Module 7: Aboriginal Community Health Services

1. Module 7: Aboriginal Community Health Services

2. Welcome to Aboriginal Community Health Services. This course takes 45 minutes to complete. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module. There is a quiz at the end of each chapter and a link to handouts and resources at the end of the learning module. Select the arrow keys at the bottom of your screen to move forward and move back, or to stop and start the module.

3. Course Learnings In this learning module, you will learn about: Aboriginal Health Access Centres Urban Aboriginal Health Services Ways to Leverage Partnerships Aboriginal Community Health Services

4. Introduction Over one-third of First Nations, Inuit and Métis (FNIM) communities are in remote, rural or isolated areas. Some people have to travel over 90 kilometres to access health services, with specialized services accessible by travelling to an urban centre.

5. These issues, coupled with others have left access barriers to a variety of health care services. These are covered in Module 1: Culture as a Determinant of Health From Cancer Care Ontario surveillance data. FNIM people are over-represented in under or never screened populations. There has been a rise of chronic conditions among FNIM people over the past several decades. Introduction In each of the FNIM populations over the past few decades. This is similar to the general Canadian population. Although research is limited, existing studies show that cancer incidence has risen dramatically: Cancer is now among the top three causes of death among FNIM people. Cancer was nearly unknown a few generations ago.

6. In Ontario, incidence rates for lung, colorectal, kidney, and cervical cancers are similar or higher among FNIM people. • Disparities in cancer screening exist due to factors such as language barriers and discrimination. • There is a rise of incidence rates of colorectal cancer in First Nations men above the general rate. • First Nations women are diagnosed at a more advanced stage of breast cancer on average than other women.

7. Let’s get started. Move forward to begin Part 1. Health equity is an important component of the Cancer System Quality Index.

8. Part I of the course explores the Aboriginal Health Access Centres (AHACs) as a pillar of Aboriginal community-led heath care. It also examines the need for the AHACs, and the collaboration of different service offerings for FNIM people. Part I: Health Access Centres As a Pillar of Community-Led Health Care

9. Chapter 1: Overview of the Aboriginal Health Access Centres

10. Aboriginal Health Access Centres (AHACs)

11. Established in 1995 • AHACs were modelled after Ontario’s Community Health Centres (CHCs) • CHCs breadth of services and support became the preferred mechanism to improve the health and well-being of communities in Ontario facing various barriers in accessing health care. • AHACs are governed by the Association of Ontario Health Centres (AOHC). • The model, collaborations and structure of AHACs have become a leader for FNIM community health care programming.

12. AHACs by the Numbers • Number of AHACs in Ontario: 10 • Registered clients accessing care and health programs: 92,678 • Average number of clients per centre: 9,267 • Registered clients receiving clinical care: 55,638 • Average number of clinical visits per client, per year: 5.2

13. AHAC’s Importance Historically, Indigenous/traditional healing was outlawed by governments. • Although, most practices have become lawful again over time, the effects to FNIM culture were felt. • Community leaders and elders have preserved the memory and practice of traditional ways that is grounded in the respect for all creation and the earth.

14. Health care and support at all AHACs are promoted and provided by health care professionals, some of whom are First Nations, Inuit or Métis by descent. They have an understanding of the inter-generational traumas that have affected FNIM people, and may have lived their own journeys to health and healing.

15. ACs provide a place where traditional healing and FNIM community strength are anchored. Culture and traditional practices are at the core of all AHAC health, health care and community development practices. FNIM clients have said that the AHACs offer a sense of safety, belonging and where they can find meaning. Pictured: Smudging Ceremony

16. Collaborating To Deliver Improved Services and Access Initiatives, including educational pieces are delivered under the model of health and wellbeing that the AHACs and CHCs collaborate together to help influence positive health care changes at the community level.

17. Attributes of the Model of Health and Well-being We will review each in more detail • Anti-oppressive and Culturally Safe • Accessible • Inter-professional, integrated and coordinated • Community-governed • Acknowledgment of the Social Determinants of Health • Grounded in a Community Development Approach • Population and Needs-Based • Accountable and Efficient

18. Anti-oppressive and Culturally Safe AHACs and CHCs provide services in anti-racist, anti-oppressive environments that are safe for people:

19. A place where there is no assault, challenge or denial of their identity, or who they are and what they need. • It is about shared respect, shared meaning, shared knowledge and experience of learning; • Living and working together with truth, respect, honesty, humility, wisdom, love and bravery. • The presence of people from various cultural and linguistic backgrounds is emphasized, resulting in their ability to control or influence the processes operating in their health services.

20. Accessible

21. CHCs and AHACs build inter-professional teams working in collaborative practice. Services: one-on-one, personal development groups, and community level interventions. Salaried professionals work together to address people’s health and wellbeing needs. Inter-professional, integrated and coordinated Facilitate the delivery of seamless and timely people- and community-centred health and appropriate referrals Develop partnerships and integrate with health system and community organizations to: Referrals include primary care, illness prevention, and health promotion.

22. Community-governed

23. Acknowledgment of the Social Determinants of Health The health of individuals and communities is impacted by the social determinants of health including: • income and employment • early childhood development and education • working conditions • food insecurity, and housing • social exclusion and social safety network • health services • gender, culture, race and racism • disability

24. Acknowledgment of the Social Determinants of Health CHCs and AHACs strive for improvements in social supports and conditions that affect the long-term health of people and communities. This is done through: • participation in multi and cross-sector partnerships and advocacy for the development of healthy public policy • within a population health framework.

25. Insert pop up exercise box • This is a non-scoring exercise • [Add in a pop-up: Choose one or two social determinants of health a FNIM patient might be impacted by and how you might be able to support them (no more than two sentences).

26. Grounded in a Community Development Approach

27. Population and Needs-Based

28. Accountable and Efficient

29. Continued Strategies for Improvement • Forming strategic alliances and initiatives helps to further community health and wellbeing. To influence positive health care changes, AHACs work with other community agencies under the AOHC including: • CHC’s Community Family Health Teams (CFHTs) • Nurse Practitioner-Led Clinics (NPLs)

30. Health Public Policy

31. Their work on public policy is guided by two fundamental principles:

32. Poverty In partnership, CHCs, AHACs, Community Family Health Teams (CFHTs) and Nurse Practitioner-Led Clinics (NPLs) and the anti-poverty movement, AOHC champions the eradication of poverty. The connection between low income and poor health is well documented. An estimated 60% of the population’s health outcomes are determined by socio-economic, cultural and environmental conditions including income, education, working conditions and child development Source: 2010 Annual Report of the Chief Medical Officer of Health of Ontario

33. High Performing Health Care SystemTo improve health outcomes and support healthcare sustainability, CHCs, AHACs CFHTs, and NPLs champion the transformation of primary health care.

34. They collaborate with partners to ensure:

35. Community Health Ontario The AOHC (with CHCs and AHACs) formed a strategic partnership with the Ontario Community Support Association, and the Ontario Federation of Community Mental Health and Addictions to form the strategic partnership called Community Health Ontario (CHO).

36. They represent the majority of the not-for-profit home and community support, mental health and addiction and community-governed primary health care providers in Ontario Move forward to start the quiz for this chapter.

37. Insert Quiz slide: Test for Part I, Chapter 1 This chapter has one question. Q: Name an AHAC strategy for health care improvement. A: __________________________

38. Chapter 2: Aboriginal Health Access Centres

39. Overview of Services OfferedAHACs are a key access point to overall FNIM family and community health and development.

40. Each AHAC offers offer a broad range of services that include primary care, health promotion and prevention, mental health services, traditional healing and youth empowerment to meet the diverse needs of the community(ies) they service. We will provide an overview of some of the common programs and services. There will be a link at the end of the learning module to each AHAC and their programming so you can determine what offerings the centre that services your community provides.

41. Primary Care/Clinical Services:

42. Some areas of focus include, culturally sensitive primary health care and: Health promotion, screening Diabetes management and prevention Treatment and monitoring of illnesses Lifestyle counseling, pre and post-natal care

43. Health Promotion & Education Services The goal of the Health Education Program is to encourage healthy lifestyle choices for FNIM people. Lifestyle choices relate to all age groups and include topics such as chronic disease, eating habits, exercise, parenting, child safety, smoking cessation, and other related issues.

44. Some of the services offered by the program are:

45. Some of the services offered by the program are:

46. Diabetes Education For Example: gestational diabetes, exercise and diabetes, lab and medication review. The program focuses on promotion. Lunch and learn sessions are available. Presentations can be geared to a certain age group or sector. The goal is early prevention. Offer nutritional guidance and referrals to additional care. They highlight wellness strategies.

47. Advocacy The goal of the advocacy program is to help members of FNIM communities ensure that they have access to culturally appropriate health-care services and programs, and to promote the empowerment of FNIM people in determining their own health care needs.

48. Areas of focusinclude: Provide patient advocacy in hospitals. Report discrimination to appropriate authorities. Assist with education, job training, income, diet, and housing. Lobby to ensure FNIM representation on: Health related decision making bodies, committees and boards.

49. Mental Health Services AHACs administer a mental health program for FNIM people to ensure that they have access to culturally appropriate mental health services and programs. They promote the empowerment of FNIM people in determining their own mental health care needs.

50. Areas of Focus Include: Intake and assessments Counselling and outreach services Couple and family support Referrals to treatment and rehabilitation programs Home visits to clients Addictions and wellness plans