NAHO CONFERENCE 2009

1. NAHO CONFERENCE 2009

2. A Pilot Project for Mental Health Service Treatment Provision for Residential School Survivors AUTHORS: Dr Bob Chaudhuri (1); Tom Terry(1); Robert Thomas(2); Brian Walmark (2) AFFLIATIATIONS (1): Northern Ontario School of Medicine (NOSM) AFFLIATIATIONS (2): KeewaytinookOkimakanak (Northern Chiefs Council)

3. Canada's Indigenous population is a vulnerable group in the health care system, with specific mental health and healing needs that are not widely being met.

4. Indigenous peoples face certain historical, cultural-linguistic, socioeconomic, and system barriers to access to mental health care that government, health care organizations, and social agencies must work to overcome. Current health indicators undermine Canadian Indigenous health status, including mental health.

5. To address some of these inequities in health and health care, some Indigenous health organizations have recently developed services to mental health that include traditional cultural approaches to healing.

6. However, Indigenous health and healing information and practices are practically non-existent through the mainstream health care system, which is dominated by Western approaches.

7. An Indigenous paradigm of health has been successfully employed by Indigenous peoples for thousands of year prior to the arrival of Europeans and colonialism. • This study seeks to create new and different methods of treating First Nations people linking traditional Indigenous healing practices and western practices using a community mental health care delivery system as well as teleconferencing • It should be noted that teleconferencing is an antiquated term . In reality we mean videoconferencing (Internet Protocol IP)

8. The focus of this research is to investigate the successes and challenges by this new delivery system, which offers both Indigenous and Western forms of healing to clients in mental health service agencies, and to get descriptive information from their clients about success of such an approach.

9. The KO Indian Residential School Survivors Program - IRSSP • The mental health treatment services delivery model for a pilot project (the KO Indian Residential School Survivors Program - IRSSP) being jointly proposed by the Sioux Lookout First Nations Health Authority (SLFNHA) NODIN Child and Family Intervention Services and by KeewaytinookOkimakanak (KO), the Northern Chiefs Council, a tribal council serving six first nations in Ontario’s far north. • This pilot project combines the resources of Multiple First Nation partners and communities. Unfortunately, the Legacy of Residential Schools And Intergenerational trauma has had a large Effects in NorthWestern Ontario among other Places in Canada.

10. IRSSP • The project will facilitate both counselling and community supports for Indian Residential School survivors in the KO First Nation communities of Deer Lake, Fort Severn, Keewaywin, North Spirit Lake, and Poplar Hill. • Both traditional and western methods for Mental Health treatment of “Post-Colonial” or Residential School Trauma survivors will be employed.

11. KO COMMUNITY MAP

12. IRSSP • The overall purpose of the KO Indian Residential School Survivors Program (IRSSP) is to: • 1. Provide appropriate and sufficient community-based therapy. • 2. Support services to promote healing from IRS trauma for survivors and families within their home community. • 3. KO is in charge of facilitating the funds for this program.

13. IRSSP • Unfortunately, we have learned the hard way that conventional models of mental health treatment services delivery for survivors of Residential Schools from remote northern Ontario First Nations have generally resulted in client recidivism. • As well, high costs associated with the conventional models of service delivery have meant that service delivery must be highly structured to control costs. High travel costs mean reduced access to client services. • Examples of how the KO IRSSP video-enabled therapy and traditional healing would address some of the existing service delivery challenges are:

14. Comparison of Existing Model with proposed KO IRSSP Community-Based Model

15. Comparison of Existing Model with proposed KO IRSSP Community-Based Model Continued

16. Comparison of Existing Model with proposed KO IRSSP Community-Based Model Continued

17. IRSSP • Telemedicine-enabled therapy, traditional healing and support services for Residential School Survivors from the KO First Nations will be cooperatively developed and initially supervised by a mental health professional (the IRSSP Pilot Coordinator) at the KO Office in Balmertown. • Regional coordination of program development, community consultation and IRSS Committee development, assistance to Chiefs & Councils in assigning support responsibilities to local worker(s), program promotion, training, approvals and billing for overall therapy and traditional healing services through NIHB, worker support and advocacy, and coordination of evaluation activities, will be the responsibility of the KO IRSSP Pilot Coordinator.

18. IRSSP • Local IRSSP Program responsibilities will include establishing a local support network amongst survivors, local promotion of IRSSP and supports, providing and/or facilitating referrals, coordinating client services (both local via tele-medicine or other and NODIN), client and group advocacy, facilitating and encouraging client follow-through on treatment plans. • Providing (or facilitating access to) emergency counselling if needed between clinical sessions, and participating in evaluation activities. • These responsibilities will be fulfilled by existing local mental health workers who will be tasked with additional responsibilities under this IRSS Program.

19. IRSSP • The mental health Single Agreement for Service Model will provide the general template for collaborative treatment. • Essential face-to-face consults with therapists normally accessed by video-technology will occur early on in the treatment process -- either up-front or after the first few therapy sessions – and will occur in the client’s home community context via a community visit by the therapist. • As well, consults with traditional healers will include a face-to-face consult early on in the treatment process (via a community visit), and will then progress to regular video-enabled consults for a majority of the treatment sessions.

20. IRSSP • IRSSP therapy and traditional healing services may be accessed by IRS survivors and their families in a number of ways: • 1) Direct contact with the IRSSP Local Coordinator by the survivor or family member(s); • 2) Direct contact with KO Health Services or KOTM, which informs the Pilot or the Local Coordinator; • 3) Direct contact with the KO IRSSP Pilot Coordinator, who will contact the Local Coordinator; • 4) Contact at-a-distance with related crisis and support contact lines, which will then contact the IRSSP. • IRSSP therapist and traditional healing services will require “prior-approvals” from NIHB. Prior-approval will be applied for once a referral is made to IRSSP staff. When necessary, IRSSP staff will assist the IRS applicant in completing the necessary forms to apply for ‘prior-approval’. The next slide will define the necessary information required for ‘prior-approval’.

21. IRSSP • The necessary information for “prior approval” in the application includes: • a) a letter from the Chief/Council recognizing the person as a Traditional Healer/Elder, and that they welcome the Elder to the community on such and such a date; • b) name and address of the Elder/Healer; • c) confirmation from the Elder/Healer that there is an appointment with former IRS student(s) - dates and times scheduled or that the person is attending a healing event; • d) if there is a community healing event - date and agenda of the event; • e) name, address, phone #, date of birth and DIAND # (band number) of the former IRS student plus names and dates of birth of family members; • f) if the person is a family member of a survivor, the actual survivors personal information, ie. DOB, DIAND#, School attended; • g) travel dates, for accommodation - dates requested.

22. IRSSP Treatment Process . • When this information is received, travel arrangements will be reviewed and the applicant will receive an IRS prior approval number from the NIHB office (which may take seven working days to process). • Once the video-session or community visit has occurred, an invoice is submitted to NIHB including the prior-approval number (IRS###), as well as a statement identifying all expenses with attached original receipts for accommodation, transportation, and a written and signed confirmation of attendance for each day of travel. • Once treatment plans are approved by NIHB, prior-approvals may apply to multiple consults as part of the overall plan.

23. IRSSP KOTM best practices (1) • Counselling environment, successful client engagement and confidentiality issues during video therapy sessions and remote sessions with a traditional healer will be addressed by applying existing guidelines / protocols established by KO Tele-Medicine (KOTM) over the last five years. KOTM serves 26 remote First Nations communities in Ontario’s far north. • These practises are articulated in the following KOTM documents: • Telecounseling Consultation Information Sheet – a client information sheet which describes KOTM and Telecounselling, as well as providing detailed information for clients on “What Happens During a Telecounselling Appointment”, “What About Privacy / confidentiality?”, “What are the Potential Risks?”, the Benefits to Telecounselling, as well as what other options are available.

24. IRSSP KOTM best practices (2) • Protocol for Telepsychiatry Consults – a program delivery tool for KOTM staff to ensure sensitive, confidential, effective and proper consults, and covering topics such as background noise, other persons in the clinic area, technical issues related to equipment operation, as well as other service delivery aspects required for successful consults such as Oaths of Confidentiality for staff and necessary consent forms for clients. • IT User Guide – providing technical instruction for use of phone and video suite equipment • Privacy and Confidentiality Policies section from the KOTM Policy and Procedures Manual • Protecting Your Personal Health Information – KOTM client information brochure

25. Timeline and Evaluation • The evaluation / assessment of video-enabled therapy and traditional healing services through the KO IRSSP will be on-going and result in a final report at the end of the Pilot period (March 2010), and for each subsequent year of service delivery. • Outside evaluators will work collaboratively with IRSSP staff to determine the scope and focus of the assessment activities and design an evaluation plan. Evaluative tools will be administered at the end of most IRSSP activities, including all video-enabled sessions and any formal support functions/events held in each First Nation. • As well, staff and Committee training will be evaluated by participants for relevancy, appropriateness and usefulness. • Quantitative analysis of statistics, together with projection of costs for same level of service/activity if not video-enabled, will provide some relative measure of cost effectiveness when compared to existing models which support client travel away to urban settings for therapy or healing services in isolation from family and peer supports.

26. IRSSP Implementation WorkplanJuly 2009 – March 2010 • Summary Objectives/Activities to be completed: • Program Design • Establish local IRS Support Communities • Community Consultations • Hiring – the appropriate coordinators • Confirming Traditional Healers • Training – include case management, confidentiality, basic counselling, crisis intervention • Program Promotion • Service Delivery • Program Planning – Year 2 • Program Evaluation/Assessment

27. Current KO Mental Health Clients • KO Mental Health Office reports that the present KO mental health client list (all 5 FNs) totals 78 individuals • 39 of which are direct IRS survivors • 18 are inter-generational victims, and the remaining • 21 (primarily children) present other MH issues. • Once in operation, the IRSSP will increase # on list

28. Community Front Line Workers

29. Questions • Thank you • Acknowledgments to Krystal Kohar.