of whom have experienced exclusion or mistrust in mainstream service systems.

Integration of Indigenous Practices and Indigenous Youth Engagement

As part of its broader commitment to reconciliation, NorWest Co-op Community Health actively supports a Truth and Reconciliation Commission (TRC) Committee and signed the Winnipeg Indigenous Accord in December 2024, outlining a three-year action plan to align with the TRC's Calls to Action. The formalization of this accord set the stage for true commitment to the values, approaches and practices required to advance this reconciliation work. Furthermore, Indigenous perspectives are embedded in the organization's governance and advisory structures since 2017, including community and youth advisory councils (YACs), half of whose members identify as Indigenous.

The integration of Indigenous practices has taken many forms over the years. Since 2023, NorWest Co-op has worked with an Indigenous Elder, who allocates two half days per week to the Huddle site. The Elder participates in direct programming (such as smudging, beading, crafting, youth sharing circles, ribbon skirt making and sewing) as well as informal activities such as spending time with youth over video games or shared meals. This presence allows youth to build trusting relationships, access cultural guidance and (re)affirm their Indigenous identity in a comfortable and relational way.

For staff, the Elder's presence has also been helpful, particularly for those who come with varying levels of knowledge and understanding of reconciliation and history. The opportunity to ask questions and receive guidance about their practices from the Elder has been particularly appreciated and is seen as an important source of support.

Multiple culturally relevant programming initiatives are also included within NorWest. These include beading and ribbon skirt making, and the integration of Indigenous art and teachings throughout the space. With many youths learning to smudge, some newcomer youths are also invited to learn by participating in smudge ceremonies. Land-based programming is emphasized, including taking youth to a sweat ceremony, although team members feel that more can be done in this regard.

Recognizing the importance of culturally safe care, Huddle NorWest seeks to understand the factors that contribute to Indigenous youths' comfort in accessing its services. For example, staff have noted that Indigenous youth are less inclined to seek services at the large, clinically focused centre; hence, staff go to smaller community-based resource centres, which offer a friendlier environment, where Indigenous youth are more likely to engage.

Creating spaces for belonging

Over the past several years, NorWest Co-op has continued to expand its presence in the community, including by renovating its main centre. The renovated site was purposefully designed to meet the needs of the diverse young people it serves, with particular attention to creating spaces that foster belonging and safety.

A key part of this process included collaborating with the Huddle NorWest YAC. Youth played a key role in shaping and designing the space. One key example of this was the youths' recommendation that the ceremonial smudge room – a beautiful space with wood highlights – be located right at the front of the building, rather than the back of the space as originally proposed by developers. This suggestion by the YAC members was a powerful statement that positioned cultural safety as a valued and visible part of Huddle NorWest (Figure 2).

Key Findings

Between April 2020 and September 2023, a total of 415 youth accessed NorWest services and participated in data collection as part of NorWest Youth Hub's partnership with ACCESS Open Minds. Of those, 29.4% self-identified as Indigenous (22.3% First Nations, 2.9% Métis and 2.3% as First Nations and Métis). This shows that NorWest served First Nations, Inuit and Métis youth at rates exceeding local population estimates and higher than what has typically been reported by traditional youth services (Okpalauwaekwe et al. 2022). Indigenous youth presented with many intersecting identities and experiences that are associated with marginalization and higher needs, with 10% identifying as gender-expansive; 54% as sexually diverse; 28% as not in education, employment or training and 21% as having unmet basic needs.

As part of the provincial IYS initiative's data collection, 412 youth reported ethnicity data between 2024 and 2025. Among them, 35.68% self-identified as Indigenous (24.27% First Nations, 10.92% Métis and the rest as Inuk). Of those, 19.67% of Indigenous youth identified as gender-expansive.

Taken together, these findings illustrate NorWest's ability to reach large and diverse populations of Indigenous youth, likely due to its engagement approaches, service strategies and commitment to reconciliation. These reach rates are notable, given longstanding evidence that Indigenous youth often face barriers to accessing mainstream youth mental health services.

Key Takeaways

1. YS can effectively reach Indigenous youth in urban settings. From 2020 onward, Indigenous youth reached out to Huddle NorWest at rates exceeding local population estimates. These reach rates are notable given longstanding evidence that Indigenous youth often face barriers to accessing mainstream youth mental health services. Although we cannot make causal inferences, the higher uptake of NorWest by Indigenous youth is likely because services were low-barrier, accessible, relational and culturally grounded.
2. A warm, welcoming environment may facilitate the engagement of all youth, including Indigenous youth. Youth-friendly spaces, access to food and technology and consistent, trusting relationships with staff may be foundational to diverse groups of youth, including Indigenous youth, accessing services.
3. Cultural safety can be enacted through governance, staffing and practices. The presence of an Elder, culturally relevant programming and Indigenous representation in advisory structures may have helped foster belonging and respect for Indigenous identity and ways of being, and affirmed Indigenous identity and cultural connectedness. These, in turn, are known to be critical for healing, wellness and service engagement (Health Canada 2015; Indigenous Child and Family Services Directors 2023).
4. There are various ways in which service design can be culturally responsive. In Huddle NorWest, some of these ways included placing a beautiful smudge room in the front of the building, integrating Indigenous arts and programming, meeting youth in smaller community settings, which they are more likely to access, embedding food and games, integrating multiple services under one roof and finally, grounding services in trust and relationality.
5. Lead agencies have a critical role in shaping the IYS’ organizational direction and culture. In this case, NorWest Co-op Community Health's commitment to reconciliation, as well as its longstanding commitment to community, integration, partnership and continuous improvement, may have significantly contributed to its youth hub's capacity to serve Indigenous youth.
6. Interventions, supports and programming should be designed to meet multiple intersecting identities of urban Indigenous youth. Aligned with previous research (Iyer et al. 2025), our data show that Indigenous youth accessing urban IYS may present with multiple dimensions, needs and vulnerabilities. IYS such as Huddle NorWest therefore have wholistic models of care, with multiple interventions such as mental health, substance use, peer support, supported housing and employment, gender-affirmative care, traditional healing and Indigenous identity-affirming practices. Our data do not, however, allow us to comment on whether and how young people were appropriately matched with services based on their preferences, needs and presenting problems.

Together, these insights offer practical considerations for strengthening the cultural responsiveness of IYS models for Indigenous youth, particularly in urban contexts. Our hope is that the principles from our example serve as inspiration for practices in other youth services that are then tailored to their Indigenous population(s), resource capacities and organizational history through co-design and stakeholder engagement.

Limitations, Future Directions and Conclusion

The data that we report on primarily reflect service uptake and self-reported socio-demographics; we did not present information on outcomes or care experiences as reported by Indigenous young people. Future research should evaluate mental health, wellness and cultural outcomes for Indigenous youth accessing IYS, and explore the role of land-based programs, ceremonies, Elders' guidance and integrated services in supporting identity, belonging and service engagement. Such research should be respectfully designed in partnership with Indigenous youth, Elders and communities, and prioritize Indigenous research, knowledge translation and data governance approaches (Melro et al. 2025; Ninomiya et al. 2022).

In conclusion, Huddle NorWest highlights the potential of culturally safe, youth-centred and community-driven approaches for enhancing the engagement of Indigenous youth in urban IYS and reducing inequities in their service access and well-being outcomes.

Funding Support

Huddle NorWest receives funding from the Winnipeg Regional Health Authority, United Way Winnipeg, the Winnipeg Foundation and RBC Bank. ACCESS Open Minds is a Canadian Institutes for Health Research (CIHR) – Strategy for Patient-Oriented Research initiative, jointly funded by CIHR and the Graham Boeckh Foundation. Srividya N. Iyer receives support from the Canada Research Chairs Program.

Comments

Be the first to comment on this!