1. Jessica Ball, M.P.H., Ph.D. E arly Childhood Development Intercultural Partnerships School of Child and Youth Care University of Victoria Intersectoral Action for Indigenous Children’s Health and Development

2. Children’s health & well-being are multiply determined

3. Coordinated action is needed across all levels (J. Evans 2005)

4. Multiple entry points to harness the ecology of children’s health & development Adapted from Bronfenbrenner (1979)

5. Key messages from research with First Nations in B.C.  Early Childhood Care & Development Programs can serve as a socially accessible & culturally resonant entry point for promoting health & delivery health services  Community development supports child health & development  One model does not fit all contexts (no ‘best practices’)  Research helps to identify promising practices  Some Aboriginal communities are demonstrating promising community-led, community-paced, community-fitting practices that engage recommendations of the AFN, NAHO & Romanow Commission, Pop Health..

6. Prevailing Individual-Centred, Fragmented Services Parent: Good luck trying to make it to your child’s appointment with a dental hygienist SLP: Good luck trying to find the child who has been referred for early intervention! Community-Admin: Good luck filling out all the forms to appeal & account to many different authorities

7. Single-focus programs have limited effects Nutrition programs must be combined with stimulation (parent coaching, preschool, play spaces) in order realize significant gains in physical growth, health, learning & development Programs to stimulate cognitive development do not have desired impacts if the child has a language delay due to hearing loss due to ear infections due to mold growing in their sub-standard housing in a wet climate.

8. Supporting families Most families want to meet ALL of a child’s many different kinds of needs Policies & service systems that require parents to engage many different professionals and programs create barriers (travel, scheduling, economic, organizational, social, cultural) Program coordination supports family life & increases the chances of children’s needs being met.

9. First Nations Early Learning & Child Care Action Plan (AFN – 2005) “sustainable, flexible funding… community driven… Integration would empower First Nations to integrate child care services and programs across jurisdictions to create a new holistic framework of First Nations child care programming.”

10. Coordinated programming… Supported by:  Common sense  Ecological perspective on change  Population health model  Cultural concepts  Research  Families  Aboriginal recommendations What more do we need to make it happen?

11. Making it happen: Research in Rural First Nations

12. Making It Happen: ►Starts with long range VISION Communities all had: VALUE that ‘Children are our future.’ COMMITMENT to invest in early years to create a foundation for adult health, achievement and economic security HOLISTIC UNDERSTANDING of health & development PLAN for coordinated programs FUNDING –soft infrastructure: training, policy development, community awareness –hard infrastructure: buildings, equipment, buses, supplies What is happening in these communities now?

13. From vision to action ► Starts with capacity building Community - University Partnerships Community-based, culturally specific as well as ‘mainstream’ training

14. Moving towards community centred, coordinated programs with ECCD as “Hook and Hub”

16. Features of Hub Approaches  Family-centred  Relationship-oriented (cultural safety)  Population-based & streamed to target programs  Strength-focused rather than deficits oriented  Efficient  Coordinated or Consolidated funding

18. From Dreams to Reality at Lil’wat Nation Mount Currie, B.C. 140 km NW of Vancouver, near Whistler

19. Supporting children’s health & development where they are..

20. On their traditional territories...

21. In their community... Pqusnalhcw multi-service community centre Opened May, 1999

22. In the families they have...

23. Partnership to develop community capacity  Training – UVic partnership  Incremental implementation  Starting with child care as a ‘hook’  Community kitchen & cultural events bringing Elders to the centre  Incremental addition of programs & services  Creative work to push the envelope with funders & agencies

24. Planned Integration, Coordination, & Co-location

25. From child care & community kitchen to…. Child development pre-school & after-school Drumming, dancing, pow wow Supported Child Care (special needs) Uscalmicts language immersion/exposure Early Intervention Therapists (SLP, OT, PT, dental hygienist) Family Wellness Worker Community Health Representatives Community Health Nurse Paediatrician Counsellors (NNADAP & Residential School) Dentist Chiropractor Elders Activity Coordinator Home Care Nursing Child welfare

26. Working together & learning across professional disciplines & services A mutually supportive community of workers with ongoing professional development opportunities yields high staff retention

27. Many pathways “ Finding our way to supporting wellness among diverse communities of children and families requires many pathways. No one approach, no one program model, will reach or work for everyone.” Meadow Lake Tribal Council Administrator Local innovation & resourcefulness can combine the ‘right’ number & variety of people, professions, services that a community wants & needs to achieve their own ECCD goals Research: compare remote, rural & urban hub potentials & demonstration projects

28. Key messages from research with First Nations in B.C.  Early Childhood Care & Development Programs may be an especially strategic entry point for Aboriginal health initiatives  Planned ECCD training & services are effective components of Aboriginal community development  One model does not fit all contexts (no ‘best practices’)  Research with Aboriginal communities can explore & demonstrate exciting new ways to think about community-driven designs for action to promote child & family health & quality of life