1. Portrait of the Situation for English-speaking First Nations Accessing Health and Social Services in English in the Province of Québec Summary of Past Research By: Amy Chamberlin, Ph.D. Candidate (School of Indigenous and Canadian Studies, Carleton University) February 2018

2. Summary of Research Introduction About the Communities Overview
Purpose
Methodology
Findings
Conclusion

3. INTRODUCTION
In 2012, English-speaking First Nations of Quebec launched a project to ‘expand and build partnerships’ to improve access to health and social services. This project allowed for the establishment of a Coalition of English Speaking First Nations Communities of Quebec (CESFNCQ).
The CESFNQC is comprised of First Nations communities/organization from different parts of Quebec, including: Kawawachikamach, Gesgapegiag, Listuguj, Akwesasne, Kanesatake, Kahnawake, Eagle Village First Nation / Kipawa, Kitigan Zibi, Long Point /Winneway,Timiskaming, and the Native Women’s Shelter of Montreal.

4. About the Communities
CESFNCQ members are located in seven (7) of Quebec’s eighteen (18) health regions in isolated, rural, and urban areas.
Six (6) of the CESFNCQ are ‘border’ communities.
Languages spoken: Approximately 64.5 % of the total Aboriginal population are predominately English- speaking, or English is the first official language spoken after their own Indigenous language.* *Data source – Aboriginal Affairs and Northern Development Canada, 2012 and Ministère de la Santé et des Services sociaux du Québec, 2012
Outaouais, Abitibi-Témiscamingue, Côte-Nord, Gaspésie-Îles-de-la-Madeleine, Laurentides, Montérégie, and Montreal
Total population of Aboriginal Peoples is (Source: AANDC – 2012); with Labrador and Newfoundland, New Brunswick, Ontario, and internationally, with the US.

5. Overview of Research
CESFNCQ oversaw multi-year research with English- speaking First Nations communities/organization.
The research documents challenges and experiences facing English-speaking First Nations (front line workers and community members) when accessing services from health and social institutions in the province of Quebec.
‘Portrait of the Situation’ community-based reports include: Health Services – Report (2013) and Addendum (2015); Social Services – Report (2016).
The research was conducted to document a portrait of the situation for English-speaking First Nations when accessing health and social services from provincial and federal institutions.

6. PURPOSE
The purpose of the research was to investigate the situation of English-speaking First Nations of Quebec when accessing health and social services.
Research objectives: a) identify issues and challenges when accessing services; b.) Document strategies and solutions (in place or recommended) to improve access

7. Methodology Action-based research approach: Research Methods:
The CESFNCQ and researcher identified research questions and methods to gather qualitative data.
Ensure consistent data collection, yet with some flexibility to meet the needs of each community or organization.
Research Methods:
Focus groups, individual or group interviews, questionnaires, and surveys.
Letters of invitation sent to all CESFNCQ members
Community Liaisons assisted with various aspects of the research (e.g., identify participants, organize focus groups, data collection)

8. Data Collection
All eleven (11) members of the CESFNCQ participated in the research, and a total of 184 individuals took part in the initiative.
HEALTH
Nine (9) First Nations communities and one (1) organization (total of 135 participants)
Total of fourteen (14) focus groups, nineteen (19) individual interviews, and five questionnaires were completed
Data collection took place in March – July 2013, October 2013, and September – November 2014.
SOCIAL SERVICES
Ten (10) First Nations communities and one (1) organization (total of forty-nine (49) participants)
Total of eighteen (18) in-depth interviews (group/individual),questionnaires
Data collection took place in April-June 2015 and Jan. – Feb. 2016
Front line workers and community members

9. Access Issues and Challenges: Health and Social Services
FINDINGS
Access Issues and Challenges: Health and Social Services
Double discrimination – language barriers and lack of cross cultural understanding (*Additional barriers for communities/individuals whose first language is their own Indigenous language).
Discrimination and lack of cultural safety Lack of understanding about colonial context and policies; lack of understanding about intergenerational trauma; and lack of understanding about Indigenous worldviews/approaches to wellbeing.
Attitudes and perceptions Participants reported feelings of anxiety and fear over not being understood when accessing health and social services from provincial institutions because of language and cross-cultural misunderstandings
Jurisdictional issues: i.) Provincial borders; ii) Corridors of Service; and iii) Lack of clarity about federal/provincial responsibilities over First Nations’ health services
Dissatisfied with quality of services in English: issues with assessments, discharge, follow up
(participants reported they are reluctant to access services because of negative perceptions about quality of care. Others spoke about ‘fears’ and ‘anxiety’ around accessing services from the province).

10. Access Issues and Challenges: Health and Social Services
Lack of access to specialized health services in English. Long wait times for services, longer wait for services in English. Barriers due to distance and/or transportation in isolated, rural and urban areas. *Isolated and rural communities face challenges accessing both general and specialized health services.
Lack of English language services for mental health. Reported that ‘quality of services’ an issue in area of mental health due to language barriers and cross cultural misunderstandings.
Lack of access to specialized social services in English (e.g., addictions’ services, child psychologists, art therapy, legal aid, occupational therapy, speech therapy, psycho-social/psycho-educational/child development assessments, autism evaluations, dietician)
Crisis Situations and Critical Care – Individuals in crisis situations have limited access to mental health services (remote, rural and urban areas). Reports of barriers because of language for individuals in critical care. Some participants noted issues due to language with Emergency Services (emergency room and dispatch).
(*rural and remote areas: lack of access to general services and services in English); (“Access to English services for addictions is a nightmare .. it’s a disaster for someone with mental health issues”.) (“You need to be able to communicate with people who are assessing you .. [especially] in very vulnerable situations”)

11. Access Issues and Challenges: Health and Social Services
Lack of English language documentation from province (e.g., health information, assessments, funding proposals (municipal), placement agreements).
Lack of funding for translation services. Bilingual (French and English) workers are providing in-house translation services, over and above their workload. Organizations are paying for translation services from administrative or program budgets.
Challenges accessing updates from province about changes to health and social services’ legislation and/or regulations.
English-speaking professionals face barriers: challenges registering with Quebec’s Professional Order because of French language requirements.
Lack of English language training opportunities in Quebec (health providers, social services’ first and second line workers).
(participants reported they are reluctant to access services because of negative perceptions about quality of care. Others spoke about ‘fears’ and ‘anxiety’ around accessing services from the province).

12. Strategies and Solutions
Agreements and protocols
Establish partnership agreements with provincial institutions
Inter-sectoral approach (internally and with province) when intervening on crisis situations (avoid duplication, reduce ‘silo effect’, and strengthen continuity of care)
Border Agreements: access to English language ‘out of province’ services
Protocol for provision of services to ‘non community member’ clientele
Increase involvement of First Nations in decision-making
Develop a Strategic Plan for English-speaking First Nations
Identify legislation and policies to support linguistic and cultural needs
Establish formal mechanism to track access issues
Identify priority areas: English language services most needed by communities/organizations
Increase awareness/information about ‘rights and responsibilities’ (e.g., linguistic, cultural and Aboriginal) when accessing health and social services from provincial institutions
Receive updates (in English) about changes to legislation and/or regulations about health and social services
(*demystify and raise awareness about Indigenous practices) (*access to services in English and Aboriginal Rights to access services, generally); and management. (Meet regularly with partners to discuss concerns, challenges and health priorities)

13. Strategies and Solutions
Cultural Awareness and Safety
Indigenous liaison person (support for community members receiving services from provincial institutions)
Training about colonial legacy and cultural awareness
Anti-racism Strategy (workshops to address racism/discrimination and to foster cross-cultural understandings)
Increased visibility of Indigenous culture/practices and Indigenous languages at provincial institutions
Language and Communication
Funding for translation services (e.g., documentation from province)
Language support services for clientele (crisis/critical/specialized)
Updates (in English) about changes to legislation/regulations (health and social services)
Improve communications with provincial and federal institutions (break down barriers, make connections, and share information about services)
address access issues because of distance, lack of funding for transportation when accessing English language services (e.g., for services received ‘outside’ of corridors/out of province)

14. Strategies and Solutions
Training, Employment, Capacity Building
Offer more training in English (health and social services)
Recruit professionals to work in community
Share strategies amongst First Nations (‘lead by example’)
Networking and Information Sharing
Within community, amongst FNs communities, and with provincial network) *what services are available, where, and how to access
Establish web-based sharing/documentation center amongst communities/organizations
Complaints’ Process
Establish a process to track and report ‘Incident Reports’; organizations to assist clients address discrimination and/or racism (e.g., fill out forms, launch complaint on their behalf, advocate and meetings)
address access issues because of distance, lack of funding for transportation when accessing English language services (e.g., for services received ‘outside’ of corridors/out of province)

15. Strategies and Solutions
Empower Community Members: ‘Raise People Up’
Move away from ‘crisis’ to ‘prevention’ approaches (health and social)
Address negative stereotypes around accessing social services
Ensure victims of violence receive support services required
Bring health and social services’ resources (e.g., specialized services, assessments, clinics, training) into First Nations communities/organizations
Mitigate transportation issues; cost effective to ‘bring in’ resources vs. sending people out; increase sense of cultural safety.
Long-term support (e.g., financial, human, and material resources) for the CESFNCQ: ensure that English-speaking First Nations can address their unique linguistic and cultural needs to improve access to health and social services.
address access issues because of distance, lack of funding for transportation when accessing English language services (e.g., for services received ‘outside’ of corridors/out of province)

16. CONCLUSION
The research documented a portrait of the situation for English-speaking First Nations in Quebec when accessing health and social services.
Language and culture are closely connected. The research revealed that English-speaking First Nations face ‘double discrimination’ when accessing health and social services:
There are obstacles resulting from language.
There are misunderstandings because lack of cross-cultural awareness/understanding.
The research affirms a desire to improve access by fostering formal and informal partnerships and communications amongst English-speaking First Nations, and with provincial and federal health and social services’ institutions. The research affirms a desire for English-speaking First Nations to be involved in decision-making and implementing of health and social services. Finally, the research affirms a need to ensure cultural safety, as well as access to health and social services reflective of Indigenous understandings of health and wellbeing.