2015 North West LHIN Aboriginal Health Forum. Designing Integrated Systems of Care Together February 19, 2015 Thunder Bay Victoria Inn

Transcription

1 2015 North West LHIN Aboriginal Health Forum Designing Integrated Systems of Care Together February 19, 2015 Thunder Bay Victoria Inn 1

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3 Introduction On Thursday, February 19, 2015, more than 100 people representing health care service providers and communities throughout Northwestern Ontario attended the North West Local Health Integration Network s (LHIN) Aboriginal Health Forum. The theme of the Aboriginal Health Forum was Designing Integrated Systems of Care Together, with the focus: To generate awareness and exchange knowledge about the design and delivery of integrated systems of care with a focus on mental health and addictions. The Aboriginal Health Forum brought together a broad range of professionals who deliver services to Aboriginal populations to network, learn together, and share their collective experiences. The attendees represented a broad range of disciplines, including but, not limited to: Health Directors, Community Health Representatives, Program Leads, Clinical Directors, Researchers, Board Members, and Chief Executives. Summary of the Day With the day beginning over a networking breakfast at 8:00am, attendees had an opportunity to meet, network and browse provider booths featuring programs and services offered by local organizations serving the residents of Northwestern Ontario. The Forum convened with opening remarks from Laura Kokocinski, Chief Executive Officer of the North West LHIN. Susan Pilatzke, Senior Director of Health System Transformation with the North West LHIN then welcomed Karen Bannon, Director of Health and Social Services with the Fort William First Nation, who acknowledged the traditional lands. Setting the tone for the day, Elder Ralph Johnson led the opening prayer which brought everyone together to share, learn, and spread goodwill. Master of Ceremonies, Dr. Christopher Mushquash, took the podium providing an overview of the work of the North West LHIN and sharing the day s objectives: Learn together from the experiences of two world class organizations delivering care Network with other health service providers Learn about local organizations delivering innovative programs and services right here in Northwestern Ontario through poster presentations Following an overview of Aboriginal Health Planning within the North West LHIN by Susan Pilatzke, the podium turned over to Southcentral Foundation, who presented on the broader theme of integrated systems of care, featuring the Nuka System of Care model. 3

4 Southcentral Foundation: Nuka System of Care Presentation and Workshop Representing Southcentral Foundation were Chanda Aloysius, Vice President of Behavioural Health Services Division and Melissa Merrick, Clinical Director of Brief Intervention Services. South Central Foundation (SCF) began their presentation by noting that there are striking similarities between SCF and the North West LHIN including a large geographical service area, similar populations, remoteness, and health priorities. SCF developed a uniquely community-centered, team-based model of care that incorporates people receiving health care as customer-owners of their own care. These initiatives have resulted in excellent health-outcomes and high staff retention. Over time, SCF developed a philosophy it calls the Nuka System of Care. This philosophy governs all aspects of the organization and is based on the notion of relationships getting to know and recognize the uniqueness of the individual customer-owner, employee, or provider in order to develop flexible strategies that fit individual needs. The Alaska-based Nuka System of Care has received national and international recognition for system redesign, high standards for performance excellence, community engagement, and overall impact on population health. This model s alternative approach to clinical practice and evidence-based practices demonstrates measurable outcomes and has a broad organizational learning potential. SCF began with a very simple question: if you could redesign the entire health care system, what would you do? What SCF heard from the people through consultation was that they wanted direct input into their health care system. The people identified their top five needs, all of which shared the common theme of the importance of whole person health: 1. Domestic Violence 2. Child Abuse 3. Child Neglect 4. Behavioural Health Issues 5. Alcohol and Drug Addictions Using defined operational principles, strategic planning cycles, and planning linkages, SCF created an operating structure that met the needs defined by the people they served: their client-owners. With common themes and defined principals SCF s goals developed into: Shared Responsibility Commitment to Quality Family Wellness In the interest of improving healthcare in the Northwest and strategically planning for the future, the first workshop exercise of the day was introduced and the Aboriginal Health Forum participants were asked: 4

5 1. If you could design your own health care system, what would it look like? Participants were asked to capture their conversations in Workbooks. Appendix A* of this Report is entitled In Your Words, and it contains the responses of participants. Once the first exercise was complete and the tables had an opportunity to capture their conversations in the workbooks the focus of the presentation then shifted to Nuka System of Care, which is South Central Foundation s (SCF) governing philosophy. Nuka, an Alaska Native word used for strong, giant structures and living things is a fitting name for the Nuka System of Care, which is, a whole health care system created, managed, and owned by Alaska Native people to achieve physical, mental, emotional, and spiritual wellness. The relationship-based Nuka System of Care is comprised of organizational strategies and processes; medical, behavioral, dental and traditional practices; and supporting infrastructure that work together - in relationship - to support wellness. In the second workshop exercise of the day, Aboriginal Health Forum participants were asked: 1. Who are your key stakeholders? 2. How do you listen to your Customer-Owners and Key Stakeholders? 3. How do you give them feedback on what you have learned? Again, participants were asked to capture their conversations in Workbooks. Appendix A, of this Report entitled In Your Words, contains the responses of participants. The presentation continued with SCF speaking on how as relationships grew with customer-owners, SCF became aware of deeper struggles that impacted overall health, and recognized that much of what was seen physically had a behavioural component. With a wait list of more than 1,200 people for behavioural health services, SCF sought to provide services to address the whole person, and reduce costs by being preventative instead of reactive. The presenters then spoke about the integration of behavioural health, which included a number of models of care including a Chronic Care, Four (4) Quadrant, Diversification, Co-Location, Referral and Enhancement. Southcentral Foundation s 10 Tips for Health System Redesign 1. Never disturb the workforce without clear cause and plan. No plan is better than a bad plan. 2. Always design for what happens 85% of the time for 85% of events. 3. Always create methods to identify exceptions to 85/85 so appropriate adjustments can occur. 4. Always design second and third level plans for exceptions to the 85/85 rule rather than primarily over over-designing for all events. 5. Always analyze before repair, look for patterns or clusters, remember rule #1. 6. Always when improving, extremes of performance are more instructive than averages to quantify progress. Segmentation is critical, trends are more important than current performance. 7. Never train entire groups when you can target only those at variance. 8. Always intervene from the back not the front where possible. Identify those doing well and recall rule #1. Always fix what is broken. Always spread what works. 9. Always, the first step in change is to design the ability to measure. Never intervene without it. 10. Never build a pathway without attaching a measure that can be applied to the entire denominator without reviewing charts or requiring individual case review. Pathways are not measures. They suggest visit based, provider driven decisions. 5

6 Operating Principles of an Integrated System Relationships between customer-owner, family and provider must be supported; Emphasis on wellness of the whole person, family and community (physical, mental, emotional, and spiritual); Locations convenient for customer-owners with minimal stops to have all needs addressed; Access optimized and wait times limited; Together with the customer-owner as an active partner; Intentional whole-system design to maximize coordination and minimize duplication; Outcome and process measures continuously evaluated and improved; Not complicated but simple to use; Services financially sustainable and viable Hub of the system is the family; Interests of customer-owners drive the system to determine what we do and how we do it; Population-based systems and services; Services and systems that build on the strengths of culture In closing, SCF spoke about the importance of intentional program design. Specifically, to recognize the services that already exist, and to build on those services through linking and partnership. Find ways for those services to support each other, rather than duplicating or competing with each other, to achieve population health without waste and duplication. Networking and Poster Presentations During the lunch hour, participants had the opportunity to network, and visit poster presentation booths featuring local services and programs offered by providers from across Northwestern Ontario. North West LHIN Aboriginal Forum participants had the opportunity to connect with and learn about: St. Joseph s Care Group Balmoral Centre Withdrawal Management Programs Meno-Ya-Win Health Centre, Integrated Pregnancy Program Thunder Bay Drug Strategy Dilico, Maamawe Kenjigewin Waasegiizhig Nanaandawe'Iyewigamig, Integrated Service Model 6

7 Fort Frances Area Tribal Health Services, Integrated Model Kenora Chiefs Advisory, Resiliency Program Shibogama Health Authority, Maternal Addictions Continuum of Care Project Centre for Addiction and Mental Health A detailed description of the poster presentations, along with contact information*, is provided in Appendix C of this Report. Tungasuvvingat Inuit s Mamisarvik Healing Centre Integrated System of Services Representing Tungasuvvingat Inuit s Mamisarvik Healing Centre were Pam Stellick - Director, Mamisarvik Healing Centre, and Reepa Evic- Carleton - Treatment Coordinator, Mamisarvik Healing Centre. This presentation centered around Tungasuvvingat Inuit (TI), a community-based counselling and resource centre and serves to empower and enhance the lives of Inuit residing in Ontario. TI offers a supportive environment that attempts to duplicate the community spirit and cultural surrounding of the Inuit homelands. The presentation explained how Mamisarvik Healing Centre s vision is to help Inuit who are struggling with alcohol and drug dependencies and/or the negative effects of residential schools, relocation and dog team slaughters. The healing centre treats victims of physical, sexual and emotional abuse, neglect, poverty, children of alcoholics, among others. Day treatment and residential treatment programs are available, as well as a transition house. The afternoon convened with the lighting of an oil fire in a traditional pot, with Reepa explaining the significance of the warmth and comfort that it offered. As described by the presenters, Mamisarvik Healing Centre offers a holistic approach and barrier-free access to Inuit community members. Mamisarvik Healing Centre has more than 60 partnership organizations including health and social service agencies, hospitals, correctional services, colleges and universities, Children s Aid Societies, Inuit-specific agencies, as well as local, provincial, and federal government agencies. An integrated services approach encourages inter-service collaboration and case management, enabling the delivery of services in a culturally-safe and appropriate environment. Pam noted that Mamisarvik Healing Centre s service delivery model has evolved to include: No need for abstinence to enter the treatment program; A continuous intake process; Improved wrap-around services post-treatment and better linkages and connections with the individual at the community level; and 7

8 Evidence has shown a 70% improvement in sustained abstinence for individuals involved in Mamisarvik s program. Action Planning and Next Steps Susan Pilatzke, Senior Director of Health System Transformation, drew upon the messages of health system integration and the journey of the day s presenters to speak about transformational change and integrated care here in the North West LHIN. Participants were asked to again collaborate and share their thoughts on two questions: 1. When you think about care at the system level, what are some next steps that you could see yourself or your organization taking based on your experiences and learnings here today? 2. Thinking about innovation, integration, and different systems of care, what opportunities exist at the program level to make change? Each group was given time to think about the questions, and the comments are shared in the words of the participants in Appendix A of this Report. In Closing The North West LHIN s Aboriginal Health Forum came to a close with a recap of the day s learning from Susan Pilatzke, and a closing prayer delivered by Elder Ralph Johnson. Summary of Next Steps The North West LHIN would like to thank everyone in the region who took the time out of their busy schedules to attend our 2015 Aboriginal Health Forum. We depend on the representation of community leaders, clinicians, and directors in our region to help guide the work of planning together to improve access to services that support Aboriginal health and well-being. Thank you as well to everyone who provided us insight through the interactive exercises that were hosted throughout the day. The messages in your feedback are clear: you support locally developed Aboriginal health programs that focus on the needs of your clients. Here is what you told us: you want health services that are welcoming, that focus on client needs first, that are community-based and meet on the clients own terms. And you believe there must be more self-management, where customers have ownership over their own health. Your desire is for a patient-centered system of care where local communities and organizations can help shape health services. Some of the other major themes that you identified include: promoting a holistic health approach where health services are integrated into a circle of care between providers. It was also clearly stated that aboriginal clients need culturally appropriate care ideally provided by aboriginal people working as nurses, doctors, personal support workers, and other clinicians whenever possible. Diversity is one of the most important values of the North West LHIN and, as such, providing culturally-appropriate and competent care is what the North West LHIN continues to strive for through an integrated health care 8

9 delivery system. Your input helps inform the development of future health programs/services across our region and will influence the broader system level changes that were discussed throughout the forum. Your feedback will also inform the North West LHIN Aboriginal Health planning priorities, specifically the key strategies to be advanced through this portfolio and through the fourth Integrated Health Services Plan Thank you once again for the many meaningful conversations and progressive ideas about the future of health care in the North West LHIN. 9

10 Appendix Appendix A In Your Words North West LHIN Aboriginal Health Forum participant workbook responses to the workshop questions posed throughout the Forum. Exercise One: If you could design your own health care system, what would it look like? Client needs first; Welcoming environment; Whole person (holistic); Connection to outside resources; Outcome focus; Enough generalists; One-stop shot mind, body, spirit; Participate Health Sector; Strong Vision and Mission mandates must be a passion. Welcoming like a restaurant analogy. What does your entrance look like? Customer Service: greeter, helper, carts, many exits, accepts all returns. Be positive, instead of scaring people. We are spending too much money don t guilt people. Welcoming at all levels. Don t question why I m there. If the person needs help, we need to help them. Services need to be clear; treat the person as a whole: o spiritual, emotional well-being o not just about physical well-being o as a team Measurable results such as: how long did it take to get well? When did he return to work? Instead of we spent xyz dollars. Culturally-appropriate. Preventative, proactive instead of reactive. Every door is the right door. One-stop shopping. Everyone pulling the rope in the same direction. Patient-centred / patient driven. Ownership. In mental health, communication: integrated care planning. Behavioural Health Unit preventative. Continuum of care / Smoother Transitions: o Patient involvement and choice; o Control in medical stream more with patient. Holistic health approach / prevention. Focus on staff wellness approach. Client becomes an active participant rather than passive. Care is done with rather than to. 10

11 Community members need to be empowered along with a shift from hierarchical power ie: Chief and Council to Community Members. Community changes get stopped. Comfortable, welcoming reception, accommodating. Zero barriers at clinic (privacy concerns) Separate suboxone clients from others. All in one location services including aftercare in the community. More local control. Try to develop system thinking. The better the job you do the less you get paid. Savings should accrete to the local community. LHIN isn t local enough! The system should serve our needs, not the converse. It should serve the needs of providers and patients. Providers should be involved in selection of IT systems. We need more than a health care system as it is more involved than that. Responsive. Comprehensive. Whatever customer-focus means; may be different in acute care versus homecare. Support people to maintain healthy lives. Culturally-safe / culturally-appropriate. Health / addictions education. Determinants of health (housing, employment, education, et cetera). Customer ownership of own health. Accessible Responsive Every door is the right door Collaborative across Ministries Listening Relationships over time Holistic (spiritual, emotional, mental, medical) Based on culture Local control Every person within the continuum of care must have front line time. This includes CEOs, Executive Directors, Management, et cetera. Communities have been kept segregated. Prevention and education. Role of public health remote communities, treaty 3, Robinson-Superior communities. Gap in mental health and addictions bring community members to the care. Medical appointments (dental and eye) mental health and addictions get bumped off Federallyfunded transportation. Mental health care needs to be embedded in the community, or a flexible model instead of by appointment the RELATIONSHIP is IMPORTANT. First Nations but not necessarily from that community. Mental Health and Addictions come to clients instead of clients coming to the service. Community-based; meet on the clients own terms. Those serving the community must know the community that they serve. Integration current system is disjointed; Clean Slate get rid of medical model; 11

12 Holistic, wellness model Mentoring of Aboriginal people to improve representation in the health workforce. All of my providers will work together to provide timely access to care in an integrated process. Get in to see who you need to see Client/Family when you need to see them. No wait times for vulnerable Primary Care / people needing assessment and Interdisciplinary treatment for mental health and Teams addictions. Local psychiatrists are connected; the system to access psychiatrists is integrated; more efficient use of mental health ER. People with addictions are treated with respect by health care providers. Tertiary Consultants Personal, inviting, accountable. Call with results of tests whether they are positive or negative. Services in one place (eg: x-ray in same building). Everyone has their own personal health care provider (not necessarily a doctor eg: midwife as option to the doctor). Use a team concept. Better use of nurse practitioners. People have the power to use traditional remedies (eg: potatoes on bottom of feet for fever). Patient education for long-term health as opposed to numerous medical visits. Better access to your own health care records so you don t have to rely on doctors as the keeper of your records (eg: be able to access results of tests online as an indicator as to whether you need to see a doctor). Person-centred care takes away racism, socioeconomic, homophobic factors when you deal with each person as a person. First Nations control over Non-Insured Health Benefits. Equal access to traditional medicine. Primary care providers no waiting lists. Integrated. Less red tape. Focused on individual. 12

13 Exercise Two Consisted of Three Questions: 1. Who are your key stakeholders? 2. How do you listen to your Customer-Owners and key stakeholders? 3. How do you give them feedback on what you have learned? 2-1. Participants identified their key stakeholders to be as follows: People that live in the district (large area First Nations and smaller communities) Community partners Regional Partners The customer is the key stakeholder: plan with LHIN, health service providers, caregivers, community partners. Talk to funding sources about how delays impact serving clients. Clients SLFNHA, St. Joseph s Care Group, Meno Ya Win, community-based organizations, district outreach. Clients, staff, HSPs, primary care, health unit, LHIN/Funders, Community Health Worker First Nation Communities Tribal Councils PTO Chiefs of Ontario People receiving services in home (CCAC) Communities eg: related to Mushkiki Community at large People with mental illness Homeless Judicial system Hospital partnerships Psychiatry ODSP Tribal Councils/Authorities Children s mental health Primary Care Schools Pharmacists Adults and youth Partner organizations Not just urban First Nations but broader engagement Vulnerable populations / hidden or transient populations Patients from across the region CAMH consults with frontline workers and then responds to needs with training Community members Organizations we interact with Chief and Council Elders Clients Traditional Healers Persons accessing services residents, families, caregivers Boards and representatives of First Nations 13

14 2-2. Participants said that they listen to Customer-Owners and key stakeholders in the following ways: Hospital strategic plan, meetings with stakeholders Work with other hospitals Retreats Surveys/ Website Press releases Patient relations staff Comment cards Community Representative Surveys and engagement events, meetings, and Health Links. Focus groups survey regularly Personal communication, survey satisfaction, focus groups, health fair Health Canada federal consultations with organizations; meetings with First Nations and Tribal Councils Mushkiki Board structure (provides feedback) Client satisfaction surveys and focus groups (clients and families) Patient-centered recovery plan Self-identify (programs) Weekly meetings residential programs Gaps include linkage between the committee (to listen) and action Open forums Surveys Hotlines Website Webinars Feedback surveys / annual surveys Through boards that are made up of community members ensuring you have representation from stakeholders Expectation of staff to gather feedback from customer-owners Weekly meetings Shared planning framework representatives from each of the hospital on a central council; feed back information to departments Satisfaction surveys Paper-based with interpreters Need to change questions / how to measure open-ended questions. Key representatives from Aboriginal Communities on the Board New patient advisory committee Community advisory committee for local Aboriginal groups to inform culturally-appropriate care Very informal they talk to us Committees also council member to be assigned to portfolio eg: health portfolio Community media Social media Nod and smile Staff available for input from clients Online tool Listening is key; advocating for client-owners/patients; collaboration; build relationships; empower staff to make their own decisions / trust; listening to community experts Face to face communication is important because non-verbal communication can be dangerous (misinterpretation of tone, etc). Too many surveys to be effective (receiving half a dozen a week). 14

15 2-3. Participants noted that they give feedback to their Customer-Owners and Key Stakeholders by: Involve in strategic planning Complaint resolutions (one to one) Post information within the organization Talk and plan with community partners Revise programs Survey and engagement events, roundtable discussion, relationships/communication, (build understanding why) changes not made based on feedback/some changes can t be made. Annual general meetings, programming, discussions, community engagement, interagency collaboration. Distribute survey results, communication of change, annual reports Formal reports / documents (Health Canada) How do we (currently) do this? (Designated) area for feedback to customer At present we solicit the areas for improvement, but the feedback loop is not currently in place Communication of change First Nations groups Community members Need to engage with First Nations communities directly Regional versus urban Quality improvement Actually make changes Newsletters / website transparency Annual reports / annual general meetings Community meetings to report feedback Community engagement meetings Newsletters Board Notes report in the newspaper Other Notes from Exercise Two: Populations we serve collectively. Staff our organizations. Institutions of care within our communities (hospital/ccac/child and Family Services/other agencies) Ministry of Health and Long-Term Care, Community Services. All in the same location Culturally-appropriate Language Services provided by people of the same culture The service users have input, and input can be built into the system. Leveled hierarchy. Holistic model of care. 15

16 Exercise Three: When you think about care at the system level, what are some next steps that you could see yourself or your organization taking based on your experiences and learnings here today? Hold leadership accountable. Take small steps. Recognition of First Nations services already in place and functioning. Look beyond the province of Ontario programming and aid in the supporting efforts. Be a stronger voice we may not be able to change the system right away, but we need to use our voices. Interesting that the TI program doesn t have applicants be sober for several days; they are immediately given treatment. Treatment close to home you can t just fix the person, the environment also needs to change. Teamwork, collaboration, less hoops for patients (don t have to repeat information). This is a slow process. Develop working relationships. Continue the process. Active listening and act on what is learned. Enhancing communications with the ownership. Patient advisory committees. Patient satisfaction services and family satisfaction surveys. Thorough governance activities. Consultants engaged to assess satisfaction of clients. Use more holistic approaches. Use indigenous thinking. Consider all elements of a person s life, social determinants of health, work, and other organizations to begin to address the real needs. Exercise Four: Thinking about innovation, integration, and different systems of care, what opportunities exist at the program level to make change? Many programs are already engaging for change. It will take senior leadership to do the systems review and the innovative integrations. Don t punish communities based on statistics; we need better performance indicators. Achievements need to be celebrated, even individually. Funding model is backwards the less kids in treatment homes of foster care, provide more funding for achieving better results. How everything works together better understanding. Open communications. Working in different levels and sectors. All working together, not against each other. More feedback from clients on what programming should be offered. Every year, do an environmental scan and strategic input document. Implement dedicated employee wellness time, workforce development, (workspace) beautification project. 16

17 Appendix B Speaker Biographies Ralph Johnson - Traditional Teacher and Elder Throughout his career, Ralph has worked in the field of social services as a trainer, teacher and volunteer. He credits Mida teachings from clan elders for guiding and enabling him to run an effective healing program for the past 30 years, and believes strongly in the effectiveness of traditional practices in health care. Ralph is a traditional teacher with WeQuenGway, an organization that delivers programs addressing addictions, mental health, post-traumatic stress, and residential school issues. WeQuenGway also produces and provides educational materials to local schools, and delivers workshops on Aboriginal Teachings. Dr. Christopher Mushquash - Assistant Professor, Lakehead University Dr. Christopher Mushquash is Ojibway and a member of Pays Plat First Nation. He is an Assistant Professor in the Department of Psychology at Lakehead University and the Division of Human Sciences at the Northern Ontario School of Medicine. He is a Canada Research Chair in Indigenous Mental Health and Addiction. In addition to his academic appointments, Dr. Mushquash is a clinical psychologist at Dilico Anishinabek Family Care providing assessment, treatment, and consultation services to First Nations children, adolescents, and adults. Chanda Aloysius - Vice President of Behavioural Sciences, Southcentral Foundation Chanda Aloysius is vice president of behavioral services for Southcentral Foundation (SCF). Originally from the Deg Hit'an Athabascan community of Holy Cross, Alaska, Chanda has emerged as an Alaska Native leader in behavioral services administration. She is responsible for executive management of a behavioral health workforce of 300 employees and a $29 million operating budget. She holds a bachelor s and a master s degree in business administration and has 25 years of experience in health care. As part of SCF s leadership team, Chanda works in partnership with the president/ceo and other VPs to solicit feedback from SCF s 65,000 customer-owners, project the short- and long-term needs of the Native Community, and set the strategic direction for the organization. Chanda began her career at SCF when SCF had three programs and 85 employees. She has been part of SCF s shuttle growth to its current size of 80 programs and 1,800 employees. Fifteen years ago, Chanda helped develop SCF s initial plans to integrate behavioral health providers into the primary care environment. This behavioral health/primary care integration has won national accolades, including SAMHSA Science and Service Award recognition. C. Among her other achievements, Chanda worked as part of the team that planned the development of a cutting-edge residential treatment facility for pregnant women with addictions and has expanded outpatient substance abuse treatment. Most recently, she led the redesign of SCF s behavioral services individual and group therapy, family counseling, group skill development, substance abuse and mental health treatment, case management, aftercare and more and the related workforce. Chanda is often called upon to provide support across the state on mental and behavioral health issues, with the primary goal of promoting wellness within the Native Community. She participated in Leadership Anchorage, a program designed to ensure voices of emerging leaders are heard among community decision makers. In 2009, she was honored statewide as a recipient of both the Rural Alaska Community Action Program s (RurAL CAP) Outstanding Community Service Award and the Alaska Journal of Commerce s Top Forty Under 40 Award. 17

18 Chanda has presented on the topic of whole system redesign at the International Forum on Quality and Safety in Healthcare in Paris, France, and other SCF Nuka System of Care speaking engagements. Chanda is the alternate tribal representative for the Alaska area on the National Tribal Advisory Committee to the Indian Health Service. She is also on the Executive Oversight Board of the Alaska Behavioral Health Association. Melissa K. Merrick - Clinical Director of Brief Intervention Services, Behavioral Services Division, Southcentral Foundation Melissa K. Merrick is a licensed clinical social worker and clinical director for Southcentral Foundation (SCF). Melissa joined SCF in She plays a key role in overseeing quality and clinical improvement for the Behavioral Services Division. She coordinates quality assurance activities and program development, and provides clinical oversight for the behavioral health integration program. She directs clinical activities for behavioral health consultants who provide services in four clinics across multiple disciplines. She has been instrumental in designing and implementing new programs in the clinics, such as the Suboxone program in primary care, and expanding co-located psychiatry in the primary care clinics. She is a recipient of the 2011 SCF Living our Values Award and the 2010 Honoring our Successes Award. She holds a master s degree in social work from New Mexico State University, in Las Cruces, New Mexico. She holds certification as a behavioral health consultant from the University of Massachusetts, with additional certification and training in Level 1 Eye Movement Desensitization and Reprocessing (EMDR) and chemical dependency counseling. She is a member of the National Association of Social Workers and Collaborative Family Healthcare Association. Melissa presents nationally on behavioral health integration within the Nuka System of Care, chronic pain and addiction, behavioral health integration in primary care, tools for reducing burnout and promoting health behavior change, and other topics. Reepa Evic-Carleton - Treatment Coordinator, Mamisarvik Healing Centre Reepa Evic-Carleton is the treatment coordinator at Tungasuvvingat Inuit s Mamisarvik Healing Centre in Ottawa. Mamisarvik is the only comprehensive, Inuit-specific, residential, trauma-and-addiction program of its kind in Canada. She is an Inuk from the Baffin Island-community of Pangnirtung and cofounded Mamisarvik s national, eight-week program in 2002, working as a trauma-and-addiction therapist since then. The program ranges from pre-treatment through intensive bio-psycho-social-spiritual treatment to continuing care and transition housing. She is deeply committed to helping fellow Inuit develop healthier lifestyles by ending substance dependence and recovering from the effects of individual and cultural trauma. Pam Stellick - Director, Mamisarvik Healing Centre Pam Stellick has 10 years experience as the Director of Tungasuvvingat Inuit s Mamisarvik Healing Centre and extensive experience in the fields of rehabilitation, mental health, addictions and social services. She holds a Master s of Education degree in Counselling from the University of Ottawa and is a member of the Canadian Counselling and Psychotherapy Association. As part of the team that originally created the Mamisarvik Healing Centre, Pam is an experienced clinician and program administrator. She has travelled to Inuit communities in the Arctic and is committed to providing quality, person-centered and culturally relevant mental health services to benefit Inuit. 18

19 Appendix C Poster Presenter Summaries Dilico Anishnabek Family Centre - Maamawe Kenjigewin Maamawe Kenjigewin is specifically targeted for First Nations communities aimed at helping create a template of Agreements that will outline a gathering of services that will increase the Circle of Care to First Nations communities in the Robinson Superior Treaty Area with respect to youth suicide prevention. Gathering of services will include relevant federal and provincial, health and mental health and addictions services. Ideally these Circles of Care will improve integration, partnerships and build upon existing linkages with these service providers. And, more importantly, for the First Nations communities, improve access to these services and ensure they have input regarding how services could be better-suited to meet the needs of their communities. Maamawe Kenjigewin aims to strengthen relationships and break down the barriers to discussing suicide in order to build a community s awareness of the resources available to them and also to build collaborative support networks with existing partners outside of communities, so that these can form a supportive system which can be accessed in times of crisis or tragedy. Working collaboratively with the 13 communities in the Robinson Superior Treaty Area, this initiative aims to help communities and their partners develop youth suicide prevention plans that are culturally-appropriate to each community and that address their unique needs and diversity. Sioux Lookout Meno Ya Win Health Centre - Integrated Pregnancy Program The Integrated Pregnancy Program (IPP) at Sioux Lookout Meno Ya Win Health Centre is the preferred site for prenatal care and delivery in the Sioux Lookout Region. Serving the town of Sioux Lookout and the 32 First Nations communities in the surrounding area, the IPP is available to assess and manage many pregnancy related complications including addictions issues in pregnancy. Opioid dependency has reached epidemic proportions in this geographical area and the need for treating the client and their family is essential to positive outcomes for the mother, the newborn and the family members. With over 10,000 visits annually, the IPP staff ensure that high quality, holistic care is provided to the family as a unit. Along with exceptional prenatal care, the organization has collaborated with the Kenora Patrica District School Board, the Northwestern Health Unit, Sunset Women s Aboriginal Circle and Community Counseling and Addictions Services to provide ongoing support and encouragement around education, parenting, and addictions counseling. Shibogama Health Authority - Maternal Addictions Continuum of Care (MACC) Project The Maternal Addictions Continuum of Care project is a three year initiative funded by Health Canada s Health Services Integration Fund. It started in late November 2012 and ends on March 31, It is a collaborative effort by Shibogama Health Authority, the Sioux Lookout Meno Ya Win Health Centre, the North West Local Health Integration Network and the Thunder Bay Regional Health Sciences Centre. The goal is to promote collaboration and integration of services that support pregnant women, mothers and families with addictions problems from the Shibogama First Nations. Corporation of the City of Thunder Bay Thunder Bay Drug Strategy The Thunder Bay Drug Strategy has a vision: To improve the health, safety and well-being of all citizens by working together to reduce the harm caused by substance use. The Strategy takes a five-pillar approach, integrating partners and actions in the areas of Housing, Enforcement, Treatment, Harm Reduction, and Prevention. Extensive planning and consultation resulted in 118 recommendations, commitment from the City of Thunder Bay to provide funding, coordination and administrative support, 19

20 and the commitment of funding and leadership from partners in many sectors. Various working groups and action committees are in place, i.e., Maternal Substance Use and Child, Harm Reduction, Housing and Homelessness, Youth Issues, and others. These partnerships have achieved the following successes: Enhanced Withdrawal Management Services; a new Managed Alcohol Program; a Community Paramedicine Pilot Program; Overdose Prevention Training and Kits (naloxone); Recovery in Focus and Recovery Day (education to reduce stigma); improved Needle Disposal; Street Outreach Services; and Maternal Substance Use Research. Ogimaawabiitoong-Kenora Chiefs Advisory Mental Health and Addictions Program Kenora Chiefs Advisory is committed and dedicated to providing culturally appropriate health and social services which address the needs and enhance the well-being and capacity of community members in our affiliated First Nations. The Mental Health and Addictions Program Mission Statement is To help people living with mental illness/addictions achieve and maintain a satisfying and meaningful life within their own community. This voluntary program s philosophy is that services are provided to the member of the community in a manner that: Maintains the person s right to choose; Respects cultural and spiritual beliefs and traditions; Respects the person s needs and values; Develops personal strengths and abilities; Advocates for your rights; and Provides support as long as it is required. The program operates within a case management model providing direct counselling to clients and their families; linking of client to appropriate professional and service agencies; supporting and training clients in life skills; crisis intervention; children s mental health; pre-arrest division; and peer helper program. The mental health age range is 16 and up, and the addictions/substance abuse age range is age 12 and up with an emphasis on youth. Fort Frances Area Tribal Health Services Fort Frances Area Tribal Health Services (FFATHS) services 10 First Nations communities and strives to promote wholistic health care by providing services that integrate the four domains of personhood. Our poster session will highlight all programs of FFTAHS including our home and community care program, diabetes education program, foot care program, and behavioural health services programs. Centre for Addiction and Mental Health - Provincial System Support Program and Aboriginal Engagement and Outreach Program Provincial System Support Program Open Minds, Healthy Minds: Ontario s Comprehensive Mental Health and Addictions Strategy commits to the transformation of mental health and addiction services for all Ontarians. The Strategy began with a three-year-plan that focuses on children and youth. The Centre for Addiction and Mental Health (CAMH) is sponsoring a part of this provincial initiative by supporting local systems to improve coordination of and enhance access to mental health and addiction services. Systems Improvement through Service Collaboratives (SISC) is one initiative encompassed within the Comprehensive Strategy. Eighteen Service Collaboratives established across Ontario focus on addressing system gaps related to mental health and addictions services. 20

21 Aboriginal Engagement and Outreach (AEO) Program 1. Build relationships and support the systems work of First Nations, Inuit and Métis agencies and communities in Ontario 2. Facilitate Aboriginal workforce development and capacity building 3. Provide information about CAMH specific programs and services 4. Support the work of the CAMH Provincial System Support Program Current Priorities of AEO - Aboriginal Strategy, Provincial Aboriginal Training Program, Mobile Training Initiative (MCYS contract), Assessment Tools Waasegiizhig Integrated Service Model Waasegiizhig Nanaandawe iyewigamig offers primary health care and preventative services through a client-focused, wholistic, interprofessional model of care that enhances access and integration, and where every provider is a point of access to the whole. Our purpose is to foster healthy Anishinaabeg and communities through traditional and contemporary health care relative to mind, body and spirit. Complementary programs include a residential healing lodge and hostel accommodation for people accessing hospital services in Kenora. St. Joseph s Care Group - Balmoral Centre The Balmoral Centre of St. Joseph's Care Group is a 22 bed medically supported withdrawal management program. Support, safety and care are offered through the acute stages of Intoxication along with withdrawal from alcohol and other drugs. The Balmoral Centre is open 24 hours a day, 7 days a week. There is no waiting period, no fees and stay is voluntary. The Centre is wheel chair accessible. Services Offered: Provide detoxification/stabilization Facilitate referrals for medical and psychiatric needs Provide direct care services/linkages between Mental Health and Addiction Services Engage clients in the assessment process to determine the most appropriate treatment plan Engage clients in the referral process for substance abuse treatment or other services as needed Discharge planning in collaboration with community agencies for specialized services when necessary Pre-treatment preparation Provide education and awareness sessions Provide 24/7 RPN services to meet medical needs of clients NP services on site 5 days per week Provide information on community resources 21

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