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Presented by Dr. Shannon Waters &
Dr. Naomi Dove
Canadian College of Health Leaders –
Vancouver Island chapter event
April 10, 2014
First Nations Health Authority: Transforming a public health perspective
1
Overview
• Transition to the First Nations Health Authority – Timeline to transition & beyond
– Governance
– Regionalized structures & planning
• Vancouver Island Partnership – Regional Health & Wellness Planning
• Public health & the medical officer role – Senior Medical Officer workplan
• Health Promotion Programs – Leading to transformation
2
Transition Planning Stages
www.fnha.ca
3
www.fnha.ca
Our Common Foundation
Healthy, self-determining &
vibrant, BC First Nations
children, families & communities
Our Values
Respect, Discipline,
Relationships, Culture,
Excellence & Fairness
Our Directives
1. Community Driven, Nation Based
2. Increase First Nations Decision-
Making
3. Improve Services
4. Foster Meaningful Collaboration &
Partnerships
5. Develop Human & Economic
Capacity
6. Be without Prejudice to First Nations
Interests
7. Function at a High Operational
Standard
Our Vision
4
The FNHA Mission Statement:
(approved by the Board on January 31, 2013):
"The FNHA supports BC First Nations individuals, families
& communities to achieve & enjoy the highest level of
health & wellness by: working with them on their health &
wellness journeys; honouring traditions & cultures; &
championing First Nations health & wellness within the
FNHA organization & with all of our partners.”
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First Nations Health Authority
Regional Work
Vancouver Island
Approach
Vancouver Island Partnership Accord
Improve the health outcomes for First Nations in the creation of a more integrated, culturally appropriate, safe, & effective health system.
Partnership Development
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Implement the broad goals of the Partnership Accord through a partnership driven, project specific work plan & ongoing relationship development.
Regional Health & Wellness Plan
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• Mental Wellness • Maternal Child &
Family Health • Primary & Community
Care • Public & Population
Health • Health Benefits
Mental Wellness & Substance Use Regional Planning & Action
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• Cultural Safety • Cultural programming as foundation of
wellness • Social determinants of health • Working collaboratively with partners
(e.g. Island Health, Ministry of Education, MCFD, Ministry of Justice)
• Integration of traditional/cultural & biomedical approaches
• Coordination of care, discharge planning, aftercare, follow-up & support
Transforming a public health perspective . . .
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Determinants of Aboriginal Health
Proximal Intermediate Distal
Health Behaviours Health Care Systems Colonialism
Physical Environments Educational Systems Racism & Social Exclusion
Employment & Income Community Infrastructure & Resources
Self-determination
Education Environmental Stewardship
Food Insecurity Cultural Continuity
National Collaborating Centre for Aboriginal Health; Health Inequalities & Social
Determinants of Aboriginal People’s Health, 2009.
15
The First Nations Perspective on Wellness • A visual expression to the First
Nations Perspective on Wellness – the way it has always been.
• Passed down from our Elders & traditional healers.
• Wellness belongs to every human being & their reflection of this Perspective will be unique; in the same way an individual has their own Wellness, so can a larger organization & its departments
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Aligning Public Health with the Wellness
Approach
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Chief Executive
Officer
VP Health Services
VP Policy Planning & Strategic Services
Acting Senior Medical Officer
VP Human Resources
VP Finance, CFO
VP Information, Innovation & Management Services, CIO
VP First Nations Health
Benefits
VP Corporate Services
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HEALTH SERVICES TODAY…
www.fnha.ca
Health Surveillance
-Collect, analyze, interpret & report on First Nations data
Nursing
- Public Health Services
-Treatment Services in remote & isolated communities
- Home & Community Care
-Training & Development
-Recruitment & Retention
-Transfer Nursing Support & functional supervision
Environmental Health Services
-Delivery of Environmental public health services including: Drinking
Water, Contaminant Research, Community Emergencies
Health Promotion & Disease & Injury Prevention
-Mental wellness – NNADAP, IRS Community Crisis intervention
-Children’s Programs - ECD, AHS, prenatal nutrition, FAS/FAE,
Maternal & Child Health
-Chronic disease (including Diabetes) &
- Injury Prevention
Health Protection
-Immunization
-Pandemic/Emergency preparedness planning
-Prevention & treatment of communicable diseases
-HIV/AIDS
HEALTH SERVICES 2 YEARS FROM
NOW…TRANSFORMATION
www.fnha.ca
.
OFFICE OF CHIEF NURSING
OFFICER Within this office the team will
continue & build on current nursing
services.
OFFICE OF CHIEF/SENIOR
MEDICAL OFFICER Moving from program
management to building on
content expertise to support
communities design & deliver
programs & services meeting
their community needs.
Creating Emergency Coordinator
Position – better support for
communities in crisis
Health Services evolves - with 2 pillars within FNHA Senior Executive Team: Chief Nursing Officer & Chief Medical Officer
What is a medical health officer?
• Training & Background • Competencies:
– Foundational Clinical Competencies – Monitoring & Assessing the Health of the Public – Public Health Consultant – Investigating & Mitigating Immediate Risks to Human Health – Policy, Planning & Program Development – Communication, Collaboration & Advocacy for the Public’s
Health – Leadership & Management – Professional Practice
A Set of Minimum Competencies for Medical Officers of Health in Canada –Final Report (2009)
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FNHA Physicians: Principles
• Cultural competence & safety
• Community driven, nation based
• Collaboration
• Prioritization of First Nations interests
• Consistency
From discussion amongst FNHA physicians
• Accountability
• Data Stewardship
• Flexibility
• Comprehensiveness
• Stability
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Deputy FN Provincial Health Officer
• Provides leadership & expert medical advice, support & guidance regarding Aboriginal health, policy development, & programs/services/initiatives;
• Reports on the status of Aboriginal & First Nations health; &
• Assists in the development of the (BC) First Nations Health Authority.
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Senior Medical Officer Workplan Priorities
• Mental Wellness
– Short-term/Weeks: protocol for mental health crisis response in communities
– Medium term/Months: changing funding requirements for crisis funding
– Longer term/Year: developing mental wellness strategy for the FNHA
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Supporting mental wellness & suicide prevention in communities
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• Incorporating traditional healing practices into health programs & services for First Nations people
– Internal advice paper from the FNHA Physician’s Advisory Group
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Traditional Wellness
Public Health & Primary Care Strategy
• Cancer strategy
• Cardiac strategy
– Very similar in terms of content but partnerships that are leveraged are different
28
FNHA Medical Officer Portfolios
Health Surveillance
Health Promotion
Health Protection
• Emergency preparedness & response
• Communicable disease
• Disease & injury prevention
• Effective practices
• Community capacity
• Baseline health assessment & surveillance
• Wellness reporting
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Health Programs Transformation
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Health Prevention &
Promotion Directorate
Early Childhood Development
Aboriginal Head Start
Maternal Child Health
Fetal Alcohol Spectrum Disorder
Canada Prenatal Nutrition Program
Mental Health & Addictions
Indian Residential Schools
National Aboriginal Youth Suicide
Prevention Strategy
National Native Alcohol & Drug Abuse Program
Injury Prevention & Chronic Disease
Aboriginal Diabetes Initiative
Injury Prevention
FNHA Health Promotion Programs
Healthy Child Development
Canada Prenatal Nutrition Program (prenatal to early childhood)
Maternal Child Health (preconception to early childhood)
Fetal Alcohol Spectrum Disorder Program (preconception to early childhood)
Aboriginal Head Start On Reserve Program
(birth – 6 Years)
Children’s Oral Health Initiative
(birth - 7 years)
Preconception / Prenatal Birth Postnatal Early Childhood
www.fnha.ca
Strategic Directions 1. Meaningful collaborative planning, knowledge sharing & timely & consistent
communication occurs with/for First Nations & Aboriginal communities 2. Increase First Nations & Aboriginal community control & leadership in collecting
information & monitoring trends in maternal, child & family health
3. Develop a culturally competent workforce, culturally safe services & culturally appropriate resources in maternal, child & family health
4. Improve access to continuous & well-connected services & resources across pre-pregnancy planning, pregnancy, birthing & post-birth care for First Nations & Aboriginal mothers, children & families
5. Promote holistic pre-pregnancy planning, pregnancy, birthing & post-birth health &
wellness for First Nations & Aboriginal mothers, children & families 6. Promote & support early childhood development & safe environments for First Nations
& Aboriginal infants, children & families
Maternal, Child & Family Health Strategic Approach
FNHA Mental Health & Wellness Programs (Vancouver Island)
• National Native Aboriginal Drug & Alcohol Program (NNADAP)
• Community based funding
– 17 communities
• Residential Treatment Centres
– Kackaammin Family Development Centre
– Namgis Treatment Centre
– Tsow-Tun Le Lum
• Indian Residential Schools (IRS) Resolution Health Supports Program
• Nuu-chah-nulth Tribal Council
• Tsow-Tun Le Lum
• National Aboriginal Youth Suicide Prevention Strategy (NAYSPS)
• 3 teams in Vancouver Island region
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National Aboriginal Youth Suicide Prevention Strategy (NAYSPS)
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• Target population: First Nations
youth on-reserve ages 10-30 yrs
• Goal: reduce risk factors &
promote protective factors
• Program elements →
• Range of activities
– ASCIRT teams
– Community based projects
– Support to communities
Prevention
Intervention Postvention
Aboriginal Suicide Critical Incident Response Team (ASCIRT)
37
Inter-Tribal
Health
Authority
ASCIRT
(Serving 29
communities)
Nuu’chah’nulth
Tribal Council
Huu-pee-stalth
(Serving 14
Communities)
Cowichan
Tribes
ASCIRT
(Serving 6
communities)
The Path to Transformation
• What is the goal? – Effective, wellness based programs responsive to self-
identified community priorities
• How do we get there? – Community engagement & dialogue – Holistic program framework development
• Epidemiology Risk & protective factors Effective prevention interventions, best practices Based on culture
– Evaluation – Environmental scan – mapping programs & services
• Gaps & opportunities • Alignment & coordination
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Working with Health Authorities
• Attendance at PHO/CMHO teleconferences
• Meet with CMHOs in regional health authorities
• Meet with PHSA agencies
39
Moving forward . . .
– Holistic view of health
– Culture is the foundation
– Focus on determinants of health
– Focus on community based, locally relevant approaches
– Build on existing strengths & assets
– Use multiple complementary strategies to promote health at the individual/community level
– Partnerships & collaboration
40
Vancouver Island Region
CHARTING OUR
PATH TO WELLNESS
TOGETHER
Huy tseep q’u
Hiskwe
Gila’kasla
Kleco Kleco
Thank you
Dr. Shannon Waters MD MHSc FRCPC Acting Senior Medical Officer Phone: 604-666-6155 Email: [email protected] Dr. Naomi Dove MD MPH FRCPC Public Health Physician, Health Promotion & Prevention Phone: 604-666-0771 Email: [email protected]
Thank You!
Questions & Discussions
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