Experience with Indigenous Community Health Planning

Department of Indigenous Services (DISC), Health Canada, has implemented a new health planning process in an effort to further enhance knowledge and skills of First Nations and Inuit, and to address accountability issues related to delivery of health programs and services. Undertaking the new Community Health Plan (CHP) process is an opportunity for communities, regardless of size or lack of experience, has an opportunity to take part in the design and delivery of its own health care.  The goal is to ensure a health management structure and health plan is developed that can guide their health programs and services.  The health planning process also informs and ensures priority health needs are met.  Each Community Health Plan is an extensive document that often exceeds 600-pages in length. In addition, based on readiness or willingness, Williams Consulting has supported First Nations enter into Simplified Block Funding Agreement.

Each community health plan includes:

The Communicable Disease Emergency Plan compliments other existing plans, including Influenza Pandemic Plan, Health Emergency Plan and All Hazards Plan.  Williams Consulting has extensive experience in the development of these plans, whether working collaborating with the community building the All Inclusive Plan from start, or as required every five (5) minimally, revising the plan and updating it to be reflective of new requirements/needs and most importantly ensuring the phone numbers and emails addresses for contacts are accurate.  In addition, we undertake Table Top exercises as part of what is commonly know as pandemic planning, but more broadly has been renamed Communicable Disease Emergency Plan by the Department Of Indigenous Services Canada.

Healthy Child Development (FASD, CPNP, MCH); Mental Wellness (Mental Health and Addictions; Crisis Management; Brighter Futures; Building Healthy Communities); Public Health; Clinical Health and Client Care; Non Insured Health Benefits; and Health Planning and Quality Management.  One main component of each CHP is Long Term Care also known as Home and Community Care.

For each First Nation, we have developed a Service Delivery Plan, Policies and Procedures and Essential Risk Assessment.  In addition, when working with communities identifying health priorities for the next five years, each First Nation has identified Hospice Palliative Care as an emerging priority.  Thus we have had to develop a resulting workplan to address this need.

Williams Consulting has developed the following community health plans for the following:

1. Temagami First Nation (2020)
2. Tootinaowaziibeeng Anishinaabe Health (2016). Communicable Disease Plan only.
3. Nipissing First Nation (2016)
4. Iskatewizaagegan Independent First Nation (2015)
5. O-Chi-Chak-Ko-Sipi First Nation (2015)
6. Ahtahkakoop Cree Nation (2015)
7. Skownan First Nation (2015).
8. Willow Cree Health Services (2014).
9. Temagami Health Services (2014).
10. Tootinaowaziibeeng Anishinaabe Health (2013).
11. Nipissing First Nation (January 2012).
12. Atikameksheng Anishnawbek Community Health Plan Evaluation (February 2012).
13. Mississauga First Nation for the Health and Social Services Unit Health Transfer Evaluation (June 2011).
14. Serpent River First Nation Community Health Plan 2011-2016 (February 2011).

More details are listed below for some projects.

O-Chi-Chak-Ko-Sipi Health Centre Community Health Plan (September 2015) Manitoba

Williams Consulting and Management Services supported the First Nation in the development of their five year Community Health Plan.

Ahtahkakoop Cree Nation Community Health Plan (October 2015) Saskatchewan

Williams Consulting and Management Services worked with the First Nation on their five year Community Health Plan.

Aboriginal Patient Journeys:  Telling our Stories  (July 2015)  London, Ontario

Williams Consulting was contracted by the  Southwest Ontario Aboriginal Health Access Centre (SOAHAC) who worked in conjunction with the South West Local Health Integration Network (South West LHIN) to undertake a project entitled “Aboriginal Patient Journeys”. They believe it is of central importance to magnify the patient voice and journey so that it can be used to inform health professionals and service providers as they continue to build innovative initiatives to support populations who may be more vulnerable and often marginalized. Using Aboriginal community engagement principles and Indigenous research ethics and methodologies, this project aimed to document the experiences of Aboriginal people accessing health care in the South West LHIN catchment area.  The report shares the stories of 17 individuals and is informing change in the healthcare system.

Skownan First Nation Community Health Plan (January 2015) Manitoba

Williams Consulting successfully worked with the First Nation  to develop the next five year Community Health Plan  which was approved under the new FNIHB accountability and approval process in Manitoba Region.

Integrated Diabetes Care Team Project Management (HSIF) – Nipissing, Temagami and Dokis First Nations (March 2015)

Williams Consulting wrote the initial HSIF proposal and then in April of 2014 was hired to implement the Integrated Diabetes Care Team project. In 2012, Nipissing First Nation received funding from the Health Services Integration Fund (HSIF) to develop an Integrated Diabetes Care Team service delivery model in collaboration with Dokis and Temagami First Nation. The model weaves together federal/provincial/ LHIN/private sector jurisdictions, to complement the First Nations governance and management structure.  The three participating First Nations represent three different geo-political realities in Ontario.

The Integrated Diabetes Care Team clinics taking place in the three participating First Nation communities are designed to decrease structural and cultural barriers through the community based clinical approach. The Integrated Diabetes Care Team members have participated in cultural competency training designed by Andrea J. Williams to assist them with interaction with First Nation members. This training is intended to increase the core competencies of the Team and encourage each Team member to approach the clinic with the utmost respect and appreciation for the communities. The priority groups (primary beneficiaries) for the project are the three First Nation communities and their members who have not been able to effectively access diabetes services.  The Integrated Diabetes Care Team take place in each First Nation and are responsible for ensuring that not only the minimal Diabetes Standard of Care Screening Tests occur annually but that optimal additional services for First Nations people living with diabetes are covered for each client they see.  The role of the integrated inter-disciplinary team is to improve continuity of services that includes ongoing screening, diabetes management, education, medical supervision and referrals to specialized services.  Collectively they will work with the client to advocate, safeguard and case manage to optimize their experience and minimize the barriers listed above.

Willow Cree Health Services Community Health Plan (October 2014) Saskatchewan

Williams Consulting was contracted to support the development of the Community Health Plan.  This work included facilitating a consultation with community members, review and revising program descriptions as well as completing a narrative of WCH’s community health needs and priorities.  The contract concluded with a strategic planning process designed to produce an action plan for the new Community Health Plan.

Athabasca Tribal Council – Nursing Services Health Planning (October 2014) Alberta

Working with ATC to obtain funding for Community Health Nurse(s) to provide services to 5 First Nation communities.

 Temagami First Nation Community Health Plan Submission for 5 year agreement (March 2014)

Williams Consulting was contracted to support Temagami First Nation in the compilation of information required by FNIHB Ontario Region for the new five year agreement.

Temagami First Nation Community Health Plan Evaluation (March 2014)

Williams Consulting carried out a comprehensive evaluation of the CHP in the fifth year of the transfer period.  Whilst evaluating the effectiveness of the CHP, changing health priorities were identified as required in the transfer agreement.

Nipissing First Nation HSIF Evaluation (March 2015)

Williams Consulting is contracted to carry out a comprehensive evaluation of Nipissing First Nation’s HSIF project, the development of an Integrated Diabetes Care Team service delivery model.

 Grand Council Treaty 3 HSIF Evaluation (March 2015)

Williams Consulting is contracted to carry out an evaluation of Grand Council Treaty 3’s Health Services Integration Fund project on mental health and addictions.

Shibogama Tribal Council Evaluation of the Maternal Addictions Continuum of Care Project (March 2015)

Contracted to facilitate the project evaluation of the HSIF Maternal Addictions Continuum of Care Project led by Shibogama Health Authority.  This project is intended to integrate existing federal and provincial maternal addictions services to address the growing concern of pregnant First Nations women with addiction problems and their newborns.

Regional Longitudinal Health Survey (RHS) Phase II (2008-2010)

Ontario Region Final Report – The First Nations Regional Health Survey (RHS) is a First Nation initiative carried out through the First Nations Information Governance Centre (FNIGC). The RHS Phase 2 was initiated in 2008 and completed in the fall of 2010. The target sample for Phase 2 was 30,000 First Nation individuals in 250 First Nations communities in the ten participating regions across Canada. In RHS Phase 2, 72.5% of the target was achieved and in total, 21,757 surveys were collected in 217 First Nations communities. Williams Consulting, was contracted by the Chiefs of Ontario in May 2011 to de-identify, analyze, interpret, and prepare the Ontario RHS Region Report. We have subsequently been contracted to prepare specific context papers and fact sheets based on the data.

Tootinaowaziibeeng Anishinabe Health Community Health Plan (2013)

Williams Consulting worked with TAH in successfully completing the five year community health plan agreement and moving the First Nation into a Block agreement with Manitoba FNIHB

Tootinaowaziibeeng Treaty Reserve Community Health Plan Evaluation (December 2012)

Williams Consulting completed  an evaluation of their contribution agreement.

Nipissing First Nation Community Health Assessment (2012)

Williams Consulting received the contract to implement the third cycle of the Nipissing First Nation Community Health Assessment (2012).  Nipissing First Nation (NFN) has been using individual health indicators as part of their community health evaluation process with assessments completed in 1992, 2001 and 2012.  It has been designed so that the assessment will be comparative or aligned with the Regional Health Survey as well as the previous 1992 and 2002 NFN community health indicators.  Williams Consulting designed the tools, methodology, stratified sample and engagement process.  We trained the community-based workers and are entering the data from the detailed survey.

This process involved an extensive health mapping exercise whereby health indicators were tracked throughout the territory of Nipissing First Nation across seven settlements (Garden Village, Duchesnay, Veterans Lane, Yellek, Beaucage, Jocko Point and Meadowside).  We received in excess of 750 completed surveys representing 33% of the on- and off-reserve population.  Data analysis and report writing were completed early March 2013. The report writing by Williams Consulting took a large survey response with more than 9000 data elements, undertook extensive statistical analysis and produced a Community Health Assessment that met the requirements for accountability and informed the planning of future programs to better meet identified needs.  A comparative report comparing findings to provincial and national survey findings was prepared as well as a separate regression analysis report comparing results of common data elements to previous survey findings from the previous 10 and 20 year community health assessments.  This required extensive literature review and subject matter expertise to provide the analysis.

Atikameksheng Anishnawbek Community Health Plan Evaluation (February 2012)

Williams Consulting undertook an evaluation of their five year contribution agreement

Mississauga First Nation for the Health and Social Services Unit Health Transfer Evaluation (June 2011)

The Evaluation provided the community with the goals and objective for its next five-year Health Transfer Agreement.  The effectiveness of the community health programs and services and changes in health status of the membership population/community is evaluated in this process.

Serpent River First Nation Community Health Plan 2011-2016 (February 2011)

Williams Consulting was contracted to support the development of the Community Health Plan.  This work included facilitating a consultation with community members, reviewing and revising program descriptions, as well as completing a narrative of SRFN’s community health needs and priorities.  The contract concluded with a strategic planning process designed to produce an action plan for the new Community Health Plan

Evaluation of the Healthy Bodies, Healthy Minds (HBHM) Initiative (March 2011)

Working with Manitoba First Nation Schools and Aboriginal Diabetes Initiative workers, this contract is an evaluation of the First Nations and Inuit Health – Manitoba Region Healthy Bodies, Healthy Minds (HBHM) initiative.  This initiative aims to foster a healthy environment by promoting and supporting healthy eating, physical activity, and healthy lifestyles.

Serpent River – Long-Term Care Program Review (June 2010)

Williams Consulting was contracted by Serpent River First Nation Community Wellness Department to conduct a review of the Long Term Care Program with a view towards expanding and enhancing its programs and services to better meet the needs of its aging population.  The project included identifying areas for program expansion, developing work plans and strategic directions.

Ontario Region First Nations Addictions Service Needs Assessment

Date (Month/Year): August 2008 – March 31, 2009

Client Name and Telephone Number:

Tracy Antone, Health Coordinator, Chiefs of Ontario, (416) 597-1266 or cell (519) 671 9357

Subject Matter:

The Chiefs of Ontario are pleased to announce that they are undertaking a needs assessment of the Region’s substance abuse and addictions services, in conjunction with Ontario Region First Nations and Inuit Health (FNIH) and the Ontario Regional Addictions Partnership Committee (ORAPC).

A needs assessment is an examination of the current situation of Ontario First Nations addictions and substance abuse problems. It looks at the changes that stakeholders and clients consider necessary to improve their health and social status. The purpose of this needs assessment is to identify strengths and gaps of the addictions prevention and treatment services accessed by the Region’s First Nations population. Based upon analysis of the findings, a comprehensive report will be produced that establishes a strategic plan for enhancing and renewing the addictions prevention and treatment services. This contract has been awarded through a competitive process to an Aboriginal Consulting firm, Williams Consulting, who has extensive experience in the area of First Nations health.

This needs assessment is being guided by an Advisory Committee composed of representatives of Ontario First Nations, the Ontario Regional Addictions Partnership Committee (ORAPC), and FNIH. The Advisory Committee will present findings to the Chiefs in Assembly as well as to the First Nations Addictions Advisory Panel (FNAAP) to articulate a regional and national program framework. This needs assessment also focuses on the existing NNADAP Program. It provides opportunities for input into changes considered necessary to modernize the system and improve the health status of First Nations members struggling with addiction and substance abuse.

Methodology:

The needs assessment used multiple data collection activities to provide an analysis of addiction treatment and prevention needs as well as services currently available to Ontario First Nations. This approach explored promising practices and models of service delivery. The project included key informant interviews, focus groups, surveys, 12 case studies to First Nations and a document/literature review to provide:

a) Contextual assessment of the structural, social and cultural factors that may influence the overall addictions and substance abuse situation

b) Drug use assessment to arrive at a comprehensive description of the addictions and substance use situation and associated problems.

c) Resource assessment identifying existing resources and gaps to address these issues

d) Intervention and policy assessment which examines the type of interventions and policies used to address the addiction and substance abuse situation and where improvements may be made.

This needs assessment engaged with knowledge partners including, but not limited to:

• NNADAP workers;
• Treatment centres;
• Health Directors;
• Policy Analysts;
• Regional Authorities (WHA, Sioux Lookout First Nation Health Authority, Nodin Counseling Services, tribal council health directors);
• Chiefs and Band Counselors
• “Communities in Crisis”
• Child welfare agencies
• Ontario Regional Addictions Partnership Committee;
• Aboriginal Health Access Centres;
• Mental health and addictions service providers in First Nations communities;
• Elders and Traditional people;
• Mainstream health providers (health authorities, provincial mental health and addictions agencies, provincial officials, etc.);
• Previous and current service users; and
• Law enforcement officials.

Main Study Questions:

1. What are the current addictions and substance abuse problems faced by Ontario First Nations?
2. What services or resources are available to address these needs?
3. What treatment modalities are currently being used?
4. What challenges are faced in meeting identified needs? Are there gaps in services?
5. What innovative approaches, structures or promising practices have been developed at the community, tribal, or regional level to address First Nation addictions prevention and treatment needs?
6. What relationships have been developed to effectively meet current Ontario First Nations addictions prevention and treatment needs?
7. How are Aboriginal values, culture and/or language incorporated into community approaches?
8. Have policies been developed to better address First Nations addictions prevention and treatment needs?
9. What are the priorities for enhancing and improving addictions prevention and treatment services for Ontario First Nations?

The final evidence-based report will identify strategic areas for action to optimize service delivery to Aboriginal people within the Ontario.

RESULTS:

Activities:

• Conducted 12 site visits (Goal and budget was 5 site visits – due to overwhelming demand we made 12 within the same budget) spending approximately two-days at each site.
• To observe program delivery where appropriate and document approach, service delivery model and impacts.
• To meet with stakeholders as identified/appropriate in the geographical area.
• To conduct key informant interviews and focus groups.
• Williams Consulting has completed the following site visits:

• • October 27-28, 2008 at Ngwaagan Gaming Recovery Centre (Rainbow Lodge), Wikwemikong. Four focus groups were held with 22 participants in total and three key informant interviews. Types of stakeholders included: NNADAP workers, staff, Board of Directors, Community Specialist, Chief and Councillors, Mental Health workers and Child Welfare.
  • October 28-29, 2008 at Anishnabie Naadmaagi Gamig Treatment Centre, Blind River. Four focus groups were held with 21 participants in total and one key informant interview. Types of stakeholders included: NNADAP workers, staff, Board of Directors and referral programs.
  • October 30-31, 2008 at Sagashtawao Healing Lodge, Moosonee. Four focus groups were held with 22 participants in total and one key informant interview. Types of stakeholders included: NNADAP workers, clients, staff, Board of Directors, doctors and service providers.
  • November 3-4, 2008 at Dilico Anishinabek Family Care, Thunder Bay. Four focus groups were held with 39 participants in total and eight key informant interviews. Types of stakeholders included: staff, community service providers and clients.
  • November 5-6, 2008 in Sioux Lookout. Six key informant interviews were held. Types of stakeholders included: Sioux Lookout First Nation District Health Authority and community service providers.
  • November 6, 2008 at Eagle Lake Health Centre, Eagle Lake. One focus group was held with 16 participants. Types of stakeholders included: staff, councillors and clients.
  • November 7, 2008 at Migisi Alcohol and Drug Treatment Centre, Rat Portage First Nation, Kenora. One focus group was held with 17 participants. Types of stakeholders included: staff and Board of Directors.
  • November 10, 2008 at Native Horizons Treatment Centre, Hagersville. Two focus groups were held with seven participants in total and two key informant interviews. Types of stakeholders included: NNADAP workers, staff and Board of Directors.
  • November 11-12, 2008 at Nimkee Niepigaioagan Healing Centre, Muncey First Nation. Three focus groups were held with 16 participants in total and two key informant interviews. Types of stakeholders included: clients, staff and Board of Directors.
  • November 13, 2008 at New Directions, Six Nations of the Grand Territory. Three focus groups were held with 18 participants in total and two key informant interviews. Types of stakeholders included: clients, staff and community partners.
  • November 18, 2008 at Reverend Tommy Beardy Memorial Family Treatment Centre, Muskrat Dam First Nation. Two focus groups were held with 15 participants in total. Types of stakeholders included: clients and staff.
  • November 20-21, 2008 at Curve Lake First Nation. One focus group was held with 5 participants in total and 8 key informant interviews. Types of stakeholders included: staff, Chief, Anishnawbek Police and youth.
  • There were a total of 198 focus group participants and 29 key informant interviews conducted on the site visits.

• Conduct key informant interviews (Goal was 30 interviews) with a broad spectrum of stakeholders including:
  • Health Directors;
  • Academics/researchers;
  • Representatives of provincial agencies;
  • Community leaders;
  • Elders;
  • Traditional healers;
  • FNIH-OR staff; and
  • Representatives from regional committees.

The Key informant matrix was approved on October 22, by the advisory committee. A total of 40 key informant interviews were completed.

• A community based survey for NNADAP workers to provide input into the needs assessment was distributed to 128 workers (Goal was 40 responses) by October 30, 2008. A total of 40 responses were received.

• • Manual distribution and collection of the survey also took place at the NNADAP conference on November 26 and 27, 2008.

• Conducted Focus Group with ORAPC on November 24, 2008 at 1:00 p.m. (N=12)
• Conducted Focus Groups with NNADAP workers and participants from residential treatment centres on November 26, 2008 (N=83). We focus-grouped the community survey questionnaire and received more in-depth results.

Outcomes:

• Professional development of a key informant interview guide, focus group guides and survey as well as thank you gifts. (Approved October 22, 2008)
• A total of 391 people participated in this study in person or by telephone.
• INPUT TO THIS STUDY WAS RECEIVED FROM 95/133 Ontario First Nations.
• Quantitative data was entered into SPSS for analysis.

Review Evidence-Base and Identify Best/Promising Practices:

Williams Consulting team members have examined 95 studies or previous research that has been completed to date on this subject matter. The team has developed a Microsoft Access database to document key fields of information such as target group, research questions, study methodology, findings, limitations of the study in order to perform a consistent and well-documented analysis of the existing research.

Williams Consulting has built upon their existing document and literature review examining the latest research on addictions prevention and treatment services. This was undertaken at the local, provincial, national and international level.

A detailed literature review was integrated into the report for context and provided as a separate resource document. Williams Consulting located and reviewed the latest research on addiction prevention and treatment services. In collaboration with knowledge partners we identified and collected data on innovative models, arrangements, and promising practices offered within the Ontario Region. In particular, culturally-appropriate approaches that incorporated traditional healing, culture and/or spiritual beliefs were reviewed.

A summary of overarching themes include:

• There are regional differences in addictions across Ontario First Nations
• Alcohol and cannabis are still prominent by are closely followed by prescription drug abuse of opiates as well as cocaine and crack.
• There are concerns about extent of FASD and additional concerns about the impact of opiate addiction on fetal development
• There are no adequate or culturally appropriate withdrawal management (detox) programs in Ontario to meet First Nations needs
• There is inadequate pre-treatment programs
• Aftercare programs are inadequate in their current form and require a multi-disciplinary case management as well as a home visiting component.
• Parenting skills remain a concern
• Underlying causes of addiction have been identified as: peer pressure, grief/loss, cultural loss, history of violence and trauma, sexual abuse, self esteem and mental health issues. Social determinants of health including poverty, housing, lack of education were also identified as contributing factors.
• Approaches to healing or therapeutic approaches for addressing addictions include: Aboriginal culture as a healing model, abstinence models, motivational enhancement, strength based approaches, cognitive behaviour theory as well as harm reduction.

The strategic action plan to address the prevalence of addiction and promote individual, family, and community health and healing addresses four priorities:

1. improved training opportunities and supportive resources;
2. increased education and prevention programming;
3. improved crisis intervention and direct treatment services; and
4. promotion of stability (relapse prevention) for communities, families and individuals.

This contract demonstrates Williams Consulting’s ability to work collaboratively with different regional sites, conduct case studies with sensitive subject matter with clients. conduct focus groups and interviews with key stakeholders, develop data collection tools within a short time frame, collect large data sets from multiple lines of inquiry, provide analysis and synthesis the material into useful evidence based reports.

• Working with Federal government, service providers, regional consultants and First Nations people
• Review of existing programs and development of performance measures
• Questionnaire design
• Key Informant interviews
• Facilitate focus groups and meetings with key stakeholders to receive feedback
• Surveying a number of different stakeholder groups including Aboriginal leadership and representative of service providers at the federal, provincial and First Nation, community levels.
• File, document and literature review;
• Case Studies – site visits
• Subject matter expertise;
• Strategic Action Planning
• Data entry, cleaning and data analysis; and
• Report Writing

Date (Month/Year): April – July 2008

Client Name and Telephone Number:

Allison Fisher, Wabano Centre for Aboriginal Health, 613 748 5999

Subject Matter:

The purpose of this study is to undertake a comprehensive comparative analysis of services provided in three urban Aboriginal Health Access Centres. The comparative analysis study used a case study approach to outline the existing situation, needs, and services for Aboriginal people regarding addictions and mental health in the three centres. The final report will document the promising practices for treatment and prevention in meeting the needs of urban First Nations and Inuit people in relation to addictions and mental health. Upon examination of the data, Williams Consulting has conducted an evidence-based gap analysis and is developing a five-year vision for services based upon the gap analysis and the comprehensive analysis of services. Based upon the findings Williams Consulting has developed a comprehensive report that identifies proposed short- (1-year), medium- (2-3 years) and long-term (5-year) strategic areas for actions.

This study has identified the optimal approach and mechanism for substance abuse, addiction and to a lesser extent, mental health services for Aboriginal people by:

• identifying evidence-based approaches and promising practices provided at the community;
• detailing the existing model of collaboration and referral/cooperation between service providers and identifying areas of efficiencies, economies and enhancement;
• documenting the culturally-relevant service delivery model utilized by the Aboriginal service providers and the impact it has on improved health outcomes;
• identifying culturally relevant indicators of change for future data collection
• assessing the best allocation of future investment for Aboriginal specific addiction and mental health services.

Methodology:

In accordance with the project requirements, a number of distinct data collection activities were developed and implemented over the brief period of this project. The data collection process consisted of five streams of gathering information, primarily through case study visits to three Aboriginal Health Centres, including:

1. Meetings with Management and Program Staff (N= 31 individual interviews or meetings);
2. Document Review (N=111 documents reviewed);
3. Focus Groups (N=13 focus groups with a total of 199 participants);
4. Key Informant Interviews with external addiction service providers (N=20 organizations);
5. Strategic Planning Meetings (N=5).

Meetings with Program Management and Program Staff

Preliminary meetings were held with the Executive Director and Program Coordinators of each site to discuss the intent of the comparative analysis and obtain relevant documentation such as annual reports, internal evaluations, publications, communications, program descriptions/materials/approaches, statistics, workplan or strategic plans and existing research.

Document Review

A comprehensive document review was conducted of approximately 111 relevant documents from the sites that examined studies or preliminary research that has been completed to date for each centre. This evidence-based examination included (but was not limited to): annual reports to funders; internal evaluations; publications and communications; program descriptions, materials and approaches. In addition, the latest literature related to Canada’s current Aboriginal health situation, addictions, mental health and successful treatment and prevention models was analyzed. An extensive literature review was conducted to obtain information on culturally appropriate approaches that incorporate traditional healing and Aboriginal culture as a treatment model. This document and literature review informed the gap analysis and findings of the interim and final report.

Focus Groups

Williams Consulting conducted numerous focus groups with Aboriginal people at each site to solicit input from participants on existing needs as well as guidance on how to improve or expand healing and wellness services particularly related to addictions and mental health. Individual Aboriginal focus groups were held with Elders, teens, young mothers with a history of addiction or FASD, pregnant mothers, former clients, homeless men and a mental health program.

Key Informant Interviews

Key informant interviews were held with stakeholders involved with providing addiction prevention and treatment services as well as mental health services to urban Aboriginal people in each of the three sites. Key informant interviews were conducted in person or by telephone. The purpose of these interviews were to provide the project with insight and guidance regarding addiction service needs, collaboration, the referral process, gaps in services, vulnerabilities, innovative programs and promising practices to better meet the health and healing needs of urban Aboriginal people.

Strategic Planning Meetings

A one-day Strategic Vision Planning session facilitated by Williams Consulting was held with each centre to review preliminary findings and gaps as well as recommendations for strategic actions.

This study engaged multiple lines of inquiry, within a short timeline. The first meetings occurred April 9, 2008 and the final interview was concluded on July 7, 2008. The Final Report is being produced for July 30, 2008. During this 16-week period, input was received from 250 individuals.

Summary of Core Competencies:

This contract demonstrates Williams Consulting’s ability to work collaboratively with different national sites, conduct case studies with sensitive subject matter with clients. conduct focus groups and interviews with key stakeholders, develop data collection tools within a short time frame, collect large data sets from multiple lines of inquiry, provide analysis and synthesis the material into useful evidence based reports.

• Working with Federal government, service providers, regional consultants and First Nations people
• Review of existing programs and development of performance measures
• Questionnaire design
• Key Informant interviews
• Facilitate focus groups and meetings with key stakeholders to receive feedback
• Surveying a number of different stakeholder groups including Aboriginal leadership and representative of service providers at the federal, provincial and First Nation, community levels.
• File, document and literature review;
• Case Studies – site visits
• Subject matter expertise – Public Health;
• Strategic Action Planning
• Data entry, cleaning and data analysis; and
• Report Writing.

Project Title: Health Canada – Environmental scan on current delivery mechanisms and funding resolution methods in Federal Programs and Services for Children with Special Needs or complex medical needs.

This project provides an example of demonstrated knowledge and understanding of issues complex health delivery systems as well as experience carrying out evaluations.

Date (Month/Year): February 10-May 30, 2006

Budget: $64,000.00

Level of Effort: 111 days

Client Name:

Dawn Walker, Special Advisor, Director General’s Office, Strategic Policy, Planning and Analysis, First Nations and Inuit Health Branch, Health Canada, 613 948 6758 and Valerie Flynn Policy Analyst

Research Subject Matter:

Health Canada and Indian and Northern Affairs Canada initiated and guided an environmental scan consisting of key informant interviews and a document/literature review to gain a better understanding of the jurisdictional realities and issues facing First Nations and Inuit children with special needs and their parents particularly from a federal department perspective. In particular, the environmental scan was designed to better understand how three federal departments and their regional offices manage requests for services and resources related to First Nations and Inuit Children with special needs and their parents.

The environmental scan provides an assessment of jurisdictional realities and issues facing First Nations and Inuit children with special needs and their parents to help identify gaps, strengths and weaknesses of multiple programs currently in place. The environmental scan examines the current delivery mechanisms and funding resolution methods in place.

This environmental scan addressed three main questions:

1. What are the delivery mechanisms in place and funding resolution methods that are currently practiced?
2. What are the jurisdictional realities and issues facing First Nation and Inuit families with children with special needs?
3. What are the challenges, issues, service requirements and creative solutions being employed by the three federal departments and their regional offices as they manage requests for services and resources related to First Nations and Inuit Children with special needs and their parents?

The environmental scan participants (key informants) were asked to provide analysis and recommendations to address the jurisdictional issues and better meet the special needs of First Nation and Inuit families with children with special needs. The environmental scan identified the issues from a micro and macro perspective to increase awareness of the strengths and weaknesses within the federal government.

Participants involved in the delivery of Special Needs programs for First Nation and Inuit children and parents were identified by the client and included representative stakeholders from:

• Indian and Northern Affairs Canada;
• Health Canada (First Nations and Inuit Health Branch, Non-Insured Health Benefits and Public Health Agency); and
• Human Resources and Skills Development Canada Methodology.

An independent consulting firm, Williams Consulting, was contracted to undertake the environmental scan. The environmental scan used two main approaches to gather information from the federal departments to enhance their understanding of how they manage requests for services, what resources they have available and whether/if they can identify their needs and provide recommendations. Key Informant interviews were determined to be the most effective means of obtaining detailed, thoughtful information from the regions. The client developed a matrix of the stakeholders that was to be representative of the regions and to engage participation of experts identified as knowledgeable on the issues. The participating regional representatives made limited responses referring to experiences with Inuit people.

A letter explaining the purpose of the study was sent to potential participants by each federal department. This was followed up by correspondence and telephone calls by the consulting team. Most participants preferred the interview method of a teleconference call although in person interviews were offered in many areas. The key informant interview process was initiated on March 17, 2006 and concluded on May 1, 2006. All participants received a copy of the purpose of the environmental scan and the interview questions in advance of the interview. Some key informants had their managers participate with them in the interview. Since this particular environmental scan focused on internal issues related to addressing the requirements of children with special needs, only federal government employees took part in the project, with the exception of the AHRDA staff, whose program is funded by the federal government.

The following interviews took place with a total of 36 participants:

• Indian and Northern Affairs Canada: seven key informant interviews were completed with a total of 11 participants.
• Health Canada, First Nation and Inuit Health Branch: eight key informant interviews were completed with a total of ten participants.
• Non-Insured Health Benefits: seven key informant interviews have been completed with a total of ten participants.
• Human Resources and Skills Development Canada: four key informant interviews have been completed with Aboriginal Human Resource Development Agency (AHRDA) staff with a total of five participants.

The second main environmental scan activity was to conduct a document/literature review. The design and the analysis of the data collection were informed by a selection of relevant literature. Five key documents were forwarded by Health Canada and the questionnaires provided an opportunity for participants to identify any other relevant documents to the project team. Additional resources included relevant provincial legislation and one other document related to early childhood development. This multi-faceted approach allowed the study team to identify the most urgent issues and inform and direct the most comprehensive means to respond. The intent of the literature review was to provide a sound understanding of the context and issues and as such is not included as a component of the final report.

Challenges:

As mentioned above, it is important to note that this approach to data collection was conducted within a tight time frame and budget for a national study. This contract involved working on an internal document regarding sensitive information and it was important to provide a safe environment for government employees to speak about their experience with jurisdictional issues. Working jointly with the client, we provided clear communication messages to engage participation in the study. A limitation of the study was the lack of discussion specific to the Innu and Inuit populations.

Summary of Core Competencies:

• Conducting and completing a literature review as a component of the environmental scan, working with public and private sector, survey methodologies, key informant interviews, gap analysis, jointly managed organizations.
• Data analysis and report writing

Tobacco Control Program Literature Review (October 2006)

The goal of the contract is to undertake a literature review of the large amount of currently existing literature documenting and evaluating tobacco control initiatives, from a wide variety of jurisdictions, agencies and organizations. This review of tobacco control initiatives would serve to inform and guide the evaluation of the Strategy while also providing direction for the future. This comprehensive literature review process would inform the draft final report to be submitted to the client. This contract was with the Tobacco Control Programme, Healthy Environments and Consumer Branch, FNIHB. Andrea Williams was project manager, senior analyst and responsible for financial management and report writing.

The B.C. Regional Health Survey 2002-03 findings (December 2005 -March 2006):

Under the direction of the B.C. First Nations Chiefs Health Committee, this report provides detailed findings from 2002-03 First Nations Regional Longitudinal Health Survey. This survey also queried potential health impacts of wastewater effluents. Andrea Williams was project manager, senior analyst and responsible for data analysis and report writing.

The 2002-03 First Nations Regional Longitudinal Health Survey

(March – October 2005):

The First Nations Regional Health Survey (“RHS” or “Survey”) is a First Nation initiative. The RHS was carried out by First Nations through the First Nations Centre (FNC), which is located at the National Aboriginal Health Organization (NAHO). The Survey was conducted between August 2002 and November 2003, and asked questions about those areas of life that relate to the health of First Nation Peoples. As a First Nation initiative, this report is designed and presented from a First Nations perspective. Accordingly this report begins with the development and explanation of a First Nations’ perspective for health and wellness. Flowing from this First Nation approach to understanding health, the summary of information collected by the RHS is presented. The information is grouped into four quadrants, with each quadrant representing a number of topics covered in the survey. Information from the adults, youth and children surveys are integrated into this holistic framework and presented under the topics explored by the Survey. This report was presented at a national conference in November 2005. Andrea Williams was project manager, senior analyst and responsible for data analysis and report writing.

The Ontario Regional Health Survey 2002-03 findings

(March – August 2005)

Under the direction of the Chiefs of Ontario, this report provides detailed findings from 2002-03 First Nations Regional Longitudinal Health Survey. Andrea Williams was project manager, senior analyst and responsible for data collection, analysis and report writing as well as presenting findings to the client and stakeholders.

Aboriginal Healing and Wellness Strategy (AHWS) (May 2001 – September 2003)

The project involves conference presentations on the Aboriginal Healing and Wellness Strategies evaluation framework, and identifying, developing and nurturing critical stakeholder relationships to encourage integration and coordination of research, performance measures and impact analysis. Andrea Williams as Team Lead Policy and Research, Katheleen Wakeford as Manager, Cheryl Elliott as Executive Director managed politically sensitive issues and research. The government is highly dependent on outcome evaluation due to the large expenditures related to health and family violence and the need to determine impacts and efficiencies. This work (supported by Kristine Neglia and Kienan Williams) provided research and evaluation expertise, analysis, advice, project leadership and support in the development and evaluation of long-term process and impact measures for the Aboriginal Healing and Wellness Strategy’s programs and services designed to improve Aboriginal Health and Reduce Family violence. Responsibilities were to design and oversee the management of quantitative/qualitative research and impact evaluation including: Performance Measures Plan, Longitudinal Study, Health Indicators, Emerging JMC Priorities/Policies and AHWS Program Evaluation with 265 AHWS-funded programs in Ontario.

This work included:

• Undertaking a sector review of all programs for a three year period to identify cost-effectiveness and efficiencies
• Calculations of costs-per-unit of services
• Visiting sites and analysis of project data
• Design of new qualitative and quantitative data collection methodologies
• Design of new reporting mechanisms
• Extracting and cleaning data
• Identifying measurable impacts
• Analysis and reporting on findings
• Facilitating training with 265 project staff
• Preparing briefing notes for Joint Management Committee
• Implementing Performance Measures Data collection tools
• Assisting with the development of an Aboriginal Healthy Babies Healthy Children Assessment tool.
• Facilitating a workshop with Sioux Lookout District First Nations people for the Northwest Mental Health

First Nation and Inuit Health Branch (January 2001 – April 2001)

Research Associate with Bear Clan Consulting to develop a model for prevention and support services for pregnant First Nation teens. Andrea Williams was senior analyst and responsible for data collection and analysis and report writing.

Southern Ontario Aboriginal Diabetes Initiative

(June 2000 – December 2000)

Research Associate with Bear Clan Consulting to analyze the relative need for Aboriginal focused basic level diabetes education services and the nature of the need by region across Ontario. The analysis is based on a comprehensive inventory of existing diabetes education services correlated with a rigorous examination of relevant socio-demographic indices. Andrea Williams was senior analyst and responsible for data collection and analysis and report writing.