Kim Brooks, Department Head,

Yúustway Health Services, Squamish

Nation & President, FNHDA

Best of Both Worlds:

Dimensions of Quality,

Indigenous Perspectives March 1, 2017

Coast Salish Territory

Carolyne Neufeld, Health and Social

Development, Seabird Island

C3: Fostering an Intentional

Process for Developing Allies

Presentation Overview

• Background

• Transformation = Quality Improvement

• Relationships and allies are key to transformation

• Moving Forward: Considerations for Building Positive Allies

The presenters have no conflicts of interest to disclose

Our Mission for FNHDA

A strong, professional First Nations Health Directors Association that works to:

• Promote culturally strong, experienced, professionally trained First Nations Health Directors;

• Provide technical advice on research, policy, program planning and design; and

• Support the implementation of community Health Plans.

FNHDA Mandate

As outlined in the FNHDA Constitution and Bylaws, FNHDA is:

• Composed of health directors and managers working in First Nations communities – a member-based organization

• Supports education, knowledge transfer, professional development and best practices for health directors and managers

• Acts as a technical advisory body to the FNHC and the FNHA on research, policy, program planning and design, and the implementation of the Health Plans. The Association is not a political advocacy body.

FNHDA Structure

Our membership is comprised of Health Directors or Health Leads working in First Nations communities FNHDA Board is made up of 15 members • 3 representatives for each

of the 5 regions FNHDA is a non-profit society and follows the FNHDA Constitution and Bylaws.

How we work together:

• For good governance and

accountability, the First

Nations health governance

structure separates:

– business (First Nations Health

Authority),

– political advocacy (First

Nations Health Council), and

– technical advice (First Nations

Health Directors Association)

BC First Nations Health Governance Structure

Our Shared Vision is key to our relationship: “Healthy, self-determining and vibrant BC First Nations children,

families and communities.”

For more information: www.fnha.ca/about/governance-and-accountability

FIRST NATIONS HEALTH GOVERNANCE STRUCTURE ENABLES

QUALITY IMPROVEMENTS IN HEALTH SERVICES

Transformation =

Quality Improvements • Transferring health services from Health Canada to the First Nations

Health Authority, each of the transfer phases has a role in quality health services

• Transition Phase - where we are building the infrastructure and systems to take on service delivery • This builds capacity to deliver quality health services

• Transfer Phase - where the responsibility for Health Canada programs is transferred to the First Nations Health Authority – This assumes the responsibility for quality health services and follows the

principles of self-determination and decolonization

• Transformation Phase – where current health programs and services are upgraded and re-oriented to better meet the needs of BC First Nations – This really focuses on quality improvement, cultural safety, and bringing

everyone along

How does FNHDA support

Quality Health Services through relationships

and allies?

Relationship with Self (FNHDA & Health Directors)

Relationship with Partners (First Nations & External)

Relationship to Self & Quality

• We recognize that a starting place for quality health services begins by looking at ourselves and how we do our work

• Looking at our Association, we promote quality

through structural vision and direction

• Looking at our Health Directors Members, we promote quality through professional development and personal wellness

• Looking at how we work, we promote lateral kindness as a way of working together that is aligned with traditional teachings about ways of treating ourselves and each other, and building good relationships

“Love and respect

for yourself is key to

happy life. So if we

find ourselves

mistreating others,

it is a reflection of

our own torment not

theirs. We project

what we are, so

love yourself.”

- Elder Leonard

George,

Tsleil-Waututh

Nation

Head to Heart Personal Wellness

Relationship to Self

• Supporting Health Directors to improve personal wellness and job retention creates capacity, good working environments and staff continuity, which will improve the quality and consistency of health services

• “Stress and Burnout” were identified as two significant challenges for Health Directors so FNHDA launched a mental wellness campaign called Head to Heart

FNHDA Strategic Plan

• Each of our Strategic Goals provides structural vision and organizational direction for quality health services:

– Goal 1: Provide professional development, training, networking

and support services for Health Directors, supporting their well-being and success in their community roles, and enabling their participation in the improvement of the broader health system

– Goal 2: Support transformation through effective participation of the FNHDA in the First Nations health governance structure and providing quality and timely technical advice

– Goal 3: Uphold high operational standards and seek to continuously improve, grow and evolve the FNHDA

Relationship to Self

FNHDA Standards of

Excellence

• FNHDA’s Standards of Excellence provide a collective vision for Health Directors to grow towards proficiencies that support quality. Each Standard relates to dimensions of quality.

• FNHDA Standards of Excellence are a standardized list of proficiencies for First Nations Health Directors in BC - created by Health Directors

• They are viewed as a positive set of inspirational proficiencies that Health Directors can strive toward

• Because each community is in a different stage of their health journey, such realities need to be understood when determining how quickly each of these Standards can realistically be achieved

Relationship to Self

Professional Development

• Through professional development opportunities, FNHDA supports Health Directors to develop the skills and knowledge to administer quality health services in their communities and participate in technical advice processes

• Examples of Professional Development Activities: – Talking Circles

• Sharing Practices to balance work / life/ self-care • Traditional Medicine, and Spirit Poling/Nature Walking

– Presentations and Workshops • Self-care strategies & techniques for First Nations Health Directors to empower clients

by Andrea Avila, PhD Creative Empowering • San’yas: Indigenous Cultural Safety Training by Aboriginal Health, PHSA • DiSC® Workplace behavior assessment tool workshop for better teamwork and

conflict management

– Webinars • First Responders First Aid • Community Living BC (development disabilities support services) • Health Protection

• Accreditation Part 1 and Part 2

Relationship to Self

• Example of a province-wide quality initiative to ensure all Health Directors have a standard foundation and ‘nobody gets left behind’

• Members voted for FNHDA develop a made-in-BC certification

program for Health Directors (FNHDA AGM 2014) which will: • Reflect our context in BC and our unique governance

arrangement, and • Be linked to FNHDA’s Standards of Excellence

• The Certification Focus Group and FNHDA Board are now guiding program delivery and implementation planning

Relationship to Self

Certification Program

FNHDA is developing a made-in-BC FNHDA Health Director Certification Program!

Lateral Kindness & Quality

Improvement

• Promoting lateral kindness creates safe spaces, cultural safety and humility, and good working relationships for delivering quality health services.

• Lateral kindness is: – A practice that aims to support one another and is based on the premise that we all have gifts

to contribute as individuals – A way to address lateral violence that is based on First Nations values that promote social

harmony and healthy relationships – A way of being that is aligned with First Nations values, traditional teachings and cultural

protocols about ways of treating ourselves and each other, building good relationships, and dealing with conflict

• Lateral violence: – Impacts people around the world, but it manifests in unique ways for First Nations because of

colonization, racism and intergenerational trauma – Occurs when we direct our feelings of dissatisfaction towards one another rather than

recognizing that the true adversaries are colonization, internalized racism, or feeling oppression in other forms

– Is expressed in many forms, such as: gossip; verbal and non-verbal assaults; passive and aggressive behaviours; blaming; shaming; attempts to socially isolate others; demeaning activities; bullying; and, threating or intimating behaviour

Relationship to Self

Relationships with our Allies &

Partners

• For quality, FNHDA and Health Directors, we recognize our roles as technical advisors and in relationships with our partners is key to quality and transformation of health services.

• Looking at our role as technical advisors, we promote quality with our Technical Advice Pathway (TAP)

• Looking at building relationships and allies, we can work together to improve our health services and system by drawing on the gifts and strengths of each partner

• FNHDA Member Engagement through TAP is an important mechanism to support culturally-safe and quality health services. It allows for evaluation, reflection, feedback and solutions to be made for research, policies, and delivery of health services and programs. It also allows for collective quality concerns to be raised to appropriate players.

FNHDA’s Technical Advice

Pathway (TAP)

Relationship to Partners

Building Relationships

Relationship to Partners – Building Relationships

• FNHDA knows that building relationships is key to supporting quality health services

• By drawing on the gifts and strengths of each partner, we can work together to improve our health services and system

Considerations for

Building Positive Allies

Relationship to Partners – Building Relationships

Partners are Principled • An effective partnership based on reciprocal accountability is based on

deep and abiding respect and trust and supported by good communication.

• These and other principle guide us: – Lead with Culture: Understand you Partners and where they come from – Honour those who paved the way: Pay respect to, and honour the wisdom of, those

that brought us to where we are today – Maintain unity and discipline: Work for the common good of all; do not criticize on

another; recognize that we all have a role to play – Create strong relationships: be tough on the issues and easy on each other: Seek

opportunity to create understanding and support one another’s dignity – Engage at the appropriate level: Partners must have authority, skills, and knowledge to

fully contribute – Respect each other’s process: Seek understanding of, acknowledge and respect the

validity of one another’s ways of working and decision-making processes, and provide assistance to one another in navigating these processes.

(Health Partnership Accord, 2012)

Relationship to Partners – Building Relationships

• We work with our First Nations Health governance partners, for example: – Ex. Health Directors participate in Regional Caucus sessions as

technical advisors, which involve discussions about FNHDA, FNHA and FNHC initiatives

• We work with external partners, for example: – Health Authorities on their First Nations health portfolios

– Community and non-profit service organizations for two-way information exchange, training opportunities, networking and service delivery

• Ex. The Red Cross attended the FNHDA AGM and engaged in two-way learning opportunities between Health Directors and partners

• Ex. This Quality Forum for networking, learning and collaborative discussions

Considerations for

Building Positive Allies

Partnership examples: Seabird Island Band

Kanaka Bar First Nation

Lytton First Nation

Sts’ailes First Nation

Boothroyd First Nation Squiala

First Nation

Fraser Thompson First

Nation

Boston Bar First Nation Spuzzum

First Nation

Skuppah First Nation

Providing services in economies of scale:

Developing Allies: Seabird Island Band

Stabilization and Transitional Living Residences – Recovery

homes for First Nations men and women dealing with substance use

Primary Care – health services to address prevention and

treatment for all primary health care needs

Mobile Diabetes Team – serving 52 communities with

detection, assessment, education, case management

Early Childhood Development – serving 0-5 year olds and their parents

Seabird College – providing adult Dogwood, trades and

other vocational training

Child and Family Development – providing in-the-family support

A:yelexw Center

for Hope and Healing

Stabilization and Transitional Living Residences: A partnership with Fraser Health,

Chilliwack Community Services,

First Nations Health Authority,

NNADAP, and

First Nations addictions and mental health workers

For men and women over

19, ready for change…

Primary Care partners: Fraser Health, FNHA

• Physician services – G.P. addictions, psychiatry

• Midwife / naturopath / traditional medicine

• Dental / pharmacy / mental health

SIB Health Center

2 First Nations general

practitioners. Dr. Fox is an

addictions specialist

Psychiatrist and Internal Medicine Specialist

Primary Care partners: Fraser Health, FNHA

• Mammogram, hearing, and optometry clinics

• Maternal & child care, pre/post natal

• Public health services – vaccines, naloxone etc.

• Health promotion activities - nutrition

2016 stats:

45 community visits, 69 clinic days, 249

clients seen with diabetes, 235 seen for

screening, 141 eye exams

Mobile Diabetes Team Partners: FNHA, UBC

Mobile Diabetes Team – what we provide:

1. Education

Client/community, health workers, public health fairs

2. Assessment

Blood tests (A1C,

Cholesterol, Creatinine)

Urine tests

Diabetes specific dilated

eye exam

3. Advice

Endocrinologist / nursing

recommendations

Community health

worker support

Child and Family Development Partners: MCFD, Xyolhemeylh

Services:

A family home, to work with the whole family and keep

children in the home

2 social workers located at Seabird Island Band

Early Childhood Development partners: Province of BC,

MCFD, FNHA, Parents

• Parents and Tots

• Aboriginal infant development

– (Someone So Small)

• Supported child development

• Ey Qwa’l Speech & Language

• Headstart, Bear Bus

• Daycare, preschool, Language Nest

• Young parents’ program

State of the art:

Cultural celebration:

Seabird College educational partners: FNHA, UFV, TRU,

NLC, UBC

Providing trades training in welding, construction craft worker,

hair stylist, heavy equipment operator

Providing dual credit in adult Dogwood and vocational programs

Seabird College funding partners: ESDC, FNHA INAC,

BC Ministry for Education and AvEd

Providing certification in LPN, ECE, education assistant, business administration,

doula, and more

We are excited to learn together and

explore opportunities to work together

with you!

Please contact the FNHDA if you are

interested in working with us!

Thank you!

fnhda@fnha.ca | p: 604-693-6500 |

f: 604.913.2081 | fnhda.ca

501–100 Park Royal South, West Vancouver, BC V7T 1A2