Clinical and Physician Services

Description

Health and Wellness Centre clients are able to use a broad range of clinical services, now including family medicine. Also, many types of health tests and screening services are provided by the Doctors, Nurses, Licensed Practical Nurses and Community Health Representatives.

These services are available in 4 ways:

• by walk-in
• by appointment
• through clinics, and
• in classes and workshops.

This approach provides a full, convenient range of options for Health and Wellness Centre clients.

Challenges and Priorities

A major challenge in this area is to find new and innovative ways of encouraging community members to use the Health and Wellness Centre for clinical services. This has meant trying to find ways to be as accessible as possible, such as with the walk-in services.

In 2005, by way of the Integrated Primary Health Care Project (see pages 88-91), the Health and Wellness Centre brought regular family medical services to the community. The Doctors who work here also teach Family Medicine at the University of Sherbrooke’s School of Family Medicine. As well, they are Medical Doctors for the Beauséjour Regional Health Authority. They provide medical services to the Health and Wellness Centre on a rotating basis.

The ongoing priority here is to develop a client-centered team approach which provides accessibility to culturally-appropriate clinical services for our community members.

Range of Services

COMMUNITY HEALTH

Healthy Living Services

Description

These services give community members the knowledge they need to make wise health choices. The programs deal with health areas where poor choices can have serious health consequences: diabetes, high blood pressure, heart disease and cancer, for example. Since many of these problems develop early in life, they are a major part of the Health and Wellness school education program.

The focus for lifestyle programs is prevention. They aim to prevent chronic diseases by having people live healthy lives. If people are active, eat right, keep their weight under control and avoid harmful substances, then they will have a lower risk of developing cancer, heart disease, diabetes and lung disease.
Other preventative services include work with FASD (Fetal Alcohol Spectrum Disorder), and outreach services for grief recovery and rehabilitation.

Challenges and Priorities

Getting people to change old health habits is always difficult. The staff is currently gathering information about the habits, attitudes, intentions and health status of community members. This will help to develop new priorities and strategies, and will put resources where they can do the most good.
At the moment, nutrition and women’s health issues are very important areas and will probably remain as top priorities for years to come.

Range of Services

Home and Community Care Program

Challenges and Priorities

The Home and Community Care Program has been running in Elsipogtog for several years and is well established.
It has a good staffing complement, but the potential demand for services still exceeds the capacity of the current staff levels.
As a result, a shift in focus is occurring emphasizing a more autonomous approach to Home Care. Through this means, clients are taught self-care and personal ownership in their own health management.

The program is well structured and has highly capable leadership. It has handled information-intensive tasks, e.g.:
• work planning
• policy development, and
• data management
with ease due in part to the availability of information management tools at the national level.

Because of its innovative approach to program planning, the Elsipogtog HCCP has been a leader for other communities with this type of program.

Description

This service area provides for the monitoring, care and rehabilitation of community members who have either long-term or short-term health care needs and who want to receive their health care in their own homes.

The services can range from scheduled appointments, to home visits by the health staff. Home visits include not only health care, but also basic home care services when needed.

Included in this is a holistic family strategy, where family members partake in developing interdependent health care in the home.
This area has evolved from a small grouping of services to a planned and well-coordinated effort that has ties to many aspects of community life. As part of a national

program, it may provide clients with:

• initial health needs assessments
• a personalized health management plan
• at-home health care services
• education for supportive care givers (family members, friends, etc.), and
• linkages with other agencies.

Range of Services

Aboriginal Diabetes Initiative

Description

Diet and nutrition are an integral part of diabetes prevention and management. Because this link is so strong, there is a great need for nutrition support in almost all community programming related to diabetes.

Nutrition education can take place in a multitude of ways. It can take place through individual counseling, group presentations, wellness days, walking and wellness challenges, prenatal classes, newspaper articles, postings on bulletin boards, menu planning at the school, day care and Headstart, school nutrition activities, diabetes screening or cooking classes to name just a few. Proper nutrition and a balanced diet through the lifespan are essential for chronic disease prevention such as diabetes.
In the Aboriginal Diabetes Initiative, there are 3 key program areas:

• Diabetes Youth Screening
• Youth on the Move, and
• Elsipogtog Fitness Centre.

EHWC decided to utilize the ADI funds to support nutrition services. We feel that nutrition education and support are essential to diabetes prevention and management. Our registered dietitian not only provides the above mentioned activities but also coordinates the diabetes clinic and provides support to other ADI driven programs such as Winter and Summer Active.

Range of Services

Maternal and Child Health

Challenges and Priorities

“Our children are our future...” as the saying goes. The Health and Wellness Centre is committed to that principle. During the past year, a staff Nurse was assigned full time to the area of Maternal and Child Health, which is a first for our community.

This year we have seen an increased focus on our expectant mothers and their children. This has led to the improvement and development of important resources and communication tools. To that end, the Eastern Door Centre pilot project has strengthened the community’s ability to assess children with behavioural and learning difficulties directly tied to FASD.

This next year will see an increased focus on our expecting and new mothers and their children. It will also lead to the development of improved resources and communication tools.

The main challenge is establishing a client base. The priority is to support expecting and new mothers (and their families) in achieving their goals.

Description

This area consists of health management programs for women of childbearing age, and for children at four stages:
• during pregnancy or adoption
• immediately after birth
• during the first year, and
• from the second to the fifth years (preschool).
Maternal and child health management focuses on healthy living for the mother, child and family, including:
• general education, including sexual health and birth control (family planning)
• group classes
• pre/post-natal nutrition programs
• risk assessments, including areas of special need (e.g., FASD)
• periodic monitoring for changes in risk
• individual follow-up
• outreach for pre-natals, and
• support in cases of abortion, miscarriage or stillbirth.

Range of Services

Prenatal Nutrition Program

Range of Services

PUBLIC HEALTH PROTECTION

Communicable Disease Prevention

Challenges and Priorities

Efforts in HIV/AIDS and diabetes management have been successful, and these will continue to be priorities for years to come. The staff continue to develop knowledge and expertise in these areas. Staff are professional and thorough in their disease prevention efforts, and they take pride in their work.
Community members are aware and supportive of diabetes management but are still having difficulty in dealing with the threat of HIV/AIDS.

Description

Community members need to be protected from communicable diseases that pose a threat to their health and safety.
An important service in this area is immunization. Infants, children and adults in the community are provided with regular shots to protect them against infection.
Other high-risk illnesses that are covered by this area are sexually-transmitted diseases, including HIV/AIDS. Activities range from education to testing, tracing and monitoring.

Disease Prevention also includes work with diabetes. Prevention activities include education and testing. As well, the Health and Wellness Centre has a well-developed and effective management program for people with diabetes, helping them to reduce the harm that this illness can have on their health.

Range of Services

Environmental Health

Challenges and Priorities

The main challenges in this area are:
• encouraging community members to accept personal responsibility for recognizing and preventing environmental health risks, and
• creating a greater awareness and understanding of the effects of environmental factors on human health.
Priorities will continue to revolve around community education and good preparation for possible environmental threats.

Description

Environmental Health, especially the part that deals with environmental hazards, is a basic service area just like communicable disease control.
Activities include assessment or monitoring of:

• air and water quality
• food safety
• the quality of the physical work environment in Band buildings
• waste removal, and
• pest controls.

The mandate of the CHR for Environmental Health covers only analysis and recommendations for these items, not their actual correction or repair. The FNIH Environmental Health Officer is available at the community’s request.

Emergency response planning and preparation are also important elements of the Environmental Health program. The Health and Wellness Centre has worked with the Province’s Emergency Measures Organization (EMO) to develop an emergency response plan and team for the community. A mutual aid agreement is also in place with a local municipality.

Range of Services

Community Food Security Project

Description

The Community Food Security Project involved a grant of $2000 to the EHWC to assist and support the lunch program at Elsipogtog School.

Elsipogtog School offers a free hot lunch to all its students. The program is utilized by approximately 200 children each day. Along with the hot lunch, students are offered milk at a cost of $0.25 per 250 mL, Elsipogtog Education covers the remaining cost.

The lunch program was initially put in place to address food security issues in our community; however numerous other benefits have emerged. For example, in addition to providing children with a healthy and nutritious meal, the program allows the students to consume and learn more about traditional foods. A healthy lunch also reinforces the teachings done in the classroom around healthy eating and diabetes prevention.

The funds received this year were used to cover some of the cost of the food and milk.

SPEICAL NEEDS

FAS Integration Project

Description:

The Project is designed to implement and evaluate an Integrated, Aboriginal, Community-Based, Service Delivery Model in Relation to FASD.
The work in this area centers around capacity building, system integration and gap analysis.

How the Project Is Working to Address Community Needs

1) Prevention:
• Keeping track of statistics—High rates of women continue to use drugs and alcohol when pregnant. A serious gap in our model is the lack of PCAP mentors so that we can not address prevention as we have diagnosis and intervention.
• Addressing the issue: Curriculum relating to alcohol, drug and tobacco use during pregnancy is now comprehensive and included throughout the prenatal education classes
• Prenatal home visits and outreach are now being carried out by MCH nurse but she has time only to do one prenatal visit and one post natal visit shortly after birth. Then she visits regularly to check on babies development.
• Our diagnostic team Family Support Worker (Masters level social worker) began to offer support to high-risk drug and alcohol using moms- but finds it difficult without mentors to help.
• Diagnostic team Family Support Worker (Social Worker) also provided support to high risk expectant moms and her family through ‘women helping women’ support group.

2) Diagnosis
• Diagnostic team met once a month to review one case per meeting
• The Team was creating a model of a diagnostic team that includes a traditional healer from the community
• In this model the elder opens each diagnostic session and contributes a spiritual history of the youth; the elder also helps with de-briefing the families and providing support post-diagnosis; this has been effective in getting families to feel comfortable and to accept services and diagnosis
• Cooperating and helping the province in setting up their FASD diagnostic team
• Hosted provincial aboriginal consultation meeting at Elsipogtog for the province to give aboriginal input
• Working on a national level to provide help to other communities with large aboriginal populations
• Working with aboriginal group in Fort Q’appelle Saskatchewan and with health professionals in Iqaluit
• Working with Health Canada re:: projects on screening for FASD, training for FASD, and developing screening guidelines for obstetricians

3) Intervention
• Elsipogtog has a long-standing evidence based FASD intervention in the community school—DVD on this intervention is available
• Elsipogtog has received an AHTF grant to help develop and package our Eastern Door Model

Challenges

The Team Family Support Worker (Social Worker) is leaving in early July 2008. Her support of the high risk mothers was a full-time job in itself and the Family Support that is essential in our diagnostic model was compromised with her having these two roles. The Family Support Worker who has been hired to replace her does not have a social work background—she has a B. Ed. as well as some social work and counseling experience.

This means that there will be no one doing prevention. This is a critical gap in service and needs to be addressed as soon as possible.
The Team would like to create a full community based model of FASD service delivery that is geared to aboriginal communities. If the PCAP model could be implemented in Elsipogtog, training could be offered to other aboriginal communities in all aspects of FASD service delivery. It would help the people in this community but also in communities across the country.

As well, the PCAP prevention piece of the service delivery model needs to be fully functional if we are to see a change in FASD prevalence rates in the community. Research has established that the community has a 20% prevalence rate, which is 20 times the national rate.

Range of Activities

Healthy Medication Use Initiative

Description

The HMU Project began in January of 2007. The following outlines the type and nature of the behind-the-scenes activities which have taken place:

Project Initiatives

MENTAL HEALTH AND ADDICTIONS

Mental Health Treatment Services

Challenges and Priorities

The main challenge in this area is to provide a broad range of appropriate, effective and culturally-sensitive services to meet the diverse needs of a community which has been facing difficult mental health challenges.

The priority is to provide sufficient numbers of skilled, compassionate and energized workers. This will enable community members to develop confidence in the long-term availability of effective mental health services.

Description

Mental Health services were created during the worst period of the suicide crisis. The goal was to prevent crisis situations from occurring in the future by dealing with psychological, emotional and spiritual aspects of individual, group and family health.

Mental Health services provide a wide range of assessments, counselling and support for people (and their families) who are facing major emotional and mental health challenges. The services are delivered in a respectful and client-centered way that is sensitive to the cultural needs of the clients.

With the Integrated Primary Health Care Project, Mental Health services are being integrated into the full range of Elsipogtog’s primary health care services. This will enable people with health needs in multiple aspects (e.g., mental and physical) to receive top-quality continuity of care to meet these needs.

Range of Services

Alcohol and Drug Prevention

Description

The Alcohol and Drug Prevention Program is centered in the Spiritual way of life in its approach to healing and to serving the needs of its clientele.
The Program’s mission is to provide guidance and support, to help people find the strength and courage to live a life free from alcohol and drugs. It does this with kindness, caring and patience, and with the skills and knowledge of its experienced staff.

The Program provides a broad range of services to its clients. Program delivery includes a variety of outreach services, as well as school education and community events.
The program staff are able to assist other agencies during a community crisis. They have close connections with treatment and rehab services, as well as with staff from Community Wellness. They are also very active with youth in the community.

The past year has been a period of growth and change for the Alcohol and Drug Prevention Program. There are currently two full time staff at the Health Centre; a third position was relocated to the Crisis Centre. The Health Transfer Evaluation Report (2004) recommended that Alcohol and Drug Prevention enhance programming by improving staff capacity, expand the range of community based programs, link with other health care providers, develop a new system of information management, and participate in community based research.

At this time, there have been some inroads in accomplishing these goals. Staff have recently had their credentials reviewed and accepted by NNADAP, ongoing staff development needs are being met by attending conferences, and a mechanism for clinical supervision of work has been implemented. Community based programs have increased with a renewal of the Men’s group, Adult Anger Management, MMTP sessions, and weekly sweat lodge ceremonies. Collaboration with Addictions in Moncton resulted in a collaborative team approach with the Health Centre, Mental Health, Eastern Door and Alcohol and Drug Prevention to deliver a community based Methadone Maintenance Treatment Program (MMTP).

The increase has led to more program delivery, group work and traditional care services. Collaboration with other health care providers is an ongoing activity with the MMTP program, clinical supervision from a mental health staff and administrative overview from the Health Center. Accountability, data collection and continuity of care have improved with an interim information management system. The Healthy Medication Use project is working with the staff to identify opportunities to establish some community based research projects.

Range of Services

Primary Prevention: taking action before a serious problem starts

• Teen Dance chaperoned
• Information Sessions (Methadone)
• Neighbourhood Watch
• Bonar Law Presentation
• Men’s Wellness
Secondary Prevention: dealing with an existing abuse problem at the earliest possible stage
• Men’s Support Group
• Restorative Justice Circles
• NA Group
• Adult Anger Management
• Sweat Lodge Ceremony

The Alcohol and Drug Program now offers two sweat lodge ceremonies per week during peak times. Attendance ranges from 5 to 15 community members in need of help for various stages of addiction treatment , after care, grief, medical concerns, etc.. Staff also attend sweat lodges in the community on a weekly basis.

Tertiary Prevention: helping people to complete treatment and keep the problem from returning

• Individual Counselling
• Family Counselling
• Corrections/Court
• Methadone Group Sessions
• Detox Referrals
• Treatment Referrals
• Risk Assessments
• Outreach Contacts

CRISIS PREVENTION AND MANAGMENT

Crisis Center Helpline

Crisis Intervention and Outreach

Description

The Community Wellness Program was created in response to the suicide crisis. The Program’s first goal was to provide the following services during crisis situations. These include:

• intervention
• treatment and healing
• support
• protection, and
• recovery.

The second goal was long-term, to prevent these situations from occurring in the future. Community Wellness does this by dealing with the historic, root causes of social and mental health problems in the community. Key efforts in this area include:

• the Youth Initiative
• Justice Capacity Building and Development
• capacity building and training initiatives, and
• Residential School Survivor support services.

Community Wellness programs provide a path back to health in the face of tragedy, crisis or injustice. These programs allow the community to deal with crises in positive ways that would be very difficult to do otherwise.

COMMUNITY WELLNESS

Challenges and Priorities

Community Wellness deals with the risk of crisis from a community-based perspective. The main challenge is to develop a sense of trust, ownership and shared responsibility among community members for these services. In that way, they will access them early and appropriately in order to prevent, identify and respond quickly to crises.

An ongoing priority is to develop an effective framework of detection and prevention that is deeply integrated into the fabric of the community.

Description

The Community Wellness Program was created in response to the suicide crisis. The Program’s first goal was to provide the following services during crisis situations. These include:

• intervention
• treatment and healing
• support
• protection, and
• recovery.

The second goal was long-term, to prevent these situations from occurring in the future. Community Wellness does this by dealing with the historic, root causes of social and mental health problems in the community. Key efforts in this area include:

• the Youth Initiative
• the Native Justice Program
• capacity building and training initiatives, and
• Residential School Survivor support services.

Community Wellness programs provide a path back to health in the face of tragedy, crisis or injustice. These programs allow the community to deal with crises in positive ways that would be very difficult to do otherwise.

Range of Services

COMMUNITY DEVELOPMENT

• Youth Development Strategy
• Community, Leisure and Culture Development
• solvent abuse
• parent support group
• Healing Networking Center (Residential School Survivors)

Violence and Abuse Prevention Project
Community, Leisure and Culture Development
Youth Development Strategy
Native Hospital Liaison
AHF Healing Network (MAWIW)
Elsipogtogeoei
Computer Access

ABORIGINAL JUSTICE PROGRAM

Range of Services

• justice panel
• justice workplan
• justice mediation
• justice healing circles
• sentencing circles
• Victims’ Assistance Program
• support for victims of crime
• group conferencing
• family support
• system referrals
• native probation worker

Restorative Justice
Victim’s Assistance
Justice Capacity Building and Development

EHWC SUPPORT SERVICES

Administrative Services: Administration

Challenges and Priorities

The main challenge for Administration is to coordinate staff activities to maximize efficiency, without taking away from staff creativity or the accountability of the Health and Wellness Centre to community members.

The priority will be to continue to make administrative decisions that are focused on the needs of community members
(i.e., not taking an administratively “easy way out”).

Description

This program area emphasizes communication and helping staff members to do their work efficiently. It provides overall Health and Wellness Centre support by managing several areas of operations:

• coordination of staff activities
• accountability
• facility management
• logistics for special events
• information gathering and use
• negotiations for resources and support
• liaisons with Chief and Council, Agencies, partners and Governments
• communication with community members, and
• reporting.

Range of Services

Administration Services: Community Relations

Challenges and Priorities

The Health and Wellness Centre is focused on and driven by community needs. Relations with the community must be mutually honest, respectful and open if Health and Wellness services are to be effective.

The challenge is to convince community members, many of whom are skeptical, wounded or detached, that the Health and Wellness Centre is sensitive and responsive to their needs.

The priority must always be to have transparent, open operations and a real commitment to two-way communication.

Description

Community Relations is a series of organized efforts to develop a common sense of vision, trust, awareness and support for the Health and Wellness Centre’s activities among community members.

In a similar way, these efforts are designed to develop a strong sense of awareness, sensitivity and commitment by the health staff to the needs and wishes of community members.

Range of Services

Every program area and health service is tied to building positive community relations. However, some are especially aimed at this area. These include:

• community surveys
• Open House
• staff participation in community events
• newspaper articles and calendar
• bulletin board
• public forums and workshops
• reporting

Administration Services: Staff Support

Challenges and Priorities

The Health and Wellness Centre has been going through an almost continuous period of growth and change for the past 10 years. This has placed a great demand on staff to develop new knowledge and skills, as well as personal strengths to deal constructively with all of the changes and their effects.

The main challenge in this area is to remain aware of, and responsive to, the personal and professional needs of staff members.

As a result, a priority must be to maintain and enhance the wellness of the front line staff who provide the first contact with Health and Wellness clients, as well as the support staff who assist them in their work. Supervisors and coordinators will be provided with the training to develop the attitudes, skills, knowledge and tools to do this effectively.

Description

This area provides support, guidance and development opportunities to members of the health staff.

Managers and supervisors ensure that staff members have the skills, tools and guidance which they need to perform at their very best. This is done through planning, training, and team building.

Written policies and procedures provide a framework that shows how the Health and Wellness Centre should work. Ongoing activities are guided by the Community Health Plan, and information systems provide staff with important and meaningful program knowledge when they need it.

Each staff member develops annual and monthly workplans that are used to keep everyone on track.
Regular staff meetings and social activities build team spirit and morale as well as providing a way to share important program information. This is strengthened through team

building workshops and special skills training sessions.

Staff wellness activities ensure that staff are energized, productive and able to handle the demands of their jobs. Morale is kept up through respect, support and recognition of staff members.

Personal and professional development are assisted through training plans, workshops and regular performance evaluations.

Range of Services

Administration Services: Partnerships

Challenges and Priorities

The Elsipogtog Health and Wellness Centre must try to understand the needs, capacities and limits of potential partners, and how they can benefit the community.

In the current business and political climates there are tremendous opportunities for leveraged help from alliances. However, these need to be approached carefully and in the knowledge that advances in community health will need many years of good, mutually-beneficial partnerships.

The priority will have to be on establishing partnerships with institutions, governments and agencies which understand and are supportive of the long-term health needs of the community.

Description

Administrative staff are involved in the development and use of partnerships. This is an area that does not receive a lot of exposure, but it is very important to the success of the Health and Wellness Centre.

Partnerships, if used properly, provide extra “leverage.” By being able to share the tools and expertise of the partners, the Health and Wellness Centre is then able to do more than it could without them.

Partners come from both inside Elsipogtog and from outside. By looking at the lists on the facing page, the reader can see how much care has been taken to build useful and lasting relationships with partners.

Committees are also important to the life of the Health and Wellness Centre. Participation on constructive committees allows the staff to extend their reach into professional areas that have a wealth of valuable information.

And, in cases like the First Nations and Inuit Health Information System (FNIHIS), it has allowed Elsipogtog to provide leadership at a national level.

Range of Partnerships

Administration Services: Infrastructure

Challenges and Priorities

The challenge with infrastructure is to make sure that it is able to support the rapidly changing demands and expectations that are placed on staff. Infrastructure planning needs to be a step ahead of program changes if those programs are going to work efficiently.

The priority will be to ensure that the Health and Wellness Centre has an internal “champion” for infrastructure, especially during the critical growth periods of July 2005-March 2006 and the planned 2006-07 facility expansion.

Description

The term ‘infrastructure’ refers to the more-or-less-permanent resources that the Health and Wellness Centre has available to it. These include:

• the Program’s core funding
• facilities, including the Health and Wellness Centre
• technologies (hardware and software) for computing and telecommunications
• human resources, including staff members and volunteers
• ‘staff capacity,’ or the collective skills and knowledge of the staff members, and
• inter-agency partnerships, both internal and external (see the previous section on “Partnerships”)

Infrastructure is often taken for granted as a support system, since its weaknesses only become evident during challenging times or periods of change. A strong and adaptable infrastructure is an important aspect of successful organizations. As a result, infrastructure planning is necessary when preparing for growth and expansion.

Selected Aspects of Infrastructure

Administration Services: Developmental Services

Description

Developmental Services is a term that has been given to a series of efforts to provide cohesion to community development and program development efforts that have the potential to have a dramatic impact on the health of the community.

The health needs of First Nations communities are more complex and, at times, fundamentally different than those of non-native communities. The Provincial health care system is focused on high-level prevention and intervention for individuals who are physically unhealthy. First Nations communities must first deal with collective and social health issues before they can make major inroads into physical health problems.

Additionally, First Nations have, and need, a much more wholistic approach which deals actively with spiritual, emotional and mental health problems and seeks to restore a balance among them. As well, families, friends and neighbours are an important part of the wellness and healing processes, much more so than in the rest of Canadian society.

Since the health care system does not see these needs as priorities, First Nations must develop their own, more meaningful services if they are to deal effectively with these needs. This can, and often does, include adapting mainstream services to reflect the cultural and social realities in First Nations communities.

Developmental Services is attempting to address this situation by developing and coordinating innovative, evidence-based programs and services that will work well for First Nations. To date, it has included pioneering efforts in:

• healing from past, historical losses and abuses
• restorative justice, victim’s assistance and preventative community policing
• youth mental health
• addictions treatment and recovery
• involvement of elders, families and others in treatment, and
• adaptation of mainstream services to include culturally meaningful aspects such as traditional approaches to health and healing.

It is important to note that none of these efforts current has sustainable funding. They are not part of the core services from the HSTA (although some discretionary resources can be used in an emergency). Instead, they have been developed over the years since the beginning of the suicide crisis in 1992 by applying for non-renewable term project dollars over and over again. Gradually, these projects have led to a coordinated and cohesive group of programs which are continuing to address some of the root causes of illness in Elsipogtog.

The cycle of non-sustained funding has taken its toll on staff and those who depend on the services which are being offered, but much ground has been gained and many skeptics have been won over. Even those who have fought this battle from the beginning are optimistic about the future and energized by recent developments.

Health Information Management

Challenges and Priorities

Information is critical to running effective programs. The types of information that are needed include:

• the needs and wishes of community members
• the reasons why some programs and services work well and others don’t
• the impact o programming on the health of community members
• technical information about the health areas that are involved, and
• the tools that are available for the professional (and how to use them).

In order to get this information and be able to understand it, staff members need a system that will manage this knowledge for them.
The EHWC’s information management system (IMS) has grown dramatically over the past few years. Challenges and priorities include:

• enabling all staff to gain access to the information they need
• encouraging staff to use the IMS to manage knowledge effectively, and
• remaining current with information sources and technologies.

Description

EHWC has recently begun to use the term knowledge management to refer to the way in which important information is gathered, examined and used. This term strengthens the message that the whole organization is constantly learning and making decisions, and needs to do this in a systematic and responsible way.

For the EHWC, knowledge management consists of 7 key elements:

• assessing the needs, opinions and experiences of community members
• sharing and discussing this information as a group
• making decisions about how to use the information (i.e., what services and activities to include)
• turning the information into guides for action (plans, policies, etc.)
• making decisions about when and how to act on the plans
• measuring the effectiveness or impact of program activities, and
• reporting back to the community and getting their reaction.

Range of Services

Primary Health Care Integration

Challenges and Priorities

A principal challenge in this area is ensuring that all key personnel see “the big picture” and are comfortable with their respective roles in it.
The priorities are maintaining organizational efficiency, encouraging innovation and collaboration and basing decisions on evidence.

Range of Services

• inter-professional teams, collaborative practice and joint case management
• staff orientation and training
• inter-group facilitation
• joint advisory and planning committee
• liaison and working agreements with external partners
• strategic documentation
– policies
– protocols and procedures
– plans
– discussion and position papers, and
– strategic frameworks
• project management and oversight

Description

The Integrated Primary Health Care Project (IPHCP) was a pilot project that built upon the highly successful Transition Fund project, the Eskasoni primary care project, with its four-party collaboration among a large First Nation community, the province, FNIHB and a university medical facility.

The Elsipogtog approach is based on a collaborative, inter-professional team of primary health care professionals that integrates primary medical care (i.e. care provided mainly by physicians) with community health programs (such as public health, home care, prenatal care and diabetes care services).

The approach involves the recruitment of a team of professionals who are committed to collaborative practice to provide comprehensive and cohesive services with an emphasis on mental health, health promotion and disease prevention.

While there are a variety of health services available to community members, federally funded programs lack co-ordination and integration with primary health and medical services available from the N.B. Regional Health Authorities. Support is required to make the transition to a system where health service providers (whether community- or provincially- employed) collaborate in the care of our high-needs population.

By implementing a collaborative practice model in Elsipogtog First Nation, this helps address current service gaps and overlaps, improves local access to primary health care services, and increases the quality of care provided to community members.

There is also another level to integration. Federally funded programs lack co-ordination and integration with primary health care services from the Regional Health Authority. Support is required to make the transition to a system where service providers (whether employed by the community or province) collaborate in the care of our high-needs population, with a special focus on mental health, health promotion and disease prevention.

This multi-focal approach addresses community priorities and lessens the burden on other health care services. A successful model of integration, with a particular emphasis on mental health, will be promoted to other Mi’kmaq communities throughout the Atlantic region and may serve as a model in other First Nation communities across the country.

The IPHCP Legacy

The IPHCP re-examined the delivery of primary health care services, looking for ways to help to address alarmingly negative trends in health status indicators among First Nations. Its main focus was to look for approaches to align community-based and external services.

The Project revealed important barriers in terms of the ability of First Nations to:

• access culturally relevant data about their respective communities, and
• participate in a meaningful way within the health care delivery system.

This led to evidence-based findings and best practices (adapted for FN realities) in the areas of service content and service delivery.
These findings have led to strategic initiatives to prepare the EHWC for future developments. Specifically, work is being done in the areas of organization development and capacity building.

It is expected that this preparation will provide compelling evidence for partners, in a language that is meaningful to them, that will lead to enhanced sustainability for HIM and related processes.

EHWC Commitments from the IPHCP

A lasting result of the IPHCP is that the EHWC has committed itself to specific approaches, based on the evidence collected from the project and extensive vetting of the findings with staff and focus groups. These legacy commitments, and how they express themselves in operations, are outlined in the Table to the right.
In the context of Health Information Management, these commitments have laid an excellent foundation for IT integration and HIM best practices by increasing the EHWC’s capacity to use mainstream business processes in a culturally appropriate way.

EHWC Commitment

1 Population health approach
2 Wholism
3 Service adaptation
4 Integrated services (EHWC)
5 Delivery system integration
6 Sustainability

How It Shows Up

– determinants of health
– community-based programming
– knowing, healing from past traumas
– social health
– cultural competence
– collaborative practice
– capacity building
– knowledge translation (strategic docs)
– project funding-to-core funding
– evidence