Socio-Cultural Working Group Health Report
Volume One, May 13, 2013
Socio-Cultural Working Group Volume One Health Report
Socio-Cultural Working Group Report
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Socio-Cultural Working Group Report
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Table of Contents Tahltan Nation Health Planning Framework
5
Executive Summary
8
Successes So Far
9
Introduction
10
Tahltan Health Governance
13
Community Health Planning Process
16
Community Overview
18
Existing Community Health Services
21
Training and Skill Development
27
Community Engagement and Consultation
27
Priorities and Objectives
28
Key Health Indicators / Determinants
32
Action Items
33
Appendices
39
Appendix: Infrastructure Needs
40
Appendix: Tahltan Health Protocol
41
Appendix: Protocol Agreement
44
Appendix: Better Healthcare for Tahltan Coming
46
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Tahltan Nation Health Planning Framework
Unity – For the Health of It
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A more personal healthcare
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“My ancestors are from [here]. I love the people. I truly love the people. The nursing station used to be managed from afar. Now it will be managed closer to home. The people will get familiar nurses. So we're not going to have a different nurse every week." - Nancy Norby-Quock, Telegraph Creek nurse
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Executive Summary The Tahltan First Nation is developing a nationwide Health and Wellness Strategy, including the development of a Tahltan Nation Health Plan (TNHP), to enhance and centralize holistic health services within Tahltan territory, streamline human resource development, and enable shared services that are culturally relevant, community directed, and nation driven and supported. This plan is based on research and consultation with Tahltan members, Tahltan community health delivery staff, Administrators, Chiefs and Councils, and representatives from Health Canada and First Nations Health Authority. The Plan will support the Vision for Health articulated at the Tahltan Leadership Forum in March 2012.
"When the community loses a person - it's not just a person. He or she is a pillar of the community. We have an emotional stake in the game. That makes all the difference." - Feddie Louie, Iskut Valley Health Services, Program Manager, April 2013 The planning process will also help to ensure that the Health service providers in each community have the capacity to deliver the most appropriate services and programs to improve the overall health and wellbeing of Tahltan Nation members. This likely will include sharing or combining services and programs, creating specific service delivery centres, and finding creative ways of maximizing effective and efficient service delivery to remote and isolated communities. The Health Plan will link into the commitment of the First Nations Health Authority to assist in the development and implementation of culturally appropriate health service delivery for First Nations communities. The plan is being developed in part to mitigate negative health impacts of rapid resource development growth, and to address health and wellness issues that could arise from a large influx of workers and others to the territory in the coming years. The Tahltan Nation Health Plan will be a reflection of the communities’ commitment to developing and providing proactive programs and services that will enhance the health and wellness of the Tahltan people. Ultimately, the objectives and outcomes described in this plan will empower the communities with the necessary tools to take ownership of and responsibility for their own health and wellness for the future.
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Successes So Far •
Completing the Tahltan Health Planning Framework – This was a major success because it sets the parameters for our planning for the next five years. The framework sets priorities, and communicates to members what we’re doing and why. The community was actively involved in the creation of this framework.
•
Greater unity between the three communities – By being unified, we are able to provide better quality of health services more cost-effectively. We’re not duplicating services, and services are more consistent.
•
Implementation of the Tahltan Health Working Group – This step means the health leads for each community are now meeting weekly to plan the health needs for the entire nation.
•
Nursing Partnership in Telegraph Creek – The partnership with the nursing services in Telegraph is a good example of how the working group had led to a positive result.
•
Four new nurses hired: o
Two FTE nurse practitioners in Telegraph Creek
o
One FTE home care nurse for the three communities
o
One FTE community-health nurse for the three communities
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Introduction In March 2012, through the Socio-Cultural Working Group, Tahltan Leadership and community members gathered to discuss the potential social and cultural impacts of rapid development on the Tahltan Nation. This gathering resulted in the Nation’s vision and goals for health and wellness to minimize the impact of development. The report for this gathering is entitled “Getting Our Voices Back.� The document articulates the Vision and Key Goals for health and well-being for the Tahltan Nation.
Vision Statement: In unity, Tahltan sustain a culturally holistic lifestyle with our traditional systems. We will have optimal health by empowering individuals, families and communities.
Goals: Tahltan Centralized Health Authority will: 1. Provide mental health and lifestyles programs 2. Enable land based cultural revitalization: food security; Tahltan medicine plan program; land-based culture camps; Tahltan food and diets; language programs; activities and fitness programs; ceremonies (i.e., dancing, songs, drumming, sewing); HeadStart and parenting programs; elder programs; and healing workshops 3. Offer centralized transportation services The communities of the Tahltan Nation are working together to develop a Tahltan Nation Health Plan (TNHP), to enhance and centralize holistic health services within Tahltan territory, streamline human resource development, shared services, culturally relevant community directed, Nation driven and supported. This plan is to be based on research and consultation with Tahltan members, Tahltan community health delivery staff, Administrators, and Chiefs and Councils. The planning process will likely also include a comprehensive review of current service delivery systems and financial implications.
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Telegraph Creek nurse Nancy Norby-Quock (right) attending to one of the newest additions to Tahltan Nation. Nancy Norby-Quock is to be hired in Telegraph Creek. Nancy, daughter of Thelma and Vern Norby, had left the community a year ago to seek professional renewal, and new training in advanced cardiac life support. She’s thrilled to be returning to support the new co-management of the Telegraph Creek nursing station with Iskut Valley Health. She foresees better emergency care, more familiar nursing staff, and better home care for the sick and elderly.
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Tahltan Health Governance Health Services will be delivered through a shared governance process, as defined through a multicommunity “Health Governance Protocol� approved by each community. The protocol is the governing document for the TNHP and will remain as such until such a time the Tahltan Nation governing bodies agree to revise the protocol. The overall responsibility for health service delivery will remain within each community. The communities will work together to move towards shared health goals and objectives, and support each other through collective planning and service delivery. Political support and direction will be provided by the elected political leadership of each community. A Health Advisory Panel will be struck to provide general guidance and support to the communities, and work to ensure that the principles and intent of the Protocol are followed.
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Governance Structure for Health Poli-cal Leadership
• Tahltan Central Council -‐ Tahltan Band Council -‐ Iskut Band Council
Guidance and Support
• Tahltan Na<on Health Advisory Panel
Opera-onal Decision Making
• Tahltan Na<on Health Working Group
Service Delivery
• Community health staff and frontline workers
Note: Tahltan Advisory Panel is made of one representative from each organization and must live in the territory (must be a politician) Tahltan Health Working Group consists of health directors, SCWG representative, TCHC, for a total of five (no politicians)
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One appointed political representative from each of the governing organizations will sit on the Tahltan Nation Health Advisory Panel. This panel will: •
Provide advice to and seek support from Leadership in regard to providing direction and promoting health and wellness priorities of communities
•
Provide Dispute Resolution and Appeals services for community Health Leads in regard to membership wellness issues
•
Articulate and oversee implementation of shared guidelines on health promotion for the Tahltan Nation
•
Provide guidance to ensure principles of the Health Protocol are being implemented effectively
•
Provide guidance and support to elected leadership for the purposes of lobbying and/or negotiating with industry, and/or Provincial or Federal Governments
•
Not interfere with or provide direction to autonomous community health program and service delivery agencies
Each Nation will retain autonomy and accountability to their community and Governing bodies, and will work to meet the Guiding Principles established by the Health Advisory Panel, until such a time as the governing bodies are ready and decide to merge into a single nationwide administrative organization. Through the Tahltan Nation Health Protocol Agreement (TNHPA) the three governing bodies will work together to centralize direction and guide staff toward a collaborative approach to enhancing and administering health services in Tahltan territory that is proactive and meets the needs of the members in the three communities.
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Community Health Planning Process The Health Planning Process will seek to determine community priorities and needs, emerging health issues, priorities and desired outcomes for the next five-to-ten years. The process will involve a wide range of Tahltan community members, including Elders, families, clients, members of Council, and other caregivers and health professionals, as well as the experiences and knowledge of existing community health program staff. The Health Planning process will also serve as a means for the Tahltan Nation to communicate its health priorities, activities and accomplishments with Tahltan community members, helping the Bands to be accountable to their membership. The Community Health Plan will support the vision and goals for health articulated in the report “Getting Our Voices Back.” The document is a reflection of the communities’ wishes, and will continue to provide guidance as the Plan is finalized and implemented in the years to come. This Plan will also identify: health priorities and needs; long term goals for each community’s health department; and any barriers and service gaps. This will help to make sure that the Tahltan Nation’s health services agencies are delivering the most appropriate and necessary health and wellness programs for Tahltan members.
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The Health Plan will include, but not be limited to: •
Nursing and Physician Services
•
Communicable Disease Strategies
•
Chronic Disease Management
•
Vision, Hearing and Oral Health Services
•
Home Care and Long-Term Care
•
Mental Health and Addiction Services
•
Traditional Healing and Medicines
•
Patient Transportation
•
Emergency Response and Medical Evacuation
•
Youth Services
•
Early Childhood Education and Child Care / Daycare
•
eHealth
•
Drugs and Medical Supplies
•
Safe Drinking Water / Environmental Health
•
Infrastructure / Operations and Maintenance
•
Health Statistics
•
Human Resources
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Community Overview The traditional territory of the Tahltan Nation covers approximately 93,500 square kilometres in the northwest corner of B.C., with the Stikine River watershed forming the heart of the territory. Much of the territory is without major roads and access is only available by air, waterway or foot. The town of Iskut is on Highway 37, which is the only major road in the area. Dease Lake lies just outside the Stikine watershed, but acts as the region’s service hub. Telegraph Creek, located in the heart of the watershed, is connected by gravel road to Dease Lake. Map of Tahltan Territory
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Population Statistics and Trends Today, the Tahltan Nation includes some 3,000 people, with 1,600 residing in their local communities. The Tahltan territory has experienced strong population growth in recent years mainly in the community of Iskut. Between 1996 and 2006 the Aboriginal population living in Tahltan communities increased by 17.8%. The population in Telegraph Creek and Dease Lake remained nearly unchanged, while the population of Iskut increased by more than 100 people, or 29.4%. This compares to a 20% increase in the Aboriginal population living on reserve in BC, and a 10% increase in the total overall population of BC1. (2011 Census statistics currently are unavailable.) Table 1: Population counts and change, Aboriginal population in Tahltan territory and comparison areas, 1996, 2001, 2006 1996 Aboriginal population on Tahltan Nation reserves 560
2001 545
2006 660
% Change 17.8%
Tahltan Nation (Dease Lake 9, Guhthe Tah 12, Tahltan 1, Telegraph Creek 6 and Telegraph Creek 6A reserves)
305
275
300
-1.6%
Iskut Band Council (Iskut 6 and Kluachon Lake 1 255 reserves)
270
330
29.4%
Aboriginal population on reserve British Columbia 42,455 Total population, British Columbia 3,689,755
46,380 3,868,870
51,060 4,074,385
20.3% 10.4%
Note: In this table, the data for British Columbia are not adjusted for differences in incompletely enumerated Indian reserves in each year. This affects the percentage change 1996-2006. When adjusted for the difference in incompletely enumerated Indian reserves, the 1996-2006 percentage change for the Aboriginal population on reserve in British Columbia is 16.8%, and for total population in British Columbia is 10.3%.Â
Age Distribution In general, the Tahltan are a young Nation, who - like most Aboriginal people in Canada â&#x20AC;&#x201C; have an increasing number of youth. Overall, Tahltan members have a median age of 32 years, compared to the average of 41.9 years across BC, and 40.6 years across Canada. However, Tahltans living in Telegraph Creek have roughly the same median age as all people across BC and Canada, while Tahltans living in Iskut and Dease Lake are much younger; Tahltans living outside the territory have the lowest median age of all groups, as much as 11.7 years lower than those living in Telegraph Creek. Generally, there are more male Tahltans living in the communities than compared to those living outside of Tahltan territory.
1
http://www.bcstats.gov.bc.ca/StatisticsBySubject/AboriginalPeoples/AboriginalReports.aspx
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Outside Tahltan F
M
1030 962
All
Dease Lake
Iskut
Telegraph Creek
F
M
All
F
M
All
1992 115
133
248
128
166
294
F 96
M
All
110
206
All Tahltan F
M
All
1369 1371 2740
The recent survey showed there are more boys and young men living in Tahltan communities than girls and young women, with Iskut having the highest proportion of people under 50, and Telegraph Creek with the highest proportion of members over 50. Dease Lake and Iskut have the highest proportion of young children with 20% of the total population of each community under the age of 12. In Telegraph Creek, however, only 12% of the population is under 12, while more than 16% are over the age of 65.
Median Age
Canada
BC
All Tahltan
Telegraph Creek
Iskut
Dease Lake
Outside Tahltan
Total
40.6 years
41.9 years
32.0 years
42.4 years
32.8 years
32.6 years
30.7 years
Male
39.6 years
41.1 years
31.2 years
44.9 years
31.5 years
31.1 years
29.6 years
Female
41.5 years
42.7 years
32.8 years
39.4 years
34.5 years
34.4 years
31.8 years
In addition to its population change, the Tahltan Nation faces other challenges in the coming years, including substantial increases in mining and other industrial activities throughout the region; an expected increase in non-Aboriginal transient worker population and corresponding increases in social and health impacts; high levels of isolation, particularly in Telegraph Creek, due to poor infrastructure and a challenging climate; and changes in health service delivery mechanisms, as Health Canada shifts services to First Nations Health Authority. Through all these changes, there will be a continued need to provide services through the First Nation health departments to ensure that community members are able to access services that are safe, timely and culturally appropriate.
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Existing Community Health Services The provision of health services to on-reserve First Nations is provided through negotiated agreements with Health Canada First Nations and Inuit Health Branch (FNIHB). Agreements range from: highly restrictive “set” transfers, which dictate how all dollars are to be allocated and accounted for; moderately flexible “integrated” or “flexible” transfers; and flexible “fully transferred” agreements that allow local organizations to allocate and spend funds as needed and carry forward funding from year to year. The recently signed “Tripartite Agreement” transfers responsibility for on-reserve First Nations health service delivery from FNIHB to the First Nations Health Authority (FNHA). All current agreements are being transferred to the FNHA, and all new agreements will be between individual First Nations and FNHA (except if a First Nation “opts out” of the Tripartite Agreement). The mandate of the FNHA is to ensure effective and flexible delivery of health services, improve inclusion of local health needs and priorities, and incorporate traditional health and wellness practices into health service delivery models.
Tahltan Band (Telegraph Creek and Dease Lake): Health Management and Administration Currently, health services are delivered to Tahltan Band members living in Telegraph Creek and on Reserve in Dease Lake through an “integrated transfer” agreement between Health Canada and the Tahltan Health and Social Services Authority (THSSA). The transfer agreement generally provides funding for basic health service categories, including: •
Children and Youth
•
Chronic Disease and Injury Prevention
•
Communicable Disease Control
•
Environmental Public Health and Research
•
Health Governance and Infrastructure Support
•
Mental Health and Addictions
•
Primary Care
•
Supplementary Health Benefits
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Iskut Nursing Station
Since 1999, Iskut Valley Health Services has been one of the only â&#x20AC;&#x153;fully transferredâ&#x20AC;? band health authorities in Canada. Its expertise and successes can be leveraged throughout Tahltan Nation, starting with the co-management of the Telegraph Creek nursing station for example.
Telegraph Creek Nursing Station
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Programs and Services The THSSA receives funding from Health Canada to provide range of services, including: •
Public health nurse (walk-in) services
•
Community health education and disease prevention programs (Community Health Representative)
•
Home and community care
•
Mental Health and Addictions counselling
•
Patient travel services and support
•
Safe house and Victim services and support
Services are provided in Telegraph Creek, primarily through the nursing station / health clinic, and in Dease Lake, through People’s Haven.
Options for Tahltan Band Health Administration The current Health Transfer Agreement between Tahltan Band and Health Canada will transition from Health Canada to First Nations Health Authority on October 1, 2013, and expires March 31, 2014. At that time, the funding and administration of health services for Tahltan Band members will need to be renewed or restructured to provide effective services for Tahltan Band members. Many other First Nations across BC, including Iskut Band Council, have negotiated specific funding agreements with Health Canada based on the community’s needs and the organization’s capacity to deliver the programs and services required. These range from a basic “Set” agreement, in which funding is relatively restrictive and provides for limited service delivery, up to “Flexible Transfer” agreements, which typically provide substantially more funding and maximum flexibility to administer funds with little reporting required. Health Canada has suggested that the Tahltan Band currently does not have the capacity to administer a fully flexible transfer agreement. This presents an opportunity to revisit the existing administrative structure, funding and service delivery model.
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Type of Agreement
Range of Services Provided
Flexibility of Delivery
Level of Reporting Required
Funding Available
Set Funding (i.e., Limited, Red Cross mandatory Station) programs prescribed by FNIHB
Very limited. Recipient must deliver programs and services as prescribed by FNIHB
Integrated Funding
Fairly flexible, Moderate Fairly flexible, based on multi- amount of within nonyear health plan. reporting on mandatory mandatory programs. Carry Must meet programs. forward generally requirements of Increased not allowed. mandatory reporting in some programs as set programs by FNIHB
Moderate. Funding available for mandatory programs, additional funding for administration and other services approved in multi-year plan
Highly flexible, Annual reports designed to meet submitted community simultaneously to needs, with community and minimal FNIHB, prescription by demonstrating FNIHB (other how programs than some are meeting mandatory or objectives. fixed funding programs)
Highest. Funding provided to meet community needs. Higher administrative funding provided.
Broader scope of services, beyond mandatory services, based on multi-year health plan
Flexible block Wide range of funding(i.e., Iskut services, as Valley Health) determined through community health plan and approved by community.
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High level of reporting, structured by FNIHB
Financial Flexibility
Very low. Funding Limited to must be spent as mandatory prescribed year services, with to year; carryminimal forward not administration allowed and some NonInsured benefits
Highly flexible. Carry forward of funding allowed year to year.
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Iskut Band Council Health Management and Administration The IVHS receives funding through a fully transferred Health Transfer Agreement with Health Canada. The IVHS first entered into a Transfer Agreement with Health Canada in 1999, and it was renewed in 2003. In 2009, the Transfer Agreement was replaced by a Flexible Transfer Model, which allows the IVHS to have more flexibility and control to manage programs and funds, and to be in a better position to meet the health needs of the community. Iskut Valley Health Services is responsible for delivery and management of health service and wellness supports for all First Nations people living Iskut, as well as any other Iskut resident, regardless of Aboriginal status. The IVHS reports to the Iskut Council through its Director.
Programs and Services Within the Iskut Band Council’s Health Transfer Agreement, Health Canada contributes funding directly to the Health Department in support of health services and programs. IVHS has a total of 14 full-time and five part-time staff who deliver the following services: •
Nursing
•
Community health promotion
•
Home care and Elder support
•
Addictions awareness and counselling
•
Mental health counselling
•
Prenatal services
•
Aboriginal Head Start
•
Dental Health (Children’s Oral Health Initiative)
•
Medical transport
•
Emergency preparedness
•
Drinking water safety
•
Environmental health
•
HIV/AIDS awareness and support
•
Janitorial services
•
Administration services
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In addition to its core funding, the Health Department receives proposal-driven grant dollars from a variety of funding sources for short-term, specific programs and services.
Comparative Services The following table provides a comparative view of the services available to Tahltan members, both on- and off-reserve. The table demonstrates the agencies responsible for providing each service.
Primary Care
TBC
IBC
THSSA
NHA
FNHC/ FNIH
OTHER
Nursing
*
*
*
Pharmacy
*
*
*
Shoppers Drug Mart
*
BC Ambulance
Physicians
*
Emergency Response and Medevac
*
Mental Health
*
*
*
*
*
*
X-ray
*
Communicable Disease Control Community Health
*
TBC
*
?
*
*
IBC
THSSA
NHA
FNHC/ FNIH
OTHER
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Health Education Home care Services
*
Chronic Disease Management Wellness Services
*
*
*
?
?
*
Safe drinking water
*
*
?
?
*
*
*
*
Maternal Child Health
*
Early Child Development
*
*
Menâ&#x20AC;&#x2122;s/womenâ&#x20AC;&#x2122;s Health
?
?
?
?
Addictions/Mental Health
*
*
?
?
Patient Transportation
*
*
THSSA
Traditional Medicines
Ancillary Services
TBC
IBC
Dental/Orthodontic Vision Care
*
*
*
OTHER * *
Specialists
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FNHC/ FNIH
NHA
*
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Training and Skill Development The Health Planning process will include the development of specific Training and Skill Development plans for all health service providers in each community. Training plans must include all communities and delivered for all three communities together; this will improve cost effectiveness and ensure that each community has equal access to training and increased quality in service. Each community will cross-train front-line workers so that workers can fill in if other community needs them for short periods, and improve knowledge and understanding across the workforce.
Community Engagement and Consultation A key component of the Health Planning Process involves direct engagement with the people living in the communities, as well as health service providers, regional professionals, and other interested parties. Between December 2012 and February 2013, community meetings were held in each of the three Tahltan communities. Participants included Elders, youth, health service providers, and general members of the community. Meetings were held in Dease Lake on December 1, 2012, Telegraph Creek on December 2, 2012, and Iskut Village on January 22, 2013. In addition, the Tahltan Health Working Group has held weekly or bi-weekly meetings to clarify and expand on priorities and planning activities for all Tahltan members.
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Priorities and Objectives Each community identified specific concerns and priorities in regard to the Health Planning process, and for health service provision in their own communities. Following is a summary of some of those concerns and priorities, by community. Community
Responses, Concerns and Health Priorities
Dease Lake
Supportive of health planning process and governance model Concerns and Issues identified in relation to the â&#x20AC;&#x153;artificial boundaryâ&#x20AC;? between available on reserve and off-reserve members Limited housing and poor housing quality on reserve, resulting in more members living off-reserve Access to care and services for off-reserve members Limited patient travel, access to vehicles and drivers Safe drinking water services not provided off-reserve Lack of home care services Early childhood education / day-care services and HeadStart program
Telegraph Creek
Supportive of health planning process and governance model Need for greater leadership in health planning and delivery Lack of home care services Concerns over safe drinking water Lack of daycare services Need for more consistent and flexible nursing services
Iskut
Supportive of health planning process Want to ensure autonomy of individual community health service providers, and ensure a balance of representation by each community on health planning team Generally happy with health services provided through IVHS, and opportunity to share information, services and knowledge with other communities
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Overall, the community health planning process revealed several key areas of priority for health service delivery to the communities, including: •
Governance
•
Primary Care: o
Nursing
o
Physician services
•
Vision Care
•
Dental Care
•
Traditional Wellness (includes Traditional Medicine)
•
Safe Drinking Water
•
Mental Health
•
Early Childhood Education and Youth Care
•
Emergency response and Medevac
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The following table identifies health priorities for the Tahltan Nation, and the goals the communities and health service providers would like to achieve for each priority: Priority Area
Goals and Outcomes
Governance
Three governing organizations work together as Tahltan Health Advisory Panel (1 representative from each), with the understanding that those are POLITICAL people, not workers Advisory Panel will advise the Tahltan Working Group (Health Directors from 3 organizations)
Nursing
Working group will engage Health Service Providers into the process Explore options to provide nursing services to all health centres
Physician services
Maximize service provision Explore formal agreement with NHA to have guaranteed access to physician services.
Vision Care
Local service: 2 - 4 times a year, including school-based vision screening (centralized optometry at Dease Lake)
Dental Care
Local dentist service, at least 4 times a year, centralized at Dease Lake (Stikine Health Centre). COHI programs in all communities, delivered by one person, instead of three Access to denturists and denturist services
Traditional Wellness
Develop programs and services to enhance traditional wellness, including traditional medicines and cultural practices.
Safe Drinking Water
Centralized standardized testing All parties coordinate their activities, and be better coordinated (First Nations Health Authority and INAC are both involved)
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Priority Area
Goals and Outcomes
Mental Health & Addictions
Explore options for services, including technical support, including: Training for councillors and front-line workers Stress, anxiety and depression support More traditional services Tahltan administered treatment centre Marriage counseling training After-care Youth addictions and suicide prevention programs Drug use and abuse prevention and support
Home Care
Explore options to provide local and centralized services, including: Local palliative care Local long-term care Local assisted living Consistent home care services in each community Coordination of home care and homemaker services Improved assessment tools to customize culturally appropriate services to individuals and households
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Key Health Indicators / Determinants The Transformative Change Accord: First Nation Health Plan identifies seven key health indicators that are used to measure the health and well-being of First Nations communities: •
Life expectancy at birth;
•
Mortality rates (deaths due to all causes);
•
Status Indian youth suicide rates;
•
Infant mortality rates;
•
Diabetes rates;
•
Childhood obesity; and,
•
Practising, certified First Nations health care professionals.
The Health Authority is quick to point out that “the presence of these indicators in the Health Plan does not prevent developing additional indicators that reflect the overall well-being in communities.” However, for the purposes of developing a Health Planning framework, the Tahltan Nation will work initially to develop a baseline for measuring progress and organizing planning activities.
“Indicators do not need to only measure illness, death and suicide rates. They can also measure positive outcomes such as traditional practices at the community level, education levels, and sport/recreation participation levels.”
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Action Items The Following Tables provide an Action Plan for the completion of the Health Planning Framework Health Priority Area Health Governance
Desired Outcome
Responsibility
Actions / Activities Year 1 (2013)
Year 2
Year 3
Establish Tahltan Health Approve Research sustainable Working Group Health integrated governance (WG) Planning service structure to Protocol delivery, coreflect and management Establish support of Stikine Terms of community Health Centre Reference for goals, priorities Tahltan Health and needs of Advisory Panel Tahltan members. Develop Guiding Principles for Tahltan Health Planning Improved health Tahltan Health Work with Negotiations service delivery Working Group FNHC and with BC and for all members (WG) Health Canada FNHC for in the Stikine to explore best enhanced NHA region options for services Tahltan Band across FNHC/HC service delivery communities Meet with NHA to discuss improved delivery of services through Stikine Health Centre, and ancillary services
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Years 4+
Implementation Monitoring of TN Health and Plan Evaluation
Completion of Monitoring Regional and Tahltan Health Evaluation Plan Agreement with FN Health Council / Negotiation of Health Health Canada Services Agreement for Tahltan Band
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Health Priority Area Community Health
Desired Outcome
Responsibility
Improved health WG and wellness outcomes for all IVHS Tahltan TFN members
Integrate traditional Tahltan medicines and cultural practices Communicable Consistent and Disease comprehensive Prevention chronic disease management Home and and education Community Care Services services for all and Elder Care the communities
TCC
IVHS TFN TCC (support)
Enhanced local and centralized services Integration of traditional medicines and cultural practices More frequent and more consistent home care services in each community Better coordination of home care and homemaker services
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Actions / Activities Year 1 (2013)
Year 2
Year 3
Baseline health data research and analysis
Integration of services and programs across communities
Establishment of health Research into targets for traditional key indicators medicines and holistic health practices Develop Expand and â&#x20AC;&#x153;Tahltan enhance friendlyâ&#x20AC;? existing education Tahltan and strategy to information accommodat material on e / mitigate STIs impacts of resource Identify and development contact incoming / Develop potential feasibility industries study / plan operating in for inTahltan community territory long-term home care Develop a and/or Home Care assisted living service and facility HR plan in each Develop and community implement culturally Develop / relevant and adapt supportive assessment palliative care model to services in ensure each appropriate community service delivery
Years 4+
Implementatio Ongoing n of new and health ongoing planning and wellness service services delivery Monitoring and evaluation
Promote safety, prevention and treatment options within incoming workforce, Tahltan families, and service providers. Build / establish long-term care / assisted living facility in community
Continue to educate and promote disease prevention and treatment Monitoring and evaluation
Implement and monitor home and community care services to ensure adequate and culturally Update appropriate Stikine Health support Centre to provide long- Deliver term care training and support certification to local home Deliver care workers training and certification to local home care workers
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Health Priority Area
Desired Outcome
Responsibility
Actions / Activities Year 1 (2013)
Improved assessment tools to determine scope and nature of home care and homemaking needs
Year 2
Year 3
Years 4+
Establish Customize Expand Monitoring priorities and and integrate respite and needs for home care services for evaluation long-term and families care, including homemaking supporting Continue to home-based services Elders and support Elders care and endthose with and families in of-life care Develop additional all aspects of services. training and needs health, skill support and Meet with development Coordinate end-of-life FNHA / HC / program for specialist services. NHA to locally trained services for explore home care Elders, both in Implement options for workers community centralized enhancing and in centres equipment elder care Develop outside of purchase, services in strategies to community. lending and each coordinate storage community, Elder travel, Implement system across and evaluate appointments systems that all policies, HR and care honour need communities needs, services out of to have end of funding, etc the community. life support Establish and care at agreements Work with home, in the with service Stikine Health community providers and Centre to specialists to enhance elder Develop a ensure that care and long- plan for a services meet term care centralized needs of all services equipment Elders and storage and families in the Develop rental / community community lending policies and system Monitoring processes and that support Recruit mental evaluation end-of-life health support care, including with expertise rules and in Elder care approaches for nurses, physicians, NHA, etc.
Establishment of community based longterm care facility and assisted living service High quality, culturally appropriate and customized care and services for Elders and families. Increased care, facilities and support for Elders and families in the communities in which they live.
Youth Support and Care
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Health Priority Area
Desired Outcome
Early Childhood Providing Education / consistent and Care meaningful
services to children ages 0-6 and their families
Responsibility
Actions / Activities Year 1 (2013)
IVHS
TCC
Appropriate and IVHS integrated mental health TFN services for all community TCC members FNHC
Water Safety
Centralized and IVHS standardized and testing, to TFN ensure water quality and TCC safety in all communities.
Year 3
Years 4+
Develop Expand Explore rough plans HeadStart and options for for community daycare to all family service communities development delivery centre(s) Provide ECE Identify ECE, certification in Deliver family HeadStart all groups in and daycare communities each opportunities community for all Develop communities Tahltan parenting program for all communities Identify Create mental Explore existing health service options for services and delivery plan youth gaps offenders and Explore strengthening Research feasibility of program, opportunities mental health land-based to utilize centre / healing technology to treatment programs, better access facility etc. services (including Eskay Creek mine site)
TFN
Mental Health
Year 2
Continue to support and promote family and child programs Monitoring and evaluation
Monitoring and evaluation
Monitoring and evaluation
Coordination of all water safety and access services Primary Care Services
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Health Priority Area Nursing
Desired Outcome
Tahltan controlled services in all communities
Physician Care Better
integration of local physician services in all communities
Responsibility
Actions / Activities Year 1 (2013)
IVHS TFN / Health Canada (tbd)
IVHS TFN / Health Canada (tbd)
Effective sharing of and access to health records of all community members, through electronic medical records
Explore options for providing nursing services across all communities
Enhance relationships and partnerships with physicians to participate more in community health programs
Year 2
Year 3
Years 4+
Develop nursing strategy
Deliver nursing services
Monitoring and evaluation
Negotiate appropriate transfer agreement to provide nursing services Continue to provide services across communities
Continue to Monitoring provide and services evaluation across communities
Pilot electronic record keeping and information sharing Explore gaps project and options for electronic record keeping and information sharing
Fully implement record keeping process
Meet with NHA and FNHC / HC to discuss improved service delivery in all ancillary services, particularly for Tahltan Nation (Telegraph Creek)
Implement Monitoring Health and Agreement evaluation and enhanced service delivery
Ancillary Care Dental Care
Provision of IVHS regular, local dentist service for TFN / Health all Tahltan Canada (tbd) members Oral health preventive and education program in all communities Consistent and effective access to denturists and denturist services
Socio-Cultural Working Group Report
Develop Health Agreement strategy for Tahltan Nation
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Health Priority Area Vision Care
Desired Outcome
Provision of regular, local optometry and eye care services for all Tahltan members, provided in community.
Responsibility
IVHS TFN / Health Canada (tbd)
School-based vision screening Emergency Response
Better IVHS integration with BC Ambulance service TFN / Health Improved Canada (tbd) access to and coordination of medevac services
Actions / Activities Year 1 (2013)
Year 2
Year 3
Years 4+
Meet with NHA and FNHC / HC to discuss improved service delivery in all ancillary services, particularly for Tahltan Nation (Telegraph Creek) Develop needs assessment and overview of emergency and ambulance service requirements for territory
Develop Health Agreement strategy for Tahltan Nation
Implement Monitoring Health and Agreement evaluation and enhanced service delivery
Meet with BC Ambulance, FNHC, NHA, to discuss improved / enhanced ambulance and emergency response systems
Implement effective ambulance and emergency response services
Monitoring and evaluation
Infrastructure/ Administration Health Facilities High quality
health facilities in each community Financial Accountability
Tahltan Health WG Working Group will identify THAP budgets for all aspects of the plan and identify funding shortfalls and financial needs to implement the plan
Recreational Services Culture/Traditional Wellness Traditional Medicine Language revitalisation
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Appendices
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Appendix: Infrastructure Needs The following is an initial identification of known minimal infrastructure needs for each community, based on current and anticipated service requirements. Dease Lake: •
Long-term care beds (6 beds minimum)
•
Daycare centre (20 spaces minimum)
•
HeadStart building and play areas
•
Office space (12 offices)
•
Patient Transportation vehicles
•
Video-conferencing and increased connectivity and capacity
•
Dental / optometry space and office for visiting professional
•
Mental Health treatment spaces (soundproof, safe, video-conferencing, etc.)
•
Storage facility for home care equipment
Iskut: •
Larger daycare and HeadStart space (30 spaces in total)
•
Assisted living units (4 units minimum, based on current needs)
•
Upgraded internet connectivity and capacity (fibre-optic connectivity)
•
Medical Transport vehicle (ambulance)
•
Mental Health treatment spaces (soundproof, safe, video-conferencing, etc.)
Telegraph Creek: •
Medical Transport vehicle (ambulance)
•
Video-conferencing and increased connectivity and capacity
•
Mental Health treatment spaces (soundproof, safe, video-conferencing, etc.)
•
Daycare and HeadStart building (space for 20, minimum)
•
Patient Transport Vehicles
•
Assisted Living units (6 units, minimum)
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Appendix: Tahltan Health Protocol Tahltan Nation Health Protocol Agreement Between Tahltan Central Council Tahltan Band Council Iskut Band Council
Background: Currently there are three (3) separate organizations responsible for elements of planning, administration and delivery of health services to Tahltan people living in Tahltan territory, including but not limited to the on-reserve communities of Iskut, Telegraph Creek and IR #9 (Dease Lake): •
Iskut Band Council (IVHS)
•
Tahltan Band Council
•
Tahltan Central Council
Each different organization has a unique governance structure and different interests or responsibilities for health service delivery. Iskut Band Council (IVHS) operates nursing station, including community health support, home care, addictions services, counseling, children’s oral health, patient transport, and other related services. Tahltan Band Council and more specifically, Telegraph Creek has a nursing station that has nurses employed by Health Canada and community health services provided by THSSA. Dease Lake community and residence of IR # 9 accesses services from Stikine Health Centre in Dease Lake which has a health center managed by NHA, that includes community medical facility with full-time doctor, nurse, X-ray facilities and emergency care, and provides medical services to all members of the public. The health centre and its physician services are accessed by members in Iskut and Telegraph Creek also. The physicians visit Iskut and Telegraph Creek once a week.
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The Tahltan Central Council has a coordinating and governing role for all Tahltan communities, and includes the Socio-Cultural Working Group, which oversees the development of the Tahltan Nation Plan, including health and wellness factors. The current multi-agency approach has impacts on the effective health service delivery and wellness for the Tahltan people. Medical records are not easily shared or accessible by medical professionals, either in the communities or in the larger centres. There are inefficiencies such as overlaps in services such as patient travel, oral health, nursing and specialist visits, while at the same time there are gaps in services throughout the region, such as mental health care, long-term care and traditional medicines, communicable diseases, emergency transportation, vision, dental and other health services. While the physicians from Dease Lake work with the nursing stations in Iskut and Telegraph Creek, there is no integrated care service among the communities, and limited collaborative planning. The Stikine Health Centre is not widely accessed by the Tahltan population other than as an emergency facility. The Stikine Health Center does not have access to specialized services and no long-term or acute care facilities. Tahltan members living off reserve in the Tahltan territory do not have consistent access to medical care in the nursing stations.
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Objectives: The Tahltan Nation wishes to create better coordination and collaboration of health and wellness services for our members within our communities. By establishing a Health Planning Protocol, the multiple health service organizations and community representatives will work together to identify shared priorities and wellness needs; document and share information regarding available health and wellness services and resources; identify gaps and challenges related to health and wellness across their communities; and work together to develop plans and strategies for addressing each community’s health and wellness needs. The Health Planning Protocol will enable the communities of the Tahltan Nation to better collaborate on: •
Identifying health and wellness priorities;
•
collecting and sharing of data, information and historical practices;
•
creating structures and approaches that meet the needs and styles of the Tahltan membership;
•
creating innovative approaches to addressing similar or shared health issues;
•
avoiding unnecessary waste, duplication or gaps in services; and
•
create a framework for longer-term planning across the region.
The protocol is not intended to replace existing health and wellness delivery mechanisms, governance structures or existing health strategies or agreements. This protocol will better allow the Tahltan Nation communities to create a baseline of knowledge, statistics and other information regarding the current health and wellness status of community members, and project the membership’s needs and priorities into the future. Ultimately, this will help to ensure better health outcomes and service delivery for all Tahltan people in the years to come.
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Appendix: Protocol Agreement Whereas: •
The members of the Tahltan Nation seek to increase collaboration and cooperation in the research, information sharing and planning for our individual and collective health and wellness priorities into the future; and
•
We recognize and respect the authority, governance structures and existing agreements of each community, health organization and agency; and
•
We see opportunities to improve the health and well-being of all our members, regardless of their place of residence or occupation in the Tahltan Territory;
We agree to work together to undertake the following activities to enhance the overall health and wellness of Tahltan members in Tahltan territory: •
By establishing a team that will collaborate, coordinate, plan and administer health and wellness services and programs in Tahltan Territory;
•
Conduct research, to create a baseline of the health and wellness of the Tahltan membership and residents of the Tahltan territory;
•
Conduct research into culturally meaningful and traditional health practices in Tahltan territory, including the creation of a “traditional medicine” inventory for the region;
•
Develop a territory-wide health and wellness plan to maximize the use and effectiveness of existing and available services, and bridge gaps in service or program availability;
•
Seek and share financial and other resources to assist with research, planning and health service delivery, where appropriate;
•
Assess the viability and suitability of a region-wide Health Services Agreement with Health Canada and/or First Nations Health Authority;
•
Create a meaning partnership with Northern Health Authority for service delivery in the territory.
•
Create a unified voice for providing information, direction and advice to the regional First Nations Health Authority, on behalf of the Tahltan Nation communities;
•
Advocate for improvements and enhancements to health services and program delivery to improve health outcomes for the Tahltan people and increase the availability and use of culturally appropriate and traditional wellness activities.
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We, the undersigned, agree to this Protocol, on behalf of the members of the Tahltan Nation and its agencies.
___________________________________________________ Annita McPhee – President/Tahltan Central Council
__________________________________________________ Rick McLean – Chief Councillor/Tahltan Band Council
___________________________________________________ Marie Quock – Chief Councillor/Iskut Band Council
__________________________________________________ Date
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Appendix: Better Healthcare for Tahltan Coming Better Healthcare for Tahltan Coming Tahltan nurse up for the challenge Telegraph Creek nurse Nancy Norby-Quock is thrilled about returning to her community amidst major changes that will dramatically improve health care in Telegraph Creek, Iskut and Dease Lake. "I like to work hard, and meet the needs of First Nations. I just felt that I should [return home] to do this for my own people," she said. The Tahltan native, daughter of Thelma and Vern Norby, left the community a year ago to seek professional renewal, and gain new training such as advanced cardiac life support.
Iskut Valley Health Services (top) will soon be comanaging Telegraph Creek nursing station (bottom).
She's returned to Telegraph Creek in April to help bring improved health care services across Tahltan Nation.
"My ancestors are from there. I love the people, I truly love the people," said Norby-Quock. The Socio-Cultural Working Group – an initiative led by Tahltan and Iskut bands and the Tahltan Central Council -- is driving the healthcare changes. Telegraph's nursing station, for example, will soon be co-managed with Iskut Valley Health - one of the only First Nations band health authorities in the country that is "fully transferred" from Health Canada. "It used to be managed from afar. Now it will be managed closer to home," said Norby-Quock. She says the co-management of the nursing station means band members will soon see more Tahltan staff caring for them, and better home care for the sick and elderly. "They'll get familiar nurses. We're going to be doing the hiring. So we're not going to have a different nurse every week."
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Emergencies will also receive faster responses without the restraint of past policies that prevented nursing staff from leaving the clinic. Such situations were brought into focus this past winter after the tragic passing of an Elder. Community members made it clear they want new approaches. Norby-Quock says, they'll get it. "If there's an accident on the road, or if someone is not able to come into the clinic, we will be able to go to them now. There won't be any policy that says we can't." Band members in all three communities will also have access to a new medical transport bus for catching a ride to doctor appointments in Terrace or Prince George. "Not everybody has a vehicle. Especially for Elders. It's a long drive." "So having this bus means people will always have a ride," said Norby-Quock.
Telegraph Creek nurse Nancy Norby-Quock (right) attending to one of the newest additions to Tahltan Nation.
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