Waasegiizhig Nanaandawe’iyewigamig Health Access Centre Organizational Review (September 2013)

Detailed review of the organizational goals, objectives, outputs and impacts was undertaken with more than 260 participants.

North Shore Tribal Council (NSTC) Strategic Planning (March 2011)

The purpose of this contract is to facilitate a strategic planning session with the Board of Directors and Management of Mamaweswen, the North Shore Tribal Council.

North Shore Tribal Council (NSTC) Economic Development Strategic Planning (March 2011)

The purpose of this contract is to facilitate an Economic Development Strategic Planning Session for Mamaweswen, the North Shore Tribal Council.

North Shore Tribal Council Health Services Strategic Planning (August 2010)

Williams Consulting has supported the member First Nations in determining health priorities and facilitated strategic planning meetings with core stakeholders, resulting in the development of a draft working document that articulates an enhanced strategic health plan.

FNIH-OR Public Health Unit Strategic Planning (September 2008- March 2009)

Williams Consulting provided facilitation services and technical support to First Nations and Inuit Health Ontario Region (FNIH-OR) Public Health Unit for the development of their strategic plan.

Georgina Island First Nation Strategic Planning Session for the Development of a Strategic Plan to Address Diabetes and Obesity Issues (January – March 2009)

Williams Consulting was contracted by the Central LHIN to develop a strategic action plan for the Georgian Island First Nation. The strategic action plan was developed through an examination of the significant health issues in the community. This was developed through working with health program staff and community members following a site visit and conducting focus groups.

Lands and trust (INAC) Think Tank Meeting (March 11-12 2009)

Williams Consulting was contracted to facilitate a two day meeting with Indian and Northern Affairs Canada Lands and Trust Service department. For the two day meeting Williams Consulting provided the agenda, planning exercise, and minute taking in addition to the facilitation of the meeting.

Ontario Independent First Nations Health Network Strategic Planning (April 2008)

Williams Consulting was contracted to facilitate a three day meeting with Chiefs and technicians from the 12 Independent First Nations to develop a three year strategic plan for the IFN Health Network.

INAC Ontario Region Strategic Planning (January 2008)

Williams Consulting was contracted to provide cultural training and facilitate strategic planning for INAC Ontario Region for the next three fiscal years. This strategic planning session was for senior managers and included capture indicators of success, human resource planning, and developing a three year strategic plan based on identified priorities.

Recruitment and Retention of Aboriginal Employees (July 2007 – March 2008)

Health Canada contracted the services of Williams Consulting to explore and make recommendations regarding the recruitment and retention of Aboriginal employees within the Department, and in particular within the First Nations and Inuit Health Branch (FNIHB). The work related to this requirement would include two key components: (a) a research and information gathering component; and (b) the development of recommendations for inclusion in the FNIHB Aboriginal Human Resources Plan (AHRP) designed to increase the representation of Aboriginal employees in FNIHB. It is expected that the Plan would also contain recommendations that could be considered for the Department as a whole.

The National Aboriginal Women’s Summit (NAWS) (June 2007)

The Government of Newfoundland and Labrador co-hosted the historic National Aboriginal Women’s Summit from June 20 to 22, 2007 in Corner Brook, Newfoundland and Labrador in cooperation with the Native Women’s Association of Canada, with support from the Government of Canada. This was a unique opportunity to bring Aboriginal women together from coast to coast to coast, to discuss the needs of Aboriginal women in Aboriginal communities, identify solutions and plan for future action. Equally important is forging a long-term partnership with governments.

The theme chosen for the summit was Strong Women: Strong Communities. We will focus on Health, Safety and Wellness; Equality and Empowerment; and, Strength, Balance and Honour. These themes were chosen because women are leaders in the home and builders of family. Organizers believe that improving the lives of women is one of the best ways to improve the lives of families and in turn their communities. This Summit served as a call to action for the federal, provincial and territorial governments, as well as Aboriginal governments and organizations, to improve the quality of life for Aboriginal women across the country. There were 150 formal Aboriginal women delegates as well as senior Ministers and government officials from the federal, provincial and territorial governments participating in the summit. More than 500 people participated in total.

Andrea Williams was a facilitator at this historic event. In addition to preparing materials and the facilitator guide, Ms Williams facilitated on the Equality and Empowerment theme. At the conclusion of the first day, Ms Williams consolidated the participant findings and briefed the Ministers. On the second day Ms Williams made a presentation to the Federal, Provincial and Territorial Ministers or their representatives and delegates reporting on the findings. This was a highly charged and exciting opportunity to work with government leadership and Aboriginal women to move forward on a groundbreaking policy agenda. The webcast is found at the following location http://www.laa.gov.nl.ca/laa/naws/agenda.htm and the preliminary findings are also listed on this website.

Approaches for Preventing Chronic Diseases Among Canada’s First Nations and Inuit People

(April 2006 – March 31, 2007)

Given recent investments in the Canadian Strategy for Cancer Control for all Canadians, including the First Nations and Inuit populations, it is highly anticipated that similar approaches will be undertaken for cardiovascular disease and other chronic diseases. The purpose of this project was to engage individuals in a public health dialogue about chronic disease to support ongoing policy and program activities in the branch. In particular participants included First Nations and Inuit, national and regional Aboriginal Organizations, the provinces and territories, Northern Secretariat and experts in chronic disease prevention to provide the branch with more information from people in the field that may be more knowledgeable about First Nations and Inuit peoples needs. This contract is with the Chronic Disease and Injury Prevention Unit, FNIHB, Health Canada. Project activities included project management, analysis and report writing and successful financial management. Submission of the final draft report for approval was on time according to the workplan and successfully within budget.

Project Title: First Nations and Public Health Network Symposium Federal/Provincial/First Nation Tripartite Meeting Chiefs of Ontario

Date (Month/Year): December 2006 – March 2007

Client Name and Telephone Number:

Tracey Antone, Chiefs of Ontario, 877 571 6527

Subject Matter

In February 2006, the Chiefs of Ontario Office (COO) began coordinating the development of a Regional First Nation Public Health Strategy in response to the broader, National Framework which is currently being spearheaded through the Assembly of First Nations (AFN). Williams Consulting facilitated a tripartite meeting between the federal government, provincial government and Ontario First Nation communities that are involved in Public health and pandemic preparedness. This meeting is an example of effective Aboriginal engagement into Federal and provincial health policy decision-making. Williams Consulting developed the teaching/curriculum aids and material, did the minute-taking, facilitated the meeting and also prepared the synthesis report of this two day workshop.

Team Member Responsibilities
Andrea Williams Project Management; Contact with client; overseeing consultation design; facilitator;Data analysis and report writing
Kathleen Wakeford Minutetaking and summary analysis;
Kienan Williams
Cheryl Elliott Planning, coordinating logistics, and report writing
This two day meeting has resulted in a five year, five million dollar public health initiative which Williams Consulting continues to support.

In Association with Aboriginal Research Institute: Project Title: Health Canada – Health Human Resources Needs Study: Continuing Care in First Nations and Inuit Communities

This project provides an example of demonstrated knowledge and understanding of issues that impact on the FNIHCC program and complex health delivery systems as well as experience carrying out evaluations.

Date (Month/Year): January – May 2005
Budget: $82,261.00
Level of Effort: 111 days
Client Name: Sean Van Liempt, Evaluation & Research Manager, First Nations & Inuit Home & Community Care Program, Health Canada, 613 948 5777
Research Subject Matter:

The study was designed to provide labour market information and identify human resource challenges and issues specific to First Nations and Inuit communities. Both recruitment and retention issues were examined, as well as how educational program curricula might be adapted to provide a more culturally relevant focus. This strategic planning study provided an analysis which considers how the required supports under the FMM Accord might be delivered in innovative or alternative ways that fit the needs of First Nations and Inuit communities. An analysis of human resources needs associated with an expanded range of Continuing Care services was also explored through the Continuing Care Research and Costing Project.

Methodology:

Williams Consulting, on behalf of the Aboriginal Research Institute, prepared a qualitative and quantitative research design in response to the research objectives. In keeping with the participatory approach and current health human resource planning practices, it was important that the primary information for this study come from the people who have the experience the researcher is seeking to understand.

In accordance with the study requirements, a number of distinct data collection activities were developed and implemented over the course of this project. The data collection process consisted of seven streams – or methods – of gathering information.

Focus Group and Survey of Continuing Care Organizations (Managers)
Focus Group and Survey of Service Providers
Family Caregivers Focus Group
Student Focus Group and Survey
Key Informant Interviews
Demographic Information
Literature Review
This study was ambitious in that it engaged multiple lines of inquiry, within both a tight budget and short timeline. The first focus group occurred April 28, 2005 and the final focus group concluded on June 9, 2005. The Final Report was produced for August 1, 2005. During this 16-week period, input was received from approximately 200 persons (69 front line surveys, 80 surveys from managers and other service providers, 29 managerial and regional network members as a focus group, 6 key informant interviews, and the remainder (>14) from focus groups held for family caregivers and other interested groups). An in depth literature review was conducted resulting in the development of an 80 entry (125 page) annotated bibliography in Microsoft Access, used as an analytical tool as well as an additional valuable deliverable for the client.

Focus Group and Survey of Continuing Care Organizations

The ARI researchers had access to two groups of health managers attending regional meetings in order to hold in-person focus groups. These opportunities were used both to identify issues through in-depth discussion and the participants formed the sample for a long-form survey.

The Home Care Managers Meeting Focus Group held in Edmonton, Alberta on April 29th 2005 involved eighteen participants.
The Personal Home Care Networking Group held a focus group in Winnipeg, Manitoba on May 26th, 2005. Eleven participants were present.
Using the results of the focus group and the long-form survey, ARI developed a short-form survey (this was to validate the long-form results at a higher level of aggregation). This short-form survey was distributed to home health care organizations by the client. The completed surveys were provided to the researchers by June 9, 2005.

The sample of provider organizations were provided through National offices, with information collected from regional offices. Many of the organizations had electronic access via Internet, but a significant minority (approximately 1/3) did not. This process of distribution and collection of surveys was managed by the client. Although it is not possible within the resources in this project to sample all the service providers the sample was large enough to allow for quantitative analysis of the results.

Care was made to ensure that the instruments were designed to ensure protection of private and confidential information.

The community care survey was part of a broader examination of continuing care in First Nations and Inuit. The intent was to look into the supply needs for staffing and expanded roles of continuing health in First Nations and Inuit communities. Crucial parts of this examination are the strategies and frameworks devised to deal with the issues identified by respondents to the survey and the other instruments employed in the study.

The survey respondents span all regions of the country (with the exception of Ontario and the territories) and a variety of sites within these provinces. The majority of surveys come from the western region with a sampling of other regions across the country. The vast majority of respondents identify their communities as rural/remote (81.1%) and First Nation (89.9%). This group submitted a total of 80 surveys.

Formal Service Providers Survey and Focus Group

This was an anonymous survey of a sample of formal service providers that was distributed to health care organizations, which were requested to distribute to their service providers and volunteers. The client distributed surveys to their health care organizations. The employer then collected the completed surveys in sealed envelopes to return to client, who in turn submitted to the researchers. Care was made to ensure that the instruments were designed to ensure protection of private and confidential information. A covering letter provided participants with information regarding the intent and use of information, emphasizing that their participation was voluntary. No names of participants were collected. It was assumed that by reading the informed consent cover letter, their submission indicates their consent for use in study. Although it was not possible within the resources in this project to sample all the service providers (there are more than 2000 staff in communities), the sample was large enough to allow for quantitative analysis of the results.

The client organized a focus group of service providers for more in-depth identification of issues (this provided more input into the survey) in conjunction with the Edmonton managers meeting on April 28, 2005.

Fourteen people attended the Formal Service Provider Focus Group in Alexander First Nation, Alberta on April 28th, 2005.
Front-line service providers completed a total of 69 surveys. Almost 70% of respondents for this survey are homecare workers. Over 70% percent of these workers are between 45-64 years of age. 21% of workers are between 25-34 years of age. Interestingly over 90% are females. 70% of these workers identify themselves as Aboriginal and all of them work in a First Nation community. 70% percent of those participating in the survey graduated from secondary school. Postsecondary education for this group was varied with some participants completing trade, technical or vocational school with some receiving certification at this level. Fewer people had university degrees with yet fewer having advanced graduate degrees. 80% of respondents state that their work with continuing care is their primary source of income with 60% stating that they were salaried and 13% stating they received hourly wages. Only 17% of respondents stated that they had another source of income. On average over 80% of the respondents worked more than thirty hours a week while over 60% earned, from all sources of income, $40,000 to $90,000 per year. 30% earned between $15,000 and $39,999 dollars. Hourly wages ranges from $9 to $35.00 depending on the labour category.

The workforce surveyed detailed that 74% of them were employed with their organization less than five years. Workers included in the survey include;

Home and Community Care Coordinator
Northern Clinic Practice
Home & Community Care Case
Adult Care Worker
Home & Community Care Coordinator
Project Manager for Home Community Care, Social Administrator and Elder Liaison.
Family Caregivers Focus Group

Through community agencies, the researchers recruited a group of family caregivers to participate in three focus groups. This was done in person and in the appropriate language of the community.

The Caregiver Focus Group in Alexander First Nation, Alberta involved three participants on April 28th, 2005.
Two separate meetings were held with family caregivers on June 17th in Iqualuit, Nunavut
Student Survey and Focus Group

The researchers were not able to distribute a short survey to students who are potential continuing care service providers though one or more Health Careers Fairs organized by FNIHB, as those dates did not coincide with the timing of this study.

The client arranged a teleconference focus group discussion in the Yukon First Nations students in programs that prepare service providers. The Student Focus Group Teleconference took place on June 9th, 2005 and involved fourteen participants.

Key Informant Interviews

The researchers conducted interviews with a group of First Nations and Inuit community leaders and postsecondary programs. It was important to include Key informants both South and North of 60. Six Key Informants were interviewed between June 8th and June 22nd, 2005.

Literature Scans

The design and the analysis of the data collection were informed by a broad selection of the relevant literature. One key deliverable of this study was an expanded bibliography of relevant reference material (60 documents), which has been entered into a database.

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. The client was instrumental in distributing and collecting surveys through its regional offices. A further challenge was that three studies on similar issues were being conducted at the same time, somewhat overwhelming worker response. Working jointly with the client, we provided clear communication messages to engage participation in the study.

Summary of Core Competencies:

This contract demonstrates our ability to work collaboratively with a committee, 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 and Inuit 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, Inuit community levels.
File, document and literature review;
Subject matter expertise;
Data entry, cleaning and data analysis (using SPSS); and
Report Writing.

Team Member Responsibilities
AndreaWilliams Project Management, Financial Management,Overseeing research design and analysis; contact with client; research design;facilitated dialogues; liaison with regional coordinators; analysis and reportwriting; and focus group facilitation.
KatheleenWakeford Strategic Planning
KienanWilliams Data Analysis and Report Writing
JanaAnderson Logistics and report preparation

Project Title: Cabinet Renewal of the Aboriginal Healing and Wellness Strategy, Ontario
This project provides an example of demonstrated knowledge and understanding of issues that impact complex health delivery systems as well as experience carrying out evaluations.

Date (Month/Year): July 2002 – April 2004

Reference Contact: Sylvia Maracle, Executive Director, OFIFC 416 956 2525

Research Subject Matter:

The Aboriginal Healing and Wellness Strategy (AHWS) Joint Management Committee has an annual budget of $40 million dollars and delivers more than 260 community programs for Aboriginal people for chronic disease prevention and screening at the primary, secondary and tertiary level. The Strategy operates under a five-year implementation agreement with four ministries of the Ontario government. Katheleen Wakeford as Manager and Andrea Williams as Team Lead Policy and Research, were the contract staff supporting an 18 month research and strategic planning activities designed to inform the cabinet submission for renewal of the initiative. The strategic planning steps involved 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. Katheleen Wakeford as Manager and Andrea Williams as Team Lead Policy and Research, 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. In her position, as Team Lead, Andrea 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 of the Andrea Williams and Katheleen Wakeford 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 survey data
Identifying measurable impacts
Analysis and reporting on findings
Training project staff
Preparing briefing notes for Joint Management Committee
Implementing Performance Measures Data collection tools
As noted earlier in the proposal, Katheleen Wakeford and Andrea Williams worked with the Joint Management Committee to consolidate all these activities into a strategic options plan. The Joint Management Committee further used this information for a final strategic plan/cabinet submission that successful led to the five-year renewal of the Strategy with an annual increase of 5 million dollars of funding for primary, secondary and tertiary prevention services designed to improve First Nation, Métis and Inuit health in Ontario.

Andrea Williams also supported the implementation of Phase 2 the Longitudinal Study. The intent of the longitudinal study is to establish a baseline of information, from which changes could be tracked, in further phases of the study. The Longitudinal Study is intended to inform Joint Management Committee and the government of Ontario on the efficiency and effectiveness of AHWS-funded programs and services. The Strategy was originally established on the assumption that previously existing health and social services were not working effectively with Aboriginal people, resulting in higher delivery costs for ineffective services. The Longitudinal Study is structured to provide information specifically related to improved service delivery to Aboriginal people; improved health of Aboriginal people, and the reduction of family violence; resulting from the delivery of AHWS-funded services. These programs are Aboriginal designed, managed and delivered on reserve, rural and urban communities with First Nation, Métis and Inuit people in Ontario.

Methodology:

Andrea Williams was contracted as Team Lead and The Aboriginal Research Institute undertook phase 2 of the Aboriginal Healing and Wellness Strategy (AHWS) Longitudinal Study. Phase 2 was designed to continue tracking the long-term impacts of AHWS-funded services and programs on the health and healing of Aboriginal people in Ontario, using measures related to the two main goals articulated in the mandate: reduction in family violence, and improvement in Aboriginal health. A critical aspect of the design of Phase 2 was to move beyond the qualitative emphasis of Phase 1, to evidence based data collection on chronic disease prevention to inform change. Phase 2 identified and documented indicators that describe incremental improvements towards “better health and well-being”.

Nine sites participated in Phase 2 of the Aboriginal Healing and Wellness Strategy which include: N’Mninoeyaa: Community Health Access Centre, (10 First Nations on the North Shore area of Ontario); Shkagamik Kwe Health Centre, Sudbury;· Noojmowin Teg Centre, (8 First Nations on Manitoulin Island; Wabano Centre for Aboriginal Health, Ottawa; Anishnawbe-Mushkiki, Thunder Bay; Southwestern Ontario Aboriginal Health Access Centre (SOAHAC), London; ·Gizhewaadiziwin Access Centre, Fort Frances Tribal Area First Nations; Six Nations Maternal and Child Centre; and Enaahtig Healing Lodge; Victoria Harbour.

A multi-prong methodology was undertaken in this study including:

• Consultation with an Aboriginal advisory committee composed of participating sites (Andrea Williams and Katheleen Wakeford)
• Extensive Literature Review
• Document Review
• Staff training on performance measures and evaluation of effectiveness of staff training.
• Client benefit questionnaires undertaken with 800 clients annually to determine their self-reported changes in the health or family situation as a result of using the program. The short questionnaire provides process and impact measures including satisfaction, timeliness of services; knowledge acquired and whether they have changed their lifestyle as a result of acquiring new knowledge; (Andrea Williams and Katheleen Wakeford)
• Key informant interviews with service providers, traditional people and Aboriginal community experts and focus groups with participating sites
• Two-day retreat with Advisory group of community experts (Andrea Williams and Katheleen Wakeford)
• Site visits
• Installation and training on generic software that track client and participant activities: reason for service; health services provided ICD 10 codes; referrals; number of clients; number of client visits; level of chronicity; number and type of participant activities; number of participants (Andrea Williams and Katheleen Wakeford)
• Design and implementation of indicators of change. (Andrea Williams and Katheleen Wakeford)
• The Aboriginal Research Institute was responsible for the integration of the Aboriginal Healing and Wellness Strategy’s cultural framework into the design of data collection activities and analysis of data.

Challenges:

There was an important need to collect consistent and comparable quantitative data to support the qualitative information collected in this study. This process had to be implemented within a very short time frame with limited funds in order to support cabinet renewal of the Strategy. Andrea Williams obtained the funding for software and worked with a number of sites to get it installed and effectively implemented within a six-month period. Ms Williams facilitated training on the software and supported/reinforced the importance of inputting consistent data within the remaining 12-month period. These efforts required site visits to the Aboriginal communities involved and networking with the Executive Directors, front-line staff and administrators. The software was not imposed on any participating site, but was offered as a resource. From a “zero” starting point eighteen months earlier, the quantitative database now consists of information relating to more than 100,000 Aboriginal clients and participants receiving primary, secondary and tertiary chronic disease programming, as a result of our efforts.

This research initiative produced a number of quantitative data sets establishing base-line data for the Aboriginal Healing and Wellness Strategy.

In addition, the following reports were produced:

• Phase 2 Longitudinal Study Synthesis Report;
• Phase 2 Longitudinal Study Summary Report including: findings; examination of cost-benefit analysis and two research papers: Aboriginal Family Violence and Aboriginal Health Status.

Summary of Core Competencies:

This project demonstrates our experience and knowledge of chronic diseases and prevention programming. Our work in Health is primarily with First Nations, Métis and Inuit people; therefore we have in-depth knowledge of First Nations and Inuit Health Issues. Important comparisons are our ability to work collaboratively with a committee, 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 and strategic plans.

• Review of existing programs and development of performance measures
• Staff training and evaluation of training
• Questionnaire design
• Key Informant interviews
• Surveying a number of different stakeholder groups including Aboriginal leadership and representatives of Federal, Provincial health departments.
• File, document and literature review;
• Subject matter expertise;
• Data entry, cleaning and data analysis (using SPSS); and
• Report Writing.
• Strategic Plans
• Cabinet Submissions

Aboriginal Healing and Wellness Strategy (November 1999 – March 2000)
Research Associate and Project Coordinator with Aboriginal Research Institute conducting a review of a specific project for the Aboriginal Healing and Wellness Strategy, completed in March 2000. Andrea Williams was senior analyst and responsible for data collection and analysis and report writing.