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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

First Nations Health Authority - CCHL – CCLS

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Page 1: First Nations Health Authority - CCHL – CCLS

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

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Page 2: First Nations Health Authority - CCHL – CCLS

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

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Transition Planning Stages

www.fnha.ca

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Page 4: First Nations Health Authority - CCHL – CCLS

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

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Page 5: First Nations Health Authority - CCHL – CCLS

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

Page 7: First Nations Health Authority - CCHL – CCLS

Regional Work

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Vancouver Island

Approach

Page 9: First Nations Health Authority - CCHL – CCLS

Vancouver Island Partnership Accord

Improve the health outcomes for First Nations in the creation of a more integrated, culturally appropriate, safe, & effective health system.

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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.

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Regional Health & Wellness Plan

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• Mental Wellness • Maternal Child &

Family Health • Primary & Community

Care • Public & Population

Health • Health Benefits

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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

Page 14: First Nations Health Authority - CCHL – CCLS

Transforming a public health perspective . . .

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Page 15: First Nations Health Authority - CCHL – CCLS

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.

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Page 16: First Nations Health Authority - CCHL – CCLS

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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Page 18: First Nations Health Authority - CCHL – CCLS

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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Page 19: First Nations Health Authority - CCHL – CCLS

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

Page 20: First Nations Health Authority - CCHL – CCLS

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

Page 21: First Nations Health Authority - CCHL – CCLS

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

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Public Health & Primary Care Strategy

• Cancer strategy

• Cardiac strategy

– Very similar in terms of content but partnerships that are leveraged are different

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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

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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

Page 34: First Nations Health Authority - CCHL – CCLS

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

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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

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Aboriginal Suicide Critical Incident Response Team (ASCIRT)

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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)

Page 38: First Nations Health Authority - CCHL – CCLS

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

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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

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Vancouver Island Region

CHARTING OUR

PATH TO WELLNESS

TOGETHER

Huy tseep q’u

Hiskwe

Gila’kasla

Kleco Kleco

Thank you

Page 42: First Nations Health Authority - CCHL – CCLS

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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