PROVINCIAL ABORIGINAL LHIN REPORT 2014/15

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1 1 P a g e PROVINCIAL ABORIGINAL LHIN REPORT 2014/15 HIGHLIGHTS

2 2 P a g e MOVING FORWARD: A COLLABORATIVE APPROACH INTRODUCTION Over the past year, the Local Health Integration Networks (LHINs) have continued to work in partnership with local Aboriginal/ First Nations, Inuit and Metis communities to facilitate meaningful engagement with the healthcare system and advance culturally-appropriate services and care which will contribute to better patient experiences, enhanced quality of care and improvements in health outcomes for Aboriginal peoples in Ontario. Each LHIN works closely with Aboriginal communities to better understand local needs, priorities and opportunities. Through the development of local Aboriginal engagement and strategic plans, the LHINs can continue to collaborate with the Aboriginal community in order to facilitate relationships across the healthcare sectors, build a base of knowledge that includes better data, traditional approaches to healing and wellness, and incorporates the values, principles and priorities of Aboriginal peoples, and their families into a framework for action that will continue to advance and transform healthcare practices and services to be appropriate, accessible, equitable and culturally safe for Aboriginal peoples. Collaboration across each LHIN healthcare system is fundamental in advancing this work locally, and collaboration across the LHINs is fundamental in advancing system wide change. Each LHIN has a dedicated staff Lead to facilitate this process and to engage directly with local Aboriginal communities. These LHIN Leads have formed a community of practice called the Provincial Aboriginal LHIN Network (PALN), which is linked to the LHINs CEO table. The scope of the PALN is to facilitate cross-lhin collaboration, communication and knowledge sharing. Starting in 2011, the PALN and the LHIN CEOs have met once a year to share information, best/ promising practices and participate in local cultural activities and experiences. These meetings have created a forum for discussion on emerging issues and potential opportunities that exist at the systems level. Outcomes of these meetings have included more profile to Aboriginal engagement and planning activities across the healthcare system, as well as a better understanding and appreciation of the historical context and policies which is a foundation for developing respectful and trusting relationships with Aboriginal, First Nations, Inuit and Métis communities. As the LHINs continue to evolve their relationships and partnerships with Aboriginal, First Nations, Inuit and Métis communities and develop respectful and inclusive practices of engagement, there have been opportunities to identify some common areas of focus across the LHINs. These areas of focus have become the first priorities that the LHINs have been able to identify as a foundation for addressing Aboriginal engagement and planning within the context of a cross-lhin systems approach. The LHIN CEOs support this strategic approach to planning, as the LHINs have been able to identify indicators to measure progress and hold ourselves accountable to the communities and to the Ministry of Health and Long-Term Care (MOHLTC) for this work. 2. This report is not intended to provide a full inventory list of activities related to Aboriginal engagement and planning by LHIN, rather it is a snapshot of the progress that LHINs have made around the four areas of focus: Advancing Aboriginal Cultural Competency Training; Alignment of Mental Health and Addictions; Aboriginal Hospice Palliative Care Planning; and Supporting Aboriginal Engagement in Diabetes. There are a number of other priorities that are currently being addressed within the context of each LHIN; however, this report is not intended to capture these activities, short of some key highlights and challenges.

3 3 P a g e ADVANCING ABORIGINAL CULTURAL COMPETENCY TRAINING Indigenous people experience the worst health outcomes of any population group in Canada. This alarming detail underscores the urgency and importance of understanding and addressing racism as a determinant of Indigenous health. First Peoples, Second Class Treatment: The role of racism in the health and well-being of Indigenous peoples in Canada Wellesley Institute,

4 4 P a g e ADVANCING ABORIGINAL CULTURAL COMPETENCY TRAINING 1. Advancing Aboriginal Cultural Competency Training Indigenous Cultural Competency (ICC) Training The Indigenous Cultural Competency (ICC) online education program is new to Ontario, and was adapted from the Provincial Health Services Authority (PHSA) of British Columbia, who has mandated this training for all health services authority staff for over seven years. Indigenous Cultural Competency Training is designed to improve health outcomes for Ontario s Aboriginal people by building culturally competent and safe health care environments, which will increase the likelihood that Aboriginal people will seek care and stay for treatment. ICC is conducted online at a participant s own pace through eight modules over an eight week period. The modules are interactive and are facilitated by an instructor. Throughout the training, participants enhance their self-awareness and build on existing skills toward a culturallysafe health care system. Designed in response to an overwhelming request for Ontario-specific ICC Training, the Southwest Ontario Aboriginal Health Access Centre (SOAHAC), supported by the South West LHIN, has worked closely with B.C. s PHSA to ensure that participants are provided with a foundation to understand Indigenous worldviews and traditional practices, the impact that history has had on Indigenous health and the effect of personal biases that often go unrecognized. Within the scope of healthcare, many factors which determine Aboriginal health outcomes are influenced by the social determinants of health (e.g. poverty) and are not within the scope or influence of the system of services and health service providers. One area that lies within the scope of influence in healthcare is the provision of Indigenous cultural competency training for health care professionals, which can have an immediate impact on improving relationships amongst Indigenous patients and healthcare providers. This in turn results in improvements in the patient experience, enables more equitable access to services and contributes to a more culturally safe system of care. All 14 LHINs support advancing cultural competency within their LHINs. As of September 2013, the LHINs have developed performance indicators to track the progress in advancing the priority areas of focus across the LHINs. Advancing Aboriginal Cultural Competency training continues to be a critical foundational piece. Based on the 2013/14 PALN Report 10 of 14 LHINs reported that they developed and met targets around staff and board training in 2013/14; however, the target levels varied between 25% and 100%. 3 LHINs had not yet met their targets, and 1 LHIN had yet to develop a target. The LHINs felt it was important to continue to see forward progress across the province in this area as uptake and availability of cultural competency training increase across the healthcare sectors. The LHINs have an important leadership role in advancing this work, and ensuring that each LHIN organization is culturally competent. PALN Performance indicators 2014/15: That all 14 LHINs continue to advance cultural competency training locally in the following ways: 1) Each LHIN is to develop an Aboriginal cultural competency plan that outlines the process to ensure ongoing and sustainable training for LHIN staff and Board 2) Each LHIN is to establish a target percentage whereby the majority of staff and board (50 % or more) will receive/ have received Aboriginal cultural competency training between the calendar years 3) A minimum of 5 staff/ board complete the online Indigenous Cultural Competency (ICC) training module in the 2014/2015 fiscal year For the 2014/15 fiscal year the Indigenous Cultural Competency (ICC) online training was made available for LHIN personnel to access training free of charge ICC training was subsidized by the South West LHIN for Ontario in this fiscal year and LHINs are encouraged to use this resource as part of their own cultural competency training. 1) Each LHIN is to develop an Aboriginal cultural competency plan that outlines the process to ensure ongoing and sustainable training for LHIN staff and Board etency.ca/training/ontario 4.

5 5 P a g e ADVANCING ABORIGINAL CULTURAL COMPETENCY TRAINING CONTINUED 2) Each LHIN is to establish a target percentage whereby the majority of current staff and board (50 % or more) will have received Aboriginal cultural competency training between the calendar years Actual % by LHIN#: 1) Erie St. Clair: 95%staff; 25%board 2) South West: 54%staff; 50%board 3) Waterloo Wellington: 75%staff; 90%board; 4) Hamilton Niagara Haldimand Brant: 85%staff; 100%board 5) Central West: 90%staff; 87%board 6) Mississauga Halton: 94%staff; 86%board 7) Toronto Central: 67%staff; 63%board 8) Central: 90%staff; 80%board 9) Central East: 50%staff; 50%board 10) South East: 70%staff; 50%board 11) Champlain: 60%staff; 80%board 12) North Simcoe Muskoka: 100%staff; 100%board 13) North East: 55%staff; 0%board 14) North West: 93%staff; 93%board 3) A minimum of 5 staff/ board complete the online Indigenous Cultural Competency (ICC) training module in the 2014/2015 fiscal year. [In the chart below, the number indicated in brackets is the actual number of LHIN staff/ board that completed the ICC.] There were some limitations noted in being able to achieve this indicator: There were several new Aboriginal Leads hired in 2014/15 which resulted in some delay as staff were oriented into local and provincial roles; as well, ICC became so popular that it was not available after December 2014 (ran wait list that took people into May-June, 2015) and staff were not able to enroll or participate in 14/15.

6 6 P a g e ALIGNMENT OF MENTAL HEALTH & ADDICTIONS 2. Alignment of Mental Health and Addictions (MHA) Addressing the burden of Mental Illness and Addictions in the Aboriginal population is a complex and cross jurisdictional task which requires consistent collaboration and communication with a number of sectors and funders. In order to create impact in the area of MHA, the LHINs need to continue to identify and build relationships with the multiple stakeholders that contribute to this work including, but not limited to: MCYS Regional Aboriginal Coordinators; First Nations NAADP programs; Municipal Aboriginal services; Health Services Integration Fund (HSIF) MHA regional projects; CAMH Service Collaboratives/ Regional Aboriginal Coordinators; Aboriginal Health Access Centre MHA programs; AHWS and local Friendship Centre Programs. Based on the 2013/14 data, it was reported that just over 50% of the LHINs were able to identify and establish relationships with other stakeholders involved in advancing Aboriginal MHA within their regions. It was determined that with the recent MCYS restructuring, there will be a need to re-establish relationships with MCYS Regional Aboriginal Coordinators across the board. From a planning perspective, building relationships across organizations, sectors and systems is foundational for enhanced communication and collaboration to minimize the duplication of services, streamline engagement efforts and minimize gaps in service for individuals and their families. Better relationships also facilitate sharing of best/ promising practices and leveraging of resources that will have the greatest impact on people who have the greatest need. PALN Performance indicators 2014/15: 1) Each LHIN is to develop an Aboriginal MHA Community Engagement Plan to establish and advance relationships with regional Aboriginal MHA stakeholders, including the Regional Aboriginal MCYS Coordinator 2) Each Aboriginal LHIN Lead will connect and establish a working relationship with the LHIN s Mental Health and Addictions Team

7 7 P a g e ABORIGINAL HOSPICE PALLIATIVE CARE (HPC) PLANNING 3. Aboriginal Hospice Palliative Care (HPC) Planning Following the Declaration of Partnership (MOHLTC Palliative Care Directive) there has been an explosion of activity in each LHIN area lead by the restructured Hospice Palliative Care Networks/ End of Life Care Networks. Each LHIN is actively involved in contributing to the development of local Hospice Palliative Care Strategies. In order to inform culturally appropriate models of Hospice Palliative Care, the Provincial Aboriginal LHIN Network (PALN) has engaged with Lakehead University s Improving End-of-Life Care in First Nations Communities Research Project (Lead: Dr. Mary Lou Kelly) an action research based project designed to meet the following objectives: To document Indigenous understandings of palliative and end-of-life care. To create a tool kit for developing palliative care programs in First Nations communities that can be shared nationally. To empower First Nations health care providers in developing their own palliative care program. To improve capacity within FN communities by developing palliative care programs, and strengthening linkages to regional palliative care resources. To develop knowledge and skills in research for FN community members, students and health professionals. As early research results and lessons learned are being disseminated from Lakehead University s Improving End-of-Life Care in First Nations Communities Research Project (Lead: Dr. Mary Lou Kelly), it is clear that the end of life process from an indigenous perspective has not been well recognized within the mainstream HPC system. As LHINs develop and implement their own Palliative Care Strategies, it will be important to ensure that there is a clear focus that reflects local Aboriginal perspectives and involves appropriate Indigenous engagement and involvement throughout. PALN Performance indicators 2014/15: 1) Each Aboriginal LHIN Lead will work with the HPC Lead to ensure that the LHIN s Palliative Care Strategy has an Aboriginal focus 2) Each LHIN will ensure that there is appropriate Aboriginal/ First Nations representation on the Hospice Palliative Care/ End of Life Regional Networks

8 8 P a g e ABORIGINAL HOSPICE PALLIATIVE CARE PLANNING CONTINUED 3) The Aboriginal LHIN Leads will establish a relationship with the Regional Cancer Program s Aboriginal Lead/Aboriginal Patient Navigator (where applicable in 10/14 LHIN regions) The need for palliative care services for First Nations people is increasing due to an aging population and the high burden of chronic and terminal disease amongst this population. Many First Nations people want the opportunity to die in the communities where they have lived all of their lives; however people in First Nations communities have limited access to culturally relevant and formalized palliative care programs. Providing equitable access to health services for all Canadians is a compelling social obligation that includes developing accessible palliative care programs for First Nations people. Improving End-of-Life Care in First Nations Communities Research Project, Lakehead University, 2015 Palliative Care Toolkit for Aboriginal Communities CCO, 2015

9 9 P a g e SUPPORTING ABORIGINAL ENGAGEMENT IN DIABETES 4. Supporting Aboriginal Engagement in Diabetes The PALN proposes that Diabetes should be added as a priority area of focus, acknowledging the recent movement of the Regional Diabetes Coordination Centres as well as many of the Diabetes Education Programs to the LHINs. This focus on diabetes is well supported as a priority within the Aboriginal community, and many LHINs have already included this as a focus in their local Aboriginal Health Strategies; however, it is clear that there has been minimal Aboriginal engagement and/ or focus within each LHIN s diabetes teams (internal LHIN staff focused on advancing diabetes strategy). The focus for 2014/15 was to ensure that there is better collaboration between the LHIN diabetes teams and the Aboriginal LHIN Lead/ community.. PALN Performance indicators 2014/15: 4) Each Aboriginal LHIN Lead will connect and establish a working relationship with the LHINs Diabetes Team.

10 10 P a g e ABORIGINAL COMMUNITY ENGAGEMENT AND PLANNING Locally, the LHINs have each continued to build and strengthen relationships with local Aboriginal/ First Nation communities. Most LHINs have developed local Aboriginal advisory structures to provide recommendations and guidance around appropriate and respectful engagement and inclusion of Aboriginal/ First Nations in healthcare decision making. These advisory circles, networks and committees establish an accountability between the healthcare system and the Aboriginal communities so that key strategies, plans, and services can be identified and designed by me, and not for me, respecting the principles of self-determination of Aboriginal peoples in any and all decisions regarding the development of or provision of services for Aboriginal peoples. Enhanced cultural competency has facilitated better relationships, and will be an enabler in enhancing the patient experience and a system which offers more culturally safe care. Through provincial legislation, the LHINs have a mandate to plan the delivery of health services for the population they serve, including Aboriginal/First Nation communities. By building mutually respectful relationships and through direct engagement with local Aboriginal communities and leadership, LHINs have been able to create roadmaps and local Aboriginal health strategies which often incorporate a wholistic view of health and wellness based on an Indigenous worldview. An important consideration in this view is to consider the impacts and relationship with the social determinants of health. In order to take this lens in planning, LHINs have developed relationships beyond the LHIN funded health service providers. As the LHINs have created relationships for a more integrated approach to planning and engagement; new partnerships have presented more opportunities to adapt and enhance existing services or supports to be more culturally appropriate. Next Steps: LHINs will ensure that the focus on Aboriginal health is prominent within each Integrated Health Services Plan (IHSP) for The Provincial Aboriginal LHIN Network and the Ministry of Health and Long Term Care s Aboriginal Health Policy Unit will formalize a working relationship to enhance collaboration and communication around Aboriginal engagement and planning LHINs will continue to advance Indigenous Cultural Competency training in a number of ways, including investing in and expanding the online ICC training, and through the participation in developing a framework for Cultural Safety in Ontario The LHINs will continue to collaborate and strategize around critical needs, including the five areas of focus: Advancing Aboriginal Cultural Competency Training; Alignment of Mental Health and Addictions; Aboriginal Hospice Palliative Care Planning; Supporting Aboriginal Engagement in Diabetes The areas of foci will be expanded to include Home and Community Care as a priority in 2015/16 The LHINs will engage in discussions to identify innovations and opportunities to advance support for improving Aboriginal data; supporting Aboriginal participation in Health Links; and expanding access to cultural-based Primary Care. 10

11 11 P a g e MOVING FORWARD AS PARTNERS IN PLANNING Good relationships are a foundation for respectful and well-informed planning processes. Having a dedicated and consistent LHIN Lead for the Aboriginal engagement and planning portfolio has proven to be an important aspect in enabling ongoing and meaningful relationships with Aboriginal/ First Nation communities. Changes within Aboriginal advisory groups, or key stakeholders can put a hold on advancing priorities and moving forward as it takes time to establish trust and a new working relationship with each new member/ stakeholder. Sustainability of relationships over time will continue to require LHIN involvement and engagement. Working within a system of care that supports culturally safe practices and culturally competent health service providers and professionals is a core requirement in advancing more equitable access to care and facilitating collaboration between Aboriginal and mainstream service providers and organizations. Much more work is needed to close the gap between Aboriginal health outcomes and the rest of the population. The PALN will continue to advance the pan-lhin key priorities into 2015/16 and make recommendations to the LHIN CEOs regarding the priorities and indicators for this year. Working within the context of the LHINs can enable and empower local communities to be in the centre of guiding healthcare transformation. Developing and maintaining respectful and mutual relationships between the LHINs and Aboriginal/First Nation communities will ensure Aboriginal peoples are able to be full participants and partners in planning their healthcare now and in the future. For more information on Ontario LHINs, connect to For inquiries or questions, please contact Vanessa Ambtman-Smith, Co-Chair, Provincial Aboriginal LHIN Network (PALN) at 11

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