Summary of Research

1. Portrait of the Situation forEnglish-speaking First NationsAccessing Health and Social Servicesin English in the Province of QuébecSummary of Past Research By: Amy Chamberlin, Ph.D. Candidate(School of Indigenous and Canadian Studies, Carleton University) February 2018

2. Summary of Research • Introduction • About the Communities • Overview • Purpose • Methodology • Findings • Conclusion

3. INTRODUCTION • In 2012, English-speaking First Nations of Quebec launched a project to ‘expand and build partnerships’ to improve access to health and social services. This project allowed for the establishment of a Coalition of English Speaking First Nations Communities of Quebec (CESFNCQ). • The CESFNQC is comprised of First Nations communities/organization from different parts of Quebec, including: Kawawachikamach, Gesgapegiag, Listuguj,Akwesasne, Kanesatake, Kahnawake, Eagle Village First Nation / Kipawa, KitiganZibi, Long Point /Winneway,Timiskaming, and the Native Women’s Shelter of Montreal.

4. About the Communities • CESFNCQ members are located in seven (7) of Quebec’s eighteen (18) health regions inisolated, rural, and urban areas. • Six (6) of the CESFNCQ are ‘border’ communities. • Languages spoken: Approximately 64.5 % of the total Aboriginal populationare predominately English-speaking, or English is the first official language spoken after their own Indigenous language.**Data source – Aboriginal Affairs and Northern Development Canada, 2012 and Ministère de la Santé et des Services sociaux du Québec, 2012

5. Overview of Research • CESFNCQ oversaw multi-year research with English-speaking First Nations communities/organization. • The research documents challenges and experiences facing English-speaking First Nations (front line workers and community members) when accessing services from health and social institutions in the province of Quebec. • ‘Portrait of the Situation’ community-based reports include: Health Services – Report (2013) and Addendum (2015); Social Services – Report (2016).

6. PURPOSE • The purpose of the research was to investigate the situation of English-speaking First Nations of Quebec when accessing health and social services. • Research objectives: a) identify issues and challenges when accessing services; b.) Document strategies and solutions (in place or recommended) to improve access

7. Methodology Action-based research approach: • The CESFNCQ and researcher identified research questions and methods to gather qualitative data. • Ensure consistent data collection, yet with some flexibility to meet the needs of each community or organization. Research Methods: • Focus groups, individual or group interviews, questionnaires, and surveys. • Letters of invitation sent to all CESFNCQ members • Community Liaisons assisted with various aspects of the research (e.g., identify participants, organize focus groups, data collection)

8. Data Collection All eleven (11) members of the CESFNCQ participated in the research, and a total of 184 individuals took part in the initiative. HEALTH • Nine (9) First Nations communities and one (1) organization (total of 135 participants) • Total of fourteen (14) focus groups, nineteen (19) individual interviews, and five questionnaires were completed • Data collection took place in March – July 2013, October 2013, and September – November 2014. SOCIAL SERVICES • Ten (10) First Nations communities and one (1) organization (total of forty-nine (49) participants) • Total of eighteen (18) in-depth interviews (group/individual),questionnaires • Data collection took place in April-June 2015 and Jan. –Feb. 2016

9. FINDINGS Access Issues and Challenges: Health and Social Services • Double discrimination – language barriers and lack of cross cultural understanding (*Additional barriers for communities/individuals whose first language is their own Indigenous language). • Discrimination and lack of cultural safety Lack of understanding about colonial context and policies; lack of understanding about intergenerational trauma; and lack of understanding about Indigenous worldviews/approaches to wellbeing. • Attitudes and perceptions Participants reported feelings of anxiety and fear over not being understood when accessing health and social services from provincial institutions because of language and cross-cultural misunderstandings • Jurisdictional issues: i.) Provincial borders; ii) Corridors of Service; and iii) Lack of clarity about federal/provincial responsibilities over First Nations’ health services • Dissatisfied with quality of services in English: issues with assessments, discharge, follow up

10. Access Issues and Challenges: Health and Social Services • Lack of access to specialized health services in English. Long wait times for services, longer wait for services in English. Barriers due to distance and/or transportation in isolated, rural and urban areas. *Isolated and rural communities face challenges accessing both general and specialized health services. • Lack of English language services for mental health.Reported that ‘quality of services’ an issue in area of mental health due to language barriers and cross cultural misunderstandings. • Lack of access to specialized social services in English (e.g., addictions’ services, child psychologists, art therapy, legal aid, occupational therapy, speech therapy, psycho-social/psycho-educational/child development assessments, autism evaluations, dietician) • Crisis Situations and Critical Care – Individuals in crisis situations have limited access to mental health services (remote, rural and urban areas). Reports of barriers because of language for individuals in critical care. Some participants noted issues due to language with Emergency Services (emergency room and dispatch).

11. Access Issues and Challenges:Health and Social Services • Lack of English language documentation from province (e.g., health information, assessments, funding proposals (municipal), placement agreements). • Lack of funding for translation services. Bilingual (French and English) workers are providing in-house translation services, over and above their workload. Organizations are paying for translation services from administrative or program budgets. • Challenges accessing updates from province about changes to health and social services’ legislation and/or regulations. • English-speaking professionals face barriers: challenges registering with Quebec’s Professional Order because of French language requirements. • Lack of English language training opportunities in Quebec(health providers, social services’ first and second line workers).

12. Strategies and Solutions • Agreements and protocols • Establish partnership agreements with provincial institutions • Inter-sectoral approach (internally and with province) when intervening on crisis situations (avoid duplication, reduce ‘silo effect’, and strengthen continuity of care) • Border Agreements: access to English language ‘out of province’ services • Protocol for provision of services to ‘non community member’ clientele • Increase involvement of First Nations in decision-making • Develop a Strategic Plan for English-speaking First Nations • Identify legislation and policies to support linguistic and cultural needs • Establish formal mechanism to track access issues • Identify priority areas: English language services most needed by communities/organizations • Increase awareness/information about ‘rights and responsibilities’ (e.g., linguistic, cultural and Aboriginal) when accessing health and social services from provincial institutions • Receive updates (in English) about changes to legislation and/or regulations about health and social services

13. Strategies and Solutions • Cultural Awareness and Safety • Indigenous liaison person (support for community members receiving services from provincial institutions) • Training about colonial legacy and cultural awareness • Anti-racism Strategy (workshops to address racism/discrimination and to foster cross-cultural understandings) • Increased visibility of Indigenous culture/practices and Indigenous languages at provincial institutions • Language and Communication • Funding for translation services (e.g., documentation from province) • Language support services for clientele (crisis/critical/specialized) • Updates (in English) about changes to legislation/regulations (health and social services) • Improve communications with provincial and federal institutions (break down barriers, make connections, and share information about services)

14. Strategies and Solutions • Training, Employment, Capacity Building • Offer more training in English (health and social services) • Recruit professionals to work in community • Share strategies amongst First Nations (‘lead by example’) • Networking and Information Sharing • Within community, amongst FNs communities, and with provincial network) *what services are available, where, and how to access • Establish web-based sharing/documentation center amongst communities/organizations • Complaints’ Process • Establish a process to track and report ‘Incident Reports’; organizations to assist clients address discrimination and/or racism (e.g., fill out forms, launch complaint on their behalf, advocate and meetings)

15. Strategies and Solutions • Empower Community Members: ‘Raise People Up’ • Move away from ‘crisis’ to ‘prevention’ approaches (health and social) • Address negative stereotypes around accessing social services • Ensure victims of violence receive support services required • Bring health and social services’ resources (e.g., specialized services, assessments, clinics, training) into First Nations communities/organizations • Mitigate transportation issues; cost effective to ‘bring in’ resources vs. sending people out; increase sense of cultural safety. • Long-term support (e.g., financial, human, and material resources) for the CESFNCQ: ensure that English-speaking First Nations can address their unique linguistic and cultural needs to improve access to health and social services.

16. CONCLUSION The research documented a portrait of the situation for English-speaking First Nations in Quebec when accessing health and social services. Language and culture are closely connected. The research revealed that English-speaking First Nations face ‘double discrimination’ when accessing health and social services: • There are obstacles resulting from language. • There are misunderstandings because lack of cross-cultural awareness/understanding. The research affirms a desire to improve access by fostering formal and informal partnerships and communications amongst English-speaking First Nations, and with provincial and federal health and social services’ institutions. The research affirms a desire for English-speaking First Nations to be involved in decision-making and implementing of health and social services. Finally, the research affirms a need to ensure cultural safety, as well as access to health and social services reflective of Indigenous understandings of health and wellbeing.