Indigenous Health Conference | November 20-21, 2014 1

INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 1

INDIGENOUS HEALTH CONFERENCE CHALLENGING HEALTH INEQUITIES

November 20-21, 2014 University of Toronto Conference Centre 89 Chesnut Street | Toronto, Ontario

cpd.utoronto.ca/indigenoushealth Follow us on Twitter: #indigenousconf

Abstract Program INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 2 INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 3

A Message from the Conference Chair

Dear friends, colleagues, respected elders and community members,

I warmly welcome you to the inaugural Indigenous Health Conference: Challenging Health Inequities.

There is a change in the air… Do you feel it? It is the resolution that the poor health indicators on every measureable level among Indigenous populations in Canada are no longer acceptable. There is no choice but for things to change. It is a human rights issue.

It is important to learn about the past, to help us with the present and change the future. Learning about the history of Indigenous peoples in Canada, the centuries of abuse, neglect and the ongoing discrimination and inequity will help us advocate for change. Through dialogue we can learn how we can learn from each other to be more sensitive and effective health care providers.

We are privileged to have numerous outstanding speakers who can bridge the Indigenous world and non-Indigenous world such as Honourable Justice Murray Sinclair of the Truth and Reconciliation Commission, and Michèle Audette, President of the Native Women’s Association of Canada, who will talk about Missing and Murdered Aboriginal Women. We will also reflect in a discussion on Genocide: The Canadian Perspective, to see if, in fact, a genocide may have occurred.

You will hear of pain, suffering, discrimination….but more importantly you will hear of hope and determination and resolution to have a better future. You will hear of the new British Columbia Tripar- tite Framework Agreement on First Nation Health Governance, led by Dr. Evan Adams, and numerous successful programs. You will learn about the growing number of Indigenous health care providers who are determined to help their communities have a better future. The job fair opens up opportunities for both underserviced health centres and for providers looking for an opportunity to make a difference with Indigenous populations. There will be opportunities for promoting health education, advocacy and research with and for Indigenous peoples as equal partners.

We need to stand together, Indigenous and non-Indigenous brothers and sisters, and Challenge These Inequities. Let us share, listen, heal and grow and work towards health equity.

Thank you for being part of this change.

>>Add Signature

Anna Banerji, O.Ont MD MPH FRCPC DTM&H Chair, Indigenous Health Conference: Challenging Health Inequities INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 4

Table of Contents

Welcome Letter from the Conference Chair...... XX Area Map...... XX Planning Committee...... XX Planning Committee...... XX Speakers...... XX Accreditation, Disclosure, Social Media Information...... XX Floor Plans...... XX Program Agenda...... XX Oral Abstracts...... XX Workshop Abstracts...... XX Poster Abstracts...... XX Author Index ...... XX Sponsors...... XX Notes...... XX INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 5

Area Map

Insert Map Showing 89 Chestnut and area attractions, e.g. Eaton Centre, ROM, etc. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 6

Planning Committee

Anna Banerji O.Ont MD MPH FRCPC DTM&H Kent Saylor MD FRCPC Conference Director Northern and Native Child Health Program Director, Global and Indigenous Health General Pediatric Continuing Professional Development, Faculty of Medicine Montreal’s General Hospital University of Toronto Sara Wolfe Evan Adams MD Brunswick House First Nation Sliammon First Nation, Coast Salish Tribe Registered Midwife, Seventh Generation Midwives Toronto Deputy Provincial Health Officer (DPHO) for President and Project Leader, Toronto Birth Centre Aboriginal health British Columbia Cathy Middleton Vanessa Ambtman-Smith Event Planner Métis-Cree Continuing Professional Development Aboriginal Health Lead & Co-Chair, Faculty of Medicine, University of Toronto Provincial Aboriginal LHIN Network (PALN) South West Local Health Integration Network

Anna Claire Ryan MPH Senior Project Coordinator Inuit Tapiriit Kanatami

Darlene Kitty MD CCFP Chisasibi Cree First Nation President, Indigenous Physicians Association of Canada Director, Aboriginal Program, UOttawa, Faculty Of Medicine Family Physician, Chisasibi Hospital, Chisasibi QC

Melanie Morningstar Garden River First Nation – Ojibway Senior Policy Analyst Assembly of First Nations

Jason J. Pennington MD MSc FRCSC The Huron-Wendat Nation Curricular co-Lead in Indigenous Health Education Faculty of Medicine, University of Toronto General Surgeon, The Scarborough Hospital

Lisa Richardson MD FRCPC Anishnaabe/Scottish Clinician-Teacher, Division of General Internal Medicine, University of Toronto Curricular Co-Lead in Indigenous Health Education Faculty of Medicine, University of Toronto INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 7

KEYNOTE SPEAKER: Justice Murray Sinclair

The Honourable Justice Murray Sinclair was appointed Associate Chief Judge of the Provincial Court of Manitoba in March of 1988 and to the Court of Queen’s Bench of Manitoba in January 2001. He was Manitoba’s first Aboriginal Judge. Justice Sinclair was born and raised in the Selkirk area north of Winnipeg, graduating from his high school as class valedictorian and athlete of the year in 1968. After serving as Special Assistant to the Attorney General of Manitoba, Justice Sinclair attended the Univer- sities of Winnipeg and Manitoba and, in 1979, graduated from the Faculty of Law at the University of Manitoba.

He was called to the Manitoba Bar in 1980. In the course of his legal practice, Justice Sinclair practiced primarily in the fields of civil and criminal litigation and Aboriginal law. He represented a cross-section of clients but by the time of his appointment, was known for his representation of Aboriginal people and his knowledge of Aboriginal legal issues. He has been awarded a National Aboriginal Achievement award in addition to many other community service awards, as well as Honourary Degrees from the University of Manitoba, the University of Ottawa, and St. John’s College (University of Manitoba). He is an adjunct professor of Law and an adjunct professor in the Faculty of Graduate Studies at the University of Manitoba. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 8

PLENARY SPEAKERS

Evan Adams MD Michèle Audette Sliammon First Nation, Coast Salish Tribe President, Native Women’s Association of Canada Deputy Provincial Health Officer for Aboriginal Health Hailing from the Innu community of Mani Utenam, next to the town of Sept-Îles on the North shore of the St. Lawrence British Columbia River, Michèle Audette followed in the footsteps of her moth- Aside from his career in the arts, Evan has completed 3 years of er, respected Innu activist Evelyne St-Onge. Working with pre-med studies at the University of British Columbia (UBC), Quebec Native Women Inc. since 1990, Audette was elected a Medical Doctorate from the University of Calgary in 2002, President of this organization in November 1998. and a Family Practice residency (as Chief Resident) in the Ab- Endorsing her predecessors’ equal rights commitments, Au- original Family Practice program at St. Paul’s Hospital in Van- dette was also a strong advocate of women’s positions on a couver, BC. He is the 2005 winner of the (provincial) Fami- number of issues such as Bill C-7 (which dealt with First Na- ly Medicine Resident Leadership Award from the College of tions governance) on the division of matrimonial real prop- Family Physicians of Canada (CFPC), and the 2005 national erty. She raised decision-makers awareness of the importance winner of the Murray Stalker Award from the CFPC Research of women’s health, safe houses for Aboriginal women, youth and Education Foundation. He is the past-President of the In- issues and international development during her term in office. digenous Physicians Association of Canada, and is currently Thanks to her efforts, four new coordinator positions were the Director of the Division of Aboriginal Peoples’ Health, created at QNW, which increased the organization’s influence UBC Department of Family Practice. He obtained his MPH and profile. The Quebec Commission des droits de la personne in 2009 with the Johns Hopkins School of Public Health while et des droits de la jeunesse (Commission of Human Rights and working with the Office of the Provincial Health Officer. Youth Rights) recognized the many accomplishments of Que- In April 2012, Dr. Adams was appointed Deputy Provincial bec Native Women Inc. with an honourable mention in 2001. Health Officer (DPHO) with responsibility for Aboriginal Audette sat on a number of committees and boards of directors health. In this role, he supports the work of the Provincial and served as acting president of the Native Women’s Associa- Health Officer (PHO), reports on the health of Aboriginal tion of Canada in 2001. She won a number of awards and dis- people in BC, and supports the development and operations of tinctions for her work on social issues, including the Quebec the First Nations Health Authority. YWCA’s Femme de mérite award in the Community involvement category in 2004. She was also one of Montreal daily La Presse’s personalities of the week in 2003. Audette’s mandate with Quebec Native Women Inc. ended in March 2004 when she was appointed Associate Deputy Minister responsible for the Status of Women Secretariat in the Government of Que- bec. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 9

PLENARY SPEAKERS

Michael Dan MD PHD FRCSC MBA Bernie M. Farber Senior Vice President Michael Dan is a neurosurgeon, philanthropist, and First Na- Government and External Relations tions advocate. In 2002 he created The Paloma Foundation, Gemini Power Corporation which in turn, has donated over $8M to charities in the Great- er Toronto Area. Through his support of The University of Human and Civil Rights Advocate Haifa, and the Michael and Amira Dan Professorship in Global Bernie M. Farber is one of Canada’s leading experts on mi- Health at The University of Toronto, he has helped to build nority and human rights, race relations and anti-Semitism. Jewish-Palestinian dialog and tolerance in Canada and around For more than a decade, Mr. Farber worked for the Youth the world. In 2014 he donated $10M to The University of Services Bureau, Ottawa’s Jewish Community Centre and the Toronto to create the first endowed institute for indigenous Children’s Aid Society of Ottawa-Carleton, specializing in as- health research in the world at the Dalla Lana School of Public sisting at-risk youth and battered women. After moving to To- Health, University of Toronto. Michael is also a strong sup- ronto, he worked with Canadian Jewish Congress eventually porter of the Canadian Museum for Human Rights, The Scar- becoming its CEO from 2006-2011. borough Hospital, and the Faculty of Pharmacy and Division of Neurosurgery at The University of Toronto. Mr. Farber was appointed by the Attorney-General of Ontario to serve on the Hate Crimes Community Working Group. He also serves as Chair on the Board of the Jewish Humanitarian group Ve’ahavta where he recently initiated the Briut program. Briut is a community-driven health promotion program which places graduate level students studying public health or social work in partnership with First Nations “host” communities for four month placements. Briut’s goal is to improve the long term health of individuals and communities by strengthening local capacity for health promotion and the delivery of community based health promotion programs. These programs are developed within the context of local knowledge and expertise.

Mr. Farber is a frequent writer for many National newspapers where he has authored thoughtful pieces on First Nations issues, human and civil rights matters. Today Mr. Farber works with Dr. Michael Dan as a Senior Vice President at Gemini Power Corp where he assists First Nations Reserves in developing hydro projects and other initiatives encouraging sustainable wealth development. He is also the CEO of the Paloma Foundation which helps develop skills of those who work on the frontlines with homeless youth in the GTA. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 10

PLENARY SPEAKERS

Phil Fontaine OC OM Angeline Letendre RN PhD Special Advisor of the Royal Bank of Canada Research Chair, Aboriginal Nurses Association of Canada Phil Fontaine is a Special Advisor of the Royal Bank of Can- Adjunct Professor, Faculty of Nursing, ada. He serves as a director for numerous private and public University Of Alberta companies including Chieftain Metals and Avalon Rare Met- als. Mr. Fontaine served as National Chief of the Assembly Lead Scientist. Communities, Alberta Cancer of First Nations for an unprecedented three terms. He is a Prevention Legacy Fund-Alberta Heath Services Member of Order of Manitoba and has received a National Angeline Letendre is the first person of Aboriginal descent to Aboriginal Achievement Award, the Equitas Human Rights graduate from the University of Alberta with a doctoral de- Education Award, the Distinguished Leadership Award from gree in Nursing. Building on more than two decades of front- the University of Ottawa, the Queen’s Diamond Jubilee, and line nursing experience, the focus of Dr. Letendre’s career has most recently was appointed to the Order of Canada. Mr. Fon- been to contribute to the improved wellnes of First Nations, taine also holds fifteen Honorary Doctorates from Canada and Inuit and Metis people. This has included work in cultural the United States. competency skills development in indigenous nursing, community-based research and partnered activities at local, provincial and national levels, as well as cancer care strategy and program planning. Currently Angeline is a primary co-Lead for two 3-year projects funded through the Canadian Partner- ship Against Cancer in partnership with First Nations, Inuit and Metis peoples of Alberta and Alberta Health Services. Re- cently, Dr. Letendre has joined forces with researchers from Australia, New Zealand and the United States to investigate the cancer research interests for Indigenous peoples from these countries. Outcomes of this work promise to include the development of international researcher-level partnerships for the exploration, strategy development and recommendations in cancer-related research with Indigenous populations in the associated countries. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 11

PLENARY SPEAKERS

Natan Obed BA Janet Smylie MD MPH Director of Social and Cultural Development Scientist, Keenan Research Centre, Li Ka Shing Nunavut Tunngavik Incorporated Knowledge Institute, St. Michael’s Hospital Research Scientist, Centre for Research on Natan Obed is a beneficiary of the Labrador Inuit Land Claim Inner City Health, St. Michael’s Hospital Agreement and originally from Nain, Nunatsiavut, but cur- Associate Professor, Dalla Lana School of rently lives in Iqaluit, Nunavut with his wife, Letia, and their sons Panigusiq and Jushua. Public Health, University of Toronto Staff Physician, Family and Community Natan is the director of social and cultural development for Medicine, St. Michael’s Hospital Nunavut Tunngavik Incorporated (NTI), the organization Full Member, School of Graduate Studies, that represents the rights of Nunavut Inuit. NTI advocates on University of Toronto behalf of Inuit in such areas as health, education, language, Adjunct Scientist, Institute for Clinical justice, housing, social and cultural research, and suicide pre- Evaluative Sciences vention. Dr. Janet Smylie is a Métis family physician and researcher. Natan has a B.A. in both English and American Studies from Through her work with Well Living House, Dr. Smylie’s goal Tufts University. Natan has worked his entire twelve year pro- is to ensure that every child born in Canada has the opportu- fessional career with Inuit representational organizations. nity to live a full and healthy life.

Dr. Smylie’s research bridges Indigenous knowledge systems and knowledge translation, public health knowledge, perinatal surveillance and Indigenous health information systems. She has forged and nurtured dozens of research partnerships with Indigenous communities and organizations around the world. Dr. Smylie holds a New Investigator Award from the Cana- dian Institutes of Health Research. In 2012, she was named a recipient of the prestigious National Aboriginal Achievement Award, which recognizes First Nations, Inuit and Métis individuals across the country. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 12

Accreditation Faculty Disclosure The College of Family Physicians of Canada It is the policy of University of Toronto, Faculty of Medicine, This program meets the accreditation criteria of The College of Continuing Professional Development to ensure balance, inde- Family Physicians of Canada and has been accredited by Con- pendence, objectivity, and scientific rigor in all its individually tinuing Professional Development, Faculty of Medicine, Uni- accredited or jointly accredited educational programs. Speakers versity of Toronto, for up to 13.5 Mainpro-M1 credits. and/or planning committee members, participating in Univer- sity of Toronto accredited programs, are expected to disclose Royal College of Physicians and Surgeons of Canada to the program audience any real or apparent conflict(s) of interest that may have a direct bearing on the subject matter of This event is an Accredited Group Learning Activity (Section 1) the continuing education program. This pertains to relation- as defined by the Maintenance of Certification Program of the ships within the last FIVE (5) years with pharmaceutical com- Royal College of Physicians and Surgeons of Canada, approved panies, biomedical device manufacturers, or other corporations by Continuing Professional Development, Faculty of Medicine, whose products or services are related to the subject matter of University of Toronto, up to a maximum of (13.5 hours). the presentation topic. The intent of this policy is not to prevent a speaker with a potential conflict of interest from making a The American Medical Association presentation. It is merely intended that any potential conflict Through an agreement between the Royal College of Physi- should be identified openly so that the listeners may form their cians and Surgeons of Canada and the American Medical Asso- own judgments about the presentation with the full disclosure ciation, physicians may convert Royal College MOC credits to of facts. It remains for the audience to determine whether the AMA PRA Category 1 Credits™. Information on the process speaker’s outside interests may reflect a possible bias in either the to convert Royal College MOC credit to AMA credit can be exposition or the conclusions presented. found at www.ama-assn.org/go/internationalcme Social Media European Union for Medical Specialists (EUMS) Follow us on Twitter #indigenousconf Live educational activities, occurring in Canada, recognized by the Royal College of Physicians and Surgeons of Canada as Ac- credited Group Learning Activities (Section 1) are deemed by the European Union of Medical Specialists (UEMS) eligible for ECMEC®.

Letters of accreditation/attendance will be available online following the course. Participants will be emailed information within two weeks specifying how to obtain their letter of accreditation/attendance online. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 13

Floor Plan 2ND FLOOR 2nd Floor Plenary Room, Workshop Rooms, Posters, Refreshments, Exhibits

STAGE

GIOVANNI ROOM

COLONY BALLROOM SUITE EAST LOMBARD CATERING OFFICE ELM SUITE

COLONY BALLROOM CENTER

ARMOURY SUITE

COLONY BALLROOM WEST CARLTON

3rd Floor Workshop Rooms, Crafts, Job Fair 3RD FLOOR

ST. GEORGE EAST ST. ANDREW

ST. GEORGE ST. WEST LAWRENCE

TERRACE EAST ST. DAVID ST. DAVID NORTH SOUTH

TERRACE WEST

TERRACE ST. PATRICK ST. PATRICK NORTH NORTH SOUTH INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 14

Program Agenda Thursday, November 20, 2014 7:15 Registration and Continental Breakfast ...... Colony Ballroom and Foyer 8:00 Opening Ceremony and Welcome ...... Colony Ballroom Dr. Anna Banerji, Dr. Darlene Kitty, Terry Audia- President Inuit Tapiriit Kanatami Chief Phil Fontaine, Assembly of First Nations (TBC), Elder Cat Crigger, University of Toronto 8:30 Justice Murray Sinclair: Truth and Reconciliation Commission ...... Colony Ballroom 9:30 Dr. Evan Adams: Transforming Systems, Transforming Ourselves – an Update on the First Nations Health Authority in BC . . . .Colony Ballroom 10:15 Refreshment Break with Posters and Exhibits

10:30 Workshop Session #1 Room

Mental Health W01 Honouring our Strengths: A Renewed Framework to Address Substance Use Issues Lombard among First Nations People in Canada 2nd Floor Carol Hopkins National Native Addictions Partnership Foundation, Canadian Centre on Substance Abuse

Mental Health W02 Connecting the Dots: An Innovative Urban Aboriginal Mental Health Project St. David North Jessa Williams, Johanna Denduyf 3rd Floor Canadian Mental Health Association British Columbia Division, British Columbia Association of Aboriginal Friendship Centres

Women’s Health W03 Supporting First Nations, Métis and Inuit Women to Engage in St. David Shared Decision Making: A Skill Building Workshop South Janet Elizabeth Jull, Minwaashin Lodge, Dawn Stacey 3rd Floor University of Ottawa, Institute of Population Health, Minwaashin Lodge - The Aboriginal Women’s Support Centre, University of Ottawa

Traditional W05 Atikowisi miýw-ay¯awin, Ascribed Health and Wellness, to Kaskitamasowin Elm miýw-ay¯awin¯, Achieved Health and Wellness: Shifting the Paradigm 2nd Floor Madeleine Dion Stout, Elder

Food security / W06 Evaluation of “Community-Led Food Assessment for Inuit Communities” model St. Patrick nutrition aimed at assessing and addressing Food Security in Inuit Communities South Kristeen McTavish, Chris Furgal, Shantel Popp, Vinay Rajdev, Kristie Jameson 3rd Floor Trent University, Nasivvik Centre for Inuit Health and Changing Environments, Trent University, Food Security Network of Newfoundland and Labrador

Cultural Safety WO7 “Don’t bother him, he’s probably just drunk”: Advancing Indigenous Cultural Colony Competency training in Ontario Ballroom Vanessa Ambtman-Smith, Guy Hagar 2nd Floor Provincial Aboriginal LHIN Network (PALN) South West Local Health Integration Network, Southwest Ontario Aboriginal Health Access Centre (SOAHAC) INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 15

10:30 Workshop Session #1 Room

Health Systems W08 There Are Good Things Done Under the Midnight Sun Armoury Julie Lys, NP, Laura Lee Evoy, RN, Bandy Thompson, RN 2nd Floor Fort Smith Health & Social Services Authority / Aboriginal Nurses Association of Canada, Fort Smith Health & Social Services Authority

Nursing W09 Collaborating for Cultural Safety in Nursing Education St. Patrick North Vivian Recollet, Pamela Walker Native Men’s Residence, Lawrence S. Bloomberg Faculty of Nursing University of Toronto 3rd Floor

Respiratory / W10 Heart and Stroke Foundation’s Indigenous Health Strategy St. George cardio / Lesley James, Ratsamy Norman Pathammavong rd chronic disease 3 Floor Heart and Stroke Foundation

11:30 Speaker TBA: National Aboriginal Women’s Association Missing and Murdered Indigenous Women ...... Colony Ballroom 12:30 Lunch and Posters ...... Colony Ballroom / Documentary Civilized to Death will be shown over lunch in the ballroom ...... Giovanni Room * courtesy of Ms. Kimlee Wong, Researcher Writer, APTN

1:30 Oral Presentations Room

Women’s Health O01 Gettin’ F.O.X.Y.: Exploring the Development of Self-Efficacy among Young Women in Lombard (including the Northwest Territories Using an Arts-based Sexual Health Intervention Reproductive 2nd Floor Candice Lys and Violence) Institute for Circumpolar Health Research

O02 Missing and Murdered Aboriginal Women Nicole Johnstone Sherbourne Health Centre

O04 Internal and External “Risk” Constructions as Barriers to Birthing Choices for Indigenous Women: Findings from a Comparative Study in Northwestern Ontario Pamela Wakewich, Kristin Burnett, Martha Dowsley, Helle Moeller Departments of Indigenous Learning, Anthropology & Geography, Health Sciences, Sociology, Women’s Studies, and Centre for Rural and Northern Health Research, Lakehead University INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 16

Oral Presentations Room

Women’s Health O05 Adapting HOME VISITING PROGRAMS in Aboriginal communities -Lessons learned St. Patrick (including from implementation North Reproductive Faisca Richer, Michèle Boileau-Falardeau and Violence) 3rd Floor Institut national de santé publique du Québec, Agence canadienne de santépublique and O06 Spirit Runner: An activity app for Aboriginal youth Children’s Health Don Patterson Every Kid Deserves a Chance Inc.

O07 Bridging the Knowledge Gap: A North-South Collaboration Marika Bellerose, Vera Nenadovic Health Canada - First Nations and Inuit Health Branch, Hospital for Sick Children

O08 Healthy Teeth, Healthy Lives: Steps to Improve Inuit Children’s Oral Health Tanya Nancarrow, Anna-Claire Ryan Inuit Tapiriit Kanatami

Mental Health O09 Methadone overdose death: Case study of a 52 year old Métis woman St. David North (including Lynn F. Lavallee, Kelly A. Fairney Substance 3rd Floor Abuse) Ryerson University O10 ITS TIME: Indigenous Tools and Strategies on Tobacco Interventions Peter L. Selby, Rosa C. Dragonetti CAMH, CAMG

O11 Getting something out of (close to) nothing: self-designed Indigenous mental health learning experiences Alex Drossos McMaster University, Department of Psychiatry and Behavioural Neurosciences

O12 Building Virtual Communities to End Isolation Peggy A. Shaugnnessy Whitepath Consulting INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 17

Oral Presentations Room

Infectious O14 Root Cause Analysis of Premature Deaths in the Aboriginal Population in Toronto Colony Disease Ballroom Chandrakant Shah, Rajbir Klair, Allison Reeves and Anishnawbe Health Toronto, Private Practitioner 2nd Floor

Determinants O16 Determinants of Sexual Health in a Northern Cree Community of Health Dionne Gesink, Lana Whiskeyjack, Terri Suntjens, Alanna Mihic, Sherri Chisan (housing, poverty, etc.) University of Toronto, Dalla Lana School of Public Health, Blue Quills First Nations College O13 The Outreach Planning & Exchange Network for HIV/STBBI Prevention Programs: An Overview Rick Harp National Collaborating Centre for Infectious Diseases (NCCID)

O15 Supporting Aboriginal Health Care Needs Through an Aboriginal Employment Program Steve Sxwithul’txw, Rod O’Connell Island Health (Vancouver Island Health Authority)

Determinants O19 Exposure to methylmercury by consumption of fish and the risk for neurotoxicity in St. David of Health the developing fetus at Walpole Island First Nation - changes from 1975 to 2014 South (housing, Judy Peters, Gideon Koren, Michael J. Rieder, Mary Jane Tucker, Rosemary Williams, Dean Jacobs, poverty, etc.) 3rd Floor Phaedra Henley, Katherine Schoeman, Regna Darnell, Christianne V. Stephens, Carol P. Herbert, and Chandan Chakraborty, Bradley A. Corbett, Charles G. Trick, John R. Bend Chatham-Kent Community Health Centre, Walpole Island Office, Walpole Island Health Centre, Environmental Walpole Island Heritage Centre, Departments of Medicine, Paediatrics, Pathology, Physiology, Health Pharmacology, Anthropology, Social Sciences, Pathology, Family Medicine, Biology, and Science, Interfaculty Program in Public Health, Siebens-Drake Medical Research Institute, Schulich Medicine & Dentistry, Western University; Ivey School of Business, Western University; Department of Anthropology, McMaster University

O18 Enhancing Traditional, Healthy Food Skills in an Urban Aboriginal Community Jaime Cidro, Tabitha Martens University of Winnipeg, University of Manitoba

O20 Provision of Sleep Apnea Care in Saskatchewan: Policy Complexities Related to Registered Indian Status Tarun Katapally, Caroline Beck, Gregory P. Marchildon, Jo-Ann Episkenew, Sylvia Abonyi , Punam Pahwa, Mark Fenton, James Dosman Department of Community Health and Epidemiology, University of Saskatchewan, Johnson-Shoyama Graduate School of Public Policy, University of Regina, Indigenous Peoples’ Health Research Centre, University of Regina, College of Medicine, University of Saskatchewan, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 18

Oral Presentations Room

Health Care O21 Reducing the Gap: Robotics technology increases access for patients in St. Lawrence Systems Northern Saskatchewan 3rd Floor and Ivar Mendez, Veronica McKinney University of Saskatchewan - also a presenter, University of Saskatchewan Cultural Competency O22 Institutional incompleteness in the urban Aboriginal health service infrastructure and Safety Kian Madjedi, Kevin FitzMaurice Laurentian University

O26 Wellness in our own words: Understanding the interconnected elements of Indigenous health through partnerships Kian Madjedi Laurentian University of Sudbury

O23 Aboriginal Cultural Safety Initiative Chandrakant Shah, Allison Reeves Anishnawbe Health Toronto

Cultural O24 Talking About Change: Understanding Colonial Rhetoric St. George Competency Pamela Walker and Safety 3rd Floor Lawrence S Bloomberg Faculty of Nursing, University of Toronto and O25 Enhancing Supportive Decision Making For Aboriginal Patients and Family Members Traditional Jenny Lynn Morgan, Anita Ho, Kim Taylor Ways and Self- determination University of British Columbia O27 Cultural continuity is protective against diabetes in Alberta First Nations Richard Thomas Oster, Angela Grier, Rick Lightning, Mari Mayan, Ellen Toth University of Alberta, Piikani Blackfoot Nation, Ermineskin Cree Nation

O28 Self-Determination in First Nations Communities Angela Mashford-Pringle University of Toronto INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 19

Oral Presentations Room

Traditional O29 Mino-bimaadiziwin: Re-honoring the relational roots of Indigenous food sovereignty Armoury Ways and Self- Michelle Daigle determination 2nd Floor University of Washington

O30 The Toronto Aboriginal Health Advisory Circle: The Development of An Innovative Model of Self Determination Ellen M. Blais Toronto Central Local Health Integration Network , Toronto Central Lhins

O32 Nehiyaw Pimatisiwin: Sharings from Onihcikiskowapowin - Cultural interventions from a community-based research partnership with the University of Toronto James Makokis, Alsena White Saddle Lake Health Care Centre, Saddle Lake Cree Nation

O31 wahkomakanak: Relationships and Language as Medicine Lana Whiskeyjack, Dionne Gesink, Alanna Mihic, Priscilla McGilvery Saddle Lake Cree Nation, University of Toronto, Blue Quills First Nations College

Indigenous O34 Community Based Participatory Research as a Path to Build Resilience Elm Research and Kevin Donald Willison Population 2nd Floor Health Data Lakehead University O36 Telling Our Stories: Population Health Surveillance in Unama’ki Elaine Allison, Darlene Anganis, Stacey Lewis, Jennifer MacDonald, Sharon Rudderham, Laurie Touesnard Wagmatcook Health Centre, Membertou Wellness Home, Tui’kn Partnership, Waycobah Health Centre, Eskasoni Health Centre, Potlotek Health Centre

O35 Letting the Body Tell Its Story: Using Body Mapping and Hazard Mapping as Visual Representations of Community Well-Being in Indigenous Health Research Christianne V. Stephens, Linda Lou Classens York University, Walpole Island First Nation

2:30 Break 2:45 Dr. Janet Smylie Resisting Exclusion – Understanding and Supporting Métis Growth and Empowerment ...... Colony Ballroom 3:30 Refreshment Break with Posters and Exhibits INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 20

3:45 Workshop Session #2 Room

Mental Health W12 Homeless and Hopeless: An examination of Toronto’s Health and Addiction Services St. David North for Indigenous homeless peoples and what can be done to improve them 3rd Floor Suzanne Lea Stewart, Nicole Estella Elliott Ontario Institute for Studies in Education/ University of Toronto

Determinants W13 The Work of Frontiers Foundation of Toronto Elm of Health Jim Bacque, Lawrence Gladue, Marco Guzmana, Don Irving 2nd Floor Frontiers Foundation of Toronto

Traditional W14 Wii Kwan De Taa (Bringing People Together for a Sacred Purpose St. David South Lori Flinders Fort Frances Tribal Area Health Services 3rd Floor

Inuit W15 More than medicine: on being an ally and a physician advocate in Nunavut St. Patrick North Madeleine Cole Qikiqtani General Hospital 3rd Floor

Respiratory/ W17 A History of Dying at Home From Pre-European Times to the Present Palliative and St. George cardio/ End of Life Care Era chronic 3rd Floor Dean Walters disease Central East Community Care Access Centre

Equity W18 Jurisdiction as a Determinant of First Nations Health Care Lombard Stephanie Ann Sinclair, Amanda Meawasige 2rd Floor Assembly of Manitoba Chiefs

Education W19 I honestly don’t think I learned anything about Indigenous peoples: Understanding St. Patrick medical school preceptors’ and students’ current knowledge and attitudes towards South Indigenous peoples and Indigenous health 3rd Floor Heather Castleden, Debbie Martin, Jeff Denis, Paul Sylvestre Queen’s University, Dalhousie University, McMaster University

Research W20 Respondent driven sampling (RDS) as a tool for urban Aboriginal health assessment Armoury and community engagement in Ontario, Canada 2nd Floor Michelle Firestone, Janet Smylie, Sara Wolfe, Constance McKnight Well Living House, Centre for Research on Inner City Health, St. Michael’s Hospital, Seventh Genera- tion Midwives Toronto , De dwa da dehs nye>s Aboriginal Health Centre

Children’s Health W60 The Atii! Health living intervention improves knowledge, builds cultural skills and Lawrence strengthens intergenerational bonds among Inuit children, youth and families in the Nunavut 3rd Floor Gwen Healey, Shirley Tagalik, Tracey Galloway Qaujigiartlit Health Research Centre (AHRNNU), Arviat Health committee, University of Manitoba INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 21

4:30 Break ......

4:45 Workshop Session #3 Room

Health Systems W21 Community health worker models: International best practices and their application Elm to remote First Nations communities 2nd Floor Ben Chan, Janet Gordon, Sumeet Sodhi University of Toronto, Sioux Lookout First Nations Health Authority, Dignitas International

Mental Health W22 An Indigenous Model of Effective Community Mental Health Services Lombard Germaine Frances Elliott, John Rice 2nd Floor Enaahtig Healing Lodge, Simcoe County Canadian Mental Health Association

Children’s Health W23 Lower Respiratory Tract Infections in Inuit Children St. Patrick North Dr. Anna Banerji Department of Paediatrics and Dalla Lana School of Public Health, University of Toronto 3rd Floor

Traditional W24 Understanding Tobacco Use Amongst Youth in Four First Nations Armoury Sheila Cote-Meek, Sonia Isaac-Mann 2nd Floor Laurentian University, Assembly of First Nations

Inuit W25 Social Determinants of Inuit Health St. David North Anna Fowler 3rd Floor Inuit Tapiriit Kanatami (ITK)

Cancer W26 Reducing inequalities in cancer for Ontario First Nations: St. Lawrence From surveillance to action 3rd Floor Loraine Marrett, Diane Nishri, Amanda Sheppard, Anna Chiarelli, Alethea Kewayosh Cancer Care Ontario, Hospital for Sick Children

Cultural Safety W27 Is cultural safety enough? Confronting racism to address inequities in St. George Indigenous health 3rd Floor Barry Lavallee, Linda Diffey, Thomas Dignan, Paul Tomascik University of Manitoba, First Nations and Inuit Health Branch, Health Canada, Royal College of Physi- cians and Surgeons of Canada

Equity W28 Manitoba First Nations Indicators of Wellbeing St. Patrick South Leona Star, Kathi Avery Kinew Assembly of Manitoba Chiefs 3rd Floor

Education W29 Come walk in our mocassins: Strategies in Recruitment, Admissions and St. David Curriculum at the Aboriginal Program at the University of Ottawa South Darlene Janet Kitty 3rd Floor Aboriginal Program, Faculty of Medicine, University of Ottawa INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 22

Workshop Session #3 Room

Research W30 Creating a First Nations health data repository in Ontario by linking the Indian Carlton Register to ICES health administrative data: a collaborative governance process that protects the interests of First Nations 2nd Floor David Henry, Tracy Antone, Carmen Jones, Saba Khan Institute for Clinical Evaluative Sciences, Chiefs of Ontario

5:30 Reception ...... Colony Ballroom 7:00 Adjourn INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 23

Program Agenda Friday, November 21, 2014

8:00 Communities to Researchers Advocacy Breakfast Discussion Chaired by Vanessa Ambtman-Smith and Dr. Lisa Richardson ...... Colony Ballroom

9:00 Natan Obed: Improving Inuit Nunangat health outcomes - A call to action ...... Colony Ballroom

9:45 Dr. Angeline Letendre: Indigenous Nursing and Nursing Knowledge as Practice toward Improved Health and Wellness in First Nation, Inuit and Metis Communities ...... Colony Ballroom

10:30 Refreshment Break with Posters and Exhibits

11:00 Workshop Session #4 Room

Children’s Health W31 The Status of Oral Health among Canada’s First Nations Peoples and Inuit Colony Ballroom Amir Azarpazhooh, Dick Ito, Martin Chartier, Tracey Guitard, Hannah Tait Neufeld Faculty of Dentistry-University of Toronto, Faculty of Medicine-University of Toronto, Mount Sinai 2nd Floor Hospital, Public Health Agency of Canada, Thunder Bay District Health Unit and Simcoe Muskoka District Health Unit

Women’s Health W32 Trafficked: Why are Aboriginal Women at Increased Risk? St. David North Eileen McMahon 3rd Floor Mount Sinai Hospital

Children’s Health W33 No Jordan’s Principle Cases in Canada? The Truth and Politics of Disparities in Armoury Access to Health and Social Services for First Nations Children Living On-Reserve 2nd Floor Vandna Sinha, Anne Blumenthal, Molly Churchill, Lucyna Lach, Nico Trocme McGill University, University of Michigan

Traditional W34 An Investigation into some Contemporary Self-Regulatory Dynamics that Operate in St. Patrick and around First Nations Traditional Healing Systems South Julian Robbins 3rd Floor Independent Community Based Researcher

Environmental W35 The potential contribution of exposure to persistent organic pollutants (POPs) and Lombard of psychosocial stress to enhanced risk for Type 2 diabetes (T2D) at Walpole Island First Nation (WIFN) 2nd Floor John R. Bend, Rosemary Williams, Gideon Koren, Michael J Rieder, Mary Jane Tucker, Naomi Williams, Phaedra Henley, Julie Hill, Zahra Jahedmotlagh, Regna Darnell, Christianne V. Stephens, Stan Van Uum, Carol P Herbert, Chandan Chakraborty, Dean Jacobs, Judy Peters, Charles G Trick Walpole Island Health Centre, Departments of Medicine and Paediatrics, Schulich Medicine & Den- tistry, Western University, Walpole Island Heritage Centre, Department of Pathology, Department of Physiology & Pharmacology, Departments of Anthropology, Social Sciences and Pathology, McMaster University, Departments of Family Medicine and Pathology, Chatham-Kent Community Health Centre, Walpole Island Office, Department of Biology, Science and Interfaculty Program in Public Health, Siebens-Drake Medical Research Institute INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 24

11:00 Workshop Session #4 Room

Cancer W36 Addressing gaps in the continuity of cancer care with and for First Nations, St. Patrick Inuit and Métis living in rural and remote communities in Canada. North Colleen Patterson, Pam Tobin 3rd Floor Canadian Partnership Against Cancer

Cultural Safety W37 Clinical tips for culturally-safe care: A new Consensus Guide for Health St. George Professionals working with First Nations, Inuit and Métis 3rd Floor Alisha Nicole Apale SOGC

Social work W39 Rahskwahseron:nis – Building bridges with Indigenous communities through Elm decolonizing social work education 2nd Floor Michael Loft, Nicole Ives, Courtney Montour McGill University, School of Social Work

Research W40 Storytellers as Public Health Facilitators St. Patrick South Joahnna Kathleen Berti, Jeanette Levall, David Osawabine Debajehmujig Storytellers 3rd Floor

11:45 Lunch and Posters Documentary Rivers of Hope: “Bringing health to indigenous communities in the Orinoco and the Amazon in Colombia” will be shown over lunch ...... Colony Ballroom / Giovanni Room

*courtesy of Pan American Health Organization (PAHO/WHO), funded by the Canada- Foreign Affairs, Trade and Development Department.

1:00 Genocide: The Canadian Perspective Panel Dr. Michael Dan, Chief Phil Fontaine, Mr. Bernie M. Farber ...... Colony Ballroom

2:15 Workshop Session #5 Room

Substance Abuse W41 Prescription Drug Misuse - Looking at Prevention in Indigenous Communities Armoury through a Population Health Lens 2nd Floor Cheryl Currie University of Lethbridge

Women’s Health W42 Beyond The Womb: Encouraging healthy pregnancies through cultural reconnection St. Lawrence Ashley Lamothe, Roslynn Baird 3rd Floor Southern Ontario Aboriginal Diabetes Initiative INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 25

Workshop Session #5 Room

Children’s Health W43 Issues in service delivery to Canadian First Nations, Métis, and Inuit children with St. George speech and language difficulties 3rd Floor Alice A. Eriks-Brophy, Francis Lori-Anne Davis-Hill, Jacqueline Dawn Smith, Laura Todd Hunter Leah Rae Radziwon University of Toronto, Six Nations Health Services

Traditional W44 Teaching cultural competence in the federal government - the Indigenous St. David North Community Development course 3rd Floor Rose LeMay First Nations and Inuit Health Branch, Health Canada, FNIHB or Aboriginal Affairs and Northern Development Canada

Environmental W45 Uranium Mining and Health: Facts, Figures and Questions St. Lawrence Dale M. Dewar 3rd Floor Society of Rural Physicians of Canada

Respiratory / W46 Respiratory health in First Nations, Inuit and Métis communities: Colony cardio / Raising awareness through community outreach and engagement Ballroom chronic Jennifer Dawn Walker, Oxana Latycheva, Wayne Warry disease 2nd Floor Nipissing University, Ontario Lung Association, Centre for Rural and Northern Health Research

Cultural Safety W47 A new way of looking at good practices in Aboriginal communities: The Canadian St. David Best Practice Initiative’s Aboriginal Ways Tried and True Methodological Framework South Nina Jetha, Lori Meckelborg, Andrea L.K. Johnston, Steve Jreige 3rd Floor Public Health Agency of Canada, Johnston Research Inc.

Health Systems W48 Back to Moss: Developing and Integrating Public Health Services for St. Patrick Northern Ontario First Nations Communities North Janet Gordon, Emily Paterson 3rd Floor Sioux Lookout First Nations Health Authority

Midwifery W49 Aboriginal Midwifery: Aboriginal Midwives working in Every Aboriginal Community St. Patrick South Ellen M. Blais Association of Ontario Midwives 3rd Floor

Research W50 Addressing health inequalities by Indigenizing health services and research Lombard Julie Bull 3rd Floor University of New Brunswick

3:00 Refreshment Break with Posters and Exhibits INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 26

3:15 Workshop Session #6 Room

Respiratory / W51 Embedding First Nations approaches into the prevention and management of Armoury cardio / chronic disease chronic 2nd Floor Shannon Tania Waters disease First Nations Health Authority

Substance Abuse W52 Honouring Our Strengths: Indigenous Culture as Intervention in Addictions Treatment Colony Ballroom Colleen Dell, Carol Hopkins, Peter Menzies University of Saskatchewan, National Native Addictions Partnership Foundation (NNAPF), CAMH 2nd Floor

Women’s Health Shared Workshop Lombard W53 The Aboriginal Women’s Health Intervention: What is the potential for 2nd Floor contributing to social change? Colleen Varcoe, Jane Inyallie, Linda Day, Madeleine Dion Stout, Holly MacKenzie, Annette Browne, Marilyn Ford-Gilboe University of British Columbia, Central Interior Native Health, Vancouver Native Health Society, University of Western Ontario

W59 Solidarity not appropriation: How non-Indigenous healthcare providers and organizations can support Indigenous women’s reproductive justice and sovereignty Holly A. McKenzie University of British Columbia

Food security / W54 Use-and-Occupancy Mapping: A tool to support food security in St. Lawrence nutrition aboriginal communities 3rd Floor Daniel Tobias D. Tobias Consulting Inc.

Cultural Safety W55 A Journey to Cultural Competency and Safety: Highlights of IPAC-AFMC St. David North Collaborative Activities 3rd Floor Darlene Janet Kitty Indigenous Physicians Association of Canada

Midwifery W56 Revolutionary Care: Indigenous Midwifery St. Patrick North Cheryllee Bourgeois, Billie Allan Seventh Generation Midwives Toronto, Well Living House 3rd Floor

Research W57 Using record linkage to study chronic diseases in the Métis population in Ontario St. Patrick South David Henry, Storm J Russell, Wenda Watteyne, Saba Khan Institute for Clinical Evaluative Sciences and University of Toronto, Métis Nation of Ontario , Institute 3rd Floor for Clinical Evaluative Sciences INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 27

Social work W58 One Canoe, One Oar: Navigating mental health with our Indigenous youth, Elm a wholistic approach. 2nd Floor Ela Smith Wholistic Child and Youth

4:00 Break 4:15 Conclusion and Next Steps Dr. Anna Banerji ...... Colony Ballroom 4:30 Adjourn INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 28

Although many of Canada’s citizens rank high in these mea- Oral Abstracts sures, the aboriginal population does not; they continue to fare O01 poorly in indicators of health, education, and income. Aborigi- nal women deal with this harsh reality on a daily basis, in addi- (Abstract ID: 25) tion to higher rates of violence victimization than aboriginal THURS. NOV. 20 - 1:30PM-1:45PM males and non-aboriginal women. Historically, most of the Gettin’ F.O.X.Y.: Exploring the Development of research focused on domestic violence for aboriginal women; Self-Efficacy among Young Women in the however in 2013, a different situation came to light and the Northwest Territories Using an Arts-based Sexual RCMP totalled 1,181 missing and murdered aboriginal women Health Intervention in the past thirty years. Aboriginal female homicides were almost seven times higher than non-aboriginal females from Candice Lys 1997 to 2000.Inquests into the missing and murdered aboriginal Institute for Circumpolar Health Research women have been demanded by aboriginal leaders, families of the missing and murdered women, Amnesty International, and The sexual health of Northwest Territories (NWT) youth is a as a recommendation of the United Nations. Aboriginal women serious public health concern; thus, a social arts-based inter- remain at high risk of violence as a result of colonization, resi- vention that uses body mapping and drama techniques, named dential schools, systemic racism, and past and present issues with FOXY (Fostering Open eXpression among Youth) was devel- the justice system and police; yet the government maintains that oped to address the sexual health needs of young NWT women. they are proud of their human rights record. There is hope; This doctoral research is grounded in social cognitive theory the RCMP have made changes to policies and are focusing on and social ecological theory and uses a community-based programs for at risk communities. Knowledge is power; as indi- research approach, developmental evaluation methodology, viduals we can educate our young aboriginal men and women and the grounded theory method to develop a theory of how until further action is taken by the government to ensure the FOXY influences sexual behavior expectations among young safety of aboriginal women. women in the NWT, considering determinants that contextu- alize sexual health outcomes. The first aim explores the intra- personal and interpersonal contexts that influence the efficacy O03 and outcome expectations of female youth in the NWT. The WITHDR AWN second aim determines if and how a social arts-based intervention influences individual efficacy expectations regarding -sex O04 ual behaviors among female youth in the NWT. The third aim (Abstract ID: 159) determines if and how a social arts-based intervention influences individual outcome expectations regarding sexual behav- THURS. NOV. 20 – 2:15PM-2:30PM iors among female youth in the NWT. In Phase I, pilot test- Internal and External “Risk” Constructions as Barriers ing occurred with 6 female youth to improve interview guide to Birthing Choices for Indigenous Women: Findings design. Phase II entailed semi-structured interviews with 41 from a Comparative Study in Northwestern Ontario female youth aged 13-18 years selected via purposive sampling Pamela Wakewich, Kristin Burnett, Martha Dowsley, 3 days post-workshop. Data collection occurred until saturation Helle Moeller of new themes was reached at 6 study locations. A multi-stage thematic analysis is in progress using memoing and coding via Lakehead University, Dept. of Indigenous Learning, the grounded theory method. Front-line workers and research- Lakehead University, Depts. of Anthropology & Geography, ers can use the results to inform arts-based intervention pro- Lakehead University, Dept. of Health Sciences, Lakehead University, grams and research among other rural Arctic populations. Depts. of Sociology & Women’s Studies; and Centre for Rural and Northern Health Research O02 In recent years there has been a growing recognition of the (Abstract ID: 188) importance of repatriating birth to rural and northern Indige- nous communities (Couchie and Sanderson 2007) and increas- THURS. NOV. 20 - 1:45PM-2:00PM ing childbirth choices for both urban and rural Indigenous Missing and Murdered Aboriginal Women women (NAHO 2004). An ongoing challenge for Indigenous Nicole Johnstone women regarding care options and birth locations has been what Kornelsen and Mackie (2013, p.1) have described as “the clash Sherbourne Health Centre of clinical and social risk [constructions]” in the determination In 2001, Canada was named the best country to live in based of safety in pregnancy and childbirth. Racism and colonialism on health, education, life expectancy, and standard of living. in Canada have produced a picture of Indigenous women that INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 29 typically constructs them as high risk as a function of racial services provided, but it can come with challenges. Pro- and ethnic identity rather than the social, economic, political, viding flexible work patterns, ongoing training / mento- and historical factors that shape their lives. This construction ring as well as psychological support may help to improve has been internalized by many women and begun to inform staff retention and prevent compassion fatigue. The sup- their personal choices and self-identification about risk. The port provided should respect Aboriginal learning styles, as moral risk of being labelled an “irresponsible” mother impacts well as provide local workers with opportunities to thrive the ability of many women to resist “authoritative’ biomedical within the organization. knowledge (Hall et al. 2012) even when it may compromise their sense of integrity and cultural values. O06 Here we report on a comparative qualitative study exploring (Abstract ID: 63) birthing choices and experiences of Indigenous,migrant and THURS. NOV. 20 – 1:45PM-2:00PM Euro-Canadian women in Northwestern Ontario. We discuss the ways in which both clinical and social constructions of Spirit Runner: An activity app for Aboriginal youth “risk” positioned many of our Indigenous participants as high Don Patterson risk limiting their perceived and actual choices of caregiver. Every Kid Deserves a Chance Inc. Negotiating a low risk status and a wider range of childbirth choices was enhanced by peer and family supports and support- Spirit Runner was designed to encourage physical activity ive care providers. amongst Aboriginal youth, to help them maintain a healthy lifestyle and to honour Aboriginal culture. The app is FREE to O05 download on iTunes, FREE of advertisements and there is no collection of data. (Abstract ID: 94) The creation of Spirit Runner was based on extensive feed- THURS. NOV. 20 – 1:30PM-1:45PM back from Aboriginal youth and leaders. The youth also shared Adapting HOME VISITING PROGRAMS in the importance of developing an app to reflect their culture. In Aboriginal communities -Lessons learned from essence, they wanted the app to feel like it “belonged” to them. implementation The stunning artwork was created by Aboriginal artist, Jessica Faisca Richer, Michèle Boileau-Falardeau Desmoulin. Institut national de santé publique du Québec, Four user-friendly components Agence canadienne de santépublique Activity log: Records the activity with 32 to choose from. Can Awash (AMA) is a home visiting program aimed at pro- also be tracked with GPS, Step Counter and Timer. Email/text/ moting early childhood development, implemented by the tweet completed activities. A great tool for remote coaching. Cree Health Board (CHB) in three pilot communities. It Reminders: Set daily, weekly reminders. Pop-up box tells the includes local paraprofessionals as home visitors, as this has user it’s time to get active! been shown to be key to ensuring the continuity and cul- Motivations: Hundreds of inspirational quotes by athletes and tural safety of family support services. A process evaluation world leaders including many Aboriginal spokespeople (e.g. was conducted to understand the successes and challenges Chief Dan George, Billy Mills, Sun Bear). Favorites can be faced by the paraprofessionals in implementing home visits starred and emailed/texted/tweeted. in this context. Achievements: As more activities are completed, achievements Methods: We used a multiple case study design with qual- pop up to reward the user. itative analysis of staff interviews in all pilot communities. Individual in-depth interviews were conducted in English, Engaging youth through technology: The Spirit Runner app French or Cree with a total of 44 staff members. Data was is accessible, useful and fun to use. Youth today are bombarded analyzed through thematic analysis with NVivo10 soft- with distractions that are increasingly non-active. Spirit Run- ware. A participatory approach was used for data collec- ner’s technology engages young minds and encourages them to tion and analysis. continue an active lifestyle. Results: Paraprofessional workers face challenges when Website: www.spiritrunnerapp.com implementing home visiting programs at the personal and Twitter: @spiritrunnerapp organizational levels (see figures 1 and 2) Discussion and implications for practice: Employing local Indigenous staff in an early childhood development program can have a positive impact on the cultural safety of INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 30

O07 improve oral health among Inuit. This presentation will outline child-focused solutions to improve oral health and will aim (Abstract ID: 170) to promote understanding around the scope of the oral health THURS. NOV. 20 – 2:00PM-2:15PM issue for Inuit children in Canada; the key factors impacting Bridging the Knowledge Gap: A North-South the issue; and the current and potential models of collaboration Collaboration among key stakeholders and the collective actions that aim to address the issues, including Inuit-specific oral health promo- Marika Bellerose, Vera Nenadovic tional materials and initiatives from Inuit regions. Health Canada - First Nations and Inuit Health Branch, The Hospital for Sick Children O09 Changes in treatment in subspecialties such as Paediatric Neu- (Abstract ID: 40) rology are not quickly disseminated to community-based health THURS. NOV. 20 – 1:30PM-1:45PM care providers creating a disparity between children with easy access to quaternary care teaching hospitals and those without. Methadone overdose death: Case study of a 52 year old In remote parts of Northwestern Ontario, health care profes- Métis woman sionals working in isolated First Nations communities are gen- Lynn F. Lavallee, Kelly A. Fairney eralists by necessity. Maintaining currency of the generalist’s Ryerson University broad based knowledge in such settings is burdensome. In 2013, the Sioux Lookout First Nations Health Authority and nurses Methadone maintenance treatment programs (MMT) were from Health Canada, First Nations and Inuit Health Branch designed as a harm reduction strategy to address the harms of in the Sioux Lookout Zone partnered with the Division of heroin injection. Currently, many people on MMT are not Neurology at Sick Kids to create a pilot series of lectures based injecting street level heroin. Rather, many have found them- on learning needs. Education delivery by powerpoint, fax and selves addicted to opioids after prescription use of narcotics. teleconference was tailored for wide community access. Edu- Although there are federal and provincial regulations about cational content was tailored in context of availability of diag- MMT, there are still instances of methadone overdose and nostic resources. An iterative process of education delivery, death. Unfortunately, these overdoes and deaths are occurring feedback and revision of content is envisioned to make a sus- in Aboriginal communities at an alarming rate. Some of these tainable outreach education program. This workshop presents overdoses and deaths have been the result of individuals taking the experience of this partnership with paediatric neurology as a someone else’s methadone (carry) but others occur during the template model of outreach education for subspecialty services. first two weeks of attending a methadone clinic. This presentation will explore the case of a 52 year old Mètis woman who O08 passed on to the spirit world after attending a methadone clinic for 10 days and receiving a lethal dose of methadone. The pre- (Abstract ID: 144) sentation will highlight the statistics related opioid addiction THURS. NOV. 20 – 2:15PM-2:30PM and methadone overdose within Mètis, Inuit and First Nations Healthy Teeth, Healthy Lives: Steps to Improve Inuit communities and provide an overview of the Health Canada- Children’s Oral Health Best Practices for MMT and the Ontario Standards and Clin- ical Guidelines. The unfortunate circumstances of this Mètis Tanya Nancarrow, Anna-Claire Ryan woman’s life will inform how further measures can be put in Inuit Tapiriit Kanatami place to ensure harm reduction strategies are actually reducing For Inuit children in Canada, access to regular dental care is harm versus causing death. The presentation will be of interest inconsistent, including for both treatment and prevention. to a wide range of practitioners and advocates working with the Inadequate funding arrangements, jurisdictional issues, poor Aboriginal community. nutrition, and difficulty in recruiting and retaining oral health service providers mean ongoing challenges in achieving an O10 acceptable oral health standard. The 2008-2009 Inuit Oral (Abstract ID: 77) Health Survey highlighted the need for urgent and compre- THURS. NOV. 20 – 1:45PM-2:00PM hensive measures to overcome the unacceptably high rate of oral disease among Inuit. In response, Inuit Tapiriit Kanatami ITS TIME: Indigenous Tools and Strategies on (ITK) and the Inuit Land Claim Organizations created Healthy Tobacco Interventions Teeth, Healthy Lives: Inuit Oral Health Action Plan to share Peter L. Selby, Rosa C. Dragonetti with the Canadian oral health community, including all lev- CAMH, CAMG els of government, the Inuit perspective on what is needed to INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 31

There is a growing recognition of the need for culturally com- to northern Ontario remote First Nations; and another rota- petent health services, including smoking cessation treatment. tion in Iqaluit this time specifically in psychiatry. In addition, Frontline workers are concerned about high smoking rates in I have also included policy and research activities related to their communities and requested more culturally safe materials Indigenous mental health whenever possible, which have been that would resonate with Aboriginal colleagues and clients. A numerous and have expanded my learning beyond the role of network of Aboriginal frontline workers, health care profes- Medical Expert, to include Advocate, Collaborator, Manager sionals, educators and Elders formed an Engagement Circle to and Scholar. Finally, ongoing reading of published journal arti- create content that is owned, controlled, and fully possessed and cles, clinical books, ethnocultural books and literature (includ- accessible by Aboriginal peoples. ITS TIME has retooled evi- ing film) have been an important part of my education. Though dence-based approaches to reflect Aboriginal ways of learning, my experiences have focused on mental health, these kinds of knowing, healing and recovery. opportunities could be easily applied to any other area of medi- ITS TIME TOOLKIT is a resource that can be used by health cine or the health sciences. care professionals and frontline workers to help their clients address their commercial tobacco use. Some of the components O12 and strategies included in the toolkit include: (Abstract ID: 248) Making tobacco ties and other craft-making activities. Tradi- THURS. NOV. 20 – 2:15PM-2:30PM tional tobacco teachings from an Elder and fact sheet. Narra- Building Virtual Communities to End Isolation tive healing through sharing and quit journey stories (testimo- nial recordings from community members and Elders). Group Peggy A. Shaugnnessy activities, trivia cards and facilitation summary sheets. This Whitepath Consulting workshop will engage participants by practicing various com- The Aboriginal population is the youngest and fastest growing ponents of the toolkit. We will demonstrate how the toolkit can segment of Canada’s population, yet the children are among the be used in both group and individual settings. Participants will most disadvantaged of all children in the country and struggle be able to: (1) Discuss the various strategies for smoking cessa- for rights that come more easily to non-Aboriginal children. tion (2) Use the toolkit to deliver smoking cessation to their Almost all of the “air access” only First Nation communities clients. in Ontario are located in the north. Isolation is a challenge for O11 remote communities, as is access to quality health care National rates of suicide among Aboriginal youth are estimated (Abstract ID: 243) to be five to seven times higher than among non-aboriginal THURS. NOV. 20 – 2:00PM-2:15PM youth. There is a lack of consistent mental health services for Getting something out of (close to) nothing: self-de- those living in remote communities. Where drug and alcohol signed Indigenous mental health learning experiences dependencies continue to be problematic. Alex Drossos Redpath is launching the first social network for those struggling with mental illness and addiction. Building on our highly McMaster University, Department of Psychiatry and Behavioural successful offline model, the online social platform delivers real- Neurosciences time access to those in need. Redpath enables participants to Even in a large University Psychiatry program in southwestern develop the skills they need to face their own daily challenges Ontario there are few formal opportunities for clinical rotations via a series of assignments and interactions with other online in Indigenous Mental Health. However, when one is resource- participants. The network is designed to be a flexible option ful and motivated, there are many ways to create a variety of for anyone who is struggling in their life, and is entirely anon- learning experiences. For me personally, these began as a clini- ymous, ensuring that users feel safe enough to remove their cal clerk when I completed Family Medicine electives in Iqaluit, masks and approach the process truthfully. Redpath is a vir- Nunavut and Churchill, Manitoba and in Suicide Prevention in tual community that aims to end isolation. The program allows Ottawa, which included policy and prevention work through people in similar situations to share their experiences and build the National Aboriginal Health Organization and Inuit Tapi- awareness that others are working through the same issues. riit Kanatami. Once in residency, I began to seek out further opportunities within psychiatry. These have included spending time at an urban Aboriginal health centre with psychiatry staff and traditional healers; working in the Aboriginal services program at a tertiary care psychiatric facility; longitudinally spending 1-2 days per week at an outpatient mental health clinic in a large reserve; conducting telepsychiatry assessments INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 32

O13 economic integration, as well as securing access to public services. The data review over this period corroborates this analy- (Abstract ID: 199) sis and demonstrates its fatal consequence: a significantly lower THURS. NOV. 20 – 1:30PM-1:45PM life expectancy for Aboriginal Canadians. The root causes of The Outreach Planning &Exchange Network for HIV/ which can be traced back to the forced assimilation of Aborigi- STBBI Prevention Programs: An Overview nal peoples through the residential school system. The intergenerational health impact of Canada’s colonial legacy perpetuates Rick Harp conditions impacting the health of Aboriginal Canadians. National Collaborating Centre for Infectious Diseases (NCCID) A project of the National Collaborating Centre for Infectious O15 Diseases (NCCID), the Outreach Planning & Exchange (Abstract ID: 202) Network (OPEN) is a set of free on-line tools primarily aimed THURS. NOV. 20 – 2:00PM-2:15PM at frontline HIV/STBBIoutreach programmers. Supporting Aboriginal Health Care Needs Through an These tools include i)a public database of outreach programs, Aboriginal Employment Program ii) a public database of program evaluation indicators, plus iii) a confidential knowledge exchange forum for programmers Steve Sxwithul’txw, Rod O’Connell interested in further communication/collaboration. Island Health (Vancouver Island Health Authority) This workshop will offer a basic overview of OPEN, including Employment has long been known to be a social determinant how to use the Network to locate other outreach programs and of health. Island Health (Vancouver Island Health Authority)has their indicators, plus sign up and post a program profile of your embarked on a long term Aboriginal employment strategy with own. a view to achieving a representative workforce by the year 2020. Island Health sees the current and future Aboriginal workforce O14 as an untapped resource that will help meet our workforce needs (Abstract ID: 57) as well as assist in providing quality, culturally appropriate care to our Aboriginal clients. Through our 4 person Aboriginal THURS. NOV. 20 – 1:45PM-2:00PM employment team Island Health is building relationships of Root Cause Analysis of Premature Deaths in the trust with Aboriginal communities, attracting Aboriginal youth Aboriginal Population in Toronto to the full spectrum of health care careers, enhancing job seeker Chandrakant Shah, Rajbir Klair, Allison Reeves skills and increasing Aboriginal organizational awareness, as we move towards our representative workforce goal. Anishnawbe Health Toronto, Private Practitioner In this session participants will learn about Island Health’s This study on premature deaths in the Aboriginal community award winning (Canada’s Best Diversity Employers award - combines a quantitative chart review, and qualitative narrative 2013, 2014 and Simon Fraser University Exemplary Initiative analysis conducted at Anishnawbe Health Toronto (AHT). Diversity Award - 2013) Aboriginal Employment Program and By providing insight in to the social issues among the urban the”5 Pillars” that guide the organization’s journey to becom- Aboriginal community from a personal, interview-based per- ing an Aboriginal employer of choice on Vancouver Island and spective, the study aims to identify the root causes of the com- in the healthcare labor sector. munity’s premature death rates. Since June 2011 Island Health has hired approximately 260 new Data collection occurred between 2008-2011 by review of Aboriginal employees and currently has nearly 500 employees medical charts of the deceased at AHT along with data provided who have self identified as being of Aboriginal descent. For the by three other social services. Interviews with those familiar last 2 year our Aboriginal employee turnover rate is lower than with the deceased were conducted. The numbers of deceased the organizational turnover rate. totaled 109 and twenty interviews were conducted. Interview- ees contributed details into the personal and social tragedies Island Health is the 4th largest health care employer in B.C. and indicated by the data. the largest employer on Vancouver Island with ~19,000 staff.” The results of our data show the average age at time of death to be 38 years of age among this group of Aboriginals. The interviews conducted demonstrate the inequality in many social determinants of health such as poverty, unemployment, discrimination, lack of access to adequate resources and housing. The qualitative research shows us that Aboriginal people moving to cities face many challenges - challenges of social and INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 33

O16 O17 (Abstract ID: 217) (Abstract ID: 242) THURS. NOV. 20 – 2:15PM-2:30PM THURS. NOV. 20 – 1:30PM-1:45PM Determinants of Sexual Health in a Northern Addressing the “need’ for sustainable food security Cree Community initiatives: Evaluating the role of a community Dionne Gesink, Lana Whiskeyjack, Terri Suntjens, freezer in Hopedale, Nunatsiavut in supporting Alanna Mihic, Sherri Chisan Inuit food security University of Toronto, Dalla Lana School of Public Health, Emily Willson, Chris Furgal Blue Quills First Nations College Trent University The Saddle Lake Cree community is a large First Nations Rooted in Inuit culture are preferences for wild foods that come community in northern Alberta reporting sexually transmit- from their local environments. These food preferences are criti- ted infection (STI) rates three to six times higher than neigh- cal for providing Inuit with nutritious food, and for connecting bouring Aspen regional health authority (non-First Nations) in Inuit to their environment, which supports their cultural iden- 2009. Our intention was to learn about sexual health at the tity, and health. However, changes in their social and physical community level to inform restoration activities at the individ- environments are challenging the use and availability of these ual and community levels. foods, and in part, accounting for the higher rates of food inse- We used the Whiskeyjack method of interviewing, an indig- curity Northern populations, such as those in the region of Nun- enous relational research method. Participants were identified atsiavut (Labrador) are experiencing. To address food insecurity, and recruited through a network of relationships. Consenting food support initiatives need to address individual requirements participants were invited to participate in an activity (e.g. cook- for food while supporting a sustainable and culturally preferred ing together) while being interviewed using an unstructured, food system. This requires developing an understanding of both visiting interview style. STI data was shared with participants the food security needs within a community, and the ability of and they were then asked why they thought STI rates were high services and environment to support them. Objective measures in the community. Interviews were recorded and transcripts of the physiological needs (nutrient and caloric intakes) for food analyzed for core and related concepts. are commonly understood, but there is limited information regarding the preferred social and cultural requirements that are We interviewed 25 community members in the fall of 2010. also key components of food security status, as recognized needs The core concept identified is that HIV and other STIs are a surrounding rights to food in many conceptualizations of food physical manifestation of widespread mental, emotional, and security, and also as elements recognized in Land Claims agree- spiritual trauma experienced through misuse and abuse of ments, such as Nunasiavuts’. Using mixed-methods of one- power in relationships. Related concepts included that the med- on-one interviews, and a community-wide survey, data on the icine wheel is out of order because historic trauma resulting in nature and diversity of food “needs” and the use of food support loss of knowledge, practice, roles, responsibilities and mentor- programs within Hopedale will be collected. By adding to our ing; disconnect and detachment, whether externally or inter- understanding of the different needs for food, results from this nally imposed, leads to relationship, blame, responsibility and study will help inform the process of developing or improving addiction shifting; an environment of fear, abandonment and community level solutions to food security issues. isolation has led to inadequate support for change; drugs, alcohol and sex co-occur but are not necessarily causally associated O18 - rather being symptoms of poverty and trauma and perceived as medicine. (Abstract ID: 86) THURS. NOV. 20 – 1:45PM-2:00PM Enhancing Traditional, Healthy Food Skills in an Urban Aboriginal Community Jaime Cidro, Tabitha Martens University of Winnipeg, University of Manitoba Purpose: Urban Indigenous people face food insecurity from limited quantities of healthy and affordable food, to limited access to traditional food. Food security, while a separate concept from food sovereignty, is certainly aligned. Within an Indigenous context, IFS is contextualized in remote, rural communities. Food insecurity also exists for urban Indigenous INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 34 communities. This research explores how to operationalize IFS Department of Pathology, Siebens-Drake Medical Research Institute, principles and practice with urban Indigenous people in Winni- Schulich Medicine & Dentistry, Western University peg through traditional, healthy food skill building. An estimated 400 tonnes of mercury were released into the St. Methods: An initial series of focus groups and interviews were Clair River, upstream from the Walpole Island First Nation held identifying how urban Indigenous people worked towards (WIFN).High methylmercury levels in fish caught at WIFN IFS. From this, a series of workshops were held in partnership resulted in the closing of the fishing enterprise at WIFN in the with an inner city organization to build skills and awareness 1970’s. Anxiety about the health effects of exposures to mercury around traditional foods. Focus groups were throughout the and other pollutants released from Chemical Valley remains an workshop series to identify consciousness shifts around grow- issue at WIFN today. A research partnership between WIFN ing, consuming and eating traditional, healthy food and the and Western University has completed a fish consumption study; lived experience of IFS. analyzed mercury in many Traditional Food species and in hair Results: Urban Indigenous people experienced food insecurity, and blood of volunteers; conducted a survey of health status; and but also were working towards larger goals of IFS with regards reviewed health records at the Walpole Island Health Centre. to cultural food specifically. Urban Aboriginal people can Our systematic review of the world’s relevant epidemiological indeed participate in growing, harvesting and eating healthy, data derived a conservative no observable adverse effect level nutritious traditional Aboriginal food in the city. When Indig- (NOAEL) of 0.3 ppm for mercury in maternal hair for mild enous people have the skills to practice IFS then a whole range neurotoxicity during fetal exposure (Schoeman et al, 2009). of positive benefits to their health and wellbeing will unfold. From comparison of our recent (2008) biomonitoring data in several volunteers to values for the same individuals in 1975 Conclusion: Organizations and public health providers in the and 1976, we found that hair mercury content had decreased by city that serve Indigenous communities have an important role 85%. By voluntary restriction of fish consumption, community to play in supporting Indigenous communities as they work members had dramatically reduced their risk of impaired fetal towards food sovereignty which enabling them to improve their neurodevelopment over this time. However, mercury poisoning health status. remains an issue of concern because 7 women of reproductive age analyzed during our study had hair mercury concentrations O19 of 0.3 ppm or higher. These individuals were counselled to (Abstract ID: 50) eat less fish in any subsequent pregnancy, an action that would reduce mercury exposures to amounts of no concern (Koren THURS. NOV. 20 – 2:00PM-2:15PM and Bend, 2010). Exposure to methylmercury by consumption of fish and the risk for neurotoxicity in the developing fetus O20 at Walpole Island First Nation - changes from 1975 to 2014 (Abstract ID: 124) Judy Peters, Gideon Koren, Michael J. Rieder, Mary Jane Tucker, THURS. NOV. 20 – 2:15PM-2:30PM Rosemary Williams, Dean Jacobs, Phaedra Henley, Katherine Provision of Sleep Apnea Care in Saskatchewan: Policy Schoeman, Regna Darnell, Christianne V. Stephens, Carol P. Complexities Related to Registered Indian Status Herbert, Chandan Chakraborty, Bradley A. Corbett, Charles G. Tarun Katapally, Caroline Beck, Gregory P. Marchildon, Trick, John R. Bend Jo-Ann Episkenew, Sylvia Abonyi , Punam Pahwa, Chatham-Kent Community Health Centre, Walpole Island Office, Mark Fenton, James Dosman Departments of Medicine and Paediatrics, Schulich Medicine & Den- Department of Community Health and Epidemiology, University of tistry, Western University, Departments of Paediatrics and Medicine, Saskatchewan, Johnson-Shoyama Graduate School of Public Policy, Schulich Medicine & Dentistry, Western University, Department of University of Regina, Indigenous Peoples’ Health Research Centre, Medicine, Schulich Medicine & Dentistry, Western University, Wal- University of Regina, College of Medicine, University of pole Island Health Centre, Walpole Island Heritage Centre, Depart- Saskatchewan, Canadian Centre for Health and Safety in ment of Pathology, Schulich Medicine & Dentistry, Western Univer- Agriculture, University of Saskatchewan sity, Department of Physiology & Pharmacology, Schulich Medicine & Dentistry, Western University, Departments of Anthropology, Obstructive sleep apnea (OSA) is a pervasive and largely undi- Social Sciences and Pathology, Schulich Medicine & Dentistry, West- agnosed chronic condition in Canada. However, eligibility and ern University, Department of Anthropology, McMaster University, coverage for treatment varies significantly depending on status Departments of Family Medicine and Pathology, Schulich Medicine as defined under the Indian Act. For example, in Saskatche- & Dentistry, Western University, Ivey School of Business, Western wan, Registered Indian patients’ access OSA treatment through University, Department of Biology, Science and Interfaculty Program federal Non-Insured Health Benefits (NIHB) rather than the in Public Health, Schulich Medicine & Dentistry, Western University, relevant provincial program. Coverage and eligibility requirements have profound implications on access to diagnostic and INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 35 treatment services. This research identifies the variations in O22 coverage between these programs to highlight challenges for (Abstract ID: 189) patients and to inform provincial and federal policy. Effective diagnosis of OSA can occur through sophisticated, laborato- THURS. NOV. 20 – 1:45PM-2:00PM ry-based Level 1 tests as well as through lower-level, home- Institutional incompleteness in the urban Aboriginal based Level 3 tests. In Saskatchewan, two public sleep laborato- health service infrastructure ries conduct publicly-funded Level 1 testing, one of which also Kian Madjedi, Kevin FitzMaurice offers Level 3 tests. Several private providers also offer Level 3 for a fee. Residents of Saskatchewan who are not Registered Laurentian University Indians can access treatment based on Level 3 tests. However, The purpose of this research is to examine the role of institu- based on NIHB requirements, registered Indians in Saskatch- tional completeness as it relates to the urban Aboriginal health ewan must undergo a Level 1 public test in order to obtain service infrastructure for persons increasingly coming to be treatment by continuous positive pressure (CPAP) therapy. known as the “Urban Aboriginal Professional Class”. Institu- High demand and low availability for Level 1 testing results in tional completeness refers to the number, variety and nature of significantly longer wait periods, and distance to travel, than institutions that serve as communal reference points for indi- does Level 3 testing through public or private clinics. Inequi- viduals to meet, interact and receive services. The term “Urban ties result, including longer waits, greater travel, and reduced Aboriginal Professional Class” represents Indigenous peoples availability of treatment for Registered Indians versus other Sas- living in cities who earn a certain income, who have attained katchewan residents. These findings suggest areas for significant postsecondary education, and who hold professional / manage- policy redress to remedy issues of access and to improve Indige- rial roles. nous population health outcomes. The Toronto Aboriginal Research Project reports that the major- O21 ity of the urban Aboriginal service “infrastructure’ is strongly social service oriented; in the city, nearly 80% of the Aboriginal (Abstract ID: 126) organizations are dedicated to providing social services such as THURS. NOV. 20 – 1:30PM-1:45PM housing and employment assistance. For some members of the Urban Aboriginal Professional Class this strong social service Reducing the Gap: Robotics technology increases orientation may create a sense of disconnection from the greater access for patients in Northern Saskatchewan urban Aboriginal community and this is termed “Institutional Ivar Mendez, Veronica McKinney incompleteness”. University of Saskatchewan - also a presenter, One key Social Determinants of Health is a strong Social Sup- University of Saskatchewan port Network (PHAC, 2013). This research makes the case In Canada, we pride ourselves on having universal medicare, equal for the creation of space, place and programming for Urban access for all. However, in reality, this “equal access’ does not exist. Aboriginal Professional people within the already-existing Many of our First Nations communities face several challenges in urban Aboriginal service infrastructure, such as Aboriginal accessing health care. The use of autonomous robotic and mobile Health Access Centres and Friendship Centres. By embedding devices enable physicians or other health care providers the health-related networking programs within the established ser- opportunity to control the device remotely, allowing for assess- vice organizations, the urban Aboriginal health service infra- ment of patients by speaking with them directly, using periph- structure can move towards increased institutional complete- eral devices such as a digital stethoscope or ultrasound to make ness and contribute to the health and wellbeing of all members a more informed decision on patient management. This reduces of the urban Aboriginal community. travel costs as well as providing more rapid initiation of appropriate care as needed. Having expert support readily available O23 supports the community and providers alike which translates to (Abstract ID: 62) increased recruitment and retention as well as improved relation- THURS. NOV. 20 – 2:00PM-2:15PM ships between communities and tertiary care centres. Additionally, the patient and their family has the ability to speak to care provid- Aboriginal Cultural Safety Initiative ers directly improving communication and opportunity for col- Chandrakant Shah, Allison Reeves laborative care. It is important to note that this technology does not replace human beings. Rather it is the medium that allows Anishnawbe Health Toronto health professionals the opportunity to come to where the patient There are approximately 57,000 students enrolled in post-sec- is, make a diagnosis and recommend what needs to be done. The ondary health sciences programs across Ontario. At present, the possibilities with this technology are endless and enables access to majority of the health sciences programs in colleges and uni- care that rivals or succeeds that available in any major centre. versities that are training front line health care workers across INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 36

Ontario have very little to no curriculum content on Aborigi- O25 nal Cultural Safety. The Aboriginal Cultural Safety Initiative (Abstract ID: 185) created by Anishnawbe Health Toronto sought to train students so that they will be better prepared to serve their Aboriginal THURS. NOV. 20 – 1:30PM-1:45PM clients and work with them in a culturally sensitive manner in Enhancing Supportive Decision Making For Aboriginal order to improve health outcomes. Patients and Family Members In order to carry out this mandate, approximately 32 volun- Jenny Lynn Morgan, Anita Ho, Kim Taylor teer Aboriginal instructors across Ontario were recruited and University of British Columbia trained to deliver relevant education materials to students in the health sciences disciplines in Ontario colleges and univer- Background: In Canada, Aboriginal peoples have higher mor- sities. Between the fall of 2011 and the fall of 2013, thirty-four tality and morbidity rates than their non-Aboriginal coun- Cultural Safety training sessions were delivered across eight terparts. Aboriginal peoples’ voices are often dismissed, with post-secondary institutions in Ontario. Student evaluations little known in the mainstream medical or bioethics literature indicate that the Aboriginal Cultural Safety Initiative was suc- regarding their experiences in healthcare decision making. cessful in increasing student knowledge in the following topic Purpose: Via stories from Aboriginal patients, supportive deci- areas: the Indian Act, government policies affecting Aboriginal sion makers (SDMs include formal surrogates and loved ones Peoples; residential schools; determinants of health for Aborigi- who make joint decisions alongside a competent patient), and nal Peoples; health outcomes for Aboriginal Peoples; Aboriginal patient navigators/liaisons, this presentation examines factors concepts of health and healing practices; knowledge of Aborig- affecting Aboriginal patients’/families’ ability to make complex inal cultures generally; and concepts of Cultural Safety. Evalua- healthcare decisions that uphold their priorities and values. tions also indicate that the initiative was successful in increasing student interest in the following areas: Interest in Aboriginal Methods: Twenty-four in-depth semi-structured interviews Peoples’ culture and well-being; interest in cultural compe- (14 patients, 10 SDMs, and 3 patient navigators/liaisons of tence/cultural safety for Aboriginal Peoples in Canada; and Aboriginal ancestry) were conducted in a Canadian city. Tran- interest in advocacy and/or empowerment work in this area. scribed data were coded and thematic analysis was informed by grounded theory. O24 Results: Participants identified three intersecting themes regarding challenges in healthcare decision making. First, patients/ (Abstract ID: 127) SDMs consistently encounter relational obstacles including dis- THURS. NOV. 20 – 2:15PM-2:30PM trust, stereotypes, or dismissal of Aboriginal stories by HCPs Talking About Change: Understanding Colonial as irrelevant to care. These barriers perpetuate the lack of cul- Rhetoric tural safety in clinical encounters. Second, some patients/SDMs face informational barriers due to their low literacy regarding Pamela Walker western and institutional medicine and lack of accessible infor- Lawrence S Bloomberg Faculty of Nursing, University of Toronto mation. Third, participants highlighted systemic factors includ- In the Canadian context, it is the responsibility of all non-In- ing their distrust of institutional care, HCPs’ ignorance of tra- digenous people to learn about the history of colonialism in ditional healing practices, and lack of coordination between Canada. One element of this responsibility is learning to rec- healthcare and other social services. ognize the stereotypes and oppressive attitudes towards Indig- Discussion: Participants highlighted the importance of promot- enous peoples that are embedded in popular and health care ing socio-historical understanding, dismantling stereotypes, discourses, and reproduced in health care interactions. In this fostering relationships, coordinating various aspects of care, workshop, the presenter unpacks colonial rhetoric through an and attending to indigenous ways of knowing in strengthen- exploration of settler colonialism, Eurocentrism, anthropology ing therapeutic alliances. Professional and systemic strategies to and positivism, and examines the powerful influence these dis- promote Aboriginal-centered care will be discussed. ciplines and ideologies continue to exert on western thought and speech. Responding to oppressive remarks in the workplace can be very challenging, and the presenter will lead an interactive discussion with participants to share and develop strategies that can help us speak up for change in health care. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 37

O26 O27 (Abstract ID: 183) (Abstract ID: 24) THURS. NOV. 20 – 1:45PM-2:00PM THURS. NOV. 20 – 2:00PM-2:15PM Wellness in our own words: Understanding the Cultural continuity is protective against diabetes in interconnected elements of Indigenous health Alberta First Nations through partnerships Richard Thomas Oster, Angela Grier, Rick Lightning, Kian Madjedi Mari Mayan, Ellen Toth Laurentian University of Sudbury University of Alberta, Piikani Blackfoot Nation, Respectful partnerships are critical to the development of effec- Ermineskin Cree Nation tive, sustainable and meaningful community health service Background: We sought to examine the association between delivery, as they allow a better understanding of the individual cultural continuity, self-determination, and diabetes prevalence and collective goals, aspirations, perspectives and narratives of a in First Nations in Alberta, Canada. community. It is critical to first understand the needs and desires Methods: We used an exploratory sequential mixed methods of a community, as defined by the community itself as a pre- approach. First we conducted a qualitative descriptive study with liminary step in conducting community-based health research. 10 Cree and Blackfoot leaders (members of Chief and Council) One way of building these partnerships is through knowledge from across the province to understand cultural continuity and sharing, and understanding the ways in which the community self-determination in the Alberta First Nations context. Inter- itself outlines and defines its own health goals. views recorded, transcribed, and subject to qualitative content The purpose of this research was to establish a baseline for future analysis. We shared the findings with interested participants for community-engaged health research with the urban Aboriginal feedback, interpretation, clarity, validity, and other concerns. community in Sudbury, Ontario by first exploring the ways in Participants also had the opportunity to be involved in data which Anishnaabe peoples define health and wellbeing “in our analysis and dissemination. We then conducted a cross-sectional own words”. Semi-structured interviews were conducted with quantitative study using provincial administrative data and pub- 16 participants, who were asked, “how do you define health and lically available data for 31 First Nations to examine any rela- wellbeing?” tionship with diabetes prevalence. There were eight emergent themes in the way health and well- Results: Qualitative: Cultural continuity, or “being who we being was understood: are”, is foundational to healthy and successful First Nations. • Strengthening community relationships; Self-determination, or “being a self-sufficient Nation”, stems from cultural continuity and is seriously compromised in today’s • Building supportive family relationships; Alberta Cree and Blackfoot Nations. Sadly, First Nations are in • Practicing tradition / culture; a continuous battle against government policy and the intergen- • Self-determination erational effects of colonization to rehabilitate their culture and achieve self-determination. Quantitative: Crude diabetes prev- • Respecting and being respected; alence varied dramatically among Nations with values as low as • (Re)connecting with the land; and 1.2% and as high as 18.3%. Those Nations that appeared to have more cultural continuity (measured by traditional Indigenous • Revitalizing Indigenous languages. language knowledge) had significantly lower diabetes preva- Defining health and wellness “in our own words” may help lence after adjustment for socio-economic factors (p = 0.007). improve the accountability of future health research with Indig- Conclusions: We conclude that cultural continuity is protective enous communities by providing a contextualized, communi- against diabetes in Alberta First Nations. ty-engaged shared knowledge base to inform research agendas that understand more fully the aspirations, identities and values of Indigenous peoples. Ultimately, this research highlights O28 the importance of developing ethical, respectful and engaged (Abstract ID: 35) partnerships when conducting health research with Indigenous THURS. NOV. 20 – 2:15PM-2:30PM communities. Self-Determination in First Nations Communities Angela Mashford-Pringle University of Toronto The perceived level of self-determination in health care in four First Nations communities in Canada was examined through a INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 38 multiple case study approach. Twenty-three participants from sovereignty. Specifically, I am interested in the spiritual aspect federal, provincial and First Nations governments as well as of Indigenous food practices and the importance of re-building health care professionals in four First Nations communities to relationships with the land and kinships networks and how this provide insight into the diversity of perception of self-determi- contributes to the (re)formation of Indigenous nationhood and nation in First Nations health care. The difference in definition self-determination. For Anishinaabe people, local food prac- between Aboriginal and the federal and provincial governments tices and the popularized discourse of food sovereignty are more is a factor in the varying perceptions of the level of control First accurately reflected through the teaching ofmino-bimaadiz - Nations communities have over their health care system. Par- iwin, living the good life. ticipants from the four First Nations communities perceived their level of self-determination over their health care system to O30 be much lower than the level perceived by provincial and fed- (Abstract ID: 116) eral government participants. The organization and delivery of health care is based on the location of the community, the avail- THURS. NOV. 20 – 1:45PM-2:00PM ability of the human resources, the level of communication, the The Toronto Aboriginal Health Advisory Circle: amount of community resources, and the ability to self-manage. The Development of An Innovative Model of Self The socio-political history including impact of contact, residen- Determination tial schools, and integration of Aboriginal worldview are factors Ellen M. Blais in the organization and delivery of health care as well as the perceived level of self-determination that the community sees. The Toronto Central Local Health Integration Network, duration and intensity of contact influences how health care is Toronto Central Lhins organized as the communities become more familiarized with The Toronto Central Local Health Integration Network ( the biomedical model that most Canadians use. TCLHINS) has been working on many aspects of Aboriginal health, including supporting the development and implemen- O29 tation of the Toronto Aboriginal Health Advisory Circle. This (Abstract ID: 115) workshop will outline the history and development of the circle, methods of community engagement and the goals which THURS. NOV. 20 – 1:30PM-1:45PM the circle is planning to achieve. This model is innovative as Mino-bimaadiziwin: Re-honoring the relational roots it is a collaborative effort with Toronto Public Health Toronto of Indigenous food sovereignty Central Lhins, and the Aboriginal community of Toronto. Self Michelle Daigle determination in all aspects of health is the one of the core values of the circle. Cultural safety will also be discussed. University of Washington Food sovereignty has become a popular discourse guiding alter- O31 native food movements since it was first coined at the World (Abstract ID: 241) Food Summit in 1996.Meanwhile, on-going colonial intervention on Indigenous lands have resulted in alarming rates of THURS. NOV. 20 – 2:00PM-2:15PM malnutrition, health problems, environmental degradation and wahkomakanak: Relationships and severed relationships with the land and kinship networks. These Language as Medicine various facets of oppression have led some Indigenous people, Lana Whiskeyjack, Dionne Gesink, Alanna Mihic, including some communities in Canada, to politically mobilize Priscilla McGilvery around concerns for food sovereignty. Yet current research on food sovereignty in Canada has largely focused on low-income Saddle Lake Cree Nation, University of Toronto, neighborhoods, racial minorities and small farmers while the Blue Quills First Nations College examination of Indigenous experiences remain, for the most Research on restoring health in Saddle Lake Cree Nation lead part, somewhat depthless. This begs the question of how food researchers from the community and the University of Toronto sovereignty is abused by various groups continuing to encroach into a paradigm shift, evolving from an academic way of think- on Indigenous lands and how sovereignty is understood according into a collective cree way of being with one another. What ing to Indigenous worldviews. My PhD research examines began as information gathering also became foundational work Anishinaabe people’s place-based experiences and knowledge on how to conduct ourselves, not only as researchers, but as of food sovereignty and how this contributes to the social, eco- community helpers. One of the solutions from the research was nomic and political goals of self-determination as defined by the importance of connecting with one another through exam- Anishinaabe people themselves. Through in-depth qualitative ining relational ideas through the Cree language. Consulting interviews with Anishinaabe people of the treaty #3 territory, and acknowledging community Cree speakers and knowledge this research looks at the relational aspects of Indigenous food keepers through interviews was an excellent start of addressing INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 39 health issues. By asking them how can the community restore O33 health, we learned about wahkomakanak, our multifaceted (Abstract ID: 79) relationships, and how it is linked to health. We learned that the importance of being interconnected is about knowing who you THURS. NOV. 20 – 1:30PM-1:45PM are, where you come from and the roles and meaning of your Human papillomavirus within Inuit women from life, which has a great impact on how we serve the collective Nunavik, Quebec work within First Nations communities. Through learning tra- Barbara Gauthier, Paul Brassard ditional knowledge one cree word at a time, First Nations community researchers/members working and learning together Department of Epidemiology, Biostatistics, and Occupational Health, with non-First Nations academics became more knowledgable McGill University, Division of Clinical Epidemiology, McGill in Cree epistemology, culturally aware of the community and University deep connected relationships were built. In learning that words This research consists of examining the Pap smear results of a are medicine, researchers as community helpers became bet- group of Inuit women from the Nunavik region in northern ter equipped in addressing and promoting health interventions, Quebec to better understand the role of human papillomavi- solutions and community development. rus (HPV) in their community. This involves describing which different variants of several high-risk HPV types (16, 18, 31, O32 33, 35, 52, and 58) are present. These different strains may vary (Abstract ID: 228) in the time it takes to be cleared from the individual. They may also vary in risk of developing cellular abnormalities found THURS. NOV. 20 – 2:15PM-2:30PM with a Pap smear. Assessment of these differences will allow Nehiyaw Pimatisiwin: Sharings from for characterization of HPV in this Indigenous community and Onihcikiskowapowin - Cultural interventions help predict which strains may be more harmful and related to from a community-based research partnership cervical cancer. This is important because the rates of cervi- with the University of Toronto cal cancer among Inuit communities are higher as compared to James Makokis, Alsena White the general Canadian population. As there are sometimes difficulties ensuring proper follow-up and healthcare within these Saddle Lake Health Care Centre, Saddle Lake Cree Nation Northern communities, this assessment of the most threatening In 2009, the University of Toronto and the Saddle Lake Cree strains will mean that in the future it will be easier to determine Nation engaged in a community based research partnership pri- which women are at the highest risk and ensure they receive the marily looking at sexual health in the community. The results proper care. and process of this research will be examined in another workshop (Gesink, Whiskeyjack, Suntjens, Mihic, Chisan), while O34 this will focus on culturally based interventions aimed at restor- (Abstract ID: 84) ing balance within our Nation. Specifically we will share about: THURS. NOV. 20 – 1:45PM-2:00PM 1) Transforming the current federally delivered prenatal program to be more reflective ofopikinâwasowin (“the way Community Based Participatory Research as a Path to of child-rearing) based on the Cree stages of life. This helps Build Resilience in preparing nehiyawak awasisak to be healthy, whole, human Kevin Donald Willison beings. Lakehead University 2) Incorporating nehiyaw muskikiya (Cree medicines) into the Background: To facilitate the translation and dissemination of Saddle Lake Medical Clinic by having a traditional medicine knowledge and improve cultural sensitivity about Indigenous person/knowledge holder work alongside the community Cree health in Canada it is important to involve Indigenous Peo- medical doctor. ples in health care planning and decision making. A potential 3) Addressing food insecurity and community development by way to do so is through community based participatory research initiating a community garden in the “town-site” area of the (CBPR). Saddle Lake Cree Nation. Future plans include the development Methodology: Using a retrospective approach and the key of a community medicine teaching garden. words “Indigenous health” and “community based participatory 4) The development of a youth outreach based clinic within the research” a review of the social as well as health science/public community at the local youth Boys and Girls Club. health literature was conducted. Relevant publications reviewed These “interventions” are based and founded in nehiyaw mam- were in English only and dated back no more than twelve years. itoneyicikan (Cree thought), and form the foundation of all our Specific databases accessed included Goggle Scholar, Pubmed, activities related to these research findings. Medline, Ageline, Sociofile, PsychLit, and CINHL. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 40

Results: Canadian publications denoting active engaged Indig- mapping for studying and representing the cumulative impacts enous populations / communities in the research process are of social inequalities, historical trauma and ‘syndemic suffering’ sparse. Of the literature that was found it appears that, when a (Mendenhall 2012) on Indigenous health. given community or chosen community representative actively participates in planning and/or decision making there is poten- O36 tial for that person and/or community to build resilience. In (Abstract ID: 210) general, there appears to be support for the idea that, when people are actively engaged their self-worth and self-esteem THURS. NOV. 20 – 2:15PM-2:30PM improves, which can help build resilience. Telling Our Stories: Population Health Surveillance in Conclusion: Deploying a CBPR approach appears to have Unama’ki potential in building resilience both at the individual (micro) as Elaine Allison, Darlene Anganis, Stacey Lewis, Jennifer Mac- well as community (meso) level. Current evidence in the liter- Donald, Sharon Rudderham, Laurie Touesnard ature points out that resilience is an important determinant of Wagmatcook Health Centre, Membertou Wellness Home, Tui’kn health. Finding ways to build resilience within Indigenous pop- Partnership, Waycobah Health Centre, Eskasoni Health Centre, Pot- ulations may aide in improving overall health related quality of lotek Health Centre life. To this end, further research on the potential of CBPR is needed. It is widely recognized that there are significant gaps in information about the health of First Nations populations. This limits O35 the ability of communities, health agencies, and governments to respond affectively to the health needs of First Nations. A wide (Abstract ID: 186) variety of information about the health of First Nations people THURS. NOV. 20 – 2:00PM-2:15PM resides in provincial and territorial health data systems. How- Letting the Body Tell Its Story: Using Body Mapping ever, using this readily available data source to support First and Hazard Mapping as Visual Representations of Nations population health surveillance efforts is difficult due to Community Well-Being in Indigenous Health Research a myriad of privacy, governance and technical challenges. This presentation will describe how the five First Nations in Una- Christianne Victoria Stephens, Linda Lou Classens ma’ki (Cape Breton Island, NS) worked with provincial, federal York University, Walpole Island First Nation and academic partners to overcome these challenges and create Research has shown that Indigenous populations in Canada the Unama’ki Client Linkage Registry - a unique population experience elevated rates of chronic and infectious diseases registry that has been linked with provincial health data sources compared to their non-Native counterparts. They are also in order to provide the Unama’ki First Nations with better more vulnerable to toxic exposure and have less access to qual- population health surveillance data. With the development of ity health care than the population as a whole. Attention has the registry and the establishment of a data sharing agreement been directed to the study of historical and systemic processes. between the Unama’ki First Nations and the Province of Nova However, a key issue that continues to be overlooked is the lack Scotia, the Bands now have unprecedented access to critical of basic information on the overall health of individual Native population health data. This presentation will describe how the communities. Data collection and linkages are problematic as registry was created. It will discuss the registry data governance many national and regional surveys overlook Aboriginal health model which is based on OCAPª principles and adheres to rel- concerns and health care needs. Moreover, these surveys often evant privacy legislation. The presentation will include high- provide a homogenized view of indigenous health that lacks lights from health indicator reports that have been developed specificity regarding local ecological threats and stressors. Our as a result of this data linkage partnership, and the presenta- collaborative project strives to answer the following questions: tion will discuss how the Unama’ki First Nations are using this Can community-devised models that expand the conventional information to improve health. theoretical and methodological boundaries of traditional health research frameworks shed new light on spaces of vulnerabil- ity, the social determinants of health and the impacts of diverse forms of structural violence on ‘local biologies’? Can these methods improve the quality of health data gathered on First Nations reserves? Our health project based at the Walpole Island First Nation applies theories and methods from the fields of occupational health, medical anthropology and health geography. We will present the findings of our pilot study and explore the utility of innovative models like body mapping and hazard INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 41

health and wellness, community engagement and partnership, Workshop Abstracts cultural competencies and safety, cultural adaptations and les- W01 sons learned during this five year project. SESSION 1 Successful mental health programs in Aboriginal communities must address key elements such as community engagement and (Abstract ID: 19) ownership, cultural relevance and competencies and the effects Mental Health of colonization and intergenerational trauma on risk and protec- THURS. NOV. 20 – 10:30AM-11:15AM tive factors. Sharing experiences and knowledge offers a unique opportunity for participants to gain a deeper understanding Honouring our Strengths: A Renewed Framework to of mental health initiatives in urban Aboriginal communities Address Substance Use Issues among First Nations Peo- in BC. ple in Canada Carol Hopkins W03 National Native Addictions Partnership Foundation, Canadian Cen- SESSION 1 tre on Substance Abuse (Abstract ID: 95) A national framework that champions a First Nations voice Women’s Health and the importance of Indigenous Knowledge as an evidence base for addressing substance use issues. The workshop will THURS. NOV. 20 – 10:30AM-11:15AM highlight the importance of partnership and process to engage Supporting First Nations, Métis and Inuit First Nations people in a meaningful policy development. The Women to Engage in Shared Decision Making: workshop will also discuss the flexibility of the framework for A Skill Building Workshop its use in policy development, strategic planning, system and Janet Elizabeth Jull, Minwaashin Lodge, Dawn Stacey program design, and service delivery. University of Ottawa, Institute of Population Health, Minwaashin W02 Lodge - The Aboriginal Women’s Support Centre, University of Ottawa SESSION 1 Introduction: When compared with general populations in (Abstract ID: 53) Canada, Aboriginal women are more likely to experience health Mental Health inequity. Shared decision-making (SDM) may narrow health THURS. NOV. 20 – 10:30AM-11:15AM equity gaps by engaging clients with their health care providers in making health decisions; however, little is known about SDM Connecting the Dots: An Innovative Urban Aboriginal interventions with Aboriginal Peoples. This workshop intro- Mental Health Project duces participants to the use of an SDM approach developed in Jessa Williams, Johanna Denduyf collaboration with a community partner (Minwaashin Lodge), to support Aboriginal women in making health decisions. Canadian Mental Health Association British Columbia Division, British Columbia Association of Aboriginal Friendship Centres Objectives: Define SDM and interventions to support SDM: what it is, how it is done, why it is important, patient decision Aboriginal people are the youngest and fastest growing segment aids, coaching. Describe how a population of women defined of the Canadian population and experience disproportionally the SDM process: Findings from work with the women of high rates of mental health challenges and are underrepresented Minwaashin Lodge. Practice providing decision support during in mainstream community mental health services. This presen- a simulated clinical encounter using coaching guided by the tation will describe an innovative, multi-partner, communi- adapted Ottawa Personal Decision Guide (OPDG). Discuss ty-led mental health promotion project in BC which is based practical features of implementing decision support for/with on an adapted evidence based Communities that Care model. Aboriginal people. The objectives of the Connecting the Dots (CTD) project are to Overview of SDM and Interventions. promote the mental health of urban, off-reserve Aboriginal youth and families by mobilizing the community to address risk and Adaptations for Aboriginal women. protective factors influencing mental health, to build cross sector Skills building exercise: Use of the adapted OPDG. Break into partnerships and to adapt the Communities that Care model to groups and choose a decision (provided by workshop facilitator) ensure cultural relevancy in urban Aboriginal communities. and roles to play. Role play using the adapted OPDG. Large Key elements for discussion will be on CTD program develop- group debriefing on the encounter. ment, implementation and evaluation, Aboriginal concepts of INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 42

Implementation Key messages: In general populations, patient Newfoundland and Labrador decision aids help clients to participate with their health care This project aims to develop an appropriate model for building providers in health decision making. This workshop introduces community competency in addressing food security in remote a patient decision aid, the adapted OPDG with decision coach- Inuit Communities. The first phase of the project focused on ing, developed by and with a population of Aboriginal women. the Northern Inuit communities of Nunatsiavut, Labrador _ a population that face some of the most extreme health inequal- W04 ities in Canada. In 2010, the community of Hopedale, Nunat- WITHDR AWN siavut successfully completed a community-led food assessment (CLFA) project entitled NiKigijavut Hopedalimi (“Our Food in W05 Hopedale”), using the BC Provincial Health Services Author- ity’s “Community Food Assessment Guide” (2008). The proj- SESSION 1 ect began by evaluating the process of implementing a CLFA (Abstract ID: 253) with the 2008 tool in Hopedale, in order to identify its use and Traditional applicability in Inuit communities. Using recommendations resulting from this evaluation, the tool was adapted in order to THURS. NOV. 20 – 10:30AM-11:15AM develop a culturally appropriate CLFA as the central aspect of Atikowisi miýw-āyāwin, Ascribed Health and Wellness, a more broadly transferable CLFA to be used by other remote, to Kaskitamasowin miýw-āyāwin, Achieved Health northern, Inuit communities. Adaptations included expanding and Wellness: Shifting the Paradigm the tool’s content into a toolkit of five learning guides, changes Madeleine Dion-Stout, Elder to the format, language, and examples, as well as creating a more detailed process and inclusion of practice activities and I use the Cree language to describe our experiences, realities additional resources. The project has developed a model for and aspirations because it provides a ready and relevant window engaging communities in addressing risk factors influencing into our social, health and health care inequities. I focus on their food supply (threats to country food harvesting, access to an important transformation that is taking place in our lives as healthy foods, food sharing networks), the activity environment we move from atikowisi miýw-āyāwin, ascribed health and well- (programs, food competency building), as well as individual and ness, to kaskitamasowin miýw-āyāwin, achieved health and well- family factors of individual food consumption. An Inuit spe- ness. This is not a linear or a straightforward process, and it is cific CLFA guide and resource materials are now available, and not happening in isolation from our mainstream health systems, undergoing evaluation in three Inuit communities. which, with the proper understanding of our perspectives and experiences, can help to bring favorable change. Still, atten- WO7 tion does have to be paid to the location and flow of significant markers on this journey. If atikowisi miýw-āyāwin is at one end SESSION 1 of a spectrum (where we are coming from) and kaskitamasowin (Abstract ID: 280) miýw-āyāwin is at the other end of the spectrum (where we are Cultural Safety going to), then nātamakéwin miýw-āyāwin, or assisted health and wellness, has to be located in the middle, where a supportive THURS. NOV. 20 – 10:30AM-11:15AM system goes hand in hand with a growing sense of the helping “Don’t bother him, he’s probably just drunk”: Advanc- “self.” ing Indigenous Cultural Competency training in Ontario W06 Vanessa Ambtman-Smith, Guy Hagar SESSION 1 Provincial Aboriginal LHIN Network (PALN) South West Local (Abstract ID: 238) Health Integration Network, Southwest Ontario Aboriginal Health Food Security/Nutrition Access Centre (SOAHAC) THURS. NOV. 20 – 10:30AM-11:15AM • Cultural Safety and healthcare Evaluation of “Community-Led Food Assessment for • Supporting the journey towards cultural safety Inuit Communities” model aimed at assessing and • Indigenous Cultural Competency (ICC) Training as a best addressing Food Security in Inuit Communities practice Kristeen McTavish, Chris Furgal, Shantel Popp, Vinay Rajdev, • Advancing ICC in Ontario’s healthcare system Kristie Jameson Trent University, Nasivvik Centre for Inuit Health and Chang- ing Environments, Trent University, Food Security Network of INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 43

W08 recommend that undergraduate nursing students receive cultural safety education during their nursing programs. However, SESSION 1 in order to provide quality cultural safety education, collabora- (Abstract ID: 226) tion between nursing faculties and Aboriginal communities is Health Systems essential. Vivian Recollet is an Aboriginal nurse whose lineage stems from the traditional territories of the Wikwemikong First THURS. NOV. 20 – 10:30AM-11:15AM Nation. Vivian has been an advocate for aboriginal health issues There Are Good Things Done Under the Midnight Sun since 1996 and currently works towards bringing a holistic care Julie Lys, NP, Laura Lee Evoy, RN, Bandy Thompson, RN model to her work in a Men’s shelter Mental Health Program. Vivian is knowledgeable about western and traditional philos- Fort Smith Health & Social Services Authority / ophies and combines the two worlds to bring the best possible Aboriginal Nurses Association of Canada, Fort Smith Health & care to her community. Pam Walker has been a nurse educator Social Services Authority at the University of Toronto for five years. Before coming to U Explore the good things done under the midnight sun. Many of T, she worked for many years as a community health nurse Aboriginal communities in rural and remote areas of Canada with Haida, Coast Salish and Carrier First Nations peoples in have high turnover rates of nursing staff. When nurses have a western Canada. As a non-Aboriginal woman and nurse, Pam is sense of belonging and professional satisfaction they are more committed to integrating cultural safety into nursing education likely to stay in the community. One solution to high turnover at U of T. Together, Vivian and Pam provide classroom and rates is to promote and support community members to become clinical education in urban Aboriginal health and co-facilitate health care professionals. In the Land of the Midnight Sun (the seminars for nursing students preparing for practicums in north- NWT) this includes recruiting Aboriginal people into the nurs- ern communities. In this presentation, Vivian and Pam describe ing profession. However, some believe it is too difficult as an their collaboration, how it influences the cultural safety educa- Aboriginal nurse to work in their home community. tion they provide, and the importance of combining Indigenous Nurses play a pivotal role in the health care system in the NWT. knowledge with contemporary nursing knowledge in order to The scope of practice for nurses and nurse practitioners sets the provide holistic nursing care. stage for true primary health care. The work is challenging, rewarding and truly satisfying. The sense of belonging and pur- W10 pose in the community also increases job satisfaction. SESSION 1 In this northern community many of the nursing staff are (Abstract ID: 130) Aboriginal and are from the community. Learn how the inter- Respiratory/Cardio/Chronic Disease active practice environments of this northern health centre, employer and community support increases job satisfaction. THURS. NOV. 20 – 10:30AM – 11:15AM Learn why these Aboriginal nurses enter the nursing profession Heart and Stroke Foundation’s Indigenous Health and how the NWT healthcare system supports them through Strategy grad mentorship, bursaries and continuing education. Learn Lesley James, Ratsamy Norman Pathammavong how these nurses and nurse practitioner draw on the sense of belonging to work successfully in their home community of Heart and Stroke Foundation Fort Smith, NWT. The Heart and Stroke Foundation (HSF), Canada’s largest char- ity dedicated to reducing the burden of heart disease and stroke W09 recognizes that the cerebral-cardiovascular health of aboriginal SESSION 1 peoples in Canada is very poor. The prevalence of cardiovascular (heart disease and stroke) disease among the First Nations (Abstract ID: 120) people is 2 to 3 times higher than the rate among the general Nursing Canadian population. While cardiovascular disease (CVD) rates THURS. NOV. 20 – 10:30AM-11:15AM are declining in Canada, data suggest they are increasing among Canada’s Indigenous Peoples. Indigenous Peoples in Canada Collaborating for Cultural Safety in Nursing Education have a higher prevalence of CVD risk factors including physical Vivian Recollet, Pamela Walker inactivity, smoking, obesity, hypertension, diabetes, and food Native Men’s Residence, Lawrence S Bloomberg Faculty of Nursing insecurity. Income security is low among Aboriginal commu- University of Toronto nities and forty percent of Aboriginal children live in poverty, which is a risk factor that makes healthy choices inaccessible. It is well documented that Aboriginal people experience dis- With over 1.4 million people self-identifying as aboriginal in crimination and racism in the Canadian health care sys- Canada and a high growth rate among this population, these tem. In response, mainstream and Aboriginal organizations CVD stats are alarming and require action. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 44

To change the poor health associated with Canada’s Indigenous W13 Peoples, HSF will invest in ensuring health equity for Indig- SESSION 2 enous People from coast to coast to coast. HSF aims to be a model national health organization in working with Aborig- (Abstract ID: 251) inal, First Nations, Inuit and Métis (AFNIM) by developing Determinants of Health an evidence-informed aboriginal health strategy. Incorporating THURS. NOV. 20 – 3:45PM-4:30PM the Aboriginal Medicine Wheel as a framework, the strategy will explore partnerships with Indigenous leadership and com- The Work of Frontiers Foundation of Toronto munities throughout Canada and with potential funders and Jim Bacque, Lawrence Gladue, Marco Guzmana, partners such as other health charities/organizations. Elements Don Irving of the strategy include food, children in schools, pathways to health, and promoting recovery. Frontiers Foundation of Toronto Are you fed up with stories of people dying in fiery shacks on W11 Canadian reserves? WITHDR AWN Do you hate hearing about despairing children forming gangs to commit group suicide, young women murdered in the streets, W12 band chiefs jailed for protesting against the theft of their lands by companies and governments, corrupt reserve councils steal- SESSION 2 ing tax money, wild waste in government spending? (Abstract ID: 68) Do you want something done about these horrors right away? Mental Health Then Frontiers Foundation is for you. Our Canadian and inter- THURS. NOV. 20 3:45PM-4:30PM national volunteers have built over 3,000 houses in Canada for Homeless and Hopeless: An examination of Toronto’s and with aboriginals and Métis. On some reserves our volun- Health and Addiction Services for Indigenous homeless teers have eliminated child suicide. Our buildings are first-class peoples and what can be done to improve them. construction, affordable and durable. Our houses on reserves cost half what private builders charge governments for giveaway Suzanne Lea Stewart, Nicole Estella Elliott houses. Ontario Institute for Studies in Education/University of Toronto Cooperating in construction of the house which is mandatory Indigenous homelessness is at a current state of crisis within for Frontiers beneficiaries instills pride and a sense of accom- the urban area of Toronto, where 15.4% of people living on plishment in every head of family. More than eight thousand the streets are of Indigenous ancestry and is disproportionate to Frontiers volunteers trained many thousands of aboriginals in the 0.5-1.5% Indigenous Toronto residents. Current literature useful trades as they built houses and happiness together. demonstrates that Indigenous peoples in Canada have less access Every year, thousands of indigenous children especially in and under use psychological services, including psychotherapy, northern Canada are taught in schools by our volunteers coop- despite a crisis of mental health disorders within their commu- erating with local authorities. In every case, our volunteers have nities. Further, Indigenous homeless individuals show higher been invited to come. They have inspired people to better their than average rates of mental health symptoms, disorders, and own lives through courage, fun and hard work. hospitalizations. This is an alarming issue as a study conducted by the City of Toronto (2009) found that 51.8% of Toronto’s The founder, the late Charles Catto, was awarded the Order of homeless identified that access to appropriate addiction, health Canada for his inspiring work. Frontiers is now staffed and run and mental health services were inadequate and served as a mainly by aboriginals helped by whites. Our president is Law- major barrier in terms of finding housing and getting off the rence Gladue, OC and our offices are in Toronto. Our western streets. Community based qualitative research with Indigenous branch run by Don Irving, is headquartered in Surrey BC. homeless individuals and with service providers of Indigenous homeless people was conducted to identify the barriers and success in mental health and social services, with an emphasis on harm reductions services in the treatment of concurrent disorders. Results revealed metathemes of racism and stigmatization, difficulty in healing with concurrent disorders, the need for harm reduction strategies in social services and tensions between traditional cultural/spiritual healing and western psychological interventions. Guidelines for practitioners and implications for service and research will be discussed. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 45

W14 their health by using our knowledge and power as physicians to create change on behalf patients or communities who have SESSION 2 less power. To be an effective and caring health care provider, (Abstract ID: 27) or policy maker for that matter, keeping in mind three C’s can Traditional help: Context, Curiosity and Conversation. These factors are indeed necessary for good advocacy as well as for cultural safety. THURS. NOV. 20 – 3:45PM-4:30PM Following decades of hardwork and advocacy by Inuit leaders, Wii Kwan De Taa (Bringing People Together for a the territory of Nunavut was created in 1999. Nunavut, which Sacred Purpose means “our land” in Inuktitut, is a vast and beautiful place and Lori Flinders though it makes up a fifth of Canada’s land mass, the territory Fort Frances Tribal Area Health Services has just over 30,000 residents. About 85% of Nunavummiut are Inuit and Inuktitut remains one of the strongest indigenous Through our traditional cultural knowledge, we breathe spirit languages in Canada, and a first language to most. into our practice. This is the leadership principle that we have adopted at the Behavioural Health Services Unit of FFTAHS. This presentation will review the historical context of health The BHSU is an adult mental health and addictions service that care in Nunavut (TB care, E numbers, the dog slaughter, high works for/with ten First Nations communities in southern Treaty arctic relocations and residential schools) and contemporary #3 in NW Ontario. This presentation will take the participant health challenges that Inuit face today. The role that physi- through the presenters “story’ of creating a shift in paradigm from cians can and must play to improve social determinants will cultural inexperience to cultural awareness through the build- be emphasized by examples from the field and efforts for small ing of culturally based personal and Agency practice bundles scale improvement in advocacy education in Family Medicine (feather, medicines, methodologies, traditional drum, eagle staff, training will be shared. pipes).The opportunities for staff “knowledge bundle” acquisi- tion (inductive traditional learning/training through teachings/ W16 ceremony), and incorporation of culturally based practice bundles WITHDR AWN will be highlighted along with staff testimonials. The presentation will include a traditional opening with smudging ceremony, hand W17 drum song, and brief sharing/introduction circle. The presenta- SESSION 2 tion will utilize a traditional oratory “story telling’ along with power point presentation to describe how inherent knowledge (Abstract ID: 181) and scared sanctioning were utilized throughout the process. This Respiratory/cardio/chronic disease presentation will describe how the traditional “code of ethics’, THURS. NOV. 20 – 3:45PM-4:30PM embedded within the seven sacred teachings of the Anishinaabe, were harmonized into a model of contemporary best practices A History of Dying at Home From Pre-European within a mental health and addictions curriculum for our con- Times to the Present Palliative and End of Life Care Era tinuum for holistic wellness. Time will be given to participants Dean Walters for question and answer on the barriers, support, and tangible Central East Community Care Access Centre outcomes from the creation of cultural bundles. The presentation is for those wishing to begin to create cultural safety and an First In Scarborough, Ontario, Canada there exists a testament to the Nation foundation of practice. care of the dying for all who wish to see it. There lay an ossuary located at Bellamy Road and Lawrence Avenue that serves as a W15 prominent reminder of an indigenous understanding of dying . Immigration and colonization brought a different art of dying SESSION 2 through the introduction of new religions but a sea change in (Abstract ID: 47) health care in the past 150 years firmly placed dying in the hands Inuit of medical practitioners inside a technologically-based health care system. Presently, those receiving palliative and end of life THURS. NOV. 20 – 3:45PM-4:30PM health care often find they cannot be pointed to a way of dying More than medicine: on being an ally and a physician of their choosing and find themselves unable to conceive of how advocate in Nunavut to die. This workshop is an historical review of how dying in Madeleine Cole present-day Scarborough has changed from pre-European contact to the current palliative and end of life health care era and Qikiqtani General Hospital offers a glimpse of what might be needed to approach dying in Health Advocacy can take many forms and has many defini- a manner that nourishes our birthright. tions. As a family doctor, it means helping people to improve INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 46

W18 medical school preceptors at a Canadian University (Spring 2014). Our thematic analysis revealed five key themes. First, SESSION 2 there is a lack of education and training about Indigenous health (Abstract ID: 131) and related issues. Second, opinions between students and pre- Equity ceptors diverge with respect to the adequacy and efficacy of the existing curriculum. Third, a tension exists between medical THURS. NOV. 20 – 3:45PM-4:30PM school norms and training and the recognition that cultural and Jurisdiction as a Determinant of First Nations historical contexts inevitably influence health care encounters. Health Care Fourth, due to a lack of awareness, understanding, and experi- Stephanie Ann Sinclair, Amanda Meawasige ence, preceptors tended to convey analogies to other marginalized populations, failing to address the nuances of both the Assembly of Manitoba Chiefs diverse and unique aspects of Indigenous peoples’ lived experi- Manitoba has one of the highest First Nation populations in ences. Fifth, while many of the participants expressed common Canada, with a large concentration of residents living in remote stereotypes, they were less likely than the general Canadian and isolated communities. This geographical context presents population to endorse victim-blaming explanations for Indig- an impediment for First Nations in seeking equitable access to enous peoples’ poor health and social issues. The next step in health care, which numerous studies have demonstrated results our research is to design an intervention with medical students in poorer health standards and outcomes for First Nations when and preceptors aimed at positively influencing their perceptions compared to that of the general Manitoba population. Further towards Indigenous peoples’ health issues through transforma- compounding this disadvantage is the jurisdictional ambiguity tive experiential learning with the goal of ensuring future med- between the Federal and Provincial governments with respect ical professionals are informed of Indigenous peoples’ cultures, to determining who is responsible for First Nation Health in histories, and health issues. Manitoba. The presentation will outline the political context of the division of powers over First Nations by the Provincial W60 and Federal governments in relation to health service provi- SESSION 2 sion. Case studies will be used to demonstrate the inequities of services and resourcing across the health care spectrum due (Abstract ID: 164) to the system(s) and policies being focused on divesting itself Children’s Health of responsibility versus a focus on improving health outcomes. THURS. NOV. 20 – 3:45PM-4:30PM Issues to be discussed will include; Jordan’s Principle, Social Determinants of Health, Historical Legacies, Disability Services The Atii! healthy living intervention improves knowl- and Cancer Care. edge, builds cultural skills and strengthens intergenerational bonds among Inuit children, youth and families W19 in Nunavut SESSION 2 Gwen Healey, Shirley Tagalik, Tracey Galloway (Abstract ID: 103) Qaujigiartiit Health Research Centre (AHRN-NU), Arviat Health Committee, University of Manitoba Education Atii! Let’s do it! is a comprehensive healthy living intervention THURS. NOV. 20 – 3:45PM-4:30PM that uses Inuit creativity and culture to improve diet and physi- I honestly don’t think I learned anything about Indig- cal activity patterns among Inuit children and youth. Supported enous peoples: Understanding medical school precep- by the Public Health Agency of Canada’s “Achieving Health tors’ and students’ current knowledge and attitudes Weights” Innovation Strategy, the project was piloted in 3 com- towards Indigenous peoples and Indigenous health munities in Kivalliq and Qikiqtaaluk in 2011-12 and expanded Heather Castleden, Debbie Martin, Jeff Denis, Paul Sylvestre to 3 communities in Kitikmeot in 2013. In June 2014 the Nun- avut Department of Education adopted the program for imple- Queen’s University, Dalhousie University, McMaster University mentation in every school in the territory. The success of the In Canada, Indigenous peoples’ experiences with health care program has exceeded its initial goals of improving health liter- are shaped by the “double burden’ of racism and colonialism. acy and promoting healthy diet and physical activity behaviours. Given this, our research documented medical school precep- The school-based component, which focuses on positive nutri- tors’ and students’ knowledge and attitudes towards Indigenous tion and active living messages delivered through youth leaders, peoples, their health and their interactions with the health care improves health knowledge in an exciting format that engages system. To do this, we conducted online surveys of first-year families, mobilizes and expands social networks, and builds medical school students as well as face-to-face interviews with social cohesion in communities. The after-school component, INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 47 a Young Harvesters’ Program, emphasizes traditional outdoor W21 hunting and fishing activities through a process that promotes SESSION 3 intergenerational transmission of knowledge, a process that not only engages young people in traditional Inuit cultural activities (Abstract ID: 216) but actually builds empowerment and self-esteem by enhancing Health Systems children’s role as knowledge carriers in families and communi- THURS. NOV. 20 – 4:45PM-5:30PM ties. Atii! is a powerful example of the ability of Nunavummiut to address the unique public health challenges facing northern Community health worker models: International best communities in creative and effective ways. Building on tradi- practices and their application to remote First Nations tional Inuit knowledge and implemented by inter-generational communities teams of Inuit Elders and youth, this healthy living intervention Ben Chan, Janet Gordon, Sumeet Sodhi is making positive and lasting changes in Nunavut communities University of Toronto, Sioux Lookout First Nations Health W20 Authority, Dignitas International The community health worker (CHW) model has been estab- SESSION 2 lished in many low-resource environments world-wide. CHWs (Abstract ID: 129) have successfully delivered essential primary care in areas such Research as maternal and child health, HIV/AIDS treatment, acute infectious diseases, health promotion and increasingly, chronic dis- THURS. NOV. 20 – 3:45PM-4:30PM ease management. Such individuals are typically high-school Respondent driven sampling (RDS) as a tool for urban educated recruits from the communities being served. Tasks are Aboriginal health assessment and community engage- shifted from other providers such as physicians, who are difficult ment in Ontario, Canada to retain in small communities. Michelle Firestone, Janet Smylie, Sara Wolfe, The community health representative (CHR) model, a variant Constance McKnight of CHWs, was first established by Health Canada in 1962 to Well Living House, Centre for Research on Inner City Health, St. serve First Nations communities. Responsibilities were broad, Michael’s Hospital, Seventh Generation Midwives Toronto, De dwa including emergency treatment, preventive health, mental da dehs nye>s Aboriginal Health Centre health counselling and housecalls. Since that time, responsibilities evolved as more trained nurses were brought into commu- The majority of Aboriginal people in Canada now live in urban nities and as Health Canada devolved responsibility for manag- areas, however Aboriginal specific health needs assessment is ing staff to individual tribal organizations. virtually absent and only a minority of Aboriginal health service funding is directed towards urban populations. Respon- The first part of this session explores the past successes of the dent Driven Sampling (RDS), a modified chain-referral sam- CHR model and current challenges, such as selection of can- pling technique, can generate representative, population-based didates, difficulties in ensuring common standards and mentor- data and effectively address this knowledge gap. The Well ship, and integration of the CHR with the rest of the health care Living House (WLH) in Toronto is an action research centre team. The session will draw on story-telling from First Nations focused on building and sharing evidence to support Indige- veterans of the CHR program. The second part will present a nous infant, child and family health and is co-governed by St. review of current global best practices in CHW program design Michael’s Hospital and a Council of Indigenous Grandparents. and case studies from Africa and Asia, using a framework which The WLH upholds the dual criteria of Indigenous community examines practices around recruitment, retention, training, relevance and scientific rigour which embodies the principle of supervision, clinical protocols and quality measurement. The “two-eyed seeing.” The WLH has led two successful RDS pri- third part will feature perspectives from First Nations leaders on mary data collections with First Nations in Hamilton and Inuit the applicability of these global examples to Canada. in Ottawa and will generate the first inclusive population based Aboriginal database in Toronto. In this interactive workshop, representatives from the WLH, De dwa da dehs ney>s Aborig- inal Health Access Centre in Hamilton, Ontario and Seventh Generation Midwives Toronto will discuss how RDS can be used as a tool to: 1) facilitate local Aboriginal community leadership; 2) emphasize the active participation of diverse urban Aboriginal communities in developing, gathering, sharing and applying their own health information and health data; and 3) be used effectively to drive policy change and action. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 48

W22 W23 SESSION 3 SESSION 3 (Abstract ID: 215) (Abstract ID: 252) Mental Health Children’s Health THURS. NOV. 20 – 4:45PM-5:30PM THURS. NOV. 21 – 4:45PM-5:30PM An Indigenous Model of Effective Community Mental Lower Respiratory Tract Infections in Inuit Children Health Services Dr. Anna Banerji Germaine Frances Elliott, John Rice Department of Paediatrics and Dalla Lana School of Public Health, Enaahtig Healing Lodge, Simcoe County Canadian Mental Health University of Toronto Association Dr. Anna Banerji will be profiling her 2 decades of research Our presentation will describe the positive impact of using cul- on lower respiratory tract infections (LRTI) in Inuit children. ture and traditional teachings in designing mental health ser- After Dr. Banerji’s first few trips to the Canadian Arctic in 1995, vices that restore balance and harmony to First Nation, Métis she documented that Inuit infants on Baffin Island had the high- and Inuit individuals and families in need of healing, based on est rates of LRTI globally, and that an Inuit infant less than 6 the concept of B’imaadziwin (The Good Life).It will demon- months of age has a 50% chance of being admitted to the hospital strate the value of using a wholistic approach in healing prac- with an LRTI. Subsequently she conducted a case-control study tices which combine Indigenous approaches with clinical prac- which demonstrated that the risks for LRTI admission included: tices. The wholistic approach includes: reconnecting to a nat- overcrowding, lack of breastfeeding, living in remote commu- ural environment, use of ceremony in healing, use of alterna- nities, smoking in pregnancy, overcrowded and associated with tive therapies, and promoting client self-determination. These being Inuit versus non-Inuit. Analysis of the viruses identi- approaches use an inclusive approach that respects the regional fied respiratory syncytial virus (RSV) as being the common- diverse Indigenous populations, and is based on traditional est infection associated with LRTI admissions, with extremely teachings of natural law. elevated rates of admission in young Inuit infants in the rural Our workshop will be in a story-telling format. We will share communities. An economic analysis demonstrated that it was the growth and development of an Aboriginal community cheaper to use an antibody to prevent RSV (palivizumab) than mental health service that includes case management and com- to pay for hospitalizations. Consequently the Canadian Paedi- munity outreach. Our co-presenter is Mr. John Rice, who is atric Society agreed, and revised their guidelines to include the a traditional teacher, knowledgeable in Indigenous approaches Inuit. Her current study across the Canadian Arctic for infants to mental health and well being. It will describe an Indigenous less than 1 year of age demonstrates major difference in the rates understanding of mental balance and mental illness. of RSV admissions, where in certain regions there would be tremendous costs savings for preventing RSV with the antibody This workshop will challenge the stereo-types of Indigenous for infants born at term. Despite the growing evidence the CPS people and mental illness. It will use a strengths based approach guidelines continue to be ignored which she will argue reflects to describe how a community service model can impact pos- a larger systematic problem for Indigenous populations in Can- itive change in individuals. Outcomes will be shared. It will ada from an equity and human rights framework. describe the work that our agencies have done in LHIN 12 to promote system change that accommodates traditional healing W24 approaches. We will share our strategies for successfully developing a regional healing model by linking mainstream partners SESSION 3 with Indigenous communities and services. (Abstract ID: 169) Traditional THURS. NOV. 20 – 4:45PM-5:30PM Understanding Tobacco Use Amongst Youth in Four First Nations Sheila Cote-Meek, Sonia Isaac-Mann Laurentian University, Assembly of First Nations Our community research partnership explored how traditional knowledge about tobacco could be used in prevention and intervention of tobacco misuse amongst First Nations Youth. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 49

Preliminary findings inform us that understanding tobacco as activities across the Inuit regions in Canada and to function as a sacred medicine is important in addressing cessation efforts a reference for organizations and governments working within and tobacco misuse among First Nations Youth. Of particular the Canadian health and social services sector. While progress interest were the needs of First Nations women in addressing is being made, substantial work is still required to address the tobacco misuse during pregnancy. In our presentation, we will conditions that lead to poor health outcomes for Inuit. review findings of our First Nations-led five year project that involved 4 First Nations communities from across Canada. Our W26 research methods applied a decolonizing methodology in work- SESSION 3 ing with four First Nations communities. Community research coordinators were involved in every aspect of research, includ- (Abstract ID: 61) ing development of research tools, data collection, data analysis, Cancer report writing, and community feedback sessions. Each com- THURS. NOV. 20 – 4:45PM-5:30PM munity team included a Research team lead (usually the Health Director in the community), a Community Based Research Reducing inequalities in cancer for Ontario First Assistant, an Elder, and a Youth representative. The commu- Nations: From surveillance to action nity-based team were supported by a Research Project Coor- Loraine Marrett, Diane Nishri, Amanda Sheppard, Anna Chi- dinator and researchers from the larger team. We surveyed 559 arelli, Alethea Kewayosh First Nations Youth, aged 12-24, living on-reserve. Preliminary Cancer Care Ontario, Hospital for Sick Children results indicate that just under half of the Youth self-reported that they are current smokers. As well, 89% of Youth surveyed Background: First Nations people (FN) suffer from many health found that it would be fairly easy to obtain cigarettes, which and socioeconomic inequalities, including in cancer: while speaks to a need to better understand access to non-traditional incidence was historically low, it is rising to approach that in tobacco from First Nations’ perspectives. the non-Aboriginal population. Little is known about cancer survival disparities. W25 Objectives: To describe research on cancer disparities between SESSION 3 FN and other Ontarians, and resulting action strategies. (Abstract ID: 142) Methods: Cancer diagnoses in Ontario FN for 1968-2001 were identified through linkage of the Indian Registry System and Inuit the Ontario Cancer Registry, and followed up through 2006. THURS. NOV. 20 – 4:45PM-5:30PM Incidence rates and survival in FN and other Ontarians were Social Determinants of Inuit Health compared. Potential prognostic factors were abstracted from charts for women with breast cancer to examine reasons for Anna Fowler survival disparities. Inuit Tapiriit Kanatami (ITK) Results: Cancer incidence was lower overall in FN, especially Inuit continue to face significant health disparities compared to for breast and prostate cancer. Rates for major cancers are non-Inuit Canadians including comparatively lower life expec- increasing; colorectal cancer incidence in particular has risen tancies, high rates of infant mortality and the highest suicide dramatically in FN. For most cancers survival was significantly rates of any population group in the country. Effective solu- poorer in FN (e.g., the risk of death from breast cancer was 1.6 tions will involve addressing the underlying determinants and times higher in FN women). FN women with breast cancer focusing on a wholistic view of health. In 2014 Inuit Tapiriit were 1.5 times more likely to be diagnosed at stages II+. Stage Kanatami (ITK) developed a report on the Social Determinants I (but not higher stage) survival was significantly worse in FN; of Inuit Health in Canada. Drawing from current data sources greater comorbidity is the main explanatory factor. and consultation with Inuit organizations, agencies and gov- Conclusions: Work is needed to decrease cancer disparities ernments, this paper highlights the key social determinants of and to monitor progress towards equity. Cancer Care Ontar- health that are relevant to Inuit in Canada including: quality io’s second Aboriginal Cancer Strategy (ACSII, 2012) includes of early childhood development, culture and language, liveli- initiatives designed to reduce cancer disparities through, e.g., hoods, income distribution, housing, personal safety and secu- creation of educational resources, enhanced prevention and rity, education, food security, availability of health services, screening, and adding Aboriginal Patient Navigators. mental wellness and the environment. While summarizing the key challenges that exist for each of these areas, the report also highlights practices that have resulted in positive outcomes. This Social Determinants of Inuit Health in Canada Report is an Inuit-specific resource designed to support public health INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 50

W27 W28 SESSION 3 SESSION 3 (Abstract ID: 88) (Abstract ID: 163) Cultural Safety Equity THURS. NOV. 20 – 4:45PM-5:30PM THURS. NOV. 20 – 4:45PM-5:30PM Is cultural safety enough? Confronting racism to Manitoba First Nations Indicators of Wellbeing address inequities in Indigenous health Leona Star, Kathi Avery Kinew Barry Lavallee, Linda Diffey, Thomas Dignan, Paul Tomascik Assembly of Manitoba Chiefs University of Manitoba, First Nations and Inuit Health Branch, Historically First Nations well-being has been measured against Health Canada, Royal College of Physicians and Surgeons of Canada urban, Non-First Nations and Canadian standards. Manitoba First Rooted in a violent colonial past and masked by our national Nations (MFNs)are redefining the focus of research, moving away identity as a multicultural, benevolent society, the racism expe- from a deficit orientated western model of defining wellbeing and rienced by Indigenous people in Canada’s health care system is health. As First Nations we have been defined through research both pervasive and largely unacknowledged. Incidents such as as failing to achieve the same standards of middle class, non-First the 2008 death of Brian Sinclair in a Winnipeg emergency room Nation Canadians. During a workshop called “Counting for highlight the dire outcomes that racism can have for Indigenous Nationhood” in February 2007, 50 representatives from MFNs patients. The Health Council of Canada (2012) notes that many worked together to develop practical, community-based indica- Indigenous people do not trust mainstream health care services tors of change which MFNs could use to track trends and pro- due to lack of safety related to stereotyping and racism, leading mote positive change. Through discussion MFNs participants set to delays and diagnosis at later stages of disease. Yet discourse the goal of community based, positive, goal-oriented, culturally around interventions to improve health outcomes for Indige- rooted/relevant indicators that made sense to First Nations. These nous patients tends to focus on culture or barriers to access and indicators of change included many social determinants of health, avoid the examination of racism and oppression that are foun- but also the MFNs insistence that the indicators be grounded in a dational to the problem. cultural foundation. Such indicators would empower First Nations This workshop will outline the work of two Canadian institu- to track their efforts in working from First Nations strengths and tions in addressing racism in the context of Indigenous health: identity, toward closing the gap between First Nations state of The new Indigenous Health course in undergraduate medicine social-economic-cultural-health status as compared with the at the University of Manitoba employs an anti-racism peda- rest of Canada. These indicators of wellbeing are currently being gogical framework, an approach that poses challenges to both tested in the Manitoba regional survey component of the national learners and instructors. Strategies for facilitating the “difficult First Nations led survey called the, First Nations Early Childhood, dialogues’ about racism with students will be explored in this Education and Employment Survey (FNREEES). The FNREEES presentation. The Royal College’s CanMEDS Physician Com- is a national survey that is based on the successful framework and petency Framework coupled with its Indigenous health values methodology of the First Nations Regional Health Survey that is and principles statement provides a platform to promote cul- governed by the First Nations principles of OCAP. turally safe care. Cultural safety dismantles power structures between the Indigenous patient and the provider; it facilitates W29 critical thinking and self-reflection in medical education and SESSION 3 practice to confront racism. (Abstract ID: 234) Education THURS. NOV. 20 – 4:45PM-5:30PM Come walk in our moccasins: Strategies in Recruit- ment, Admissions and Curriculum at the Aboriginal Program at the University of Ottawa Darlene Janet Kitty Aboriginal Program, Faculty of Medicine, University of Ottawa Since its inception in 2005, the Aboriginal Program at the Faculty of Medicine, University of Ottawa has endeavoured to address cultural competency and cultural safety of medical INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 51 students as part of the social accountability mandate and con- The data governance agreements determine how and when the tribute to improved health and social issues of Indigenous pop- linked data-sets can be used. Data governance is currently over- ulations. The Aboriginal Program has been successful in admit- seen by the Chiefs of Ontario and separate agreements are being ting and training Indigenous students to become physicians and discussed with other representative organisations and some supporting them through medical school. Several recruitment communities. The agreements establish mutually beneficial strategies will be described, which have helped to promote the and ethical partnerships to enable timely and relevant research program and inspire Indigenous youth, post-secondary and studies using linked health administrative data. The agreements mature students to prepare and become physicians. For example, work in an open and collaborative manner that respects the First Mini-Medical Schools (MMS) sessions are organized and led Nations principles of OCAPª (Ownership, Control, Access and by our Aboriginal medical students, portraying to the partici- Possession). At the workshop the history of these agreements pants what a day in medical school is like. This MMS simulate will be presented by staff from The Chiefs of Ontario and ICES. lectures, physical exam skills and diagnostic imaging sessions, The governance arrangements that protect the interests of First and teach medical procedures, such as casting and suturing. Our Nations people and communities will be discussed, along with medical students share their stories and advice on getting into the plans to use the linked data to support efforts to improve the medical school, inspiring participants that they too can become health of First Nations in Ontario. a physician. Their successful admission and progress through the medical program demonstrates to potential applicants that W31 they too can “walk in their moccasins” in this supportive set- SESSION 4 ting at the Ottawa Faculty of Medicine’s Aboriginal Program. Also, curriculum activities, such as the Aboriginal Celebra- (Abstract ID: 250) tion,are done to sensitize all medical students on the health and Children’s Health social issues,complemented by engaging Indigenous commu- FRI. NOV. 21 – 11:00AM-11:45AM nity members and organizations. The Director and Program Co-ordinator of the Aboriginal Program work together with The Status of Oral Health among Canada’s First our students and faculty, so that all medical students become Nations Peoples and Inuit knowlegeable and practice with cultural competency and cul- Amir Azarpazhooh, Dick Ito, Martin Chartier, tural safety in their residency and practice, with urban, rural Tracey Guitard, Hannah Tait Neufeld and remote Indigenous communities. Faculty of Dentistry-University of Toronto, Faculty of Medicine, University of Toronto, Mount Sinai Hospital, Public Health Agency W30 of Canada, Thunder Bay District Health Unit and Simcoe Muskoka SESSION 3 District Health Unit (Abstract ID: 172) Young children of First Nations and Inuit ancestry are 8.6 Research times more likely to have early childhood tooth decay treated under general anaesthesia in hospital than other Canadian chil- THURS. NOV. 20 – 4:45PM-5:30PM dren. More than 85% of Aboriginal children 3 to 5 years of age Creating a First Nations health data repository in have experienced tooth decay with an average of 7 to 8 teeth Ontario by linking the Indian Register to ICES health affected. Not only young children, but First Nations peoples administrative data: a collaborative governance process and Inuit across all age groups have poorer oral health compared that protects the interests of First Nations to other Canadians. Clinical examination undertaken for oral David Henry, Tracy Antone, Carmen Jones, Saba Khan health surveys indicated that higher percentages of First Nations peoples and Inuit required dental services in virtually all the Institute for Clinical Evaluative Sciences, Chiefs of Ontario categories assessed - fillings, extractions, root canals, dentures The Chiefs of Ontario, the Institute for Clinical Evaluative and periodontal treatments. As with dental decay, the need for Sciences (ICES) and Cancer Care Ontario have established treating gum disease, was more than eight times higher in the data-sharing and data-governance agreements that enabled Aboriginal than for the non-Aboriginal population. In addi- transfer of the Indian Register (IR) from the Department of tion to clinical examinations, as part of the oral health surveys, Aboriginal and Northern Affairs Canada to ICES. ICES as a in self-reported questionnaires more First Nations participants prescribed entity under the Personal Health Information Pro- reported having fair to poor oral health, avoiding particular tection Act was able to receive the file with personal identifiers foods due to oral problems, and having persistent pain in the that enabled probabilistic matching of the records to the many mouth in the past 12 months, than the non-Aboriginal popula- health administrative files already held at ICES. After linkage, tion. This workshop aims to bring a panel together to examine all files were anonymised and can now be used for disease sur- the data on the oral health status of First Nations Peoples and veillance, evaluation of quality of healthcare and for research Inuit and their difficulties in access to dental care. into the health of First Nations people living on and off reserve. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 52

Oral diseases in children are an important public health issue. Trafficking of Girls and Young Women in Canada, a multi-site, They are a public health problem because of their high prev- cross country project, does provide crucial information regard- alence, their effects on the functional, psychological and social ing human trafficking in this marginalized group. dimensions of a child’s well-being, and their high cost of treat- Conclusions: Human trafficking especially for the purpose of ment. Despite the gains in Canada in reducing the burden of oral sexual exploitation, is happening in Canada and it is dispropor- disease, Canadian children continue to have a high rate of dental tionately affecting Aboriginal women and girls. Understanding disease, and this burden of illness is disproportionately repre- the mechanisms through which Aboriginal women and girls are sented by children in Aboriginal communities. In fact, young disproportionately targeted will assist service providers. This children of First Nations and Inuit ancestry are 8.6 times more workshop will provide the historical context as well as clinical likely to have early childhood tooth decay treated under general tips for responding to and caring for victims. anaesthesia in hospital than other Canadian children. Also, more than 85% of Aboriginal children 3 to 5 years of age have experi- W33 enced tooth decay with an average of 7 to 8 teeth affected. SESSION 4 High prevalence and severity of oral diseases in indigenous populations further compromises their nutrition, overall health, (Abstract ID: 107) quality of life, and educational and work potential, exacerbating Children’s Health socioeconomic and health disparities. This workshop brings a FRI. NOV. 21 – 11:00AM-11:45AM panel of academic researchers, policy makers, and field clinicians to examine the data on the oral health status of First Nations No Jordan’s Principle Cases in Canada? The Truth and Peoples and Inuit, to identify the barriers to access care, and to Politics of Disparities in Access to Health and Social elaborate on potential solutions in addressing these inequalities. Services for First Nations Children Living On-Reserve Vandna Sinha, Anne Blumenthal, Molly Churchill, W32 Lucyna Lach, Nico Trocme SESSION 4 McGill University, University of Michigan (Abstract Id: 58) Jordan’s Principle is a child-first principle designed to ensure Women’s Health that First Nations children do not experience delays, denials or disruptions of services due to jurisdictional disputes. First FRI. NOV. 21 – 11:00AM-11:45AM Nations children are particularly vulnerable to jurisdictional Trafficked: Why are Aboriginal Women at disputes over payment for services because of a structural Increased Risk? framework in which the federal government funds on-reserve Eileen McMahon health and social services for Status First Nations people, while provincial governments are responsible for funding and pro- Mount Sinai Hospital viding these services to most other people. Accordingly, Jor- Aim: Human trafficking is the “recruitment, transportation, dan’s Principle is key to ensuring equitable services for First transfer, harbouring or receipt of persons by means of threat or Nations children. Disparities in on-reserve health and social use of force or other forms of coercion, of abduction, of fraud, of services are well documented, and anecdotal evidence suggests deception”. The sexual exploitation of persons through human Jordan’s Principle cases may be prevalent. Yet, the federal gov- trafficking is a crime that disproportionately affects women ernment has proclaimed that there are no known Jordan’s Prin- and girls. Marginalized and exploited populations of women, ciple cases in Canada. This workshop will present findings of and in particular Aboriginal women, are most vulnerable to research exploring the basis for this federal government claim being targeted. Understanding the historical background and and describing factors which contribute to delays, denials and mechanisms through which Aboriginal women and girls are at disruptions of health and child welfare services for First Nations increased risk for being trafficked will assist service providers in children. Research findings are based on a content analysis of responding to and caring for these victims. Jordan’s Principle related documents and exploratory interviews Methods: Review relevant literature on human trafficking and with health service and child welfare workers. Research was Aboriginal women and girls including MEDLINE, CINAHL, conducted in partnership with the Assembly of First Nations, the Joanna Briggs database, and Diane Redsky’s research through UNICEF Canada, the Canadian Paediatric Society, and the the Canadian Women’s Foundation National Task Force on Sex Canadian Association of Paediatric Health Centres. We draw Trafficking of Girls and Young Women in Canada. on a human rights framework to asses the implications of current approaches to implementing Jordan’s Principle, and to Results: There is a paucity of literature available on human traf- addressing disparities in services, for First Nations children. ficking as it relates to Aboriginal women and girls. However, the Canadian Women’s Foundation National Task Force on Sex INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 53

W34 Island Heritage Centre, Department of Pathology, Department of Physiology & Pharmacology, Departments of Anthropology, Social SESSION 4 Sciences and Pathology, McMaster University, Departments of Family (Abstract ID: 177) Medicine and Pathology, Chatham-Kent Community Health Centre, Traditional Walpole Island Office, Department of Biology, Science and Interfaculty Program in Public Health, Siebens-Drake Medical Research Institute An Investigation into some Contemporary Self-Reg- ulatory Dynamics that Operate in and around First Our systematic review (Henley et al, 2012) confirms the Nations Traditional Healing Systems enhanced risk for T2D from environmental exposures to many different POPs including pesticides such as DDE and nonachlor, Julian Robbins and several PCB congeners. Ettinger et al (2009) associated Independent Community Based Researcher gestational diabetes with increasing environmental arsenic The evolution of health regulation processes in Canada has exposures. Our WIFN-Western University research partner- focused on the development of standards of practice premised ship analyzed 71 POPs (20 pesticides and 71 PCB congeners) upon the principle of “do no harm’ and the approval of these in serum; arsenic in blood and hair; and cortisol in hair (as a by government regulatory agencies. This principle of ‘do no biomarker of psychosocial stress) in 57 volunteers at the Walpole harm’ are also present in other non-western systems of health- Island Health Centre. We simultaneously conducted a health care and healing but their healing methodologies can often be status survey with these individuals. Several factors relevant misunderstood in the context of modern western medicine. to T2D emerged from these investigations. Geometric mean This workshop will illicit discussion based on 4 communities plasma concentrations of several POPs positively associated with of practice, examined by the author during his PhD thesis, that risk for T2D were significantly higher at WIFN than in general bring traditional indigenous knowledge and indigenous healers members of the Canadian (Health Canada, 2010 data) or US forward into health care and their approaches to regulation. The (NHANES, 2009 data) populations suggesting higher risk for results of this exporatory study indicated that surrounding con- T2D as a result of these current exposures. Blood concentra- texts of meaning influence understandings about self-regulation tions of arsenic at WIFN approached those that have been pos- and that these understandings are dynamic because contempo- itively associated with gestational diabetes by Ettinger and her rary practices of First Nations traditional healing can occur in colleagues (2009). The hair cortisol content of WIFN volun- different contexts. The study cautioned that unless we remain teers is significantly greater than in a Caucasian reference group close to these “healer centred’ contexts, there is no guarantee residing near London, Ontario (Henley et al, 2013). Given that that the self-regulatory value systems stemming from modern lower socio-economic status is positively associated with met- Western medical communities of practice will not be applied by abolic syndrome (Abraham et al, 2007) our results suggest that default or that the emerging “integrative’ models of self-regula- combined environmental exposures to POPs and arsenic in tion developed between governments and First Nations will be concert with psychosocial stress at WIFN are partly responsible an accurate representation of the true understandings that exist for the 3-5 fold higher incidence of T2D in First Nations com- and are practiced in traditional Indigenous health systems. munities in Canada. W35 W36 SESSION 4 SESSION 4 (Abstract ID: 49) (Abstract ID: 70) Environmental Cancer FRI. NOV. 21 – 11:00AM-11:45AM FRI. NOV. 21 – 11:00AM-11:45AM The potential contribution of exposure to persistent Addressing gaps in the continuity of cancer care with organic pollutants (POPs) and of psychosocial stress and for First Nations, Inuit and Métis living in rural to enhanced risk for Type 2 diabetes (T2D) at Walpole and remote communities in Canada. Island First Nation (WIFN) Colleen Patterson, Pam Tobin John R. Bend, Rosemary Williams, Gideon Koren, Michael J Canadian Partnership Against Cancer Rieder, Mary Jane Tucker, Naomi Williams, Phaedra Henley, The Canadian Partnership Against Cancer has recently launched Julie Hill, Zahra Jahedmotlagh, Regna Darnell, Christianne V a national initiative to improve cancer care disparities experi- Stephens, Stan Van Uum, Carol P Herbert, Chandan Chakraborty, enced by First Peoples in Canada. This workshop will provide a Dean Jacobs, Judy Peters, Charles G Trick, John R. Bend high level overview of the initiative that includes partners from Walpole Island Health Centre, Departments of Medicine and Paedi- across First Nations, Inuit and Métis organizations, the health atrics, Schulich Medicine & Dentistry, Western University, Walpole sector and the Partnership. The overall goal of the initiative is to INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 54 improve the cancer patient journey from diagnosis to transitions In this session, we will present key facts, clinical tips and evi- in care back to an individual’s home community. dence-based recommendations for improved, culturally-safe This collaborative approach has been implemented among care for Aboriginal women as published in the 2013 Consen- 9 jurisdictions (7 provinces and 2 territories) and will help sus Guide for Health Professionals working with First Nations, us learn from one another and identify common solutions to Inuit and Métis developed by the Society of Obstetricians and improve the experience for First Nations, Inuit and Métis can- Gynaecologists of Canada (SOGC)in partnership with the cer patients. National Aboriginal Health Organization (NAHO). Through a brief presentation, we will demonstrate how engage- W38 ment is being facilitated in participating jurisdictions and provide context about why appropriate engagement of First Peoples WITHDR AWN improves the likelihood of initiative support and sustainability. W39 The focus will benefit individuals interested in learning more about engagement. In addition, examples of lessons learned will SESSION 4 be shared through an Indigenous lens of story-telling. (Abstract ID: 74) Throughout the workshop, linkages will be drawn to cancer Social Work control disparities and promising strategies for community FRI. NOV. 21 – 11:00AM-11:45AM engagement among the Indigenous populations of Australia, New Zealand, Canada and the United States. Rahskwahseron:nis – Building bridges with Indigenous communities through decolonizing This is an opportunity for dialogue about what participants social work education think are the health care disparities in their own regions and what is needed for the sustainability of people-specific cancer Michael Loft, Nicole Ives, Courtney Montour control initiatives that best reflect the needs and priorities of McGill University, School of Social Work First Nations, Inuit and Métis communities. This presentation focuses on how an interdisciplinary course can build bridges with Indigenous communities and nurture W37 culturally safe practices through decolonizing social work edu- SESSION 4 cation. McGill University’s School of Social Work began its first (Abstract ID: 148) cultural immersion course, with the collaboration of the Kahn- awake Mohawk community, in 2010. The course creates space Cultural Safety for students to gain insight into the cultural, social, economic, FRI. NOV. 21 – 11:00AM-11:45AM and health contexts of one First Nations community from the Clinical tips for culturally-safe care: A new community’s perspective. It includes a unique grouping of Consensus Guide for Health Professionals working Social Work, Law, Medicine and Anthropology students and with First Nations, Inuit and Métis introduces them to Indigenous teachings, particularly how these teachings connect with and apply to their own areas of study Sara Wolfe and their own cultural identities. Facilitating these connections SOGC supports the students’ practice by making evident firsthand how Youthful. Increasingly urbanized. Rapidly growing. First Nations, a holistic approach can address the multifaceted challenges fac- Inuit and Métis comprise the fastest growing segment of the ing Indigenous families and communities. The course provides Canadian population, with a birth rate that is nearly double that of students with a grounded understanding of context when work- the non-Aboriginal population. Whether working in urban, rural ing with Indigenous communities- they live and learn firsthand or remote areas, most women’s health professionals will encounter from community members through presentations, interactive Aboriginal peoples in their practices and health professionals need workshops, cultural activities and adapted ceremonies. skills and training to provide culturally-safe care. Cultural immersion initiatives provide an opportunity to Pregnancy is a unique opportunity to acknowledge and affirm strengthen relationships and understanding among Indigenous the sexual and reproductive health rights, values and beliefs of and non-Indigenous learners, and aid in decolonizing social First Nations, Inuit and Métis. Yet, many Aboriginal women work practices. Presenters will discuss strategies on how social experience poor access to culturally-safe maternal health care, work educators can engage Indigenous communities in the pro- and statistics show that this often leads to poor maternal health cess of social work learning, by facilitating community connec- outcomes Ð low and high birth weight babies, preterm birth, tions and centering mutual dialog. Presenters will also describe gestational diabetes, caesarean sections and poor access to spe- how social work education today can be used to liberate and cialist care. heal ruptures in our social fabric. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 55

W40 University of Lethbridge SESSION 4 Background: Psychoactive prescription drug misuse (PDM) is an increasing problem worldwide. In Canada, where pre- (Abstract ID: 173) scription drugs are readily available, the associated harms have Research become a leading safety and public health concern. A number of FRI. NOV. 21 – 11:00AM-11:45AM Indigenous communities in Canada, both urban and rural,have identified PDM as a significant and growing concern. Storytellers as Public Health Facilitators Issue: To date, most work on substance use has focused on alco- Joahnna Kathleen Berti, Jeanette Levall, David Osawabine hol and illicit drugs. The paucity of information available on the Debajehmujig Storytellers prevention, early identification and treatment of prescription Storytellers as Public Health Facilitators Debajehmujig Storytell- drug problems has left both communities and health profession- ers proposes to deliver a community based story creation process, als uncertain on how best to proceed. utilizing health professionals, Aboriginal Traditional Knowledge Workshop: In this workshop I will examine key determinants and community Elders. The Storytellers pioneered a unique story of PDM among Indigenous youth and adults as identified in the creation process that involved community Elders, artists, children various studies I have conducted on this topic. In this interactive and youth to create works that would reflect issues directly back workshop I will discuss what it means to approach PDM from an to the community in ways that would deepened their under- individual vs. population health perspective, and what it means standing and acceptance of their circumstances and facilitate pos- to focus on the causes of cases or the causes of incidence and itive change. Debajehmujig Storytellers has been Canada’s First why it matters. I will review current evidence-based programs Aboriginal Theatre Company to be based in a Reserve commu- that are or may be adapted to prevent PDM within Indigenous nity, Wikwemikong First Nation; touring with professional works, communities, using the Frieden Framework for Public Health by and about Canada’s Indigenous people. Shirley Cheechoo Action to organize audience participation. This workshop will started the company on Manitoulin Island in 1984. generate interactivity and critical thinking across audience The mandate of the organization was to share and educate about members. Space will be provided to brainstorm answers to the culture, heritage and life ways of the Anishnabe. Since 1997, challenging questions and to work as a group to consider those the Storytellers have partnered with Aboriginal Health Centres answers in the context of what is being learned. Attendees will and Public Health Programs to engage Aboriginal communities be able to use this information to consider population-based in raising awareness about lifestyle changes that would impact strategies to address PDM in their communities. community mental, physical and social health. W42 The process was developed through the company’s outreach practice in isolated and remote First Nations in the far North. SESSION 5 The creation process identifies the community issue through (Abstract ID: 174) community contacts addressing the issue, explores the com- Women’s Health munity challenge from a Traditional Healing perspective, and collaboratively generates a collaborative group metaphor for the FRI. NOV. 21 – 2:15PM-3:00PM change that needs to take place. Beyond The Womb: Encouraging healthy pregnancies The workshop will utilize a small group collaborative format through cultural reconnection to bring participants through the creation process, building the Ashley Lamothe, Roslynn Baird confidence of participants to optimize project building within Southern Ontario Aboriginal Diabetes Initiative their own communities. Gestational Diabetes is a form of high glucose during preg- W41 nancy and affects Indigenous women at a higher rate than the average Canadian women (4% of pregnancies versus 18%).Both SESSION 5 Gestational Diabetes and prenatal high glucose can increase the (Abstract ID: 106) rate of Childhood Obesity in children. The Southern Ontario Substance Abuse Aboriginal Diabetes Initiative (SOADI) is a non profit organization with the goal of reducing the staggering rates of diabe- FRI. NOV. 21 – 2:15PM-3:00PM tes in Southern Ontario through prevention and management, Prescription Drug Misuse - Looking at Prevention including Gestational Diabetes. In 2014, SOADI created the 7 in Indigenous Communities through a Population Generations Gestational Diabetes Prevention Program with the Health Lens goals of:- Raise awareness of Gestational Diabetes separate from Cheryl Currie Type 1 and 2;- Educate Front Line workers on incorporating INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 56

GDM material into regular programming;- Encourage Indig- they these children receive more appropriate services. The pre- enous specific content for before, during and after pregnancy. sentation will include implications for culturally appropriate This was accomplished through resource tool kit development assessment and intervention for First Nations, Métis, and Inuit and Front Line Worker Training. In amalgamating medical children in domains other than speech and language, including information with traditional knowledge, 7 Generations has psychology and education. been able to develop a solid base of cultural programming and increase awareness to Indigenous communities. This being W44 brought forward as a cultural GDM best practice and can be SESSION 5 adapted to a variety of community programs. Future prenatal programs with focus on GDM prevention are needed to reduce (Abstract ID: 247) high glucose during pregnancy thus reducing the risk level of Traditional childhood obesity. This can be done by returning to original FRI. NOV. 21 – 2:15PM-3:00PM instructions of health and wellness and keeping mothers, fathers and family in finding and keeping balance before, during, after Teaching cultural competence in the federal and beyond the womb. government - the Indigenous Community Development course W43 Rose LeMay SESSION 5 First Nations and Inuit Health Branch, Health Canada, FNIHB or (Abstract ID: 119) Aboriginal Affairs and Northern Development Canada Children’s Health The Indigenous Community Development course is an inten- sive two-day course for federal government employees, with FRI. NOV. 21 – 2:15PM-3:00PM a focus on building Indigenous cultural competence. Cultural Issues in service delivery to Canadian First Nations, competence is defined as first knowledge of Canada’s history Métis, and Inuit children with speech and language and long-term impacts from colonization and Indian residential difficulties schools, second the personal awareness of one’s own culture so Alice A. Eriks-Brophy, Francis Lori-Anne Davis-Hill, Jacque- as to be able to respect others’ cultures, and third resulting in line Dawn Smith, Laura Todd Hunter Leah Rae Radziwon effective relationships with Aboriginal peoples in Canada. The key learning objectives are to increase cultural competence, University of Toronto, Six Nations Health Services increase knowledge on Canada’s history, and to build partner- To date, no principles or procedures deemed to be appropriate ships of support for Aboriginal community success. Over 1000 to assessment and intervention for First Nations, Métis, or Inuit participants have taken the highly successful course. This work- children who are referred with potential speech and language shop will cover two aspects of the two-day course: essential difficulties and who present with a variety of communication factors of Aboriginal cultural competence, and an overview of and behavioral characteristics have been agreed upon in the field Canada’s history of relationship with Aboriginal peoples and in order to ensure that these children receive appropriate and the long-term impacts on health and community well-being. culturally valid services. This situation is compounded by a lack of culturally adapted test tools, the lack of accessible services W45 in speech-language pathology, especially from culturally com- SESSION 5 petent clinicians, and the diversity of the cultural, linguistic, and geographic environments of First Nations, Métis, and Inuit (Abstract ID: 197) children in Canada; all of which complicate the situation sur- Environmental rounding appropriate service delivery to these children. The FRI. NOV. 21 – 2:15PM-3:00PM development of a culturally valid approach to assessment and intervention is therefore urgently needed and requires careful Uranium Mining and Health: deliberation and discussion. This presentation will discuss the Facts, Figures and Questions diverse issues surrounding valid and unbiased speech and lan- Dale M. Dewar guage assessment and intervention for Canadian First Nations, Society of Rural Physicians of Canada Métis, and Inuit children. Questions for consideration in service provision include issues surrounding the appropriate use Uranium mining occurs mainly on indigenous territories and scoring of existing standardized tests, the potential utility of whether in Canada and around the world. Uranium has distinct developing new assessment tools that might be more applicable effects upon health. Research has been limited and many ques- to the population, and the desirability of adopting alternative tions remain. perspectives on assessment and intervention that may ensure INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 57

Uranium is a radioactive heavy metal; mining is a messy busi- W47 ness and environmental contamination occurs. Health effects of SESSION 5 heavy metals are known but the longer term effects of radioac- tivity have been poorly examined. (Abstract ID: 192) This is a review of the current literature; it will present what is Cultural Safety known about the effects of uranium on health and also present FRI. NOV. 21 – 2:15PM-3:00PM the questions that have arisen amongst people living in affected A new way of looking at good practices in areas in Northern Saskatchewan, Australia and Arizona. Aboriginal communities: The Canadian Best W46 Practice Initiative’s Aboriginal Ways Tried and True Methodological Framework SESSION 5 Nina Jetha, Lori Meckelborg, Andrea L.K. Johnston (Abstract ID: 122) Public Health Agency of Canada, Johnston Research Inc. Respiratory/Cardio/Chronic Disease The Public Health Agency of Canada’s Canadian Best Practices FRI. NOV. 21 – 2:15PM-3:00PM Initiative (CBPI) is pleased to share a ground-breaking, cultur- Respiratory health in First Nations, Inuit and Métis ally relevant, and inclusive framework with which to identify communities: Raising awareness through community systematically assess Aboriginal health promotion and preven- outreach and engagement tion interventions. Jennifer Dawn Walker, Oxana Latycheva, Wayne Warry This innovative approach expands our understanding of what constitutes practice-based evidence and provides a new tool to Nipissing University, Ontario Lung Association, Centre for Rural identify and include evidence-based interventions within a cul- and Northern Health Research tural context that respects traditional approaches to health and Respiratory health is an important issue facing First Nations, wellness. Using this tool, the CBPI has identified 30 new First Inuit and Métis communities. Higher prevalence of chronic Nations, Inuit and Métis interventions on priority public health respiratory disease in these communities is related to the con- topics that include mental wellness, strong healthy bodies, and fluence of risk factors arising from marginalization and poverty. maternal and child health which will be shared on the Best Prac- Many of these risk factors are modifiable and communities can tices Portal (http://cbpp-pcpe.phac-aspc.gc.ca) in a new section improve their outcomes by raising awareness of key environ- entitled: Aboriginal Ways Tried and True. These interventions mental risk factors. However, there is a need for culturally safe are intended to inspire and support public health practitioners, materials and methods for sharing information about respiratory program developers, evaluators, and others by sharing informa- health in First Nations, Inuit and Métis communities. tion on programs and processes that have worked in Aboriginal To address this, a participatory intervention model was devel- contexts and thus helping to address health inequities. oped to empower communities to create better awareness and This exciting framework will be described in this workshop to establish community-based resources on respiratory health. along with a guided tour of the Best Practices Portal. The pre- The project was led by the Asthma Society of Canada in part- senter(s) will share their experience with the development of nership with the Assembly of First Nations, Inuit Tapiriit the Framework methodology and selection criteria and will Kanatami, Métis Nation of BC, and AllerGen NCE Inc. The also introduce several of the selected Aboriginal Ways Tried model was implemented in five First Nations communities, one and True featured on the Portal. Métis community and one Inuit community across Canada in 2011/12. W48 This presentation will provide an overview of the model, the SESSION 5 toolkit of resources that were developed, and the evaluation (Abstract ID: 65) results. In general, the model and the toolkit materials were well-received by the communities. The process of implement- Health Systems ing the model incorporated substantial community engagement FRI. NOV. 21 – 2:15PM-3:00PM and capacity building activities. Overall, participating commu- Back to Moss: Developing and Integrating Public nities expressed increased levels of respiratory health awareness Health Services for Northern Ontario First Nations over the course of the project. In addition, the community sup- Communities port for respiratory health practices increased in most communities on most measures. Some communities showed marked Janet Gordon, Emily Paterson progress in the development of community capacity to address Sioux Lookout First Nations Health Authority, Sioux Lookout Firs respiratory health in their communities. Nations Health Authority INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 58

The Sioux Lookout Area Chiefs, under Resolution 10/06, man- pregnancy in both rural and urban settings. Aboriginal midwives dated the Sioux Lookout First Nations Health Authority (SLF- are also community leaders that can work with families in the NHA) to develop a regional public health system for 31 First context of the child welfare system to decrease stress in pregnancy Nations Communities in the Sioux Lookout Area. SLFNHA is and increase the rates of healthy outcomes for mothers and their developing the model with a three-year grant from the Health babies by practicing culturally safe care and by integrating cultural Services Integration Fund and in partnership with the First practices and traditions in pregnancy, during birth and the post- Nations Inuit Health Branch, the Ministry of Health and Long- partum. A short 4 minute film of a client story will be part of the term Care, local public health units, Northwestern LHIN, Tribal presentation to highlight the role of the Aboriginal midwife in Councils, and First Nations communities. As 80% of our com- mitigating the social determinants of health. munities are remote fly-in communities, access to health services poses a continual challenge. Although there are some public health W50 programs and services, the variety of funders and managers creates SESSION 5 a patchwork system. Through our efforts of collaboration, we aim to integrate services to create a unique system that fits the needs (Abstract ID: 179) of our First Nations communities while meeting the Ontario Research Public Health Standards. To date, we have conducted an environ- FRI. NOV. 21 – 2:15PM-3:00PM mental scan of First Nations public health systems, an assessment of public health services and human resources in our communi- Addressing health inequalities by Indigenizing health ties, a conference with health directors, key informant interviews services and research with frontline health program staff, and community sessions to Julie Bull inform the development of the public health framework. In Feb- University of New Brunswick ruary 2015 we will present a model and implementation plan to the Sioux Lookout Area Chiefs. During our workshop we will There are significant health disparities between Indigenous and outline the steps of our project and allow opportunities for partic- non-Indigenous people in Canada. Health care professionals ipants to share their perspectives and recommendations for a First play a key role in addressing these disparities. In order to meet Nations public health system. the needs of Indigenous people, it is necessary to involve Indig- enous people themselves in the design and delivery of health W49 care services and research. By drawing on the principles of ethical research involving Indigenous people (including OCAP SESSION 5 (Ownership, Control, Access, Possession) and the Tri Council (Abstract ID: 105) Policy Statement for Research Involving Humans, Chapter 9, Midwifery Research with First Nations, Inuit, and Métis), this presentation will highlight best practices in working with Indigenous people FRI. NOV. 21 – 2:15PM-3:00PM while providing a framework by which clinicians and research- Aboriginal Midwifery: Aboriginal Midwives working in ers can meaningfully engage with Indigenous people. By focus- Every Aboriginal Community ing on a wholistic method with self-determination at the core, Ellen M. Blais this presentation will illustrate how to implement the principles into practice by highlighting the integral role of relationship Association of Ontario Midwives building with Indigenous people. The Association of Ontario Midwives has been working to reclaim birth in Aboriginal communities across Ontario. This W51 presentation will shed light on the work of many Aboriginal SESSION 6 midwives and community stakeholders who are passionate about Aboriginal babies being born on the land to which they (Abstract ID: 157) belong, and the work that has been done to try and open up Respiratory/Cardio/Chronic Disease a funding stream for communities across Ontario will be dis- FRI. NOV. 21 – 3:15PM-4:00PM cussed. The pathways to practice and the work of Aboriginal midwives working under the Exemption Clause in the Mid- Embedding First Nations approaches into the preven- wifery Act, as well as other models of Regulated midwifery care tion and management of chronic disease for Aboriginal families will be outlined. Traditional teachings Shannon Tania Waters about pregnancy and birth will also be shared. First Nations Health Authority The role of self determination for communities in bringing birth The First Nations Health Authority [FNHA] is currently devel- back is vital for the health of these communities as the mid- oping strategies to promote mental wellness and address chronic wife is often the only supports a woman may have during her conditions, such as cancer, vascular disease and HIV. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 59

The FNHA is taking a collaborative approach to developing addressing physical, emotional, mental, and spiritual wellbeing and these strategies in order to share knowledge and build capacity the identification of 22 cultural interventions to facilitate well- among healthcare providers who serve Indigenous people. ness. These results were verified among our varied team members, All strategies will include shared definitions of cultural safety participating treatment centres and their communities at large. and competency, patient-centred care and the role and place of Indigenous knowledge shares that traditional culture is vital for spirituality and traditional healing. The strategies will also con- client healing. Our project is the first of its kind in Canada and is sider care across the continuum and across the lifespan. suitably timed with renewal processes underway in Canada’s First Nations addictions treatment system. A key recommendation of First Nations people consider the mental, emotional, spiritual the renewal has been the establishment of a culturally competent and physical aspects of health and the focus of the strategies will evidence base to document the nature and demonstrate the effec- be “health through wellness’.This perspective will be a common tiveness of cultural interventions within treatment programs. FNHA approach to strategies for mental wellness and chronic conditions, meaning that wellness and wholistic perspectives W53 will “surround’ each strategy so that keeping people well and supporting them across their life journey will be based on com- SESSION 6 mon approaches. (ABSTRACT ID: 151) As the FNHA has limited direct operational oversight for care Women’s Health delivery, the strategies will elaborate on the role of advocacy, FRI. NOV. 21 – 3:15PM-4:00PM engagement and collaborative partnerships. The Aboriginal Women’s Health Intervention: What is FNHA’s vascular strategy [heart disease, stroke, diabetes, renal the potential for contributing to social change? disease] is set for release in October 2014. This work is being done in partnership with government, experts and research Colleen Varcoe, Jane Inyallie, Linda Day, institutes. The strategy, process, successes, challenges and rec- Madeleine Dion-Stout, Holly MacKenzie, ommendations for improvement will be presented at the Indig- Annette Browne, Marilyn Ford-Gilboe enous Health Conference. University of British Columbia, Central Interior Native Health, Vancouver Native Health Society, University of Western Ontario W52 Indigenous women in Canada experience disproportionate SESSION 6 levels of intersecting forms of violence including interpersonal (Abstract ID: 128) and structural violence such as racism and policy-induced poverty. Our goals are to (a) examine whether a health promotion Substance Abuse intervention designed for women who have experienced inti- FRI. NOV. 21 – 3:15PM-4:00PM mate partner violence can improve the health and wellbeing of Honouring Our Strengths: Indigenous Culture as Inter- Indigenous women living in an urban context and (b) make a vention in Addictions Treatment “shift happen” to disrupt pernicious stereotypes about Indige- nous women that obscure the effects of and responses to inter- Colleen Dell, Carol Hopkins, Peter Menzies secting forms of violence. The study involves the integration University of Saskatchewan, National Native Addictions Partnership of culture and traditional practices in an Elder-supported Cir- Foundation (NNAPF), CAMH cle, and 1:1 support of the women by nurses. We are working The aim of our community-based research team’s work is to eval- simultaneously to support women to improve their health, and uate the effectiveness of First Nations culture as a health inter- shift public and health care providers’ perceptions in order to vention in alcohol and drug treatment. Health for First Nations is promote social justice, and health and healthcare equity. In this broadly envisioned as wellness and is understood to exist where workshop, we discuss our development process, including: a) there is physical, emotional, mental, and spiritual harmony. We guidance from an expert reference group of Indigenous women, gathered understanding of how Indigenous traditional culture is and interviews with Elders, b) integration of Cree concepts to understood and practiced at a sample of 12 First Nations residen- loosen the colonial confines of working in English, and c) a tial treatment programs by undertaking a three day environmen- pilot test for acceptability and feasibility prior to the full study. tal scan. From this, a valid instrument to measure the impact of We discuss the results from the pilot showing considerable cultural interventions on client wellness is being developed. We improvement in health and quality of life for participants, and prioritized Indigenous knowledge in our data analysis. In doing changes made to the intervention based on the pilot. We also so, we applied 3 “lenses’ to analyzing the information we collected report findings from the first cohort of women who completed across the treatment centres. We involved treatment centre partici- the intervention in the full study. Workshop participants will pants, Indigenous knowledge keepers and research team members. engage in dialogue regarding how research findings can be used Our work resulted in the development of a wellness framework toward broader change. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 60

W54 Admissions and Curriculum, which will be briefly described. In 2008, two surveys were conducted to see how Canadian med- SESSION 6 ical schools were carrying out these recommendations. This (Abstract ID: 171) year, a survey of all Canadian medical schools was conducted, Food Security/Nutrition looking at Indigenous student recruitment, admissions and support including academic, personal and financial resources. FRI. NOV. 21 – 3:15PM-4:30PM Indigenous health curriculum content and methods, as well as Use-and-Occupancy Mapping: A tool to support food community engagement as outlined in the FNIM Core Compe- security in aboriginal communities tencies and Curriculum Toolkit was also surveyed. This survey Daniel Tobias assessed how well Canadian medical schools have taken on the recommended curricular and admissions activities outlined by D.Tobias Consulting Inc. IPAC and AFMC. We found similar and innovative ways that Food security is a major issue in many aboriginal communi- Indigenous health curriculum, Admissions and Student support ties. For many of those communities, land and marine-based are carried out. Results showed that most schools incorporate resources such as fish, moose, caribou and waterfowl are a major lecture and case-based activities to teach Indigenous health, and source of high quality calories. These resources have been are encouraged to utilize Indigenous community resources, such destroyed in some communities and are threatened in others as Elders, to add cultural perspectives. There are clinical expe- by extractive-industries such as mining, logging and oil and riences offered by most schools, including urban centres, rural gas. Land Use-and-Occupancy Mapping is a survey research- and remote communities. Various recruitment activities have method, first developed by the Inuit in Arctic Canada, that is helped to increase medical schools admissions of Indigenous used to document a community’s reliance on these land and students since 2008. Canadian medical schools have progressed marine-based food resources. The data and geo-coded maps, in producing Indigenous physicians and training all students to the products of these surveys, are used by aboriginal communi- become culturally competent in working in a culturally safe ties as evidence of their use of the land as a food-supply in nego- way, with Indigenous patients, families and communities. This tiations with resource companies and government agencies. can be potentially echoed in other health professional programs, This workshop will: describe the use-and-occupancy map- ultimately to reduce Indigenous health inequities through cul- ping methodology used by the presenter over the past six tural competency and safety. years as documented in the 2010 best-methods book, “Living Proof: The Essential Data-Collection Guide for Indigenous W56 Use-and-Occupancy Map Surveys” (T. Tobias 2009); articulate SESSION 6 the strategies used to implement this methodology in aboriginal (Abstract ID: 156) communities across Canada and Australia; provide examples of situations where this tool has been useful; showcase some of Midwifery the finished map products; and provide participants with the FRI. NOV. 21 – 3:15PM-4:00PM opportunity to role play negotiations using maps that do and do Revolutionary Care: Indigenous Midwifery not include use-and-occupancy mapping data to highlight the value of the tool. Cheryllee Bourgeois, Billie Allan Seventh Generation Midwives Toronto, Well Living House W55 This workshop will address the role of Indigenous midwives SESSION 6 in their communities and the revolutionary nature of their (Abstract ID: 232) work. More specifically, the presenters will highlight Indige- nous midwifery led research, including an ambitious commu- Cultural Safety nity based population health research study currently under- FRI. NOV. 21 – 3:15PM-4:00PM way in Toronto. In addition, participants will be introduced A Journey to Cultural Competency and Safety: to examples of Indigenous midwifery leadership in health care Highlights of IPAC-AFMC Collaborative Activities systems change as demonstrated through ground breaking projects such as the Toronto Birth Centre, the Midwifery program Darlene Janet Kitty in the North West Territories and the efforts of the National Indigenous Physicians Association of Canada Aboriginal Council of Midwives (NACM) to bring birth closer The Indigenous Physicians Association of Canada (IPAC) has to home for Indigenous people in Canada. Finally, the presenta- collaborated with the Association of Faculties of Medicine tion will discuss Indigenous approaches to health care provision of Canada (AFMC), producing several documents regarding in reproductive,maternal and infant health that create lasting First Nations, Inuit and Métis (FNIM) Core Competencies, positive impacts for women, infants, families, communities and Nations. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 61

Participants will be invited to engage in dialogue about the ongo- W58 ing revitalization of Indigenous midwifery and the implications SESSION 6 for their own areas of work. This workshop will be of particular interest to health care practitioners and social service providers (Abstract ID: 81) working with Indigenous women of childbearing age, as well as Social Work policy makers and researchers working to advance the health and FRI. NOV. 21 – 3:15PM-4:00PM well being of Indigenous families, communities and Nations. One Canoe, One Oar: Navigating mental health with W57 our Indigenous youth, a wholistic approach. SESSION 6 Ela Smith (Abstract ID: 180) Wholistic Child and Youth Research The question of how to work “effectively “with Aboriginal children, youth and their families has been largely debated in FRI. NOV. 21 – 3:15PM-4:00PM social work and particularly in the field of mental health and Using record linkage to study chronic diseases in the addictions. Indigenous mental health workers insist on the need Métis population in Ontario to develop practices rooted in the worldviews of Indigenous David Henry, Storm J Russell, Wenda Watteyne, Saba Khan people, the culture and traditions of our different Nations. Institute for Clinical Evaluative Sciences and University of Toronto, This interactive workshop will present a social work, Indig- Métis Nation of Ontario , Institute for Clinical Evaluative Sciences enous-based approach to work with Aboriginal youth facing mental health and addictions from the perspective of a canoe The Métis Nation of Ontario (MNO) maintains a register for trip. The guiding principle of our agency: One Canoe, One those who can supply genealogical documentation and proof of Oarwill be developed. This approach is rooted in Indigenous Aboriginal ancestry. A data sharing and governance agreement principles of self-determination, non-interference, intercon- was established between MNO and ICES to enable linkage of nectedness, relational and reciprocal therapeutic work. the citizenship registry with Ontario health administrative data. Of 14,480 individuals in the Métis registry, 14,021 (96.8%) were According to this principle, we embark on a journey with our linked. After anonymisation the linked records were used to clients on their canoe. The canoe has room for more than one study the incidence and prevalence of a range of chronic dis- person, but there is only one oar. The oar belongs and must eases and cancer. We can identify several factors underpinning remain in the hands of the client so that he or she can determine the success of this work: 1) the project was conceived of and the course of the journey. If the goal of the therapy may be the initiated by the MNO who retained control at all times 2) ICES same from a Eurowestern perspective (allowing the client to is a prescribed entity that can legally receive link and analyse acquire enough navigating skills to be able to paddle the canoe, personal health information. This avoided lengthy applications make a safe journey, and ideally, enjoy the ride) the clinician’s to government departments to release data 3) engaged from the role, the course of the therapy and the clinical setting are sig- start ICES brought technical skills in the linkage and analysis nificantly different from the One Canoe, One Oar perspective. of data and clinical expertise to the interpretation of findings. 3) planning and execution of the analysis and writing phases of W59 studies were collaborative at all times 4) final decisions about SESSION 6 data presentation and interpretation were made by the MNO 5) (ABSTRACT ID:162) communication of the data was planned and carried out collaboratively. The products of this work included reports generated Women’s Health for use by the Métis population, health professionals and pol- FRI. NOV. 21 – 3:15PM-4:00PM icy makers, and fact sheets disseminated at multiple meetings. These experiences and data from the studies will be presented Solidarity not appropriation: How non-Indigenous at the workshop. healthcare providers and organizations can support Indigenous women’s reproductive justice and sovereignty Holly A. McKenzie University of British Columbia Many non-Indigenous organizations provide reproductive health services informed by reproductive choice, or a pro- choice politics. Indeed, since within the current conservative climate access (and legal rights) to abortion and birth control INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 62 remains under threat, providing pro-choice services is political. However, as women of colour have consistently pointed out, the “pro-choice’ framework is limited. Women of colour continue to fight for their right to give birth to and raise their own children, a right denied to many Indigenous women in Canada through several colonial mechanisms, such as, the coercive ster- ilization of Indigenous women and the apprehension of Indig- enous children from their families through residential schools and the child welfare system. Pro-choice organizing and services continue to marginalize these historical and present-day violations of Indigenous women’s rights. A number of organizations led by women of colour have articu- lated, and employ, a reproductive justice framework. Reproduc- tive justice asserts that one has the right to determine whether or not to have children and to raise one’s children in safe and healthy environments. Indigenous women’s activism has long made the interconnections between reproductive justice and community self-determination visible. First, this workshop will explore how “reproductive choice’ and “reproductive justice’ frameworks make certain violations of Indigenous women’s reproductive self-determination (in)visible. We will discuss how recently some pro-choice services and organizations have adopted the label ‘reproductive justice’ without significantly changing their practices. Finally, we will examine how reproductive service providers can better support Indigenous women’s reproductive justice and self-determination while disrupt- ing politics of exclusion, domination and appropriation. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 63

University of Ottawa, Institute of Population Health, University of Poster Abstracts Ottawa, Brandon University P01 Objective: This study describes the adaptation and usability (Abstract ID: 59) testing of the Ottawa Personal Decision Guide (OPDG) to support health decision-making by Aboriginal women. Anishinaabek Cervical Cancer Screening Study: A mixed-methods approach to a community-based Methods: An interpretive descriptive qualitative study was con- participatory cervical screening project in Indigenous ducted using a postcolonial theoretical lens. An advisory group communities of Northwest Ontario with representation from the Aboriginal community partner (Minwaashin Lodge) developed a mutually agreed-upon ethical Brianne Wood, Julian Little, Pauline Sameshima, framework. Eligible participants were women at Minwaashin Pamela Wakewich, Ingeborg Zehbe Lodge, which provides support to Aboriginal women who are University of Ottawa, Lakehead University, Thunder Bay Regional survivors of violence. The OPDG was first discussed with par- Research Institute ticipants in focus groups and then used with decision coaching Histories of colonialism have led to health inequities that con- during individual usability testing interviews. Iterative adapta- tinue in most Indigenous communities today. In particular, tions were made to the OPDG. Transcripts were coded using First Nations women endure a higher burden of cervical cancer thematic analysis with themes identified and then corroborated compared to the general population. The Anishinaabek Cer- by Minwaashin Lodge leaders. vical Cancer Screening Study (ACCSS) is a community-based Results: Nineteen Aboriginal women identifying as First participatory research project investigating the cervical cancer Nations, Métis or Inuit participated in one of two focus groups burden in ten First Nations communities in Northwest Ontario. (n=13) or usability interviews (n=6). Seven themes reflected or In ACCSS, findings from qualitative interviews and focus affirmed OPDG adaptations: 1) “This paper makes it hard for groups helped to inform and implement a cluster-randomized me to show that I am capable of making decisions”; 2) “I am controlled cervical screening trial (ISCRTN84617261). In this responsible for my decisions”; 3) “My past and current expe- trial, communities were randomized such that women were riences affect the way I make decisions”; 4) “People need to first offered either (1) Pap testing, the current cervical screening talk with people”; 5) “I need to fully participate in making my modality offered in Ontario, and a self-collection method for decisions”; 6) “ I need to explore my decisions in a meaningful HPV testing later; or (2) the self-collection method followed way”; 7) I need respect for my traditional learning and commu- by Pap testing. In ACCSS, community-based research assistants nication style”. (CBRAs), a community steering committee, and local health Conclusion: A culturally adapted lower health literacy version care providers have shaped how cervical screening is offered of the OPDG with decision coaching was found to better meet to women as part of the ACCSS trial. Incorporating arts-inte- the needs of a population of Aboriginal women. grated research into new educational strategies, working with CBRAs to engage community members in culturally sensitive P03 dialogue about cervical cancer, and frequent communication with community representatives encouraged active commu- (Abstract ID: 139) nity participation in ACCSS. The mixed-methods approach in Prevalence of Abuse and Intimate Partner Violence ACCSS allows multiple voices to be presented, from screening Surgical Evaluation (PRAISE) in Nunavut: proposed participants to health care providers and community stakehold- project ers, broadening our understanding of cervical screening cul- Aparna Swaminathan, Kim Madden, Mohit Bhandari ture in these First Nations communities. The community-based approach with attention to ethical, reparative outlooks, along- Family Medicine Centre, St. Joseph’s Health Centre, Toronto, side mixed research methodologies will enhance the relevance McMaster University, Division of Orthopedic Surgery, and impact of ACCSS when sharing findings with communities McMaster University and making recommendations to stakeholders about cervical Background: The experience of violence in aboriginal com- screening. munities in Canada has far out-paced efforts to quantify the scale of the problem and develop effective interventions. The P02 situation in Nunavut is particularly acute: the rate of police-re- (Abstract ID: 96) ported violent crimes against women in Nunavut is 13 times higher than the rate for Canada overall, with the majority of Cultural Adaptation of a Shared Decision Making Tool these crimes caused by an intimate partner. The Prevalence With Aboriginal Women: A Qualitative Study of Abuse and Intimate partner violence Surgical Evaluation Janet Jull, Audrey Giles, Yvonne Boyer, Dawn Stacey (PRAISE) in orthopedic fracture clinics is the largest multi- national prevalence study of its kind in orthopedics. Its study INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 64 team will now turn its focus to documenting the experiences were smoke-free at Baseline in Community A= 73/173=42.2%. of women presenting to health centres with musculoskeletal However, all 321 households in Community A will be invited trauma in Nunavut. to participate in the Green Light Program. Methods: A partnership will be established with the Government Number of homes in Community B that participated in the of Nunavut, orthopedic centres in Ottawa, Winnipeg and Yel- study=233/259=90%. Number of homes that were smoke free lowknife, as well as other agencies working on this issue in the at Baseline in Community B=117/233=50.2%. However, all territory. The project will seek to establish the prevalence rate of 259 households in Community B will be invited to participate intimate partner violence experienced by women presenting to in the Green Light Program. health centres in Nunavut with musculoskeletal injuries. Women By choosing the Green Light Program, these communities who consent will anonymously answer a validated questionnaire became part of a larger initiative which includes 61 other com- on their health and experience of violence in the past 12 months munities in Saskatchewan & Manitoba. and in their lifetime. The target sample size will be500 completed questionnaires over a6 month period. All participants will be Conclusions: Since this is the second year of a five year program, given information on local resources for support. results will be reported to September 30, 2014. Expected Outcomes: A multivariable logistic regression analysis P05 will be used to analyze and investigate the risk factors associated with IPV. The findings will be shared with the participating (Abstract ID: 231) agencies to aid their existing activities, program development The Development and Testing of an Aboriginal Chil- and impact assessment. dren’s Interactive Measure of Pain and Hurt Margot Latimer, Sharon Rudderham, Vanessa Nickerson, P04 Kayla Rudderham, Allen Finley (Abstract ID: 113) IWK Health Centre, Eskasoni Health Centre The Green Light Program: A Community Chosen Background: Aboriginal children have a higher prevalence of Health Intervention chronic, disease-related and dental pain, and are more likely Vivian R Ramsden, Kathleen McMullin, Priscilla Gardipy, than non-Aboriginal children to not be treated for it. There is Jarret Nelson, Shari McKay, Chandima Karunanayake, some indication that children are stoic and do not express their Sylvia Abonyi, Jo-Ann Episkinew, Punam Pahwa, pain and hurt in a way Western clinicians are trained to assess James Dosman it. Finding a culturally appropriate mechanism to assist the chil- University of Saskatchewan, Willow Cree Health Centre, Duck dren to convey their hurt may be an important step in reducing Lake, SK, William Charles Health Centre, Montreal Lake Cree it and improving Aboriginal children’s wellbeing. Nation, Montreal Lake, SK, University of Regina Objective: To describe the development and content valid- Background: In partnership with two Saskatchewan First ity testing of an Aboriginal children’s interactive hurt app Nations communities, the study entitled Assess, Redress, mechanism. Re-assess: Addressing Disparities in Respiratory Health Among Sample & Setting: Aboriginal children and youth from Eastern First Nations People aims to improve respiratory health out- Canadian urban and rural communities. comes with community members. The Green Light Program, Procedure: This presentation will outline our team’s mixed celebrating smoke-free homes, is a community chosen, evi- method approach used to develop a mechanism for Aborigi- dence-informed activity to be undertaken by and with the nal children to convey their pain and hurt. Using a Two-eyed community. seeing perspective combining the best of Indigenous ways of Objective: To increase the number of smoke-free homes and knowing (narrative, artwork) and established Western gold thereby reduce the impact that environmental tobacco smoke standard pain assessment mechanisms a novel interactive mech- has on children and older adults in communities that have high anism has been created. The steps taken to develop and validate rates of tobacco mis-use. the application’s content will be described. Methods: The overall design of this community chosen, evi- Conclusion: Pain care remains a major problem in health care dence-informed activity was informed by participatory health irrespective of culture or place of residence. Untreated pain may research (the communities will be engaged in the implemen- be even more profound and result in poorer outcomes amongst tation of the Green Light Program), transformative action Aboriginal children given high rates of ill health. The audi- research and program evaluation. ence will learn about baseline research conducted by this team Results: Number of homes in Community A that participated and consequently the process to develop a culturally appropriate in the research study=173/321=53.9%. Number of homes that mechanism to assist children to convey their pain and hurt. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 65

P06 youth with evidence suggesting a greater emphasis on values of kinship, spirituality, self-reliance, and finding meaning in (Abstract ID: 245) social relationships. These cultural differences, combined with a Risk and Resilience: exploring the sexual health of shortage of volunteers, may impact the extent to which Aborig- Cree youth with FASD inal youth benefit from mainstream mentoring programs. Alanna Mihic, Florence Large, Dionne Gesink Objective. This study compares the mentoring relationship University of Toronto, Saddle Lake Eagle Healing Lodge experiences and possible health and social benefits of program-supported mentoring for Aboriginal and non-Aboriginal Fetal Alcohol Spectrum Disorder (FASD) describes the range youth. of permanent cognitive and behavioural disabilities in children with prenatal alcohol exposure. Youth with FASD exhibit high Method. 130 Aboriginal youth and 848 non-Aboriginal youth rates of inappropriate sexual behaviour, are highly vulnerable ages 6-17 participated in a national survey of Big Brothers Big to sexual victimization and are perpetrators of sexual offenses. Sisters mentoring relationships. Non-Aboriginal youth were divided into two groups: White (European Canadian) (n=516) Work from a community-based participatory research partner- and other visible minorities (African, Asian, and Hispanic ship between Saddle Lake Cree First Nation and the Univer- Canadian) (n=332). Youth and parents reported on youth men- sity of Toronto found the sexual health of community members tal health and behavior at baseline (before youth could be paired with FASD to be of concern to community members. to a volunteer) and at five follow-ups (until 30 months). At Between March and May 2014, five circles (Cree-adapted focus follow-up, youth, parents, and volunteers reported on aspects of groups) were held to explore the sources of risk and resilience the mentoring relationship. in the lives of youth with FASD living in Saddle Lake. Partic- Results. 2% of the 516 adult volunteers were Aboriginal com- ipants were personal and professional care-providers of youth pared to 13% of youth. Aboriginal youth were just as likely to with FASD, including biological, foster and adoptive parents, be paired to a volunteer as other youth but more likely to see mothers with FASD, and professionals in the fields of education, their relationships dissolve. Aboriginal youth spent more time social work, child social services and FASD diagnostic services. each week doing things with their volunteers than White youth Factors promoting resilience against sexual ill-health include and participated in a greater range of activities. Aboriginal champions in the home and school, which act as advocates, pro- youth were less likely than White youth to perceive shared sim- vide stability, routine and protection. Importantly, the champi- ilarities with their volunteers. However, they were more likely ons themselves need support from social services. Factors pro- than White and other visible minority youth to view their men- moting risk include: 1) the historic influence of the church and toring relationships as trusting and happy. Adjusting for baseline stigma around sexual health education and protection; 2) inac- covariates, at follow-up, mentored Aboriginal youth (relative curate sources of sexual health information; and 3) the failure of to non-mentored youth) experienced significantly fewer con- social services to be equipped/trained to deal with the complex duct and emotional problems, fewer symptoms of depression needs of patients with FASD (such as co-occurring mental ill- and social anxiety, and stronger social skills. Implications for health, addictions and disability). culturally relevant mentoring programs are discussed. Holistic and dynamic social support programming is necessary to promote family-level stability, which in turn promotes resil- P08 ience in the youth’s lives. (Abstract ID: 64) Urban First Nations Men: Narratives Of Identity. P07 Striving To Live A Balanced Life (Abstract 270) Celina Carter, Jennifer Lapum, Lynn Lavallèe, Mentoring Relationships and the Health and Well-Be- Lori Schindel Martin ing of Aboriginal Youth Ryerson University David Dewit, Tara Elton-Marshall, Samantha Wells Dominant discourse contains an abundance of negative stereo- Background. Although evidence suggests that youth involved typical images of First Nations males that are steeped in colo- in program-supported mentoring relationships experience many nial issues. These images and racialized stories are locked in health and social benefits, little is known about the mentoring time and can influence both First Nations mens’ sense of self experiences of Aboriginal youth. Aboriginals often prefer to and health care providers’ practices. To counter these negative be paired with Aboriginal volunteers. However, a shortage of stereotypes a strength-based perspective and the theoretical lens volunteers has resulted in most youth not being paired to vol- of Two-Eyed Seeing was used to conduct a narrative study to unteers sharing the same cultural background. The needs of explore the identity of First Nations men who identify as liv- Aboriginal youth may be different from those of non-Aboriginal ing a balanced life within the urban environment of Toronto. INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 66

Three First Nations men participated in two semi-structured interventions are essential to preventing suicide and promoting interviews and Anishnaabe Symbol-Based Reflection. Findings mental wellness and resiliency among Indigenous groups in cir- indicate that these men’s narratives of identity are focused on cumpolar contexts. positive mindsets and resilience. Furthermore, positive First Nations identity was supported by having mentors, knowing P10 family histories, and connecting with healthy Aboriginal com- (Abstract ID: 132) munities. Implications of this research are three fold, first, it provides positive stories about First Nations men striving to live Relieving the measurement dilemma: a balanced life, which other First Nations men and children A revolutionary method for assessing risk of may benefit from hearing. Second, the positive stories counter abuse and diversion in pain patients negative stereotypes prevalent in dominant discourse. Third, it Carina Fiedeldey-Van Dijk encourages healthcare providers to employ strength-based and ePsy Consultancy decolonizing frameworks, as well as reflexive practices which reveal biases, in order to promote culturally safe care. While the misuse, abuse and diversion of chronic pain drugs are alarmingly on the rise in North America, aberrant behav- P09 ior remains under-detected and –reported. The Risk Assess- ment for Controlled Substances™ (RACS) is psychometric (Abstract ID: 187) measure of an individual’s risk of diverting medication from Suicide Prevention Interventions in the Circumpolar what is intended. This may stem from varying behavior pat- North: a Scoping Review terns associated with Abuse, Manipulation, and/or Deception, Jennifer Redvers, Sahar Fanian, Susan Chatwood depending on six drivers of aberrancy: Institute for Circumpolar Health Research Derivative Effect Personal Desperation Emotional Need Transactional Strain Background: In circumpolar regions, Indigenous populations experience disproportionately higher rates of suicide than Unsupportive Context Symptomatic State non-Indigenous populations, most notably among youth. Sui- Also included in the assessment is a Depression Indicator and cide presents a serious public health problem across northern Critical Alerts. The RACS the preferred detector to provide an regions. Thus, there is need for a review of current suicide pre- individual’s scientifically orchestrated diversion results at your vention efforts for Indigenous peoples in circumpolar regions in fingertips in one package. The RACS was developed to offer six order to inform future interventions. parallel versions of 43 statements that individuals can complete Objective: This scoping review examines publications in the in about five minutes during consecutive visits to health provid- primary and grey literature in order to map current suicide ers. This feature enables dynamic tracking over time to verify interventions and mental health promotion efforts targeting and highlight changes in patient/client behavior. Indigenous communities across the circumpolar north. Providers get assessment results from the RACS in graphed Design: Online databases were searched to identify suicide inter- and listed formats, with the ability to drill down further where ventions for Indigenous peoples in circumpolar regions from needed. Specifically, comparative percentage scores are pro- 2004-2014. To capture relevant interventions published outside vided for each of the above aspects, along with a simple inter- of the primary literature, regional, national and international pretational guideline indicating any degree of risk. Providers researchers, policymakers, health practitioners and community are able to view specific aberrancy indicators that may be partic- members were consulted and online searches were performed. ularly revealing in understanding and follow-up of an individual’s displayed risk of diversion. Published by Verimed, results Results: Of 187 papers examined in the primary literature, 17 from the RACS can also help combat medical insurance fraud, articles published from 2004-2014 described specific suicide offer a safer supply chain, and identify individuals early on with interventions for circumpolar Indigenous peoples. Among the purpose of effecting early treatment. these, 8 provided a description of evaluation methods and results. The majority of relevant publications were found in the P11 grey literature. (Abstract ID: 167) Conclusions: Publications on suicide interventions for Indige- nous populations in circumpolar regions are lacking in the pri- Naturally Acquired Antibody in an Aboriginal mary literature and, among those published, there exists a bias Population at High Risk for Invasive Haemophilus in favour of North American interventions. Furthermore, there influenzae Type A Disease is critical need for more evaluations to be conducted and for the Eli B Nix, Kylie Williams, Andrew Cox, Frank St. Michael, development of new evaluation tools and indicators. The present William McCready, Marina Ulanova literature suggests that community-based, culturally-relevant INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 67

Northern Ontario School of Medicine, National Research Council Department of Biology, Science and Interfaculty Program in Public Background. Haemophilus influenzae type a (Hia) has emerged Health, Schulich Medicine & Dentistry, Western University as an important cause of invasive bacterial disease among certain Results of recent research show, in many epidemiological stud- North American Indigenous groups. Anti-Hia capsular poly- ies, a positive correlation between exposures to persistent organic saccharide antibodies are the major defence mechanism against pollutants (POPs) and an increased risk for Type 2 diabetes (T2D). invasive infection. Predominantly, adult cases of invasive Hia Moreover, stress related to lower socio-economic status is posi- disease occur among immunocompromised individuals. tively correlated with metabolic syndrome, a precursor to T2D. Methods. Functional antibody activity against Hia was studied A research partnership between the Attawapiskat First Nation, in 70 Aboriginal and 70 non-Aboriginal healthy adults using a its Health Centre and Western University analyzed 91 POPs (20 serum bactericidal assay (SBA). Anti-Hia capsular polysaccharide pesticides and 71 PCB congeners) in serum; and hair cortisol, a antibody concentrations (IgG, IgM) and functional activity were known biomarker for psychosocial stress, in 50 volunteers. The assessed in 30 Aboriginal and 30 non-Aboriginal patients with geometric mean concentrations of almost all POPs analyzed in chronic renal failure (CRF) and compared to those of healthy serum were significantly higher at Attawapiskat than at Walpole controls of corresponding ethnic background and similar age. Island First Nation, and were significantly higher at Walpole Island than in representative members of the Canadian and US Results. Among healthy adults, the Aboriginal group exhibited populations, as measured by Health Canada in 2010 and the US significantly higher anti-Hia functional antibody activity com- Centres for Disease Control (NHANES in 2009). In addition, pared to those of the non-Aboriginals. The same was true for hair concentrations of cortisol were significantly higher in volun- Aboriginal versus non-Aboriginal CRF patients. Regarding the teers from Attawapiskat than in those from Walpole Island, which naturally acquired anti-Hia antibody, overall IgM concentra- in turn were significantly higher than in a Caucasian reference tions were markedly higher compared to IgG. group. In concert, these results from analysis of two risk factors Conclusion. Our results suggest that the high rate of invasive for T2D (exposure to selected POPs and psychosocial stress) show Hia disease among affected Aboriginal populations is not due to that community members of remote Attawapiskat First Nation a decreased capacity to produce functional anti-Hia antibodies. are at greater risk for T2D than community members at Walpole Increased anti-Hia antibody functional activity among Aborig- Island, who, in turn, are at greater risk than members of the Cana- inal groups may be explained by a high rate of Hia circulation dian and US populations analyzed during recent surveys. These within Aboriginal communities. data may help to explain the 3-5 fold higher incidence of T2D in First Nations in Canada than in other Canadians. P12 (Abstract ID: 51) P13 Exposure to persistent organic pollutants and elevated (Abstract ID: 87) psychosocial stress may enhance the risk for Type 2 Cancer-Related Risk Factor Prevalence and Screening diabetes at Attawapiskat First Nation in Participation in Ontario Off-Reserve First Nations and northern Ontario Métis Adults John R. Bend, Barbara Lent, Mary Jane Tucker, Abigail Amartey Zahra Jahedmotlagh, Carol P Herbert, Dean Jacobs, Cancer Care Ontario Joyce Johnson, Jackie Hookimaw-Witt, Norbert Witt, John Hookimaw (deceased), Mike Gull, Theresa Spence, The extensive array of health-related indicators within the Cana- Regna Darnell, Gideon Koren, Stan Van Uum, dian Community Health Survey (CCHS) provides the most Charles G Trick comprehensive look at cancer-related risk factors and screening behaviour among Ontario’s First Nations and Métis population. Department of Pathology, Siebens-Drake Medical Research Institute, Schulich Medicine & Dentistry, Western University, Department of CCHS surveys from 2007-2011 were combined to increase the Family Medicine, Schulich Medicine & Dentistry, Western University, sample of Ontario’s off-reserve First Nations and Métis respon- Department of Medicine, Schulich Medicine & Dentistry, Western dents, in order to estimate the prevalence of smoking, obesity, University, Department of Pathology, Schulich Medicine & Dentistry, alcohol consumption, physical activity, diet, and colorectal, Western University, Departments of Family Medicine and Pathology, breast, and cervical screening uptake. Odds ratios adjusted for Schulich Medicine & Dentistry, Western University, Walpole Island socioeconomic factors (SES) were also obtained, and non-Ab- Heritage Centre, Attawapiskat First Nation, Former Council Mem- original Ontarians were analyzed for comparison. ber, Attawapiskat First Nation, Chief, Attawapiskat First Nation, Significantly higher rates of smoking and obesity were found Departments of Anthropology, Social Sciences and Pathology, Schulich in both the First Nations and Métis population compared to Medicine & Dentistry, Western University, Departments of Medicine non-Aboriginal Ontarians. Significantly heavier alcohol con- and Paediatrics, Schulich Medicine & Dentistry, Western University, sumption was reported among First Nations and Métis males, INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 68 while inadequate fruit and vegetable consumption was more and arthroplasty compared to the general population are not yet reported among First Nations. First Nations women were more understood. likely to report having had an FOBT (colorectal cancer screening test) in the past two years than non-Aboriginal women. P15 After adjusting for SES, a no longer significant difference in (Abstract ID: 138) alcohol consumption and fruit and vegetable intake among Métis males and First Nations males, respectively, compared to Prevalence of Inflammatory Arthritis Conditions in the non-Aboriginal males was seen. First Nations Population of Alberta Understanding how the prevalence of these risk factors varies Cheryl Barnabe, C Allyson Jones, Don Voaklander, in subgroups is essential to informing cancer prevention and Deborah Marshall , Christine Peschken, Lawrence Joseph, control programs tailored to the specific needs of these groups, Sasha Bernatsky, John Esdaile, Brenda Hemmelgarn and to monitor equity. Analyses such as these should be repeated University of Calgary, University of Alberta, University of Manitoba, over time to monitor trends and track progress toward targets McGill University, University of British Columbia for improvement. Objective: The prevalence of inflammatory arthritis (IA) conditions of Rheumatoid Arthritis (RA), Ankylosing Spondylitis P14 (AS), Psoriatic Arthritis (PsA), Reactive Arthritis (ReA), and (Abstract ID: 100) Crystal Arthritis has not been widely studied in First Nations Imbalance of Prevalence and Specialty Care for First (FN) populations. Prevalence estimates from Alberta would Nations with Osteoarthritis in Alberta provide a good overall view of the IA landscape given the rich diversity in tribal ancestry. Cheryl Barnabe, Allyson Jones, Don Voaklander, Christine Peschken, Joanne Homik, John Esdaile, Methods: Population-based healthcare data (years 1993 to 2011) Sasha Bernatsky, Brenda Hemmelgarn, Deborah Marshall was used to define cohorts of people with RA, AS, Ps, ReA and crystal arthritis based on ICD-9-CA and ICD-10-CM codes (2 University of Calgary, University of Alberta, University of Manitoba, physician billing codes or 1 hospitalization). Disease prevalence Arthritis Research Centre of Canada, McGill University rates in fiscal year 2008/2009 were used to calculate a rate ratio Objective: Estimate the population-based prevalence and (RR) for FN relative to non-FN. healthcare use for osteoarthritis (OA) by First Nations (FN) and Results: RA was the most prevalent IA condition in FN, with non-First Nations (non-FN) in Alberta. an RR of 1.81 (95%CI 1.74-1.88, p<0.001) compared to Methods: A cohort of adults with OA (32 physician claims non-FN. AS (RR 1.72 (95%CI 1.57-1.88, p<0.001) and ReA in 2 years or 1 hospitalization with ICD-9-CM code 715x or (RR 2.23 (95%CI 1.23-4.02, p=0.0063) were also more fre- ICD-10-CA code M15-19, years 1993-2010) was defined, with quent in FN. PsA was less frequent (RR 0.77 (95%CI 0.62- FN determination by premium payer status. Prevalence rates 0.95, p=0.0118). Crystal arthritis was the most frequent IA in (2007/8) were estimated from the cohort and the population non-FN, with an RR three times that of FN (RR non-FN to registered with the Alberta Health Care Insurance Plan. Rates FN 2.89 (95%CI 2.67-3.13, p<0.001). of outpatient primary care and specialist (orthopedics, rheuma- Conclusion: RA is the most frequent IA in the FN population tology, internal medicine) visits; arthroplasty (hip and knee); of Alberta. RA, AS and ReA prevalence estimates in FN are and all-cause hospitalization were estimated. twice that of the non-FN population, whereas PsA and crys- Results: OA prevalence in FN was twice that of the non-FN tal arthritis are less frequent. These results further explain the population (16.1 vs 7.8 cases/100 population; standardized rate higher self-reported rates of arthritis conditions in the FN pop- ratio (SRR) adjusted for age and sex 2.06, 95%CI 2.00-2.12). ulation and validate the need for enhanced IA health services to The SRR (adjusted for age, sex and location of residence) for address disease burden. primary care visits for OA was nearly double in FN compared to non-FN (SRR 1.88, 95%CI 1.87-1.89), and internal medicine P16 visits were increased (SRR 1.25, 95%CI 1.25-1.26). Visit rates (Abstract ID: 165) with an orthopedic surgeon (SRR 0.49, 95%CI 0.48-0.50) or rheumatologist (SRR 0.62, 95%CI 0.62-0.63) were lower in Housing Conditions and Respiratory Outcomes in two FN with OA. Hip and knee arthroplasties were performed less Saskatchewan First Nations Communities frequently in FN (SRR 0.48, 95%CI 0.47-0.49), but all-cause Shelley Kirychuk, Donna Rennie, Chandima Karunanayake, hospitalization rates were higher (SRR 1.59, 95%CI 1.58-1.60). Joshua Lawson, Eric Russell, Jeremy Seeseequasis, Everett Conclusion: We estimate a 2-fold higher prevalence of OA in Gamble, Daisy Bird, Arnold Naytowhow, Punam Pahwa, the FN population, with differential healthcare use. Reasons for Sylvia Abonyi, Jo-Ann Episkenew, James Dosman higher use of primary care and lower use of specialty services University of Saskatchewan - CCHSA, University of Saskatchewan, INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 69

Beardy’s and Okemasis First Nation, Montreal Lake Cree Nation, statistics, yet there have been very few changes to the living con- University of Regina ditions of aboriginal people. The federal government continues Housing conditions are known to be associated with respiratory to offer humanitarian aid and assistance to other countries. In outcomes such as respiratory infections, bronchitis and asthma the 2012-13 fiscal year, the federal government offered nearly in First Nations populations. Little is known about the housing 5.5 billion in financial aid to Africa, Asia, the Americas, Eastern conditions responsible for respiratory conditions in Saskatche- Europe, and the Middle East. In the past few years, Canada has wan First Nations reserves. We examined housing factors and accepted tens of thousands of refugees from Syria, Afghanistan, respiratory health in two rural First Nations communities in Somalia, Pakistan, and Iraq, and provided financial assistance Saskatchewan. and free healthcare to these newcomers. The Government of Canada website boasts, “Our compassion and fairness are a METHODS: Adults and children completed respiratory ques- source of great pride for Canadians.”Therefore, it is the duty tionnaires and lung function testing while 144 homes under- of the government to extend the same compassion towards our went environmental assessments. Environmental assessments aboriginal Canadians to ensure improved living conditions and included an interviewer administered housing survey, floor dust an acceptable standard of living in our developed country. collection, and temperature and relative humidity measures. Floor samples were assessed for endotoxin and beta 1-3 glucans. P18 RESULTS: Homes were visited between January and April (Abstract ID: 223) 2014. Preliminary results from the homes undergoing assessment showed that most homes were 2-4 bedroom with the Community-based participatory research to address majority (59%) built after 1990. Average number of people/ cistern drinking water quality: Experiences from home was 4.24±1.51. There were 44.4% of homes that Beardy’s & Okemasis First Nation, Saskatchewan needed major repairs and 61.1% had water or dampness in their Karlee McLaughlin, Lalita Bharadwaj home in the past 12 months with a quarter of homes that were University of Saskatchewan, University of Saskatchewan, School of wet or damp for more than 30 days of the year. Major reasons Public Health for water damage were surface water from flooding/raining (26.4%) plumbing malfunctions (21.5%) and leaks in the wall/ The provision of safe drinking water (SDW) is a key driver of roof (10.4%) resulting in 49.3% of homes having damage. The public health, yet access to this valuable resource is a perennial majority of reported damage was in the basement/crawl space problem in First Nations communities across Canada. Addi- (31.9%) and bathrooms (18.1%). A musty odour was reported in tionally, waterborne infections are an alarming 26 times higher 53.2% of homes. in First Nations. Inequity in access to SDW is linked to historical discriminatory governmental policies that have disad- CONCLUSIONS: Water damage is a major contributor to vantaged Canada’s First Nations. Access to SDW is tied to the housing damage. Addressing water related conditions within Indian Act as a Federal responsibility. However, as of 2013, the these communities should assist in improving the respiratory Federal government transferred SDW responsibility and legal health of residents. liability to First Nation communities by passing of Bill-S-8 The SDW for First Nations Act. Legally binding standards created P17 and enforced by the Federal Government now apply to First (Abstract ID: 190) Nations Bands. The community of Beardy’s & Okemasis Canada’s Compassion for Aboriginal Canadians First Nation is one community that has been affected by policy in Saskatchewan, with over half of the reserve on cisterns. Nicole Johnstone However, cisterns are known as the “prairie problem” due to Sherbourne Health Centre frequent contamination issues and limited attention in terms In 2005, half of Canada’s aboriginal people had an income below of government initiatives and academic research. In partner- $16,752, which was almost $10,000 less than their non-aborigi- ship with this community, research will identify the potential nal counterparts. A median income of $11,229 was reported for risks to water quality through the supply chain of trucked water on reserve aboriginals in the same year. Overcrowding remains delivery to cistern. Water trucks and selected residential cisterns high in aboriginal housing with aboriginals being three to nine will be analyzed for drinking water quality, deterioration and times more likely to live in crowded conditions than non-ab- point source contamination from the period of July-October originals. On reserve, 40% of homes required major repair in 2014. Analyzing multiple water parameters, asking key infor- 2006, and aboriginal homes are three times more likely to be mant interviews and characterizing the risk of contamination. in need of major repair than non-aboriginal homes. These liv- The data gathered will advance guidelines on management, ing conditions are unsatisfactory in a developed country such monitoring, and strengthen governmental policy change for as Canada, and greatly impact the health and well-being of the SDW for First Nations across Canada. aboriginal population. The federal government is aware of the INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 70

P19 between sea ice use and health, with primarily positive impacts for non-physical health aspects (mental/emotional, social, mate- (Abstract ID: 72) rial, cultural) and negative impacts for physical health. The impor- Investigating environmental determinants of injury and tance of ‘place-meanings’ _ the experience of being on the ice trauma in the Canadian North and the role of sea ice as a platform for hunting _ emerged as Agata Durkalec, Chris Furgal, Mark Skinner, Tom Sheldon central themes. Environmental change was associated with the loss of health benefits and impacts on place-meanings and knowl- Trent University, Nunatsiavut Government edge. Our findings demonstrate the complex ways that a criti- Unintentional injury and trauma rates are disproportionately high cal element of the environment influences Inuit health, and the in Inuit regions, and environmental changes are predicted to exac- value of incorporating place-based approaches into investigations erbate injury rates. However, there is a major gap in our under- of Indigenous health. They also demonstrate how climate change standing of the risk factors contributing to land-based injury and acts an agent of environmental dispossession. Using this case study, trauma in the Arctic. We investigated the role of environmental we developed a conceptual model of the role of environment and other factors in search and rescue (SAR) incidents in Nain, for health that integrates key concepts in health geography (e.g., an Inuit community in Nunatsiavut, northern Labrador. We used a concern for place, well-being, and culture) into a population a collaborative mixed methods approach that involved universi- health approach, furthering our understanding of the role and ty-community research partnerships with Nain Ground Search meaning of environment for health. and Rescue and the Nunatsiavut Government. We analyzed SAR records from 1995 to 2010 and conducted key consultant inter- P21 views in 2010 and 2011. Data showed an estimated annual SAR (Abstract ID: 196) incidence rate of 19 individuals per 1,000. Weather and ice conditions were the most frequent contributing factor for cases. In con- Generational Differences in Traditional Food trast with other studies, intoxication was the least common factor Knowledge in Southwestern Ontario associated with SAR incidents. The incidence rate was six times Hannah Tait Neufeld higher for males than females, while land-users aged 26_35 had Western University the highest incidence rate among age groups. Thirty-four percent of individuals sustained physical health impacts. Results demon- Major disparities in the health status of Canada’s Indigenous strate that environmental conditions are critical factors contrib- populations continue to exist, including shorter life expectancies uting to physical health risk in Inuit communities, particularly and significantly higher rates of chronic disease than the gen- related to travel on sea ice during winter. Age and gender are eral population. Rates have reached epidemic proportions, yet important risk factors. Our study also points to issues of under- prevention research has focused quite narrowly on behavioural reporting of land-based injury and trauma, and the inadequacy change, with little recognition of the broader social, cultural, of current injury surveillance systems. This knowledge is vital for historical or environmental factors that may influence food informing management of land-based physical health risk given security in contemporary First Nation contexts, such as how rapidly changing environmental conditions in the Arctic. food insecurity may be related to cultural loss or the inter-generational trauma of residential schools. Students suffered sig- P20 nificant cultural loss, including loss of language, ties to family, and traditional teachings, which led to disrupted transmission (Abstract ID: 72) of traditional knowledge across generations. A shift from tradi- Exploring the environment as a determinant and place tional foods to market foods has been shown to negatively affect of Indigenous health: A case study of Inuit-sea ice dietary quality and cultural identity in many communities, and relationships contribute towards a decline in nutritional status and overall Agata Durkalec, Chris Furgal, Mark Skinner, Tom Sheldon health. The research is nested within the structure of a larger on-going collaborative food choice study between the South- Trent University, Nunatsiavut Government west Ontario Aboriginal Health Access Centre (SOAHAC), This study contributes to our understanding of Indigenous and Western University. Building on research gaps revealed in health and sociocultural and place-based dimensions of health earlier collaborative research, the study examines the potential and well-being by investigating the relationship between one key mechanisms that have impacted the inter-generational transfer element of the environment _ sea ice _ and diverse aspects of of knowledge around traditional food, including access to, and Inuit health. We used a case study design and community-based availability, of traditional foods within urban and reserve-based participatory research approach with the community of Nain in First Nation communities in Southwestern Ontario. Results Nunatsiavut, northern Labrador, Canada. Focus groups (n=2), presented as stories and photographs will highlight: current interviews (n=22), and participant observation were conducted knowledge surrounding access, availability and traditional food in 2010-11. We demonstrate a strong overall positive relationship practices between generations of urban and rural First Nation INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 71 families; and the historical context of present day urban and Accessibility to health care services and availability of health rural food environments. care professionals play a role in the building of health capacity in northern regions. The College of Nursing at the Uni- P22 versity of Saskatchewan developed a principled approach to Abstract ID: 20 the creation of an Indigenous nursing workforce in Northern Saskatchewan. This approach builds on Williams’ concept of Surveying and Identifying the Need for Northern Therapeutic Landscapes, which recognizes the connectedness Medical Elective Opportunities for University of among environment, social interaction, and symbolic meaning Ottawa Students within a population, and offers a way to analyze the influence Kendra Barrick, Leigh Fraser Roberts of the contextual factors of place on health, and values and attitudes on well-being. In order to succeed, the College developed University of Ottawa, Children’s Hospital of Eastern Ontario mutually beneficial, capacity-building relationships with north- Context: The University of Ottawa Faculty of Medicine has no ern communities, finding local champions to assist them. They established northern elective program in Nunavut for students. reorganized their administrative structure to give visibility to Medical students have demonstrated a strong interest in pursuing their northern relationships, and built a distributive learning further training in northern and/or Aboriginal communities. approach based on the commitment to “learn where you live”. The purpose of this project is to initiate contact and facilitate Measuring the success of such approaches requires the devel- communication between the University of Ottawa and medical opment of new and innovative evaluation strategies, beyond practitioners in Nunavut. This information will help identify the usual markers of individual student success. It requires the need for northern medical electives for medical students. approaches that capture the impact of such education program- Ideally, this will help facilitate the creation of funded medical ming on the fabric of the community as a whole. elective opportunities for medical students in pre-clerkship and clerkship in the Canadian north. P24 Intervention: A survey was developed to assess the current pro- (Abstract ID: 99) grams that exist between Canadian medical schools and northern communities and administered to a list of northern medi- Inflammatory Arthritis Treatment Outcomes at a cal elective program contacts from across Canada. The survey First Nations Reserve Rheumatology Specialty Clinic assessed the strengths of established elective programs and key Cheryl Barnabe, Erin Bell, Sharon LeClercq, Dianne Mosher, logistical issues and funding sources for programs. Another Hani El-Gabalawy, Marvin Fritzler survey was developed for medical students at the University University of Calgary, University of Manitoba of Ottawa to quantify the current interest in pursing northern medical electives. Then, funding sources necessary for program Introduction: Inflammatory arthritis disproportionately affects development were investigated. Finally, the Faculty of Medi- Canada’s First Nations population. Treatment outcomes may cine at the University of Ottawa and other funding sources were be ameliorated by health service models that mitigate logistical contacted to determine the potential for creating financial bur- barriers to care and provide specialty services embedded in the saries to assist in the costs associated with developing a northern primary care context. This study assessed the effectiveness of a elective program. specialty care model delivered in a First Nations primary care setting. Observations/Discussion: Surveys highlighted numerous existing programs throughout Canada, primarily funded by medical Methods: Participants were recruited to an arthritis screening faculties and grants, as well as a strong student interest and need program held in a First Nations community (June 2011-August for northern and Aboriginal medical electives opportunities. 2012). Patients with IA received ongoing follow-up with col- No bursaries/funding currently exist for northern electives. lection of disease activity measures, patient-reported outcomes, and treatment recommendations. Repeated measures ANOVA P23 was used to examine disease activity measures over 24 months. The frequency of treatment changes based on moderate or high (Abstract ID: 32) disease activity state was calculated. Transforming the Health Landscape in Northern Results: 131 visits by 47 participants (79% female, mean age Communities: Shared Leadership for Innovation in 47 years, diagnosis of rheumatoid arthritis n=34) occurred Nursing Education over the 24 month study period. At the baseline visit 70.6% of Lois Berry, Lorna Butler, Amy Wright participants had moderate or high disease activity. Significant decreases in joint counts were achieved (mean swollen joint University of Saskatchewan, College of Nursing count decrease 7.0, 95% CI 3.5-10.4, p=0.0061; mean tender People living in northern areas throughout the world expe- joint decrease 7.2, 95% CI 4.1-10.3, p=0.0116). Patient-reported rience poorer health status than their southern neighbours. outcomes for pain, global assessment and physical function were INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 72 not significantly improved during treatment. A recommenda- Tracey A Herlihey, Alison Jones, Olga Kniazeva, Elizabeth tion for treatment change based on moderate or high disease Stacy, Justyna Berzowska, Helen Novak Lauscher, Svetlena activity was made at 67% of visits. Taneva Metzger, Anjum Chagpar, Erin Schellings, Jeff Niles, Conclusions: The program addressed physician-derived disease Kendall Ho, Joseph Cafazzo, Valerie Flynn activity targets, but patient-reported outcomes were not signifi- Healthcare Human Factors, eHealth Strategy Office, University of cantly improved during follow-up. Modifications to the model British Columbia, First Nations and Inuit Health Branch, such as involvement of a multi-disciplinary team to address Health Canada holistic aspects of First Nations health is critical. The benefits of electronic health (eHealth) technologies are many, including enhanced patient safety, improved access to P25 care and improved health information management. While (Abstract ID: 101) eHealth tools are widely used in urban centres and increasingly A Chart Audit of First Nation and Métis Patients in a in isolated care facilities, there remains a need to modernize Saskatoon, Saskatchewan Hospital health service delivery within remote and isolated First Nations communities. Charlene Haver, Gary Eagle, Tamara Colton, Caitlin Cot- trell-Lingenfelter, Gabe Lafond Health Canada’s First Nations and Inuit Health Branch (FNIHB) is working to modernize and transform the way health services University of Saskatchewan/Saskatoon Health Region, Saskatoon are delivered in remote and isolated First Nations nursing sta- Health Region, University of Saskatchewan tions through eHealth technologies. To ensure a successful tran- Introduction: Many patients admitted to St. Paul’s Hospital sition to modernized health service delivery, it is critical that the (Saskatoon, Saskatchewan) are First Nation and Métis; however, selection and implementation of eHealth technologies acknowl- little is known about these populations’ and their health care edges and takes into consideration the unique challenges related use. Upon request from the First Nation and Métis Health Ser- to the demographics, geographical location, and political cli- vice, the Vice-President Research and Innovation Office con- mate of First Nations communities. ducted a chart audit to determine characteristics of First Nation To this end, FNIHB engaged researchers at Healthcare Human and Métis patients and their hospital stay. Factors in Toronto and the University of British Columbia’s Methodology: A retrospective chart audit was completed with eHealth Strategy Office to identify communication and tech- patients from February 2012-December 2013. Inclusion criteria nology needs in First Nations nursing stations and to recom- consisted of any First Nation or Métis patient admitted to gen- mend appropriate eHealth tools. eral medicine or renal wards. The research team adopted a three-pronged approach: 1) a sur- Results: A total of 103 First Nation patients were identified. vey was distributed to regional health employees; 2) job shad- Métis patients were unable to be identified due to current health owing and focus groups took place with front line staff at four information recording standards. The mean age of First Nation nursing stations across three provinces; and 3) preliminary rec- patients was 48.4 (±17.5 years) and 70% were admitted ommendations were presented at a technology showcase event through the Emergency Department. Fifty-three percent resided for nursing station staff and FNIHB personnel for validation in urban areas, 32% rural, and 13% lived on reserves across Sas- purposes. katchewan. Length of stay (LOS) for patients on reserve (31.3 Based on the findings, a series of recommendations outlining days) was significantly longer than LOS for patients in rural how the needs of First Nations nursing stations can best be met (7.0 days) or urban (9.1 days) areas (p<0.05). Twenty-eight with eHealth technologies were devised. percent had a delay in discharge, with 17% delayed for medical issues / complications and 11% delayed for navigation issues (i.e. P27 transportation or approval from Non-Insured Health Benefits). (Abstract ID: 29) Conclusion: This work provides preliminary evidence that disparities exist for First Nation patients living on reserve and First Nations Experience of the 2013 Alberta Floods: highlights the need for patients to have the option to self-iden- Media Representations and First Hand Experiences tify upon admission. Patient-oriented research is needed, in Kaela A. Schill, Wilfreda E. Thurston partnership with First Nation and Métis peoples to improve University of Calgary services and provide optimal care. Background: In June 2013, a severe flood affected a 55,000 km2 P26 area in southern Alberta, Canada. Many residents from the First Nations reservations of Siksika and Stoney were displaced from (Abstract ID: 208) their homes as a result of the flooding. Improving First Nations health through appropriate Methods: By combining the results of a media analysis eHealth technologies INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 73 with key informant interviews, the authors explored how Medicine, Debajehmujig Storytellers non-Aboriginal Canadians frame First Nation issues, and We describe a pilot project where medical students on rural how individuals involved in First Nation flood relief efforts placements joined Manitoulin Island’s Debajehmujig storytell- responded to these frames. ers. The mandate of the Debajehmujig storytellers is to edu- Results: Four frames emerged from the newspaper articles col- cate and share original creative expression with Native and lected for the media analysis, called the “sympathetic frame”, the Non-Native peoples, thereby vitalizing Anishnaabeg culture, “unprecedented support frame”, the “unappreciative or ‘whining’ language and heritage. The project aim was to show learners frame”, and the “property damage or loss frame”.The interview how arts organizations engage in the health of their communi- data revealed the perception of bias in print media, reflecting ties while experiencing opportunities to practice communica- larger social issues surrounding Aboriginal peoples in Canada. tion and interview skills. Participants perceived the media simultaneously as a tool, and as The students were introduced to previous community health a “double-edged sword”. Social media also emerged as a means projects from the Debajehmujig archives, including the Elders by which local leadership reaches members of their communities. Gone AWOL initiative. However, most of their time was spent Discussion: The interview data indicated that First Nations in simulated patient scenarios, exploring themes of mental ill- communities use (or avoid)coverage to the benefit of the com- ness and social disadvantage. Animators developed complex munity,indicating a more nuanced approach to media relations characters utilizing their culturally relevant knowledge and than is reflected in existing literature. Further,the assumption lived experiences, curriculum objectives from the Northern that First Nation communities desire mainstream media cov- Ontario School of Medicine, and resources on cognitive error. erage may be ethnocentric in and of itself. Our findings sup- The social context for each condition was constructed with port existing literature that indicates that technology provides special consideration given to cross cultural issues in North- First Nation members with a means of emerging as agents and ern health care and regional economic realities. Following each political actors in an otherwise oppressive context, in this case, interview, the animator provided formative feedback. through the use of social media The simulation format allows for a safe learning environment P28 in emotionally complex situations, while reflecting Bleakley, Bligh and Brown’s(2011) “strong patient-centred exchange”. Abstract ID: 146 Debajehmujig storytellers incorporated Anishnaabeg views as Inuit Health Human Resources Framework and authors, as “patients” and as educators. Native authorship of Action Plan patient scenarios in particular may help to address the challenges as identified by Ewen et al (2011) in “achieving consistency, Joyce Ketura Ford authenticity and avoiding stereotyping of Indigenous patients Inuit Tapiriit Kanatami within case development and implementation.” A project that The Inuit Health Human Resources Framework and Action Plan began with a focus on arts and communication has relevance to 2011-2021 (IHHRFAP) developed by Inuit Tapariit Kanatami cultural competency education. and the four Inuit regions has as its vision “to advance Inuit health by creating an Inuit workforce that will deliver a full spectrum of P31 health and wellness services within Inuit communities, primarily (Abstract ID: 224) in the Inuit language”. The IHHRFAP will help to reduce the Unpacking the mechanisms related to the engagement health disparities between Inuit and the rest of Canadians. of Australian Aboriginal families and young people in This poster presentation will outline the vision of the frame- social and emotional wellbeing programs: work and the six goals and main actions of the Action Plan. A realist review Margaret Cargo, Peter Lekkas, Alwin Chong, Ellie Piggott, P29 David Evans WITHDR AWN University of South Australia, University of Adelaide P30 Background: Aboriginal peoples are over-represented in statistics related to the utilisation of mental health services, hospital (Abstract ID: 158) separation for injury and self-harm, and incarceration. Few sys- Storytellers as Medical Educators tematic reviews of Aboriginal social and emotional wellbeing Maurianne Reade, Shelagh McRae, Joahnna Berti, (SEWB) provide decision-makers in the Aboriginal communi- Bruce Naokwegijig ty-controlled and government sectors with culturally applicable and transferable advice on what works, for whom and in what Manitoulin Central Family Health Team, Northern Ontario School circumstances. Objective: To understand the core mechanisms of Medicine, Gore Bay Medical Clinic, Northern Ontario School of INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 74 underpinning programs on the prevention of mental health diffi- from the program in 2011 and the second trainee will complete culties and promotion of SEWB among Aboriginal children and the program in June, 2014. This poster will be a description of youth. Method and Results: This realist review was based on pri- the year and will describe some of the successes of the PGY3. ority areas identified by policy-makers: crime and violence, substance misuse, adverse mental health, cultural pride, strengthening P33 families, strengthening communities and education. A systematic (Abstract ID: 141) search of academic databases and the grey literature retrieved over 50 Australian programs implemented in the last 15 years for What is “Mino Bimaadiziwin”? Exploring the which program processes or impact information was reported for meaning(s) of “Living Well” among Anishnaabe Aboriginal children and youth. Social identity theory and the cul- peoples living in Northern Ontario tural respect framework informed the initial review framework. A Kian M. Madjedi, Kevin FitzMaurice core set of mechanisms (i.e., trust, respect, cultural identification, Laurentian University of Sudbury physical safety, feeling comfortable, feeling supported) related to the engagement of participants and families cut across all program Intro: Mino Bimaadiziwinis an Anishnaabemwin (“Ojibwe”) types; mechanisms varied by program type and contextual factors. term that has been translated in many ways, most predominantly Conclusions: History, time and factors related to the implement- as “The Good Life” or “Living Well”. Although the term itself ing community, sponsoring organisation, inter-agency collab- appears relatively frequently in research relating to Anishnaabe oration and the workforce emerged as powerful influencers of wellbeing, there have been no studies to date exploring the con- engagement. This review finds that “upstream” investments need structions and definitions of Mino Bimaadiziwin at the level of to be made to establish and maintain participant engagement in the individual. order for programs to impact SEWB. Methods: The purpose of this research is to: 1) explore the ways in which Anishnaabe persons living in Northern Ontario P32 understand, define and conceptualize this fundamental notion (Abstract ID: 246) of ‘wellbeing’, and 2) to use these definitions to examine perceptions of factors that foster and inhibit Mino Bimaadiziwin in Enhanced Skills Year in Indigenous Health at the local context of urban Northern Ontario. Using a grounded The University of Toronto’s Department of Family theoretical approach rooted in Indigenous Critical Theory, and Community Medicine: A Program Description semi-structured interviews were conducted with 12 Anish- Fatima Uddin, Jennifer Wesley, Difat Jakubovicz naabe students and 1 elder. There were six emergent themes University of Toronto in the way Mino Bimaadiziwinwas understood by participants. In 2011, there were approximately 1.4 million indigenous peo- Discussion: Although the conceptualizations of Mino Bimaa- ples living in Canada, more than half of them living off reserve diziwin were diverse, Mino Bimaadiziwin was most commonly and in urban areas. There are many significant health and social defined as 1) Living in a balanced way; 2) Respecting the inter- challenges facing indigenous communities and their health connectedness of all elements in Creation; 3) Living life accord- care providers including poverty, chronic disease, poor mental ing to the Seven Grandfather Teachings; 4) Learning and speak- health, and substance abuse. These struggles are rooted in the ing the Anishnaabemwin language; 5) Practicing tradition and long-term effects of colonization, racism, and inequity. culture; and 6) Self-determination and decolonization Physicians interested in working with indigenous populations Conclusion: The articulation of what it means to Live Well by need to be better prepared in order to provide care in a respect- Anishnaabe peoples themselves may help provide a basis for the ful, knowledgeable, and culturally safe manner. They should development of decolonizing community-health programs and be competent clinically, and must be sensitive to the historical, may lay the groundwork for future health research that supports political, and cultural issues that impact the health of Canada’s Anishnaabe wellbeing in Northern Ontario and beyond. indigenous peoples. P34 Unfortunately, very little time has been dedicated to indigenous health in undergraduate and postgraduate medical training. One (Abstract ID: 184) way this gap is being addressed at the University of Toronto has Sexy Health Carnival: HIV Prevention Outreach by been the development of an enhanced skills year in indigenous and for Indigenous Youth health in the Department of Family and Community Medicine. Renée Monchalin, Sarah Flicker, Jessica Danforth, Alexa This one-year fellowship strives to improve the knowledge, Lesperance skills, and attitudes of the family medicine trainee in a number York University, Native Youth Sexual Health Network of areas related to the health of indigenous populations in urban, rural and remote areas of Canada. The first trainee graduated The Sexy Health Carnival is an Indigenous youth lead project INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 75 that creates a fun and interactive opportunity for other Indige- urban Aboriginal women (n= 24- 36). nous youth to become educated on HIV prevention and sexual Preliminary thematic analysis of data reveals that separate and health in a culturally appropriate way. The goal of this paper parallel mental and physical health treatment options do not is to determine the most effective method of HIV prevention offer interventions that are accessible, integrated and tailored outreach for Indigenous youth. for Aboriginal women dealing with co-occurring health con- A research team consisting of Indigenous youth from the peer- ditions. Thus necessitating the use of holistic approach by com- lead Native Youth Sexual Health Network and researchers at bining Indigenous perspectives with gender sensitive and trau- York University will be surveying Indigenous youth ages 16 to ma-informed practice to address the interconnected risk factors 25 at four pow-wows throughout Ontario in July and August for co-occurring chronic physical and mental health challenges, 2014 during the implementation of the Sexy Health Carnival. and addiction; linked to wide-based supports in housing, edu- The survey will have questions for youth surrounding their cation, employment, recreation and the wider social network. current HIV prevention knowledge, the Sexy Health Carni- val booths, and sexual health outreach methods. The survey P36 responses will be collected through an offline ipad survey tool WITHDR AWN and will be exported to SPSS for analysis. Who better to ask about the most efficient HIV prevention outreach methods for Indigenous youth than the youth themselves? Indigenous youth’s voice can be an agent for positive change, and may be an important part of the solution to tackling the devastating HIV statistics within our communities. Through this peer-lead project, this paper will disseminate effective methods for HIV prevention outreach methods in the Indige- nous youth community. P35 (Abstract ID: 136) Meeting the Health Service Needs of Urban Aboriginal Women for Co-occurring Diabetes, Mental Health and Addiction Issues HASU Institute of Population Health, University of Ottawa, Ivy Bourgeault, Cecilia Benoit Institute of Population Health, University of Ottawa, University of Victoria Aboriginal adults with diabetes have high rates of co-occurring mental health and addiction, which adversely affect their overall health and well-being. But how this is experienced specifically by Aboriginal women living in urban settings is largely unexplored. Though the intensity, pattern, and causal relationship between co-occurring health conditions are yet to be fully explored in Aboriginal health context, they have practical implications for improving overall health of Aboriginal women as well as determining their health service needs. This poster will begin to map out an ongoing study of urban Aboriginal women’s health service needs for co-occurring diabetes, mental health and addiction. Our methodological approach consists of three forms of primary data collection: one-on-one semi-structured interviews, surveys, and follow up deliberative focus group discussions across two phases. In the first phase, we collect data from key informants (n= 8-12), including health and social service providers and decision makers. This is followed in the second phase of data collection from INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 76

Author Index Last First Abstract(s) Last First Abstract(s)

A Dewar Dale M. W45 Abonyi Sylvia O20 Diffey Linda W27 Allan Billie W56 Dignan Thomas W27 Allison Elaine O36 Dion Stout Madeleine W05 W53 Ambtman-Smith Vanessa W07 Dosman James O20 Anganis Darlene O36 Dowsley Martha O04 Antone Tracy W30 Dragonetti Rosa C. O10 Apale Alisha Nicole W37 Drossos Alex O11 Avery Kinew Kathi W28 Azarpazhooh Amir W31 E Elliott Nicole Estella W12 B Elliott Germaine Frances W22 Bacque Jim W13 Episkenew Jo-Anne O20 Baird Roslynn W42 Eriks-Brophy Alice A. W43 Banerji Anna W23 Eves Robert W01 Beck Caroline O20 Evoy Laura Lee W08 Bellerose Marika O07 Bend John R. O19 W35 F Berti Joahnna Kathleen W40 Fairney Kelly A. O09 Blais Ellen M. O30 W39 Fenton Mark O20 Blumenthal Anne W33 Firestone Michelle W20 Boileau-Falardeau Michèle O05 FitzMaurice Kevin O22 Bourgeois Cheryllee W56 Flinders Lori W14 Browne Annette W53 Ford-Gilboe Marilyn W53 Bull Julie W50 Fowler Anna W25 Burnett Kristin O04 Furgal Chris W06 C G Castleden Heather W19 Galloway Tracey W60 Chakraborty Chandan O19 W35 Gesink Dionne O16 O31 Chan Ben W21 Gladue Lawrence W13 Chartier Martin W31 Gordon Janet W21 W48 Chiarelli Anna W26 Grier Angela O27 Chisan Sherri O16 Guitard Tracey W31 Churchill Molly W33 Guzmana Marco W13 Cidro Jamie O18 H Classens Linda Lou O35 Hagar Guy W07 Cole Madeleine W15 Harp Rick O13 Corbett Bradley A. O19 Healey Gwen W60 Cote-Meek Sheila W24 Henley Phaedra O19 W35 Currie Cheryl W41 Henry David W30 W57 D Herbert Carol P. O19 W35 Daigle Michelle O29 Hill Julie W35 Darnell Regna O19 W35 Ho Anita O25 Davis-Hill Francis Lori-Anne W43 Hopkins Carol W01 W52 Day Linda W53 I Deleary Raymond W01 Inyallie Jane W53 Dell Colleen W52 Irving Don W13 Denduyf Johanna W02 Isaac-Mann Sonia W24 Denis Jeff W19 INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 77

Last First Abstract(s)

Ito Dick W31 Ive Nicole W39 J Jacobs Dean O19 W35 Jahedmotlagh Zahra W35 James Lesley W10 Jameson Kristie W06 Jetha Nina W47 Johnston Andrea L.K. W47 Johnstone Nicole O02 Jones Carmen W30 Jreige Steve W47 Jull Janet Elizabeth W03 K Katapally Tarun O20 Kewayosh Alethea W26 Khan Saba W30 W57 Kitty Darlene W29 W55 Klair Rajbir O14 Koren Gideon O19 W35 L Lach Lucyna W33 Lamothe Ashley W42 Latycheva Oxana W46 Lavallee Lynn F. O09 Lavallee Barry W27 LeMay Rose W44 Levall Jeanette W40 Lewis Stacey O36 Lightning Rick O27 Lodge Minwaashin W03 Loft Michael W39 Lys Candice O01 W08 M MacDonald Jennifer O36 MacKenzie Holly W53 Madjedi Kian O22 O26 Makokis James O32 Marchildon Gregory P. O20 Marrett Loraine W26 Martens Tabitha O18 Martin Debbie W19 Mashford-Pringle Angela O28 Mayan Mari O27 McGilvery Priscilla O31 McKenzie Holly A. W59 McKinney Veronica O21 McKnight Constance W20 McMahon Eileen W32 INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 78

Last First Abstract(s) Smylie Janet W20 Sodhi Sumeet W21 McTavish Kristeen W06 Stacey Dawn W03 Meawasige Amanda W18 Last First Abstract(s) Meckelborg Lori W47 Mendez Ivar O21 Star Leona W28 Menzies Peter W52 Stephens Christianne V. O19 O35 W35 Mihic Alanna O16 O31 Stewart Suzanne Lea W12 Moeller Helle O04 Suntjens Terri O16 Montour Courtney W39 Sxwithul’txw Steve O15 Morgan Jenny Lynn O25 Sylvestre Paul W19 N T Nancarrow Tanya O08 Tagalik Shirley W60 Nenadovic Vera O07 Tait Neufeld Hannah W31 Nishri Diane W26 Taylor Kim O25 Thompson Bandy W08 O Tobias Daniel W54 O’Connell Rod O15 Tobin Pam W36 Osawabine David W40 Todd Hunter Laura W43 Oster Richard Thomas O27 Tomascik Paul W27 Toth Ellen O27 P Touesnard Laurie O36 Pahwa Punam O20 Trick Charles G. O19 W35 Paterson Emily W48 Trocme Nico W33 Pathammavong Ratsamy Norman W10 Tucker Mary Jane O19 W35 Patterson Don O06 Patterson Colleen W36 U Peters Judy O19 W35 Popp Shantel W06 V Van Uum Stan W35 Q Varcoe Colleen W53 R W Rae Radziwon Leah W43 Wakewich Pamela O04 Rajdev Vinay W06 Walker Pamela W09 O24 Recollet, Vivian W09 Walker Jennifer Dawn W46 Reeves Allison O14 O23 Walters Dean W17 Rice John W22 Warry Wanye W46 Richer Faisca O05 Waters Shannon Tania W51 Rieder Michael J. O19 W35 Watteyne Wenda W57 Robbins Julian W34 Whiskeyjack Lana O16 O31 Rudderham Sharon O36 White Alsena O32 Russell Storm J. W57 Williams Jessa W02 Ryan Anna-Claire O08 Williams Rosemary O19 W35 Williams Naomi W35 S Willison Kevin Donald O34 Schoeman Katherine O19 Wolfe Sara W20 W37 Selby Peter L. O10 Shah Chandrakant O14 O23 X,Y,Z Shaugnnessy Peggy A. O12 Sheppard Amanda W26 Sinclair Stephanie Ann W18 Sinha Vandna W33 Smith Jacqueline Dawn W43 Smith Ela W58 INDIGENOUS HEALTH CONFERENCE | NOVEMBER 20-21, 2014 79