BRIDGING THE GAPS THE CRITICAL ROLE OF INDIGENOUS COMMUNITY GOVERNANCE IN HEALTH CARE

BRIDGING THE GAPS Disclosure of Commercial Support  This program has received financial support from AOHC in the form of remuneration. Disclosure of Commercial Support  This program has received financial support from AOHC in the form of remuneration.

BRIDGING THE GAPS Full Disclosure  I am not Indigenous  I am personally connected to someone who works in Indigenous health  I have worked in several areas connected to Indigenous health care  I am not an expert in health care Full Disclosure  I am not Indigenous  I am personally connected to someone who works in Indigenous health  I have worked in several areas connected to Indigenous health care  I am not an expert in health care

BRIDGING THE GAPS Quick Quiz: Aboriginal Healing and Wellness in Ontario Quick Quiz: Aboriginal Healing and Wellness in Ontario

BRIDGING THE GAPS Quick Quiz on Aboriginal Healing and Wellness in Ontario  Aboriginal Health Access Centre’s provide services to:  80% of Aboriginal people in Ontario?  5% of Aboriginal people in Ontario?  26% of Aboriginal people in Ontario?  50% of Aboriginal people in Ontario? Quick Quiz on Aboriginal Healing and Wellness in Ontario  Aboriginal Health Access Centre’s provide services to:  80% of Aboriginal people in Ontario?  5% of Aboriginal people in Ontario?  26% of Aboriginal people in Ontario?  50% of Aboriginal people in Ontario?

BRIDGING THE GAPS The Aboriginal Wellness and Healing Strategy (AWHS) identified which of these priorities:  Self-determination in Health Care?  Indigenous community governance in Health Care?  Access to traditional medicines, healers and ceremony?  All of the above? The Aboriginal Wellness and Healing Strategy (AWHS) identified which of these priorities:  Self-determination in Health Care?  Indigenous community governance in Health Care?  Access to traditional medicines, healers and ceremony?  All of the above?

BRIDGING THE GAPS An Aboriginal Wholistic Health Model includes:  Mental, spiritual, emotional, community  Physical, mental, emotional, spiritual  Emotional, family, physical, mental  Decolonization, traditional medicines, physical health, mental wellness An Aboriginal Wholistic Health Model includes:  Mental, spiritual, emotional, community  Physical, mental, emotional, spiritual  Emotional, family, physical, mental  Decolonization, traditional medicines, physical health, mental wellness

BRIDGING THE GAPS The Guiding Principles for Decision Making for Aboriginal Health and Wellness Services include:  Respecting Indigenous approaches to health and wellness  Controlling health planning and ensuring equitable resourcing  Self-Determination  Self-Governance  Ownership Control Access and Possession (OCAP) principles must be respected and guide all research with Indigenous people  All of the above? The Guiding Principles for Decision Making for Aboriginal Health and Wellness Services include:  Respecting Indigenous approaches to health and wellness  Controlling health planning and ensuring equitable resourcing  Self-Determination  Self-Governance  Ownership Control Access and Possession (OCAP) principles must be respected and guide all research with Indigenous people  All of the above?

BRIDGING THE GAPS Cultural Safety includes (select all appropriate answers):  Includes autonomy and local control  Moves beyond cultural sensitivity  Addresses systemic racism in health care systems  Recognizes and addresses power imbalances  Is determined by Indigenous clients Cultural Safety includes (select all appropriate answers):  Includes autonomy and local control  Moves beyond cultural sensitivity  Addresses systemic racism in health care systems  Recognizes and addresses power imbalances  Is determined by Indigenous clients

BRIDGING THE GAPS What is included?  The Critical Role of Indigenous Community Governance in Health Care What is included?  The Critical Role of Indigenous Community Governance in Health Care

BRIDGING THE GAPS What is included?  An overview of the critical role of Indigenous governance in the delivery of healthcare to Aboriginal people in Ontario. What is included?  An overview of the critical role of Indigenous governance in the delivery of healthcare to Aboriginal people in Ontario.

BRIDGING THE GAPS What is included?  The Aboriginal Wellness and Healing Strategy (AWHS),  The Ontario Federation of Indigenous Friendship Centres (OFIFC) and  The National Aboriginal Healing Organization (NAHO) What is included?  The Aboriginal Wellness and Healing Strategy (AWHS),  The Ontario Federation of Indigenous Friendship Centres (OFIFC) and  The National Aboriginal Healing Organization (NAHO)

BRIDGING THE GAPS What is included?  Illustrate how Aboriginal health care is best delivered through a wholistic model that includes:  Decolonization,  Self-determination and  Cultural safety What is included?  Illustrate how Aboriginal health care is best delivered through a wholistic model that includes:  Decolonization,  Self-determination and  Cultural safety

BRIDGING THE GAPS What is included?  Accreditation standards for services to Aboriginal people What is included?  Accreditation standards for services to Aboriginal people

BRIDGING THE GAPS Why?  Patients First:  “The health outcomes of Indigenous Peoples in Ontario — particularly those living in remote and isolated communities — are significantly poorer than those of the general population.” Why?  Patients First:  “The health outcomes of Indigenous Peoples in Ontario — particularly those living in remote and isolated communities — are significantly poorer than those of the general population.”

BRIDGING THE GAPS Why?  “Improving health care and health outcomes for First Nations, Métis and Inuit peoples is a ministry priority.” Why?  “Improving health care and health outcomes for First Nations, Métis and Inuit peoples is a ministry priority.”

BRIDGING THE GAPS Why?  “This means the health care system must provide better supports and services for patients, families and caregivers, and these services must respect traditional methods and be culturally appropriate.” Why?  “This means the health care system must provide better supports and services for patients, families and caregivers, and these services must respect traditional methods and be culturally appropriate.”

BRIDGING THE GAPS Who?  Aboriginal Health Access Centres (AHACS) and Aboriginal Community Health Centres Who?  Aboriginal Health Access Centres (AHACS) and Aboriginal Community Health Centres

BRIDGING THE GAPS Understanding “Indigenous Governance ”

BRIDGING THE GAPS Wholistic Models of Health and Wellbeing

BRIDGING THE GAPS

Why this model?  Capacity re-building  Recovery of families, communities and nations  Provision of culturally safe health care Why this model?  Capacity re-building  Recovery of families, communities and nations  Provision of culturally safe health care

BRIDGING THE GAPS Why this model?  Understanding “governance” from an Indigenous perspective Why this model?  Understanding “governance” from an Indigenous perspective

BRIDGING THE GAPS Why this model?  In part ~ reconciliation Why this model?  In part ~ reconciliation

BRIDGING THE GAPS How?  How? 

BRIDGING THE GAPS How?  Mamaweswen North Shore Tribal Council  N’Mninoeyaa AHAC:  AHAC Model fully optimized as a regional, full service provider How?  Mamaweswen North Shore Tribal Council  N’Mninoeyaa AHAC:  AHAC Model fully optimized as a regional, full service provider

BRIDGING THE GAPS How?  Culturally safe primary health care, traditional health and healing, mental health and addictions  Overall regional management of Community Support Services  Care coordination  Occupational Therapy How?  Culturally safe primary health care, traditional health and healing, mental health and addictions  Overall regional management of Community Support Services  Care coordination  Occupational Therapy

BRIDGING THE GAPS How?  Physiotherapy  Rehabilitation Assistants  Assisted Living for High Risk Seniors Program How?  Physiotherapy  Rehabilitation Assistants  Assisted Living for High Risk Seniors Program

BRIDGING THE GAPS How?  Assisted Living for High Risk Seniors Program  Systems navigation  Hospital discharge planning  And other home and community care services on an outreach and collaborative basis How?  Assisted Living for High Risk Seniors Program  Systems navigation  Hospital discharge planning  And other home and community care services on an outreach and collaborative basis

BRIDGING THE GAPS How?  Partnering with local Friendship Centre  Best practice in accountability to Indigenous patients and communities  Respect for Indigenous treaty rights and rights to determination in health, as outlined in Ontario’s Aboriginal Health Policy How?  Partnering with local Friendship Centre  Best practice in accountability to Indigenous patients and communities  Respect for Indigenous treaty rights and rights to determination in health, as outlined in Ontario’s Aboriginal Health Policy

BRIDGING THE GAPS How?  Shkagamik-Kwe Health Centre: Woven Blanket concept  Integrating western clinical best practice with traditional Indigenous healers and healing approaches How?  Shkagamik-Kwe Health Centre: Woven Blanket concept  Integrating western clinical best practice with traditional Indigenous healers and healing approaches

BRIDGING THE GAPS How?  A model incorporating a cultural symbol, the Blanket.  Blankets are woven deep into Indigenous history and cultures.  Involves the mutual commitment by all team members to work towards the shared goal of improvement in the overall health of an SKHC client. How?  A model incorporating a cultural symbol, the Blanket.  Blankets are woven deep into Indigenous history and cultures.  Involves the mutual commitment by all team members to work towards the shared goal of improvement in the overall health of an SKHC client.

BRIDGING THE GAPS How?  Relationship that the SKHC team has with the client is to support the person to take a major for her care  Partnership is a genuinely equal one with no helper being subservient nor superior How?  Relationship that the SKHC team has with the client is to support the person to take a major for her care  Partnership is a genuinely equal one with no helper being subservient nor superior

BRIDGING THE GAPS Woven Blanket Model of Care  Reinforces client focused approach  Recognizes self-determination for clients  Helps rebuild family/community connections Woven Blanket Model of Care  Reinforces client focused approach  Recognizes self-determination for clients  Helps rebuild family/community connections

BRIDGING THE GAPS Woven Blanket Model of Care  Flexible model of care that supports “cross-over” roles for team members  Avoids language of ownership…”my patients” “your clients”  Ensures culturally safe care Woven Blanket Model of Care  Flexible model of care that supports “cross-over” roles for team members  Avoids language of ownership…”my patients” “your clients”  Ensures culturally safe care

BRIDGING THE GAPS De dwa da dehs nye>s AHAC:  Homeward Bound – Innovation in addressing determinants of health through collaboration De dwa da dehs nye>s AHAC:  Homeward Bound – Innovation in addressing determinants of health through collaboration

BRIDGING THE GAPS Homeward Bound – Innovation in addressing determinants of health through collaboration  Population data informed program  City of Hamilton’s 20,000 Home Campaign  28% of Hamilton’s homeless population are of Indigenous ancestry Homeward Bound – Innovation in addressing determinants of health through collaboration  Population data informed program  City of Hamilton’s 20,000 Home Campaign  28% of Hamilton’s homeless population are of Indigenous ancestry

BRIDGING THE GAPS Homeward Bound – Innovation in addressing determinants of health through collaboration  Collaborative adaptation of Homeward Bound Model  Between April 2015 and April 2016 housed 40 people Homeward Bound – Innovation in addressing determinants of health through collaboration  Collaborative adaptation of Homeward Bound Model  Between April 2015 and April 2016 housed 40 people

BRIDGING THE GAPS Homeward Bound – Innovation in addressing determinants of health through collaboration  Outreach and wellness workers  Cultural workers  Access to primary health care, mental health and addictions services Homeward Bound – Innovation in addressing determinants of health through collaboration  Outreach and wellness workers  Cultural workers  Access to primary health care, mental health and addictions services

BRIDGING THE GAPS Waasegiizhig Nanaandawe’iyewigamig ( WNHAC ) : Northern and remote oral health innovation and travelling primary healthcare provision  Comprehensive primary health care services to  Ten First Nations with twelve points of service in northwestern Ontario  Urban Anishinaabe and Métis population in Kenora Waasegiizhig Nanaandawe’iyewigamig ( WNHAC ) : Northern and remote oral health innovation and travelling primary healthcare provision  Comprehensive primary health care services to  Ten First Nations with twelve points of service in northwestern Ontario  Urban Anishinaabe and Métis population in Kenora

BRIDGING THE GAPS Northern and remote oral health innovation and travelling primary healthcare provision  WNHAC provides a broad spectrum of children’s oral health services to 9 of the 10 First Nations it serves Northern and remote oral health innovation and travelling primary healthcare provision  WNHAC provides a broad spectrum of children’s oral health services to 9 of the 10 First Nations it serves

BRIDGING THE GAPS Northern and remote oral health innovation and travelling primary healthcare provision  the clinicians (5 NPs, 4 diabetes clinicians, 2 RPNs, and 2 Community Health Nurses (CHNs) travelled a total of 169,940 KMs  Carried out 1,124 community clinics.  Eight health promoters, including the oral health care providers traveled 79,580 KMs  Completed 210 events in communities Northern and remote oral health innovation and travelling primary healthcare provision  the clinicians (5 NPs, 4 diabetes clinicians, 2 RPNs, and 2 Community Health Nurses (CHNs) travelled a total of 169,940 KMs  Carried out 1,124 community clinics.  Eight health promoters, including the oral health care providers traveled 79,580 KMs  Completed 210 events in communities

BRIDGING THE GAPS Southwest Ontario Aboriginal Health Access Centre (SOAHAC)  Extending primary health care and traditional healing services across small, rural First Nations and with Indigenous Friendship Centres and Métis Communities Southwest Ontario Aboriginal Health Access Centre (SOAHAC)  Extending primary health care and traditional healing services across small, rural First Nations and with Indigenous Friendship Centres and Métis Communities

BRIDGING THE GAPS Extending primary health care and traditional healing services across small, rural First Nations and with Indigenous Friendship Centres and Métis Communities  Indigenous community-governed, primary health care agency  Blends western and Indigenous healing approaches  Status-blind Extending primary health care and traditional healing services across small, rural First Nations and with Indigenous Friendship Centres and Métis Communities  Indigenous community-governed, primary health care agency  Blends western and Indigenous healing approaches  Status-blind

BRIDGING THE GAPS Extending primary health care and traditional healing services across small, rural First Nations and with Indigenous Friendship Centres and Métis Communities  Four primary health care sites  70 Staff serving 35,000 Indigenous people in 13 communities  Doctors, Nurse Practitioners  Traditional Healers and Elders  Youth Workers  Mental Health and Addictions Counselors  Social Workers  Nurses  Support staff and more Extending primary health care and traditional healing services across small, rural First Nations and with Indigenous Friendship Centres and Métis Communities  Four primary health care sites  70 Staff serving 35,000 Indigenous people in 13 communities  Doctors, Nurse Practitioners  Traditional Healers and Elders  Youth Workers  Mental Health and Addictions Counselors  Social Workers  Nurses  Support staff and more

BRIDGING THE GAPS Extending primary health care and traditional healing services across small, rural First Nations and with Indigenous Friendship Centres and Métis Communities  All service and aspects of service delivery relate to:  Life cycle and relationship with everything in creation  Culture and empowerment  Self, family/clan, community, nation and the universe Extending primary health care and traditional healing services across small, rural First Nations and with Indigenous Friendship Centres and Métis Communities  All service and aspects of service delivery relate to:  Life cycle and relationship with everything in creation  Culture and empowerment  Self, family/clan, community, nation and the universe

BRIDGING THE GAPS Anishnawbe Health Toronto (AHT)  Development of a Traditional Healer Training Model – Innovative practice to advance Indigenous health human resources capacity Anishnawbe Health Toronto (AHT)  Development of a Traditional Healer Training Model – Innovative practice to advance Indigenous health human resources capacity

BRIDGING THE GAPS Development of a Traditional Healer Training Model – Innovative practice to advance Indigenous health human resources capacity  “To recover, record and promote Traditional Aboriginal practices where possible and appropriate.” Development of a Traditional Healer Training Model – Innovative practice to advance Indigenous health human resources capacity  “To recover, record and promote Traditional Aboriginal practices where possible and appropriate.”

BRIDGING THE GAPS Development of a Traditional Healer Training Model – Innovative practice to advance Indigenous health human resources capacity  Model of health care is based on Traditional Indigenous practices  Approaches and are reflected in the design and delivery of its programs and services Development of a Traditional Healer Training Model – Innovative practice to advance Indigenous health human resources capacity  Model of health care is based on Traditional Indigenous practices  Approaches and are reflected in the design and delivery of its programs and services

BRIDGING THE GAPS Development of a Traditional Healer Training Model – Innovative practice to advance Indigenous health human resources capacity  Fully accredited community health centre through the Canadian Centre for Accreditation  Offers access to health care practitioners from many disciplines :  Traditional Healers, Elders and Medicine People  Ancient ceremonies and traditions are intrinsic to AHTs health care model are available at AHT daily and regularly Development of a Traditional Healer Training Model – Innovative practice to advance Indigenous health human resources capacity  Fully accredited community health centre through the Canadian Centre for Accreditation  Offers access to health care practitioners from many disciplines :  Traditional Healers, Elders and Medicine People  Ancient ceremonies and traditions are intrinsic to AHTs health care model are available at AHT daily and regularly

BRIDGING THE GAPS Wabano Centre for Aboriginal Health  Innovation in urban Indigenous knowledge exchange and mobilization – Cultural Symposium Series Wabano Centre for Aboriginal Health  Innovation in urban Indigenous knowledge exchange and mobilization – Cultural Symposium Series

BRIDGING THE GAPS Wabano Centre for Aboriginal Health  Expanded services include:  Maternal and child wellness centre,  Social enterprise programming  Enhanced mental health services and  Much more. Wabano Centre for Aboriginal Health  Expanded services include:  Maternal and child wellness centre,  Social enterprise programming  Enhanced mental health services and  Much more.

BRIDGING THE GAPS Wabano Centre for Aboriginal Health  “Culture as Treatment” - Symposium Series  Indigenous thinkers  Though leaders  Traditional knowledge keepers  Scholars  Practitioners, Elders and  Medicine people Wabano Centre for Aboriginal Health  “Culture as Treatment” - Symposium Series  Indigenous thinkers  Though leaders  Traditional knowledge keepers  Scholars  Practitioners, Elders and  Medicine people

BRIDGING THE GAPS “Culture as Treatment” - Symposium Series  Topics have included:  Historical Trauma and Impacts on Aboriginal Youth and Families  The importance of Culture, Environment, and Language in the Wellbeing of Aboriginal Youth and Families  Working with Aboriginal Youth and Families within Child Welfare  Public Schools  Health Care  Criminal Justice Systems  Aboriginal Dispute Resolution  Cultural Safety and more. “Culture as Treatment” - Symposium Series  Topics have included:  Historical Trauma and Impacts on Aboriginal Youth and Families  The importance of Culture, Environment, and Language in the Wellbeing of Aboriginal Youth and Families  Working with Aboriginal Youth and Families within Child Welfare  Public Schools  Health Care  Criminal Justice Systems  Aboriginal Dispute Resolution  Cultural Safety and more.

BRIDGING THE GAPS What does this all mean?

BRIDGING THE GAPS Guiding Principles for Services to Indigenous People  Involvement in planning, consultation, delivery and evaluation  Equitable access regardless of residency  Choice of services acknowledged and respected Guiding Principles for Services to Indigenous People  Involvement in planning, consultation, delivery and evaluation  Equitable access regardless of residency  Choice of services acknowledged and respected

BRIDGING THE GAPS Guiding Principles for Services to Indigenous People  Involvement in planning, consultation, delivery and evaluation  Equitable access regardless of residency  Choice of services acknowledged and respected Guiding Principles for Services to Indigenous People  Involvement in planning, consultation, delivery and evaluation  Equitable access regardless of residency  Choice of services acknowledged and respected

BRIDGING THE GAPS Guiding Principles for Services to Indigenous People  Interrelationship with environment  and its protection essential for  survival of Aboriginal people  Aboriginal people distinct from  multicultural mosaic  Continual collaboration, review and  evaluation Guiding Principles for Services to Indigenous People  Interrelationship with environment  and its protection essential for  survival of Aboriginal people  Aboriginal people distinct from  multicultural mosaic  Continual collaboration, review and  evaluation

BRIDGING THE GAPS Getting Better Educated About Indigenous Health Needs and Priorities  AHAC and Aboriginal CHC Response to Patients FirstAHAC and Aboriginal CHC Response to Patients First  Operationalizing and Indigenous Health Model Operationalizing and Indigenous Health Model Getting Better Educated About Indigenous Health Needs and Priorities  AHAC and Aboriginal CHC Response to Patients FirstAHAC and Aboriginal CHC Response to Patients First  Operationalizing and Indigenous Health Model Operationalizing and Indigenous Health Model

BRIDGING THE GAPS Getting Better Educated About Indigenous Health Needs and Priorities  Cultural Safety Cultural Safety  Diane Smylie -  Canadian Centre for Accreditation Canadian Centre for Accreditation Getting Better Educated About Indigenous Health Needs and Priorities  Cultural Safety Cultural Safety  Diane Smylie -  Canadian Centre for Accreditation Canadian Centre for Accreditation