Aboriginal Health Care Search

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					Aboriginal Health Care Search

“What should the health care experience
              be for Aboriginal people?

                           Facilitator’s Report
                 February 29, March 1&2, 2008




                                             1
    Aboriginal Health Care Search


                                    Conducted by:
Health Opportunities for Aboriginal People (HOAP)
             Aboriginal Community Members and
                       PMHubbard and Associates


                  February 29, March 1 & 2, 2008




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Table of Contents
1.Introduction...................................................................................................................... 4
2. Background to Consultation on Aboriginal Health Care................................................ 5
   2.1    Health Opportunities for Aboriginal People (HOAP) Committee...................... 5
   2.2    The Search Question ........................................................................................... 5
   2.3    Participation ........................................................................................................ 6
3.The Search ....................................................................................................................... 6
   Stages of the Search ........................................................................................................ 7
4 . Results of the Search...................................................................................................... 8
   4.1    Shared History (Friday night) ............................................................................. 8
   4.2    Current Trends (Saturday Morning) ................................................................... 9
   4.3    Exploring Trends .............................................................................................. 10
   4.4    Ideal Futures (Saturday Afternoon) .................................................................. 11
   4.5    Principles of an Ideal Future ............................................................................. 13
   4.6    Projects and Big Ideas....................................................................................... 16
   4.7    Action Planning ................................................................................................ 17
   4.8    Next Steps ......................................................................................................... 19
5.Feedback on the Conference.......................................................................................... 19

Appendix A – Members of the Health Opportunities for Aboriginal People
Appendix B – Conference Workbook
Appendix C – Considerations in Setting up this Conference.




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1. Introduction
This report documents a two and a half day conference on Aboriginal health care
experiences sponsored by the Hamilton Niagara Haldimand Brant Local Health
Integration Network (LHIN) and the associated Health Opportunities for Aboriginal
People (HOAP) Committee. The conference was held at the Six Nations Community
Centre in Oshweken on February 29th, March 1st and 2nd, 2008.

LHINs are relatively new organizations in Ontario and are in the process of building
relationships and understanding the issues associated with stakeholders in their areas. In
order to assist them in building these relationships and understanding the Aboriginal
Health Care issues, they formed a committee representing several Aboriginal interests.
The HOAP Committee has been established to assist the LHIN determine how to reach
and consult with the Aboriginal community. (See Appendix A for a list of HOAP
Committee members and their terms of reference). The LHIN’s purpose in carrying out
this consultation is to better understand Aboriginal health care issues and the Aboriginal
community.

The LHIN is beginning to establish a dialogue with Aboriginal people and is supportive
of forums that will be effective and meaningful and will help them better understand
Aboriginal health care needs. This consultation forum was initiated by the HOAP
Committee as a means to assist the LHIN in better understanding the Aboriginal health
care needs within its jurisdiction. This type of consultation forum is recognized as being
supportive of and amenable to traditional Aboriginal dialogue

The Conference provided an opportunity for a diversity of Aboriginal people to come
together over a weekend to share their experiences and to identify the types of actions
that need to be taken by them and others to improve their health care experience. The
Conference highlighted the importance of providing opportunities for Aboriginal people
to articulate their health care needs and to do so in an environment that acknowledges and
values their opinions. This conference was successful because it was planned for an by
Aboriginal people.




                                                                                             4
2. Background to Consultation on Aboriginal Health
   Care
LHINs are not-for-profit corporations created in 2006 in Ontario. They work with local
health providers and community members to determine the health service priorities of
their regions. LHINs do not provide services directly, but are responsible for integrating
services in each of their specific geographic areas. Through community engagement,
LHINs work with local health providers and community members to develop integrated
health service plans for their local area. LHINs are based on a principle that community-
based care is best planned, coordinated and funded in an integrated manner at the
community level, because local people are best able to determine their health service
needs and priorities.
Since its inception, the Hamilton Niagara Haldimand Brant LHIN has been working to
better understand Aboriginal health care issues and to better define how that LHIN can
best contribute. They have started this discussion by, among others, establishing a
committee of representatives from Aboriginal organizations to assist them in determining
how to reach the Aboriginal communities in this area. This committee, supported by
LHIN staff and established in 2007, is called Health Opportunities for Aboriginal People
or HOAP. (refer tp Appendix A for a list of HOAP members). HOAP provided the advice
and ground work necessary for planning and implementation of this conference.

2.1 Health Opportunities for Aboriginal People (HOAP)
Committee
   The HOAP Committee identified the need for the LHIN to obtain a more in depth
   understanding of Aboriginal health care issues in the Fall of 2007. In determining the
   best type of forum to use, they considered that health professionals at Six Nations had
   previous success with a Search Conference method in 1996 that addressed midwifery
   and birthing needs. That model was considered to be complementary and particularly
   sensitive to traditional Aboriginal dialogue. The Committee endorsed this approach
   and began planning for the session.


2.2    The Search Question
   Key to a search conference is the question that is put forward to the participants.
   Given that the LHIN is trying to establish what the health care experience could be
   for Aboriginal people and is not focused on any particular aspect of health care at this
   early point in their dialogue with Aboriginal people, the HOAP Committee
   established the following general question for the search conference:

       “What should the health care experience be for Aboriginal people?”

   This question is broad and provides a lot of opportunity for the participants to explore
   health care in general or to be as specific as they need to be.



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2.3    Participation

   The method for inviting participants required each HOAP member to identify and
   personally invite at least 10 Aboriginal people to the session about 1-1.5 months in
   advance. Each confirmed participant was sent an invitation to the session 2 weeks in
   advance. All participants who attended from another community were reimbursed for
   their travel and mileage. All meals were provided during the session including
   breakfast so that there were no additional costs for the participants.

   The level of participation was quite high (76 participants attended for part or all of the
   session) and most people stayed for the entire four sessions over 2.5 days. This is
   noteworthy since many people attended from other communities and there was a
   major snow storm on the first day and evening.

        “I’ve never been at a conference before where everyone stayed until the end –
       this is amazing.”

       “This is great. There is so much work being done here even when people are not
       participating in the big group discussions.”


3. The Search
Setting the Context – Creating Good Minds
Each day of the conference began and ended with a traditional thanksgiving. In keeping
with respecting the territory of the community hall being Iroquois and at Six Nations, the
conference began with school age Iroquois children from Kawennio Immersion School
reciting the Thanksgiving Address in their native language. They then carried out a play
about the Creation Story. They were followed by a welcome from the Six Nations Band
Council Chief Bill Montour, Hereditary Chief Arnold (Arnie) General, and the LHIN
Board Chair Juanita Gledhill. On Saturday, Métis Elder Doris Lanigan provided the
Thanksgiving and on Sunday the Cree-Ojibway Faithkeeper Walter Cooke provided the
thanksgivings.

The social on Saturday night also provided an opportunity to enjoy Iroquois, Ojibway and
Métis drumming, dancing and music.

Thanksgivings are essential to the beginning and ending of dialogue – creating the state
of mind in which each person participates and giving thanks for the opportunity to do so
and the people that could come together. The space for each nation to do a thanksgiving
respects the territory in which the conference took place as well as the nations that
participated. The involvement of youth in the thanksgiving, the Creation play and
musicians and dancers at the social reminded everyone of their interests and their
connection to their culture and gave everyone hope. While a social is not a necessary
component of Search conferences, it is an important element of Aboriginal culture and all
participants appreciated the opportunity.


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A workbook provided the framework for the session and included the agenda, guiding
principles, roles of the facilitator, and suggestions for working in small groups and key
questions for each session (See Appendix B).

Conference Management
Managers of the Conference included Ruby Miller, Six Nations Health Director and Pam
Hubbard from PMHubbard and Associates in Hamilton.

Stages of the Search
The Search consisted of four stages depicted in the following diagram:




                                                           Personal
                                SHARED
                                HISTORY                    Local

                                                           Global




     ACTION                                               CURRENT
     PLANNING                                             TRENDS
      What can be done?                                        Mapping Trends

      Who takes action?                                        Exploring Trends




                                  IDEAL
                                  FUTURE
                                  Principle Elements

                                  Projects/Ideas




                                                                                            7
4 . Results of the Search
4.1    Shared History (Friday night)
The Shared History session used three large circles to indicate the context for exploring
the historical events that have shaped Aboriginal experiences in health care. The first
circle provided an overview of personal health care experiences, the second indicated
local health care events and the third documented global or world events.

Over dinner, participants began to document their history with health care. Even children
in the room contributed to the shared history wall mural. Over the space of dinner and for
about an hour after, the wall and the circles filled up with thoughts, memories and events.
During this time, and as an extension of the dinner conversation, people sat at tables and
talked about what they were seeing. Finally, everyone gathered at the wall to express
their thoughts about everything that they saw on the wall.

Several participants then reflected on the history of the health care system that the murals
documented. These stories reflected both personal and community experiences. They
were stories of:
       o Personal and cultural isolation of Aboriginal people in dealing with
           mainstream medicine;
       o The long term struggle with overcoming severe traumas from the past such as
           the experience with the residential school system;
       o The subsequent struggles with addictions and the lack of facilities and
           professionals to deal with and understand Aboriginal culture, traumatic
           experiences, and spiritual healing;
       o Being treated poorly and being misunderstood as patients by mainstream
           medical professionals. Aboriginal people have not been treated well by the
           health system or its professionals;
       o Being misdiagnosed because mainstream medical professionals have not
           recognized the link between emotional, mental, spiritual and physical health.
           These things are inextricably linked in Aboriginal experience;
       o The western medical system has not fit with Aboriginal people and their
           culture;
       o Aboriginal people trained in western medicine have difficulty applying
           western medical practices as the practice, in their experience has been
           primarily based on pharmaceuticals as the healing agents. Aboriginals trained
           as nurses have quit nursing and young people have avoided medical training
           because they cannot accept this basis for healing.
       o Aboriginal medical practitioners have been encouraged to work off the
           reserve;
       o Aboriginal people have lost their connection to their traditional medicines and
           healing practices;
       o The community has had a few good medical practitioners and also those who
           have abused Aboriginal patients and are still remembered. These people have
           been shuffled from one reserve to the next when problems are uncovered;



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       o Historically, the medical profession made decisions for Aboriginal women
         around significant health issues like birth control and parenting and, for
         example, sterilized women without their consent or took their children away
         from them for no apparent reason. Aboriginal women have deep emotional
         scars and distrust of the medical profession as a result;
       o Out of some of these historically difficult times there has been some progress.
         For example, the death of a Six Nations woman in hospital resulted in a better
         understanding by the hospital of Aboriginal people’s needs. The Cancer
         Centre and the De Dwa Da Dehs Nye>s all came out of an emerging
         awareness of Aboriginal health care needs as a result of difficult times; and
       o A lot of the Aboriginal problems with the law have been related to alcohol and
         drug addictions. Historically, addiction treatment is only available outside the
         Aboriginal community. Treatment is often not available because of long
         waiting lists.

All of these stories provided a picture of what happens when the fundamental need for
Aboriginal people to be in touch with and connected to Aboriginal culture and language
is lost or not acknowledged by those who have the power and authority to make decisions
about their health. Historically, for Métis and off reserve Aboriginals in particular, this
has resulted in emotional and physical health problems and addictions. Western medicine
has not acknowledged nor understood Aboriginal culture and this has resulted in
mistreatment, misdiagnosis and disconnection to the spiritual, emotional and physical
health needs of Aboriginal people.

 ‘Our healing comes from within. We have lost the connections to the Creator. Some of
our elders have said that we are missing 500 years of who we are. Until we get that back
we have a long journey to the Creator.”



4.2    Current Trends (Saturday Morning)
In this session, the large group gathered around an empty wall space to identify the
current trends that they are observing in Aboriginal Health Care. The group worked for
over two hours to develop a complex map (See photo below) that shows how
interconnected the health care issues are for Aboriginal people. The main branches of the
map identified the following types of trends:
         o Obesity and all of the problems that this causes (e.g. heart problems, Type II
            diabetes, complications);
         o Chronic diseases including trauma counseling, addictions, and dialysis. There
            is an increasing need for dialysis and there is an effort being made to get a
            clinic at Six Nations;
         o Mental health issues including suicides, misdiagnosis of “gifts”, no recreation
            for youths;
         o Lack of Public Health standards for First Nations reserves;
         o Many issues associated with the government not paying for traditional
            medicines or western medicines;


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       o Trends that continue with the medical profession and hospitals that
         misdiagnose problems, have insufficient ability to provide medical services
         such as surgeries in a timely way; and professionals who have no sensitivity to
         Aboriginal culture;
       o The lack of adequate and wholistic medical treatment by the mainstream
         medical professional;
       o The overuse and misuse of pharmaceuticals in treating Aboriginal people;
       o The downloading from the federal government to the provinces and to the
         First Nations. This includes: lack of action and respect for First Nations and
         Aboriginal people through the Indian Act and treaties, lack of recognition of
         the Métis population and their access to health services, as well as non-
         recognition of all Aboriginals in the latest Federal budget;
       o Several issues associated with the quality of care and facilities needed for
         seniors;
       o The need for Aboriginal people to be trained to treat their own people.
       o Difficulty in obtaining specialized equipment;
       o There is no data and no epidemiology locally;
       o CCAC doesn’t provide care to Aboriginal people;
       o Discrimination in the system as a result of access to Treaty rights. Most
         people don’t understand Treaty rights;
       o The need for several types of services to address the impact of the residential
         school system on individuals and families. This is connected to the loss of
         culture and identity;
       o Many diseases caused by lack of exercise. Seniors need exercise but there is
         little opportunity to exercise in a rural area – the need for fitness facilities;
       o Need to change diets to prevent diabetes and obesity; and
       o Métis people don’t get health benefits

 “Residential schools….we need a place for the survivors…there are deep traumas that
they (regular counselors) cannot deal with. It’s comparable to the holocaust…I don’t see
any counselors who can deal with my trauma. I’d like to see a special department....for
not only counseling but for kids to learn the culture.”

“We have something so precious in the way that we care for our people. We need to take
what we know and make a business of it”.


4.3 Exploring Trends
The large group then answered two questions:
       i. What are you doing about these trends?
       ii. What are you doing that you are proud of?

They identified several groups, programs and actions that are being taken to address the
trends that have identified and for which they are proud. These included the following
support groups, programs and other initiatives:



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       o Aboriginals are taking significant leadership roles in the health care system
         and are working to making changes from within the system;
       o Aboriginals trained in alternative health care want to provide and are working
         to provide services at Six Nations;
       o Six Nations has four Native doctors; 2 have graduated and one is considering
         Aboriginal traditional medicine. This has been actively promoted;
       o Enhanced Mental Health services using video conferencing are now available;
       o Métis have negotiated funds from the Ministry of Health for Métis students
         going into the health professions;
       o There is more collaboration of Aboriginal people e.g. this conference, and this
         will create inroads;
       o Several groups are providing support services:
         o Miles to Go Group at Six Nations
         o Aboriginal Men’s Circle
         o AHWS (Aboriginal Healing and Wellness Strategy)
         o De dwa da dehs nye>s – Hamilton and Brantford
         o Haudenosaunee Resource Centre
         o AHAC (Aboriginal Health Access Centre)
         o Advocacy – Case Conference Team (Friendship Centre and AHWS)
       o Aboriginal Programs include:
         o Diabetes programs
         o Cancer Advocacy Pilot Project

4.4 Ideal Futures (Saturday Afternoon)
After the session to develop current trends, the large group reorganized into several small
groups to develop their vision of an ideal future for Aboriginal health care. They were
asked to imagine that they are back in this room ten years from now and they’re reporting
on all of the things that they have achieved. What did they achieve and what were the
challenges that they overcame? They worked all afternoon to develop their ideas and to
present these ideas to the large group. Then each group took the ideas that they identified
on flip charts and cut them so that each idea was on its own separate piece of paper. They
posted each of their ideas on the wall. The wall had three possible categories:
        i.       Shared Future
        ii.      Big Ideas/Projects
        iii.     Differences

The goal of a search conference, as mentioned earlier, is to identify common ground or
elements that are shared by the entire group. Differences in opinion as to what constitutes
an ideal future are documented so that these elements are not lost. The action planning,
however, focuses on the shared elements.

When the group reassembled on Sunday morning to review the list of ideas, several
important understandings and realizations around the idea of common ground and a
shared future emerged.




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The first thing that happened is that while trying to categorize ideas for a shared vision,
they realized that this was causing them to lose sight of their wholistic framework. They
were concerned that the discussion was becoming too fragmented. This was resolved by
putting the circle of connectedness (see photo below) front and centre in the discussion.
Participants explained that they do not and cannot talk about their ideas in separate
                                                                   categories and without
                                                                   this reference to guide
                                                                   them. All of these ideas
                                                                   are multi-layered and
                                                                   interconnected and they
                                                                   must be able to show this
                                                                   and speak about an ideal
                                                                   future in this context.

                                                                  The second realization is
                                                                  that they could not
                                                                  identify differences or
                                                                  disagreements about
                                                                  what constitutes
                                                                  elements of an ideal
                                                                  future. They spoke as
                                                                  one on all of the issues.
                                                                  They realized that all of
                                                                  their experiences, past
                                                                  and present, and their
vision for the future are shared and they could not separate out any “Differences”.
Therefore, the “Differences” heading on the wall was removed by participants. The ideas
were layered on each other just as ideas are multi-layered and rich in life and they are
gathered around the diagram symbolizing wholistic health and wellbeing.

“Ten years form now we have realized the need to be closer to the essence of who we
are. We have so much to bring forward in a contemporary sense. The lived experience
through the generations is with us now, we acknowledge where we are at…we are
resilient. We are able to understand and to articulate our needs…..Everything is
connected…..the language is important…we have stronger partnerships with each
other…we are a united force and have gotten a lot more done…We tell government what
we need, they don’t tell us what they want us to have…land claims are settled and we
have community leadership….we do not deny our own being, the cultural identity, the
thing that makes us who we are…we are a people of honour. We have a dream for an
equal future.”




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4.5. Principles of an Ideal Future
The large group worked through and discussed several of the ideas to provide clarity and
developed the following principles/elements for an ideal future (See the photos for all of
the ideas) as they were posted/rearranged on the wall:
    o Everyone is laughing, feeling well and happy, humour is important;
    o Healing and wellness is more than pills – it includes spiritual and emotional
        support/approach and it uses alternatives to pharmaceuticals ;
    o There is improved doctor/patient relationships and doctors listen;
    o Physical activity is part of a healthy lifestyle;
    o There is improved health for individuals and families and everyone is working
        together for this goal;
    o We don’t rely on the written word for communication – we use interpreters and
        symbols (i.e. advocacy);
    o Health care is:
          o Free, universal and equal, all inclusive, equity for everyone, consensive
              decision
          o respecting the individual
          o choices to be honoured and supported and addressed
          o meet the pf/person where they are at
          o cooperation
          o proactive instead of reactive
          o respecting choices by western providers – need education and awareness
          o accepting ceremonies and need for family support
          o adequate health services
          o no wait periods for needed services
          o extended health benefits (dental/prescription)
    o Prevention is prevalent;
    o More alternative health care professionals;
          o Homeopaths
          o Naturopaths
          o Health care and natural resources are working together
    o Essential services are funded and in place;
    o There are adequate seniors support in the community;
    o Aboriginal health care facilities, staff and administered by Aboriginal people,
        multi-layered care, all Aboriginal cultures;
    o Health professionals are all from the community – doctors, nurses, physio, OT,
        nutrition, etc;
    o There will be education for & education by Aboriginal people. We will have
        quality & dedication in service and not just quality;
    o Traditional and western medicine working hand in hand;
    o Not just medical doctors;
    o Have a choice of medicines offered - wholistic, natural, traditional; to be offered
        with mainstream pharmaceutical stuff;
    o Spirituality is an important part of healing;


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o Holistic assessment of being to make diagnostic decisions;




o Inclusive planning for care by:
  o Professional
  o Friends
  o Family
o People have more than one need;
  o Coordinated care
  o Meet all needs – holistic approach
o Adequate after care and follow up and support services for people recovering
  from surgery or other major medical procedures/alcoholic and substance
  abuse/smoking;
o Resources are available;
  o To meet basic needs
  o Transportation is provided
  o Healers are available
  o People speak the languages
  o Advocacy and navigation in place
o Ongoing support and after care throughout an illness;
o Personal support, home are, transportation able to meet needs;
o Youth and adults are drug and alcohol free;
o LHINS listened to what our health needs are:
  o Wholistic structure
  o Policies and programs developed by Aboriginal people
o Work with LHINs, our people;
o It takes a community to raise a child
o It takes a community to help an elder
o Native foster care – while in care to nurture the fundamental cultural & spiritual
  rights and heritage of the native children: addresses maintenance of wholistic –
  mental health & wellness; and



                                                                                   14
o Respect – individual needs are met; no assumptions are made; cultural awareness.

Environment:
o Clean environment;
o What you drop you eventually drink;
o 100% green – physically/environmentally; and
o Good water, good hunting, good fishing, good living.

Government/Political:
o There is more collaborative effort between Aboriginals and politicians;
o Politicians have stepped back and let us develop our programs front line workers;
o A healthy striving community has been created by government cutting inadequate
   funding and land claims being settled;
o Land rights are honoured. Compensation equals economic independence. An
   economic revenue base (work) equals self sufficiency;
o Aboriginal people administer own funds;
o All across Canada would be native land;
o Would not have to pay out $$ out of pocket for what is needed to maintain good
   health;
o Pay equity for all;
o Everyone can get what is needed in spite of economic status in a timely fashion;
   and
o Stronger partnerships with each other (Aboriginal communities).

Education:
o Traditional history and culture in university, high schools, day school;
o Taking responsibility for your own actions;
o Funding Barriers – educating the Canadian Public to Aboriginal History (Six
   Nations, First Nations, Metis Educational Museum, Douglas Creek);
o Education should start early and include preventative medication; disease versus
   traditional model;
o Board of education evaluates and implements ongoing phys-ed and Aboriginal
   nutrition in schools (and throughout life);
o Training Aboriginal youth in traditional medicine;
o Prevention starting with healthy child and youth;
o Better understanding of historical traditions and culture ;
o Advocacy;
o Train health professionals (scholarships/bursaries); and
o Language (Bi-Lingual - stores products, stop signs, health centres, arena, council
   meetings).

Barriers:
o Government (Indian Act system);
o Health (mentally, physically, emotionally, spiritually);
o Diabetes, dialysis, health promotion; and
o No access to Transportation.



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4.6 Projects and Big Ideas
Within the visioning, projects and big ideas were shared. The following are the projects
that the groups identified in an ideal health care future. The idea of a 24 hour clinic or
wholistic health care centre was raised several times during the conference and this
session in particular. In addition, the idea for the LHIN to host an annual Aboriginal
Health Care forum was also raised a few times.


   o Good Mind, Good Heart, all of one mind & heart – atoniiotohake non kwa ni tora;
      Back to the Future”, the late Tona Mason
   Supportive Facilities:
   o Centres of Excellence – TEKA – Traditional, Education, Knowledge, Awareness
      Centre
   o Aboriginal walk-in clinic (24 hrs):
   o Traditional healers
   o Traditional medicines (organic and traditionally harvested)
   o Family Health Care Centres. Extended 24 hour care
   o ONE STOP WELLNESS SHOP (physical, mental, spiritual, emotional shopping)
   o Aboriginal Health and Wellness Access Centre
   o 24-7 WALK IN CLINIC
   o Home Care Services: cleaning, cooking, visiting, personal care (looking after our
      own)
   o Aboriginal and Non Aboriginal annual forum (AB/Health Forum)
   o therapeutic pool and swimming pool
   o Aboriginal midwifery extended classrooms to accommodate all students to
      service all First Nations communities
   o Buildings – senior centre with walking trails and recreational facilities
   o Mental Health Adult and Child Psychiatry; Detox treatment and Training Centre
   o Mental Health team – providing mental health care in holistic way
   o Métis specific treatment centre for addictions
   o Six Nations dialysis unit in full operation. Aboriginal doctors with specialties
      (orthopedic, surgeons, and First Nations nurse practitioners)
   o Satellite hospitals with at least 24 beds. Focus on prevention for children.
   o Adequate ultra sound facilities, diagnostic center

   Environmental/public health:
   o New water plant
   o Water to every home
   o Sewer mains
   o Air quality control
   o By laws
   o Planning locations
   o Public transportation – bus stops



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4.7    Action Planning
Participants were asked to think about what they could do personally or through
organizations and networks that they are connected to. In small groups, they discussed
what actions could be taken to get them closer to the ideal future. The following is a list
of the actions that they believe that they can take both individually and in their capacity
as part of organizations.

   o Take information back to the community re: purpose of the LHIN and outcome of
     this meeting (through staff programs, native organizations, and community
     members)
   o Develop a committee to further identify needs (focus groups, questionnaires,
     community gathering)
   o The goal is to work towards ensuring Aboriginal services by Aboriginal people
     continue in our community
   o Support group development – formation to address gaps:
   o Miles to Go
   o Canadian Cancer Society
   o Métis Nation
   o DAHG
   o AbP (Aboriginal People) +Nav (JCC)
   o Haldimand Region – gaps in Aboriginal specific services i.e. Hagersville,
     Dunnville, Cayuga, Selkirk and across the Region > MNO/JCC/HEDAC. There
     are only 9 AHACs across Ontario and they do not all have traditional programs
   o Prevention – MNO/-JCC/Metis-F.C.
   o Niagara Region – awareness, collaborations, projects - FCa, DAHC, Métis
     ABP+Nav (JCC)
   o Seek out and enlist the aid of traditional healers. Give them an atmosphere in
     which they feel comfortable to use and share their knowledge for the benefit of
     the community.
   o Start by being more open, friendly and approachable
   o Start communication where there hasn’t been any or little
   o Develop partnerships
   o Do a local SWAT analysis (strengths, weaknesses, assets, threats)
   o Set a goal – Aboriginal Health
   o Develop the Steering Committee
   o Get buy in from each of the Aboriginal communities in the area
   o Community consultation on what community members need and envision for
     their health center.
   o Research to support the initiative
   o Proposal develop – capital, program/service
   o Make linkages with training programs for potential staff in the future
   o Get the political buy-in from the partner communities
   o Develop Plan B … how to get the remaining $ we didn’t get
   o Open doors with ribbon cutting with Aboriginal politicians and LHIN members,
     other funders, delegates.
   o Develop partnerships between AHC and NWC (mental health.)


                                                                                          17
o   Maintain existing partnerships
o   Continue partnerships – traditional
o   Work with mainstream agencies
o   Work with other Aboriginal agencies
o   Everyone work on their own healing
o   Take this plan to HEDAC
o   Involve friends, family in care/service provided
o   Provide individuals with resources, information and opportunities (Sharing)
o   Develop a resource guide
o   On/off reserve work together
o   Educate self about “other systems” e.g. child welfare, CCAC
o   Fund aboriginal specific programs and services (Homecare) (PSWs)
o   Work with employment programs – GREAT, OGI, SISO
o   Collaboration with mainstream CCAC to establish Aboriginal programs
o   Advocate for day week/24 hr (AHC needs funding)
o   Healthy clean water and environment
o   Adequate housing to address the growing needs of the population and schools
o   Poverty reduction
o   Enhanced traditional medicines and traditional teachings
o   Work with other reservations
o   Adequate funding and maintain partnership with AHWS and create a partnership
    with the LHINS
o   Work with the Confederacy and elected Council
o   Community consults on health needs
o   A Conference
o   Traditional teachings to educate all LHINS across Ontario
o   i.e. teachings of the Circle of Life, mental, physical, emotional and mental all
    connected to health the well being of all people with various beliefs
o   i.e. physical – lacrosse, gathering berries, agriculture (recreation, medicine games)
o   Spiritual – Heart and Head working together i.e. compassion and empathy
o   Emotional – young people teaching, respectful for each other i.e. women/men
    relationships – through rites of passage. Majority of people are non native. All
    need to understand our belief system. Values, culture and language & how
    incorporated , how Aboriginals think,, feel, live and bring up children, effects of
    residential centre, update on land claims and relationship to our human rights to
    perceptual care & maintenance. Teachings of Cree, the wampum belts, covenant
    chain etc.etc. Métis teaching allowed
o   Policies – policy makers need help in understanding how their policies are
    detrimental to the everyday health of the Ogwehonwe’ (original people). Very
    important to change at systemic levels in order to value the needs of the
    communities.
o   Advocate for increased $ to train Aboriginal health care providers &
    administrators
o   Orators in a collective group that are willing to present/advocate with gov’t, social
    services, education etc. when required.
o   Advocate for more European contact education in schools (All levels)



                                                                                      18
   o Support family and friends when having social or health problems
   o Encourage healthy lifestyle to grandchildren
   o Research – communication of research projects to one central source so that we
     all are aware and have access to what has been done and what is being done now.
     Purpose – education between reserves, to government policy makers so that we
     don’t have to keep reinventing the wheel.
   o Promotion of philosophy of health care not sick care. Purpose – to educate our
     people to start caring for themselves before chronic disease takes hold and to
     identify people with risk factors.
   o Naturopathic care
   o Bring about the nest integrated governing system and we tell government what we
     needed, not what they wanted us to have
   o Empower the people and leadership through community consultation
   o Motivating and envisioning a healthy community for the next seven generations
   o Secure funding
   o Develop a centre that includes space for: a kitchen, music, fitness, family
     activities, language and cultural teaching and a library (the centre will be in the
     shape of a turtle – see photo)


4.8 Next Steps
The next steps are important in keeping the momentum going towards achieving the ideal
future that the participants described. While this conference is a step in the process, what
happens next will determine how the process will move forward. From this data report, a
community report will be produced by HOAP and shared with the conference participants
and broadly with traditional and non-traditional partners at an anticipated launch June 17,
2008. This launch will be an opportunity to reconvene the search conference
participants and present the plans of the people to a wider audience who may play a role
in action planning.


5. Feedback on the Conference
Participants provided the following feedback as they left the conference:
           o Good food, good company
           o Consult with the people! The people will tell you what needs to be heard.
           o Wonderful beginning. Need to follow up.
           o It is all “our shared history”. All of us – because our future and our present
               do become our future. We have a common beginning – a shared culture –
               a common culture that has evolved and continues to transform and adapt
               and radiate outwardly from that starting point – like blood within our
               bodies that circulates through and out –and back again to the heart and
               then through…our common shared history is ousr heart. Nya weh for
               bringing this beautiful clarity to my heart & mind & spirit this weekend.
           o Good conference – feel energized
           o Awesome education – looking forward to follow-up
           o Food excellent


                                                                                         19
o   Open forum wonderful – good company
o   Most informative
o   Great effort – well done
o   This was the best run conference that I have EVER ATTENDED. I liked
    the “Our Shared History” part that really set the tone of the conference and
    put our opinions in a “cultural perspective”! I liked the moving around the
    room idea to give different space for different creative thoughts. I liked
    how comfortable this model was to participate in.
o   Good work done here – I now have a better view of the whole picture.
o   Great experience – need more consultations like this.
o   Did you feel empowered? Yes!
o   Two minds - hopeful and realistic – thankful to creator
o   Good experience. Nice to see all people and learn about how we an
    improve health for the future – like the idea of accept all ideas & opinions.
    Freedom to express is great.
o   I feel better educated.
o   Too much food. Ditto!
o   Good conference, very informative, not well attended
o   Wonderful, positive, hopeful
o   Very interesting learning experience – hoping to learn more
o   Excellent – informative, shared feelings
o   Action and words must match




                                                                              20
21
MEMBERSHIP OF HEALTH OPPORTUNITIES FOR ABORIGINAL PEOPLE
                   COMMITTEE (HOAP)



 Mr   Peter     Doolittle     Brantford Native Housing

 Ms   Linda     Ense          Native Women's Centre

 Ms   Barb      Harris        Six Nations

 Ms   Ruby      Jacobs        Six Nations Health Centre (retired)

 Ms   Geralda   Jamieson      Fort Erie Native Friendship Centre

 Mr   Glen      Lipinski      Métis Nation of Ontario

 Ms   Ruby      Miller        Six Nations Health Centre

 Ms   Wanda     Smith         Native Horizons

 Ms   Lee       Styres-Loft   Juravinski Cancer Centre
                              De dwa da dehs nye>s Aboriginal Health
 Ms   Marilyn   Wright        Centre


 Ms   Pat       Mandy         CEO, HNHB LHIN
                              Planning & Integration Consultant,
 Ms   Leslie    Cochran       HNHB LHIN

 Ms   Kathy     Gilchrist     Administrative Support, HNHB LHIN
            Workbook

 Aboriginal Health
Search Conference
       Feb. 29th -March 2nd, 2008




               “What should the
   health care experience be for
            Aboriginal people?”



Inside:

• Agenda

• Session Directions

• Space for Notes
                                                                      “What should the health care experience be for Aboriginal people?”



                                                                    NOTES/IDEAS/DRAWINGS
Guiding Principles

•   Encourage real, meaningful and purposeful dialogue;
•   Actively value everyone’s commitment, contribution and ex-
    pertise;
•   Acknowledge differences with an understanding that they can
    not be worked on or resolved at the
    Conference; and
•   Build important relationships amongst participants.


This conference asks the following:
•   For people to represent themselves not organizations
•   For everyone to actively participate in whatever way they are
    comfortable
This means that we will:
•   Share in the work that will be done (recording, reporting,
    drawing, note taking, time keeping) in whatever way we are
    able
•   Look at the big picture (past, present and future)
•   Work towards a “shared” vision. This means honouring our dif-
    ferences rather than having to solve them
We agree that:
•   All ideas are valid
•   We will listen to each other
•   Differences and problems are acknowledged – not “worked
    out”
                                                                   “What should the health care experience be for Aboriginal people?”



   9. NEXT STEPS AND FOLLOW-UP                               Facilitators’ Roles
                                                               •   Set time and tasks

GROUP DISCUSSION:                                              •   Assist with the Large Group Discussions
                                                               •   Keep the conference purpose front and center
What needs to happen in the short term to get started on
the Action Plan?


                                                             Shared Leadership in Small Groups
                                                             Part of the conference includes work in small groups. Each
                                                             small group manages its own discussion, information, time
                                                             and reports. Here are useful roles for self-managing this
                                                             work. Roles can be rotated. Divide up the work as you wish –
How can you follow-up to see the progress that is being
                                                             these are suggestions only:
made and to work on strategies to continue the progress?

                                                             Discussion Leader – assures that each person who wants to
                                                             speak is heard within the time available.


                                                             Time Keeper – Keeps the group aware of the time left in the
                                                             small group discussions and reminds the reporter of time left
What role can you play in taking next steps and following-   in the report back session.
up?
                                                             Recorder - Writes group’s output on the flip charts, using
                                                             speaker’s words. Asks people to restate long ideas briefly.


                                                             Reporter – delivers report to large group.
                                                “What should the health care experience be for Aboriginal people?”



                                                 8. GROUP ACTION PLANNING

For their participation, thank you!        Purpose: To identify the actions that can be taken by people at
          Chief Bill Montour                        this conference to work toward the ideal future for
         Chief Arnold General                       Aboriginal Health Care.
Elders Doris Lannigan & Walter Cooke
Teachers and Students at Kawennio          Individually: What actions can you take right now to work to-
                                                    ward an ideal future for Aboriginal Health Care?


                                           Small Group Discussion:
  All sessions include nutrition breaks:
                                           What action(s) can you take with the people in this room to work
        10:15 am and 2:15 pm
                                           toward an ideal future for aboriginal health care?
                                           Short Term (3 months?)
                                           What we can do               Who do we need help from

     Inquiries:
     Contact Kathy Gilchrist, Program
     Assistant
     (905) 945-4930 extension 222
     Kathy.Gilchrist@lhins.on.ca


     Hamilton Niagara Haldimand            Long term (3 years?)
     Brant Local Health Integrated
     Network                               What we can do               Who do we need help from
     270 Main Street East, Units 1-6
     Grimsby, Ontario L3M 1P8
     905-945-4930 ext 217
     Toll Free 1-866-363-5446
                                                                       “What should the health care experience be for Aboriginal people?”




        7. DEVELOPING OUR SHARED
                      IDEAL FUTURE                                                          AGENDA

Purpose: To discover what is shared by everyone about an ideal                                     Morning
                                                                                                   Sunday, March 2nd
         future for Aboriginal Health Care.                                                        8:00 Breakfast
                                                                                                   8:45 Opening
                                                                                                   9:00 Confirming the
Small Group Discussions:                                                                           Shared Vision
                                                                                                   10:30 Actions Planning,
•   Prepare a list of the features of an ideal future that you all                                 Next Steps
                                                                                                   11:45 Closing
    want (list of values, principles). This is what everyone                                       Noon Lunch
    wants.
•   Make a second list of projects and “big ideas” (how to
                                                                       Afternoon & Evening                                   Friday, February
    make it happen).                                                                                                         29th
                                                                       Saturday, March 1st
Join Another Small Group                                                                                                     4:00 Registration
                                                                       1:00 Identifying a
                                                                                                                             5:00 Opening
                                                                       Shared Vision for the Fu-
•   Join another group and compare your two lists. Develop a           ture
                                                                                                                             5:15 Welcome
                                                                                                                             5:30 Creation Story
    joint list of shared values and principles. For those items you    2:15 Break                                            6:00 Dinner
    don’t share make a third list (differences). Compile all of your   2:30 Shared Vision                                    7:00 Shared History
    projects/big ideas in one list.                                    4:00 Closing                                          9:00 Closing
                                                                       5:00 Dinner
•   Cut your lists into strips (one item per strip) and place on the   6:00 Social
                                                                                                   Morning,
    wall.
                                                                                                   Saturday March 1st
                                                                                                   8:00 Breakfast
                                                                                                   8:45 Opening
NOTES:                                                                                             9:00 Identifying Recent
                                                                                                   Trends
                                                                                                   10:30 Break
                                                                                                   10:45 Exploring Recent
                                                                                                   Trends
                                                                                                   Noon Lunch
                                                                          “What should the health care experience be for Aboriginal people?”




               1. SHARED HISTORY
                                                                           6. DEVELOPING OUR SHARED
Purpose: To tell the story of our shared history and establish a
         context for our shared future.                                                    IDEAL FUTURE
                                                                     Purpose: To discover what each group shares about an ideal fu-
Individually
                                                                              ture for Aboriginal Health Care.
1. Take a few minutes to think about memorable personal, local
   health or national/global care events that you feel should be     Individually:
   heard here. You can use the space below to write down your        As you listen to the scenarios being presented, note your
   thoughts.                                                         thoughts on the following:
                                                                     1. The ideal Future (what you want) - What does the desired
2. Use a marker to write or draw symbols for the events you             future of Aboriginal Health Care look like? Note these fea-
   wish to note in the circles on the wall. You don’t have to use
                                                                        tures.
   specific dates but it would be useful to identify the decade or
   the year that the event happened.


NOTES:
Personal events



                                                                     2. What projects, policies or ideas have contributed to creat-
                                                                        ing the ideal future for Aboriginal Health Care?
Local Health Care events




National/Global events
                                                                           “What should the health care experience be for Aboriginal people?”




                                                                                      2. SHARED HISTORY
              5. OUR IDEAL FUTURE
Purpose:    To imagine a future you want to work toward               Purpose: To tell the story of our shared history and establish a
                                                                               context for our shared future.

Small Group Discussions                                               In Small Groups:
1. Put yourself 10 years in the future. Imagine that Aboriginal       When everyone has had an opportunity to place their information
   Health Care is the way that it should be.                          on the wall, join a small group. Decide on Leadership roles for
                                                                      your group (discussion leader, recorder, time keeper, reporter).
   •   What does it look like?
                                                                      Review what you’re seeing in the three circles and tell a story
   •   Who have you worked with to get here?                          about;
                                                                           •   the people in this room
2. List all the things that have happened since this conference to         •   the history of Aboriginal Health Care
   get you to this point. What programs, policies, structures exist        •   our history
   in this ideal future?
                                                                      Why is this story important for the future of Aboriginal health
                                                                      care?
3. Think back to the year of this conference. What was the major
                                                                      NOTES:
   barrier you had to overcome? How did you do it?


4. Choose a creative way to present your vision as if its happen-
   ing now. Your scenario should be:
  A. Feasible—people can do it
  B. Desirable—Aboriginal people would benefit
  C. Motivating—You would work to make it happen


Do not consider cost or difficulty. Describe what you really want.
                                                                        “What should the health care experience be for Aboriginal people?”




                                                                        4. EXPLORING RECENT TRENDS
 3. TRENDS AFFECTING THE FUTURE
                 OF                                               Purpose: To find out what we care about, what we are doing
                                                                           now and what we want to do.
      Aboriginal HEALTH CARE
                                                                  Small Group Discussions:
Purpose:   To create a shared picture of Aboriginal Health Care   Each of the trends identified on the wall for discussion will be
           and its influences                                     placed on a flip chart at one of the small groups. In this session,
                                                                  you have a choice of staying with one group to discuss one trend
                                                                  in detail or visiting other discussion groups to provide your input.
Method:    The whole group will brainstorm the recent trends in
           Aboriginal Health Care. These are trends that people
           believe are shaping their future.                      Discussion Leaders
           All ideas are valued and recorded.                     You may want to consider the following questions/ suggestions in
           The person who names the trend says where it will      your group’s discussions:
           go on the map.                                         •   Draw a map or diagram of the trend and what is influencing it.
           Opposing or conflicting trends are OK.                     Are there connections to other trends?
           Give an example of your trend if you can.              •   What are you doing now about the trend?
           Once all trends are identified, identify the trends    •   What are you not doing that you would want to do?
           that the group would like to discuss in more detail.   •   What are you proud of in relation to this trend?
                                                                  •   What do you wish you could have done differently?
NOTES:
                                                                  Provide a brief summary report to the large group.
                                                                  NOTES:
Appendix C – Considerations in Setting Up This Conference
Searching and Search Conferences
There are several approaches to conferences that seek to produce action plans. In essence,
a search conference is “ …a participative planning event that enables people to create a
plan for the most desirable future of their community or organization, a plan they carry
out themselves” (Futures that Work – Using Search Conferences to revitalize Companies,
Communities and Organizations. Rehm et al., 2002). Search Conferences have been used
all over the world since the 1960s to create action plans for which participants take
ownership because they have been involved in exploring the issue(s) and developing their
concept of the ideal future. Search Conferences are based on a model of exploration that
takes place over 2.5 days and require two nights in between sessions in which to “soak
in” all of what’s been heard.

Similarly, Future Search, another model, takes place over 2.5 days and has a similar
structure to Search Conferences. It seeks to find common ground and develop action
plans with shared ownership by the participants. Both types of conferences have evolved
over the years. The methods used to obtain information and the structure of the sessions
used have changed with experience.

Both types of conferences are based on similar principles:
▪ The whole system is in the room i.e. there are representatives of those who can not
   only frame the issue but have the authority and the ability to make changes
▪ There are no more than 50 (for Search Conferences) or 64 (for Future Searches)
   people involved in the session. Search Conferences use parallel sessions for more
   than 50 people.
▪ People represent themselves not their organizations
▪ The conference is only the beginning of the action planning. There must be incentive
   and motivation to continue to meet and refine the action planning.

In these types of search conferences, the participants not only take ownership of the
issues but they also take ownership of the solutions. They differ from traditional strategic
planning sessions in that they do not seek to problem solve, resolve issues or conflicts or
to come to consensus. In these processes, the differences are acknowledged, the conflicts
are noted but the emphasis is on finding common ground on which to focus action
planning.

The process uses methods of small and large group discussions. Every session ends with
a large group discussion and sharing of the findings. The conference is comprised of four
sessions:
▪ Shared History – this is the first session and here participants develop an
    understanding of personal, local and national/international events or milestones that
    have influenced the topic/question
▪ Current Trends – This session examines all of the current trends and their influences.
    This session also examines the trends and determines what is being done to address
    the trends, what participants are proud that they’ve accomplished and what they
    wished they could have changed.
▪ Ideal Future – explores the ideal future for the search question. Small groups develop
  ideal future scenarios and report on them in a creative way to the large group. The
  components of each ideal future are identified and posted under three headings:
      ▪ Common Elements – this is what all groups agree on
      ▪ Big Ideas/Projects – these are the concepts and projects that everyone would
          like to see happen
      ▪ Differences - these are the concepts/ideas/projects that not everyone agreed
          on. This list is kept and some people may want to move forward with in the
          future. However for the purpose of the conference, they are not addressed in
          the Action planning
▪ Action Planning – this is where everyone identifies what they can take action on and
  agree to help move forward.

The most important element of this type of conference is that every participant has the
ability to take action either individually or with others at the conference. This gives
people a better sense of being able to accomplish the ideal future rather than having to
rely on someone or some organization to do it for them. In these conferences,
participants take ownership of the issues and the solutions, they drive the discussion and
the documentation of the discussion. The facilitator ensures that the question is front and
centre and that the participants have clear directions and are supported in their
discussions.

Pure Search Conference and Future Search Conferences have very specific requirements
in their set up, participant selection and numbers of participants. In this conference,
modifications were made to the pure search conference models. For example, in pure
search conference models, the emphasis is on getting the “whole system” in the room.
The whole system includes a broad cross section of stakeholders both internal and
external to the community and representing a cross section of sectors.

The emphasis of this conference was focused on bringing together a diversity of
Aboriginal people and their experiences rather than getting the “whole system in the
room”. In order to build relationships and better understand health care issues, it was
considered more important for the participants to be Aboriginal and to speak from their
own personal/professional experience rather than to also include those who have the
ability to influence the outcomes - many of whom may not be speaking from an
Aboriginal perspective.

Logistical considerations are extremely important in these conferences. Participants are
spending 2.5 days in the same room so their comfort and nourishment must be conducive
to encouraging participation for the entire time. It’s important to hold the sessions in a
place that’s accessible and preferably away from other activities. The room should have
good natural light.

There must be sufficient wall space to post the paper that’s needed for each session. In
this conference, the sessions used graphic facilitation and recording – a combination of
Search and Future Search Conference techniques. All sessions consisted of the
participants reporting and/or controlling their information on wall charts. This created a
very visual record of the sessions.

The wall charts have been modified to be relevant to and reflect Aboriginal thinking and
philosophy. For example, the Shared History wall charts are usually three linear time
lines. In this case they are three large circles with Aboriginal symbols to reflect local and
broader contexts. The healing circle reflects local/community health care and the turtle
represents creation and the broader health care context. These symbols were suggested
and drawn by Committee members.

Healthy food for refreshment breaks and meals are also critical and must take into
consideration dietary needs for all types and ages of people. In this case, a local
Aboriginal catering company (Traditional Family Catering) at Six Nations provided high
quality traditional food and beverages for the conference.

The sessions in the Conference were structured as per the Future Search and Search
Conference methods. However, at times, the large group made decisions about how they
preferred to work. In some cases, they opted to work together as a large group for a
longer period of time and in other cases they worked in small groups.

Traditional Search conferences provide for times when participants work in mixed groups
and in stakeholder groups. In this conference, no one was assigned to groups. Participants
worked with whatever group of people they felt comfortable having discussions.
Throughout the conference, the participants found the space and the time to have smaller
discussions and to join the larger group as they saw fit. The room was large enough to
accommodate this and there was flexibility to allow them to do it. This was considered a
very positive attribute of the conference.