Priority: network of Inuit addictions counselors Executive Summary Recommendations prepared and approved by Addictions Advisory Committee On October 2nd, 2014: Community Services Department-Inuulitsivik Health Center Community Services Department-Ungava Tulattavik Health Center Regional Youth Rehabilitation Department-Tulattavik Health Centre Complementary Services-Kativik School Board Isuarsivik Treatment Center Kativik Regional Police Force Makivik Corporation-Regional Partnership Committee Nunalituqait Ikajuqatiittut Nunavik Elders Committee Planning & Programming Department-Nunavik Regional Board of Health and Social Services Public Health-Nunavik Regional Board of Health and Social Services Saturviit Inuit Women Association of Nunavik
Preamble Every organization and its representatives on the Addictions Advisory Committee, along with the vast majority of Nunavimmiut, concur that alcohol and drug abuse is a major issue that directly affects all of Nunavik s residents, organizations and communities. The problem s extent and severity are reflective of the individual and collective malaise affecting a large percentage of the population. And although the NRBHSS and the regional health centres are of the same opinion, the existing service supply in the area of addictions remains highly inadequate. In spite of their long-term commitment to raising awareness of substance-abuse issues in Nunavik and deploying prevention initiatives, Nunalituguait Ikajuqatigiitut (NI) and its partners are struggling to encourage healthy changes in the behaviours of a significant part of the population. Nunavik s organizations as well as its leaders and the general population must play an active role in changing the existing social norms that promote the excess consumption of alcohol (binge drinking). Binge drinking accounts for some of the riskier behaviour observed, among them criminal acts, parental neglect, violence, physical and sexual abuse, suicidal acts, accidents and driving under the influence. In addition to strengthening the services offered by formal organizations, the Addiction Advisory Committee would like to stress the importance for every partner to support the community development approach in the field of addictions. The flourishing of community initiatives aiming at reducing the impact of substance abuse carries lasting changes for Nunavimmiut. This approach is embedded in Puvirnituq s Isaruit self-help group mission as perceived by one of its leading member: We declared among one another that we should work together more; to teach people how to live together in harmony; to help those who can t come out of their bitterness in their own lives; to teach them how to make decisions among one another; to learn to live together without attacking one another. Despite the scope and severity of the needs associated with alcoholism and drug abuse, there are few professionals specialized in addiction services in the region and only one institution that offers treatment to adults only: the Isuarsivik Treatment Centre. Furthermore, this community organization is run out of an old inadequate building that
cannot accommodate clients with children. Given this reality and uncertain funding, the centre also has a difficult time retaining its employees. In addition, the region lacks professional after-care and support services for Nunavimmiut coming out of a treatment cycle and who want to go back to their communities and families. This situation often increases the possibility of relapses. The development of direct professional support in each community for the individuals who want to get healthier in regards to substance abuse is a regional priority that must be at the top of the agenda for the NRBHSS and the two health centres for the years to come. In the face of the magnitude of the challenges associated with substance abuse, there is a need to strengthen the whole continuum of care in Nunavik in an urgent manner. Offering individuals with such problems an opportunity to limit the effects of their addiction on their lives and the lives of their loved ones will require major investments in the areas of prevention, detection, professional community-based support and specialized treatment. Each service provider that is strengthened will have a positive impact on the situation and will assist the efforts of its partners. The Addictions Advisory Committee believes that, currently, there is a window of opportunity that the regional and local partners must seize in order to increase, in a timely, concrete and significant manner, the support that is provided to individuals, families and communities. For that purpose, it is recommended to implement the following measures as soon as possible: 1-Inuit addictions counsellors It is recommended to create two positions for Inuit addictions counsellor in each community. In order to provide services in the preferred language of the client and interventions as relevant as possible for the Inuit of Nunavik, the positions for Inuit addictions counsellors should be reserved for Inuktitut-speaking JBNQA beneficiaries. The Inuit addictions counsellor s mandate will primarily be to: -work with youth and adult clients in order to establish an individual intervention plan to work on their addiction issues and other related problems; -counsel individuals and family members affected by a loved one s substance-abuse issues; -provide after-care support to clients who underwent treatment; -conduct group sessions; -facilitate access to detoxification, treatment and specialized addictions services;
-facilitate the creation and maintenance of self-help/therapeutic groups in respect of the community development approach; -collaborate in regional and local initiatives related to addictions prevention and public awareness; -work in partnership with cross-sector partners; -engage in a personal development program. 2-Training program for the Inuit addictions counsellors It is recommended that the training program be an on-the-job training program leading to a university or at least a college-level diploma. The training should be offered by an aboriginal organization or an institution that has a long and positive relationship with aboriginal peoples in Canada. The training program must be certified by a recognized Canadian certification agency in the field of addictions. The training material must be available and delivered in Inuktitut. In addition, the training program must: -recognize and value trainee s background, culture, history, experience, knowledge and skills; -be coordinated regionally by the NRBHSS; -offer the graduates the possibility of pursuing their training in order to develop a specialty; -integrate the particular history of the Inuit of Nunavik and include components regarding appropriate interventions and approaches in the context of personal, collective and intergenerational trauma; -include youth- and adult-intervention components; -offer planned continuing education, refreshers and updating of the knowledge; -offer on-the-job coaching by qualified and experienced addictions counsellors; -offer the opportunity for workers from other departments and organizations to access parts of the training. In order to support the deployment of the training program, personal counselling and clinical supervision must be offered. Due to the size of the territory to be covered and the number of trainees, a minimum of four positions shall be created as the training program is being deployed. These counsellors should be made available for other workers of the continuum of care in the addictions field as they get involved in parts of the training program. See Appendix B for complete terms of reference for the design and selection of a training program for the Inuit addictions counsellors. 3-Scenario for deployment of the Inuit addictions counsellors
In view of the needs related to addiction services across Nunavik, it is recommended to create at least two positions for each community and more depending on the needs of the local community. A minimum of 18 positions must be created from the start in order to create a critical mass of trainees and workers. The local Inuit addictions counsellor will be integrated into the CLSC workforce. 4-Network of Inuit addictions counsellors: Steering committee It is recommended to create a regional steering committee to contribute to the successful training, hiring and deployment of Inuit addictions counsellors across Nunavik by the NRBHSS, the Inuulitsivik Health Centre and the Ungava Tulattavik Health Centre. The regional steering committee shall be composed of experienced individuals from the main stakeholders of the addictions field in Nunavik. Through its ongoing involvement in the process, it ensures the new addiction services offered are adapted to the needs, values and culture of the Nunavik population. The regional steering committee should also take part in the evaluation of the deployment of the network of Inuit addictions counsellors under the CLSC in order to propose adjustments if necessary. If the original model proves to be unsatisfactory after a few years, an alternative model could be recommended. See Appendix C for Regional Steering Committee for the deployment of Inuit addictions counsellors charter. 5-Strengthening the addictions continuum of care in Nunavik The development of Inuit-specific continuum of care in addictions will require the development of very specific services within the region. And should be guided, supported and maintained by the health and social services network. Every regional and local actor in the field of addictions is an important partner in the continuum of care in Nunavik. In order to provide more efficient and complete services, every partner must be strengthened. In order to achieve that goal, it is recommended that: 5.1 The Isuarsivik Treatment Centre, supported by the Addictions Advisory Committee, the NRBHSS, the health centers and other relevant partners, initiate a process of diversification of its funding by lobbying regional and out-of-region organizations; 5.2 The NRBHSS and the health centres commit, in practical terms, to support Isuarsivik s plan to build a new facility that would allow increasing the number of clients and creating urgently needed family units where clients could come with their spouse and children; 5.3 The NRBHSS ensure that components of the Inuit addictions counsellors training program are accessible to workers of Isuarsivik, NI and other partners of the Nunavik health network (student counsellors, CLWWs, social aides, etc.);
5.4 The clinical supervision and personal support/counselling measures created for the Inuit addictions counsellors training program be made available to workers of other organizations and departments taking part of the training programs; 5.5 In view of the professional/clinical development of the workers in the addictions field in Nunavik, mechanisms to facilitate internships, service loans and replacement between NI, Isuarsivik and the CLSC be put in place. 6-Communications campaign In order to build healthier communities, it is recommended to set up a structured, planned and long-term regional communications campaign for prevention and aiming at changing current practices of drug use, drinking and gambling in Nunavik. The communications plan shall recognize, value and encourage local communications initiatives. This communication campaign shall focus on strengths of the individuals and communities as well as resiliency and Inuit history. The content shall also take into account the impact of unresolved historical and personal/family trauma affecting Nunavimmiut. In that context, it is crucial to meaningfully engage with the youths in order to validate their experience and break the cycle of abuse and addiction. Conclusion The current social context faced by Nunavimmiut and their communities requires leadership if meaningful change is to occur. Responsibility and commitment must be demonstrated at all level, including provincial and federal governments. This must be translated in the form of significant and sustained funding to strengthen, develop and maintain the necessary services. The causes behind the problems of substance abuse must be explained to the population and the service providers, and the act of reaching out for help must be encouraged and recognized as a sign of strength. For their part, the service providers must pay close attention to the flexibility, accessibility, quality, continuity and cultural adequacy of the services offered in the region or by out-of-region partners.