INDIAN HEAD DISTRICT

Indian Head

Photo Credit: Dan Loran

PRIMARY HEALTH CARE PLAN

JULY, 2009

TABLE OF CONTENTS

DEFINITIONS or DESCRIPTION...... 1 INTRODUCTION...... 3 BACKGROUND INFORMATION ...... 4 The Regina Qu'Appelle Health Region...... 4 Primary Health Care...... 4 Description of Indian Head District...... 5 The Primary Health Care Community Consultation Process...... 7 INDIAN HEAD DISTRICT – STRENGTHS, CHALLENGES AND FUTURE ...... 9 THE PLANNING PROCESS...... 11 Systems Thinking Approach...... 11 Where do we want to be? – The vision for the future...... 11 How will we know when we get there? - Outcomes and key measures...... 12 Where are we now? - The current situation...... 12 What on-going changes may/will affect the vision? - Current / future environment ...... 15 How do we get there? The strategies to move towards the vision...... 16 Our 2020 Vision of Primary Health Care...... 16 Chronic Conditions ...... 16 Service Provision ...... 17 Healthy Living...... 18 Education ...... 19 ACTION PLAN...... 19 CONCLUSION...... 20

LIST OF APPENDICES

APPENDIX 1 ...... 21 List of Participants

APPENDIX 2 ...... 22 Community Consultation Committee Meeting Dates, Locations and Purpose/Task

APPENDIX 3...... 23 Community Profile ƒ Health Services ƒ Other Services, Programs, Organizations and General Information

APPENDIX 4...... 29 RQHR’s Rural Health Status Report 2008

APPENDIX 5...... 30 Diabetes

APPENDIX 6...... 31 HealthLine

APPENDIX 7...... 32 Patterns of Care

APPENDIX 8 ...... 33 Outpatient Visits ƒ Montmartre Health Centre ƒ Indian Head Union Hospital

APPENDIX 9...... 34 Indian Head EMS Call Report – April 1, 2007 to March 31, 2008

DEFINITIONS OR DESCRIPTION Chronic condition is a prolonged disease, which is rarely cured, and causes challenges for the person, their family and care providers.

Community: Our community (as intended within this report) includes: • our residents; • RQHR; • municipal governments; • social services; • education system; • recreation; • police; • spiritual organizations; and • other local community organizations which address other factors that influence our health such as housing, childcare, employment, income and social supports.

Community Consultation Committee: The purpose of a Primary Health Care Community Consultation Committee is to assist Regina Qu’Appelle Health Region with the initial development of a local Primary HealthCare plan by providing input and ideas regarding: • Local health issues and needs that Primary Health Care could address; • Achievable short and long-range service priorities for Primary Health Care in the communities; • Potential Primary Health Care programs and services; • Local evaluation of Primary Health Care programs and services1

Community Participation Committee: The purpose of the Community Participation Committee is to assist the Regina Qu’Appelle Health Region with the ongoing development of the Indian Head District Primary Health Care Plan by providing input and ideas regarding: o Local health issues and needs that Primary Health Care could address; o Potential Primary Health Care programs and services; o Evaluation of local Primary Health Care initiatives.

The roles and functions of the Community Participation Committee are to: • Become knowledgeable about Primary Health Care principles, philosophies and potential programs and services. Understand the linkages between Primary Health Care and First Nations and Métis health initiatives; • Become aware of available resources for Primary Health Care development; • Bring knowledge of community and local initiatives that may contribute to primary health care services; • Assist with public communication related to primary health care in the community as requested by the Regina Qu'Appelle Health Region; • Identify opportunities for developing linkages or partnerships with related initiatives complementary to PHC2.

1 PHC Community Consultation Committee, Terms of Reference, June 2008, RQHR

Indian Head District Primary Health Care Plan Page 1 Covered population – The (2008) Covered Population is based on eligibility for health benefits in Saskatchewan. All residents of Saskatchewan are included except: a. members of the Canadian Armed Forces, members of the Royal Canadian Mounted Police, and inmates of federal prisons, all of whom are covered by the federal government; and b. people not yet meeting the residency requirement (coverage begins on the first day of the third calendar month following their move to Saskatchewan). Saskatchewan residents moving elsewhere remain eligible of coverage for the same period, and anyone whose coverage extends through June (i.e. who left the province April 1st or later) is included in the report. In case of death, people who had coverage any time in June are included. Age distribution is calculated as of June 30th. People born in the period from July 2007 to June 2008 are reported in the under one (<1) age group. People born between July 2003 and June 2007 comprise the 1 to 4 age group, and so on3.

Patterns of Care – Discrete Patient Count by Regional Health Authority and By Patient Residence is the number of individuals which had at least one contact with a clinic, each person counted only once. Discrete patients are not additive4.

Primary Health Care is a philosophy of health care and an approach to providing everyday health services that focus on patients, clients, families, and communities working with a team of health professionals. Primary Health Care: • recognizes the relationship between physical, mental, social and spiritual well-being; • includes a wide range of coordinated services including prevention, health promotion, treatment and rehabilitation; • is provided using a team approach; • includes better management and follow-up once a health problem has occurred; • involves preventing and effectively managing chronic conditions; • involves linking with agencies and organizations to address other factors that influence health (like housing, education, employment, income, social supports); • involves working together with community members and service providers to plan and develop services5

Work-life balance is a self-defined, self-determined state of well being that a person can reach, or can set as a goal, that allows them to manage effectively multiple responsibilities at work, at home and in their community; it supports physical, emotional, family and community health, and does 6 so without grief, stress or negative impact .

2 Twin Valleys PHC Community Participation Committee (draft) Terms of Reference, January 2009, RQHR 3 Government of Saskatchewan Ministry of Health website (www.health.gov.sk.ca) 4 Saskatchewan Ministry of Health, 2006-2007 5 Programs and Services, Primary Health Care, RQHR website (www.rqhealth.ca) 6 Human Resources and Skills Development Canada website (www.hrsdc.ca)

Indian Head District Primary Health Care Plan Page 2 INTRODUCTION The Indian Head District Community Consultation Committee undertook the task of developing a Primary Health Care plan for their area in partnership with the Regina Qu’Appelle Health Region. This report is a summary of that process and the Primary Health Care vision and strategies developed for the participating communities.

The plan speaks to creating a “culture” that focuses on improved and enhanced services, healthy living, education and chronic conditions management. As a physician and nurse practitioner were already in place, discussions did not focus on recruitment of these services.

Throughout the planning process, the values of community and family in the broadest sense of the words were of utmost importance. The well-being of children and youth and their role in creating a positive future became a key focus. The committee identified a need for the community(s) to work together and assume responsibility for its future. The Community Consultation Committee drafted an overall vision statement:

Our 2020 Vision of Primary Health Care is a community empowered to build upon existing strengths and capacities, to act collectively and effectively, and to support individual and community health and well-being.

They identified the future role of the Community Participation Committee in bringing the plan to fruition and making it a living document. The identified a lack of time and the inability of the community volunteers to assume full responsibility for the plan. They recognized a need to develop strong partnerships and working relationships while strengthening the community’s capacity and ownership through education and on-going information sharing.

This Primary Health Care plan does not speak to specific health services but rather to the processes, which will lead to improved health and well-being for the communities as a whole.

Indian Head District Primary Health Care Plan Page 3 BACKGROUND INFORMATION The Regina Qu'Appelle Health Region The Regina Qu'Appelle Health Region (RQHR) is the largest health care delivery system in southern Saskatchewan, and one of the most integrated health delivery agencies in the country. RQHR provides tertiary care to residents of Saskatchewan in two provincial hospitals - the Regina General Hospital and the Pasqua Hospital.

RQHR offers a full range of hospital, rehabilitation, community and public health, long term care and home care services to meet the needs of more than 245,000 residents living in 120 cities, towns, villages, rural municipalities and 17 First Nations communities within the region. The region covers a diverse geographic area of approximately 26,663 square kilometres.

The region employs directly and indirectly approximately 9,000 employees. More than 500 physicians have privileges in the region. The region’s annual operating budget is roughly $670 million - that's more than $1.8 million per day spent on meeting the health care needs of residents.

The governing body of the region is the Regina Qu'Appelle Regional Health Authority. The twelve (12) members of the Authority are appointed by the Minister of Health under the Regional Health Services Act. The RQHR is administered by the Senior Management Team.7

Primary Health Care In 2003, RQHR through the RQHR Plan for Primary Health Care established a vision for Primary Health Care (PHC) team/site development. RQHR’s vision was consistent with the visions identified in the provincial Action Plan for Saskatchewan Health Care (2001) and The Saskatchewan Action Plan for Primary Health Care (2002). The RQHR now has over 5 years of experience in PHC planning and team development. Between 2004 and 2006, plans were completed for one rural area: Twin Valleys, and two urban areas: the North Central and the Core and Al Ritchie neighbourhoods. (The Twin Valleys area is comprised of Broadview, Whitewood, Grenfell, Wolseley, Ochapowace, Kahkewistahaw, Cowessess and Sakimay and including the Rural Municipalities of Chester, Elcapo, Kingsley, Silverwood, Willowdale and Wolseley).

The RQHR remains steadfast in its original vision. It continues to view PHC as the foundation of a reorganized, revitalized health care system. RQHR continues to be committed to establishing PHC teams and networks of physicians, nurse practitioners and other health care providers working with teams of individuals, families and communities to meet everyday physical, mental, spiritual, social, and health care needs; and with other sectors to address other determinants of health. The region believes that by doing so, services will be strengthened and delivered in a more effective and efficient manner.

7 About the Regina Qu’Appelle Health Region, RQHR website (www.rqhealth.ca)

Indian Head District Primary Health Care Plan Page 4 The RQHR’s overarching principles used to guide the planning and development of PHC are: • Accessibility, • Public participation, • Effective health promotion and disease prevention, • Proactive and collaborative approach to management of chronic diseases, • Intersectoral cooperation, • Patient / client centered care, • Community development approach, • Human resources continuum, • Integration and coordination of services, • Communication / information sharing, • Appropriate infrastructure and resources, • Improved health status.

The 2008-2013 Primary Health Care Strategic Plan targeted the development of PHC for the Indian Head area in 2008-2009.

Description of Indian Head District Situated to the east of Regina, the district is comprised of the towns of McLean, Qu’Appelle, Indian Head, Sintaluta, (District of) Katepwa, Montmartre, Kendal, the Rural Municipalities (RM) of Indian Head and Montmartre, and Carry the Kettle First Nations. The communities of McLean, Qu’Appelle, Indian Head, and Sintaluta are located on Highway #1; the District of Katepwa is located north of Indian Head (Highway 56); Montmartre and Kendal are located south of Sintaluta on Highway #48 while the community of Carry the Kettle is located south of Sintaluta or north of Montmartre. The distances from Regina vary from 40 to 84 kilometres. The district is geographically large with the distance from Montmartre to Katepwa being 93 kilometres.

Katepwa

McLean Sintaluta Qu’Appelle

Carry the Kettle

Kendal

Indian Head District Primary Health Care Plan Page 5 The Indian Head District is diverse in its makeup. The close proximity to Regina has both positive and negative effects on each of the communities. Some communities reported an increase in new families that are actively involved in their community while others identified commuters and a lack of “sense of community” as a weakness.

There are a variety of businesses and services in the larger communities while the smaller ones spoke to having no or only essential services. Oil development has occurred within the Montmartre or southern part of the district. Agriculture and the related services and businesses, i.e. implement dealerships, inland grain terminals, experimental farm, continue to be an important component. Economic development and the development of strong partnerships is a priority for many of the communities.

The populations of both the RM of Montmartre and Indian Head have decreased while the number of corporate farms in the area has increased. In the summer, the population of Katepwa Beach and the communities in close proximity increases considerably, resulting in an increase usage of services. A detailed community profile is included as Appendix 3.

The communities identified an increase in population in keeping with the reported increase to the provincial population. This growth in population has necessitated the development of housing subdivisions and the related service infrastructure..

The total covered population in 2008 was 5298; a 2% increase over the 2006 covered population. The 2006 Stats Canada census total population for the PHC area was 5043, or 255 people less than the total recorded in the 2008 covered population.

Population by Sask. Health 2008 Ministry of Health 2006 Stats Canada 2006 Community Covered Population Covered Population Census Data McLean 386 364 275 Qu’Appelle 764 754 624 Indian Head 1,874 1802 1,634 RM of Indian Head 273 266 356 Sintaluta 112 120 98 Kendal 107 113 59 Montmartre 511 503 413 RM of Montmartre 427 437 503 District of Katepwa 54 49 *410 Carry the Kettle 790 778 **671 Total 5,298 5,186 5,043 * Combined Census figures for South Katepwa (125) & Katepwa (285) ** The Carry the Kettle First Nations website 2008 population figures listed 625 Carry the Kettle residents and 2,041 band members.

Indian Head District Primary Health Care Plan Page 6 The percentage of the total covered population by age groupings in 2008 and 2006 is as follows:

2008 Covered Population 2006 Covered Population Total per age % of Total Total per age % of Total Age Group group Covered Pop. group Covered Pop. < 15 years of age 993 19% 982 19% 15 – 24 years of age 713 13% 714 14% 25 – 54 years of age 2,090 40% 2006 39% 55 – 64 years of age 595 11% 561 11% 65 – 74 years of age 463 9% 446 8% 75 years or > 444 8% 476 9% Total 5,298 100% 5186 100%

There was no significant change in any of the age groupings.

Carry the Kettle is the only First Nations community in the district. This community is working towards increased independence and self-sufficiency and has developed a number of community programs, services and business ventures.

The Primary Health Care Community Consultation Process In the fall of 2007, RQHR hosted a meeting in the area to talk about PHC. The elected councils received invitations and posters were hung in the communities. Thirty-three people attended representing the communities of Qu’Appelle, Indian Head, Katepwa, Edgeley, Montmartre, Kendal; and the RMs of South Qu’Appelle, Montmartre and Indian Head. The communities expressed a willingness to work with RQHR to develop a primary health care plan. Letters of interest were exchanged in the spring of 2008.

One of Indian Head’s two physicians left the community resulting in a shortfall in medical services. Working closely with RQHR and the Ministry of Health, Indian Head and Montmartre joined a number of the surrounding communities to recruit a new physician. In the fall of 2008, the recruitment of a physician and nurse practitioner resulted in a Primary Health Care team being established. The town of Indian Head and Montmartre spearheaded a cost sharing agreement with a number of the surrounding communities and RMs to offset the costs of recruitment, renovations and on-going operations of the Indian Head Regional Health Clinic.

In October 2008, RQHR and representatives of the town, village and RM councils within the area formed a PHC Community Consultation Committee (CCC). Others invited to participate included representatives from Carry the Kettle, RCMP, Prairie Valley School Division, Indian Head Hospital Foundation, the local physicians, pharmacist and dentist, and the RQHR Health Services Managers. At the formation meeting, those present received information on primary health care, the planning process and the CCC’s Terms of Reference. The villages of Odessa and Vibank, and the RM of South Qu’Appelle did not attend or decided not to participate further. Carry the Kettle First Nations did not attend any meetings but continued to express an interest in the process, were kept informed and have been included in this report. See Appendix 1 for a list of participants.

Indian Head District Primary Health Care Plan Page 7 Seven meetings were held from December 2008 to April 2009. The inclement weather was a major factor and resulted in the rescheduling of 3 meetings. This resulted in the holding of meetings on a weekly basis in March to ensure that the planning process was completed prior to spring seeding. See Appendix 2 for a list of meeting dates, locations and tasks. On average 15 people attended each meeting.

At the first two CCC meetings, each of the members was asked to answer four questions about their community or organization/department. The questions were: • What makes your community (organization/department) a special place to live (work)? • What are your community’s (organizations/departments) strengths? • What are the challenges that your community (organization/department) faces? • What will your community (organization/department) be will be like in the future?

The following is a summary of the information as gathered. This information was referenced throughout the planning process.

Indian Head District Primary Health Care Plan Page 8 INDIAN HEAD DISTRICT – STRENGTHS, CHALLENGES AND FUTURE

Indian Head District

Montmartre Indian Head ☼ 15 acute care beds Indian Head ☼ Growing ☼ 3 emergency rooms ☼ Everything a small community needs ☼ 37 LTC beds - respite/short ☼ Good community support ☼ Beautiful & well kept community stay, Adult day program Montmartre ☼ Safe place Strengths ☼ Good cross-section of ages ☼ Integrated Facility • Faciliities ☼ 4 Respite beds o New & good shape Strengths ☼ 12 LTC beds - o Recreation ☼ Adult day program • New families o Educational ☼ Home Care • Lots for youth/children to do o Centre 48 – accessed by other communities ☼ Meals on Wheels Multilevel educational • – outreach programs ☼ EMS • Facilities • Economic Development ☼ Physiotherapy o Health care centre • Cooperation between communities ☼ Public Health o Nursing home • Wealth of volunteers ☼ Mental Health & Addictions - visiting o Private care homes ☼ Pharmacy o Community health facility Challenges ☼ 2 Physicians o Recreation • No community hall ☼ Nurse Practitioner o Churches/Social Clubs • Lack of Pharmacy ☼ Visiting – Chronic Conditions Nurse o PFRA/Experimental Farm • Limited access to Dr/NP Educator, Dietitian & Health Good infrastructure • • Limited human resources Promotions Geographic location • • Rental – lack of diversity ☼ Parenting Plus • Many basic community businesses/services Future Strengths • New motel • Oil development • good network of people – common goal • New licensed day care centre • Hospital Foundation - $s for equipment • Dentist • Close proximity • Optometrist/ Chiropractor – weekly • Well used/supported by surrounding areas • Massage Therapy • Looking beyond treatment – health promotion • Pine Lodge • Long-term committed staff Qu’Appelle • EMS Challenges o Broadening scope of practice • Cliquey ☼ Caring, neighbourly o “My life capsules” • Not enough child care options ☼ Younger population o Key access for people with Lifeline • Lack of rental property, no diversity ☼ Lots of energy o First Responders • Economic development • Specialized HR recruitment Strengths Challenges • Potential gangs • Increasing volunteer base • Education – healthy living, fall prevention, • Lack of Accommodations • Outdoor rink motivation of people to care for own self, • Town hall farm safety Future • Seniors Centre • Health care education – each community • Build on community partnerships • Easy commuting - on #1 • HR challenges – not enough staff to run • Build on youth engagement • Proximity to Regina “just right” programs let alone go further • Karate club • Community run volunteer programs • Very active social clubs • Understanding & action on root causes of o Lions club determinants of health Sintaluta o Forever Friends • Palliative care – lack of: formal programs - in home o Karate Club • EMS ☼ Quiet • K – 9 school – see advantage in children going Improve service & level of care to larger school for high school o HR recruitment Strengths • Maintain “small town community” feel o

• Caring/tight knit • Growing Future • Facilities • Basic Businesses • HR – recruitment of quality staff o Town Hall o Grocery Store • Increased utilization of Nurse Practitioner o Senior’s Centre – gathering place o Café o Creekside Gardens • Cultural shift towards decreased demand / Challenges usage • No health care facilities or school Challenges • Increased education in all service areas – help • Limited business • 65% work in Regina people to navigate the Health Care System • Limited infrastructure to support growth • Avoiding “bedroom community” name (water) • Maintaining momentum • Elderly population increasing • Potential gang activity Future • Transient population Infrastructure → 5 year plan in place

Future • No big plans

Indian Head District Primary Health Care Plan Page 9

Katepwa Prairie Valley School Division ☼ Beautiful ☼ Resort Community ☼ Range of services and supports. . . all students including those with diverse needs/requiring intensive supports Strengths ☼ Broad range of services: specialized & individualized programming, • Provincail Park (& resources available) counselling, speech/language services, assessment, early childhood • Lion’s Club support (early entrant), interagency collaboration • TransCanada Trail ☼ Provided mainly by through the curriculum & instruction, student • Wide range of outdoor recreation activities services team & multidisciplinary approach • Growing ++ • Mayor/Council → long term vision - planning Strengths • Draws people from a large area – summer • Effective community-based & interagency relationships • New facility – Culture Center/Library • Additional supports available in area of MH & addictions • Multidisciplinary approach – full range of services – holistic interventions & supports implemented Challenges • Lack of sense of community – Challenges few volunteers • Insufficient services for drug and alcohol addictions • Few permanent • Distance to access counselling services for addictions residents/summer influx • High taxation Future • Lack of infrastructure Ideally . . . maintain & increase services especially in area of addictions as there appears to be an increase in • No post office the # of children and youth who are impacted personally & through caregivers’ addictions

• Few year round services - hotel

Future • Growing • More permanent residents

RM of Montmartre RM of Indian Head ☼ Very good road system ☼ Almost all the roads have been ☼ Close proximity to Regina overhauled in last 10 years ☼ Double lane highway McLean ☼ Access through RM good ☼ Access to Indian Head health care & facilities

Strengths ☼ Very young population • Active Town/RM – split expenses, etc. Strengths ☼ No crime o Excellent cooperation • Pretty fair roads • Peaceful community • Have $s to spend → pipeline • RM snow club for roads • Everyone looks out for each • New office/library (6 yrs ago) other • Share fire department with town • Amalgamated with Town → common office staff & • Improved relationship with town administrator Strengths • Share some recreation costs with town • Work with other communities – Kendal (snow • New community hall attached to school • Grain terminal removal) • Vol. Fire Dept./1st Responders • Historic • Joint boards with Town – volunteers • Large Lumberyard • PFRA/Research Farm • Fundraising for hockey team (mostly rural • Experiencing growth o As well good summer employment for members) – rent land to grow crop → town benefits • Best H 0 youth 2 from spin off • Outdoor rink • Tourist destination Challenges • Hotel/Restaurant • Decreasing population • Volunteer Base Challenges • Corporate farms • 30 child care spaces • Decreasing population • Working off farm → change in social fabric o potential for new building • Oil development but not enough $s to compensate • Travel - for everything • Pipeline → road maintenance Challenges • Child care • Lack of qualified child care • No Senior’s Housing • Older retirees are relocating to Regina → for • Need to work off farm • No grocery or convenience store/service station medical reasons primarily

• Lack of seniors activities Future Future • Lack of $s for Infrastructure • Decreasing population • Corporate farms – primarily seasonal work. • Small population base • More acreages/subdivisions • Lack of housing/lots • Oil development

Future • Proposed Subdivision • Build on partnerships with other communities

Indian Head District Primary Health Care Plan Page 10 THE PLANNING PROCESS Systems Thinking Approach An adaptation of the Systems Thinking Approach® to planning was used. This approach uses a “backwards thinking” format to move from the vision to strategies. The five key questions used to guide this process are:

• Where do we want to be? Outputs: the vision for the future • How will we know when we get there? Feedback: the outcomes and key measures of success • Where are we now? Inputs: the current situation • How do we get there? Throughputs: the strategies to move toward the vision • What on-going changes may/will affect the vision? Current and/or Future Environment: the possible8

The CCC worked through each of the steps using a number of different facilitation techniques, i.e. Consensus Workshops and Focused Conversations. Prior to each meeting, committee members received a list of “things to think about” which were designed to assist them in preparing to answer the key questions. The following is a compilation of their answers and forms the basis of the Indian Head District’s plan9.

Where do we want to be? – The vision for the future As the first step, the Community Consultation Committee was tasked with creating their vision for PHC. Visioning directed their focus to the positive conditions that they wanted to create for their community. The main question they needed to answer was: “What will PHC look in the Indian Head District in 10 years from now?”

Prior to the meeting, the committee members were asked to think or imagine, and to talk to other community members, about:

• What they or others would be like in ten years? • How their or other’s health care needs would have changed? • What kind of supports would they need? • What would be helpful in managing chronic conditions? • What changes need to occur to improve health care and access to health care over the next 10 years? • Consider the background information they had received previously about PHC.

The committee opted to develop an overriding 2020 Vision Statement and four supporting vision statements, which speak to community empowerment and ownership, service provision, healthy living, education and chronic conditions. The CCC adopted an all-encompassing definition of

8 The Systems Thinking Approach®, Haines Centre for Strategic Management (www.hainescentre.com) 9 Consensus Workshop© and Focused Conversation© - Canadian Institute of Cultural Affairs, 1985, 1995, 1998, 2003, 2004

Indian Head District Primary Health Care Plan Page 11 “community”10 The Indian Head District’s vision is as follows.

OUR 2020 VISION OF PRIMARY HEALTH CARE

Our 2020 Vision of PHC is a community empowered to build upon existing strengths and capacities, to act collectively and effectively, and to support individual and community health and well-being.

SUPPORTING VISION STATEMENTS:

CHRONIC CONDITIONS . . . In our area PHC strives for optimal quality of life through the prevention and management of chronic conditions.

SERVICE PROVISION . . . In our area, Primary Health Care involves all of the community and services working together to enhance health.

HEALTHY LIVING . . . Primary Health Care in our area supports individuals and communities in achieving physical, psychological, social and spiritual well-being within supportive environments (socially, politically, culturally and economically). A priority for our area is the healthy development and positive involvement of our children and youth.

EDUCATION . . . Our PHC vision is to create a knowledgeable community, which accepts responsibility for our own health and well-being, and that of our communities as a whole.

How will we know when we get there? - Outcomes and key measures For each of the four supporting vision statements the Community Consultation Committee identified outcomes and key measures of success. The outcomes describe the changes within the community or an individual(s) and include new knowledge, increased skills, changed attitudes or values, modified behaviours, improved conditions, and/or altered health status. Outcomes may be short, medium or long term. As well, the CCC identifies a number key ways to measure the change if the outcomes are achieved.

The outcomes and key measures have been included in the charts on pages 17 – 20.

Where are we now? - The current situation To assist the Community Consultation Committee in answering the question “Where are we now?” information and data was gathered from a number of sources. The gathering and sharing of information became an on-going component of the planning process and included:

10 Community, as intended within this report, includes our residents, RQHR, municipal governments, social services, education system, recreation, police, spiritual organizations, and, other local community organizations which address other factors that influence our health such as housing, childcare, employment, income and social supports.

Indian Head District Primary Health Care Plan Page 12 • The Community Profile (Appendix 3) • The conclusions of the RQHR 2008 Rural Health Status Report (Appendix 4) o Information on childhood overweight and obesity rates within in Saskatchewan o 2008 immunization rates for children 2 years and older o Projected rates of diabetes (Appendix 5) • Projected usage of HealthLine (Appendix 6) • Patterns of Care as they pertain to the Indian Head Union Hospital (Appendix 7) • Outpatient usage of the Montmartre Health Centre and Indian Head Union Hospital (Appendix 8) • Indian Head EMS – patient call reports (Appendix 9) • Community special characteristics, strengths, challenges, and future (pages 9-10)

The committee was then asked to consider, identify and discuss: • What are the strengths of the current state that fit with Primary Health Care? • Where are there gaps between this and the vision? Where are there opportunities for change? What are the consequences of not closing the gaps? • What obstacles are blocking us from realizing our vision? What issues, blocks, irritants, etc. must be dealt with if we are to reach the vision? Why or what is causing it? How it blocks us? • What combined strengths of the communities will help to overcome the obstacles and gaps?

Through a brainstorming process the following were identified:

Identified strengths that fit with or will assist the community to bridge to PHC:

• Integration and coordination of services between Montmartre and Indian Head • Demonstrated flexibility to accommodate needs/gaps in services i.e. outpatients doing dressings for Home care • Good compliment of service providers – wide range of services • First Responders & 911 combined provide: o Improved response time o Increased piece of mind and security o Response time to 90% of calls within 30 minute target • Infrastructure (highways) allowing for more mobility of services. • Increased population growth – people relocating to Indian Head PHC district • 40% of population is between 25-54 yrs of age • Indian Head has an established/core Intersectoral working group • Commitment from the health region • Commitment of local government • Individuals within the community who care • Access to service providers (who also care) to work within the communities

Indian Head District Primary Health Care Plan Page 13 Identified gaps which may affect the district’s ability to meet the Vision

• Limited number of First Responders e.g.: o No First Responders in Indian Head o Other communities have limited numbers o Lack of First Responder leadership on Carry the Kettle • Lack of communication between local governments and community - communities not informed. Community members not communicating with councils • Limited or no public access to buildings ie. wheelchair accessibility, accessibility for persons with other disabilities • Lack of communication with and inclusion of smaller and First Nations communities, and RMs • Limited working relationships between the communities • Prevention and health promotion resources are limited • Limited human resources which leads to service reduction in facilities/services • Lack of confidence in HealthLine • Lack of meaningful involvement of youth in the community(s) • Decreased importance of the family and family values • Lack of opportunities / venues to engage youth • Lack of knowledge of how to engage youth • Limited availability/accessibility to services in individual/smaller communities • Limited dollars • Lack of Telehealth • Not enough Primary Health Care providers – Physicians/Nurse Practitioners • Lack of detailed information – detailed community profile • Lack of community participation/voice • Limited availability to educational opportunities/venues • Lack of public transportation within and between communities • Lack of qualified people to fill positions

Identified obstacles, which may block the district’s ability to meet its Visions

• Size of the communities – depending on size there is a lack of resources • Lack of housing options • Overworked / overextended service providers • Lack of volunteers or volunteers that have the time needed to achieve the vision • Close proximity to Regina (bedroom community) • Community friction • Limited access to a full compliment of health care providers • Centralizing of services – moving to bigger centres or cities • Distance between communities (Katepwa to Montmartre) • Not enough or appropriate service providers to fully realize our vision

Indian Head District Primary Health Care Plan Page 14 Identified combined strengths of the community, which will assist to close the identified gaps and overcome the obstacles

• Cooperation between local governments in some communities • Caring, neighbourly communities • Infrastructure • History of working together • Recent experience/collaboration in physician recruitment and PHC planning • Increasing populations • Leadership in and loyalty to communities • Community pride • Willingness to work together

What on-going changes may/will affect the vision? - Current / future environment Although identifying the current and/or future environment is the fifth step in the planning process it was completed immediately following the third step and prior to drafting the strategies. The Community Consultation Committee identified a number of changes that could have either a positive or negative effect on the Indian Head PHC District’s vision. The changes as identified are: • Building a children’s hospital (very positive) • State of and uncertainty around economy and employment • Population is changing • Tax cuts – multifaceted • Patient First Review – spin offs • Recruitment of internationally educated nurses • Erosion of the “farm” community and small business • Feeling in the communities that life is “good” – “best it’s been” while pockets of people/industries are at risk. • Increased stress and mental health problems and awareness • City of Regina expanding out towards area – closer proximity • Drug and alcohol use • Gangs • Latch key kids, boomerang kids & sandwich generation • Lack of or limited resources for policing • Lack of transportation • More mobile population • Inability to retire as planned – financial impact • Rethinking retirement – baby boomers wanting to work • Information overload • Increased global awareness & influence • Changes in lifestyle, ‘expectations” – wanting more – better standard of living.

Indian Head District Primary Health Care Plan Page 15 How do we get there? The strategies to move towards the vision The final step in the planning process was drafting the strategies. The strategies build on the recognized strengths while striving to overcome the gaps, obstacles and challenges identified in the two previous steps.

These strategies are the actions that need to occur to ensure that the Community Consultation Committee’s visions become a reality. The overall 2020 vision statement, the supporting vision statements, the outcomes, key measures and strategies are presented in the following four charts.

Our 2020 Vision of Primary Health Care Our 2020 Vision of Primary Health Care is a community empowered to build upon existing strengths and capacities, to act collectively and effectively, and to support individual and community health and well-being.

Chronic Conditions In our area PHC strives for optimal quality of life through the prevention and management of chronic conditions.

OUTCOME KEY MEASURES STRATEGIES How will we know when we get there? How will the change be measured? How do we get there? − Community residents are healthier. − Decreased complications Education & Prevention − There is a decrease in chronic − Decreased number of incidence of − Provide ongoing education to increase conditions. chronic conditions in all age groups the publics’ knowledge of personal health management and prevention − Community residents are more − Increased knowledge. including the importance of regular knowledgeable about the causes − Increased adherence to prevention screening to identify preventable and prevention of chronic conditions. and management measures of illnesses, which may result in death, − The quality of life of individuals with chronic conditions i.e. colorectal, breast, prostrate and chronic conditions has improved. − Correlation between appropriate use cervical cancers. − Individuals are managing their of medication and improvement in − Develop a network of community lead conditions better. health status support groups − There is earlier diagnosis & Chronic Conditions Team treatment of chronic conditions − A team of multi-disciplinary health (including mental health). professionals oversees programs and services which focus on the prevention & management of chronic conditions − Use an interdisciplinary approach to ensure that care is based on best practice guidelines. (RQHR)

Indian Head District Primary Health Care Plan Page 16 Service Provision In our area, Primary Health Care involves all of the community and services working together to enhance health.

OUTCOME KEY MEASURES STRATEGIES How will we know when we get there? How will the change be measured? How do we get there? − Services meet the health needs of the − On-going assessment of client Service Delivery & the Health Care communities. experience Team − Services are delivered through a client- − On-going monitoring of team − Complete on-going assessments of centered team approach effectiveness. community health services needs − Clients are seen by appropriate care − Decreased wait times for access − Develop an action plan that identifies & providers. to services address service/team needs and take steps to meet identified needs. − Interventions occur earlier. − Increased ease in referrals − Explore options to increase − Health care services are provided in a − Flexibility and availability of accessibility and flexibility of services timely and flexible manner. services to better meet the (eg. mobile team, health bus, extended determined needs of the − Services are responsive to the hours of service) changing needs of the community communities. − Create a PHC team approach with all There is improved continuity of care. − Increased efficiency health service providers Individuals, who wish to, are staying in − Public is better informed and Children and Youth their homes longer receives timely rural health status − Culturally appropriate services are information − Develop linkages and share our PHC plan with all youth oriented available. − Increased diversity within the groups/services − Communities are working together to workforce First Responders enhance the health of area residents − Increased understanding of other − Communities within the PHC area are cultures − Increase public awareness of importance of the 1st Responder engaged in “health related” Regular meetings of all − program within the communities partnerships. communities within the PHC district are held. regularly. − Conduct on-going & active recruitment − Expand and strengthen the program within all communities. − hold annual recognition and appreciation event(s) Public Awareness − Host a public forum to share the PHC plan − Hold public forums annually, to share information about the progress on the plan and to hear the “community’s voice” − Provide information about PHC and wellness through on-going communication . . . newsletters, articles Community Participation Committee (CPC) − Strike a CPC to ensure that the plan becomes a “living” document and comes to fruition. − Hold ongoing meetings − Increase membership to include Intersectoral partners, PHC community “champions”, and others

Indian Head District Primary Health Care Plan Page 17 Healthy Living Primary Health Care in our area supports individuals and communities in achieving physical, psychological, social and spiritual well-being within supportive environments (socially, politically, culturally and economically). A priority for our area is the healthy development and positive involvement of our children and youth.

OUTCOME KEY MEASURES STRATEGIES How will we know when we get there? How will the change be measured? – How do we get there? − Residents of all ages are physically − Increased opportunities Community Linkages active. − Increased participation − Work with the community (community development committees, recreation − Individuals and the community have − Increased number of boards, councils, employers, etc.) to made a cultural shift to adopt healthy intergenerational activities choices and lifestyles. shift to a healthy living & inclusive − Improved work-life balance “culture” − Individuals assume responsibility for their healthier well-being − Increased support of employers / − Undertake joint community projects employees for work-based and programs to promote “healthy − Communities are: volunteerism living”, the importance of family, work- Safe o − Increased “family” functions and life balance Stronger through increased o philosophy “resident” ownership. − Identify and work to remove barriers to healthy living o Family focused. − Decrease in risky behaviours i.e. o Inclusive and welcoming. crime, violence, drug/alcohol use. Volunteers o Recognized for our innovation − Increased awareness of the − Increase awareness of the need for and creativity. positive outcomes of healthy living and roles of volunteers within the PHC − Barriers to healthy living have been − Increased opportunities and team, i.e. community PHC champions, eliminated participation of youth etc. − Youth are actively involved in our − Develop an on-going volunteer communities and taking leadership recruitment plan. roles − Hold annual recognition events. Children and Youth − Hold regular youth forums to listen to the youth’s “voice” and identify their needs − Jointly develop and implement a “healthy living” action plan − Work with/mentor youth to take ownership and/or implement the action plan. Transportation − Work within the communities (community at large, service groups, etc.) to identify options to meet the overall need for transportation. − Explore what other communities are doing − Identify and overcome obstacles (such as insurance, liability) Community Development − Based on the assessed need develop a community development strategy which may include a designated resource.

Indian Head District Primary Health Care Plan Page 18 Education Our PHC vision is to create a knowledgeable community, which accepts responsibility for our own health and well-being, and that of our communities as a whole.

OUTCOME KEY MEASURES STRATEGIES How will we know when we get there? How will the change be measured? How do we get there? − Community residents assume − Decrease in inappropriate use of Community Education increased self responsibility for their health services − Increase community awareness and own health − Changes (↑↓) in utilizations stats knowledge about “healthy living” & − There is improved health status. i.e. HealthLine, Outpatients, Acute general health information (i.e. on- Care going newspaper /newsletter articles, − Education sessions focused on public forums, speakers, workshops, meeting the varied health education − Increased support for and number training sessions, community access to needs of all segments of the of community initiatives. Telehealth sessions) community. − Increased awareness of healthier − A priority of RQHR Health Promotions − There is greater focus on health in the choices professionals is to achieve our vision schools. − Increased promotion of healthy − Engage Health Professionals to − The community has assumed lifestyles: prepare or provide information specific increased responsibility for the − Decreased acceptance of to the identified needs of the improved health of the community as a unhealthy life choices community (i.e. preventable diseases, whole. immunization, healthy eating) − Increased immunization for − There is increased understanding of preventable health problems − Increased awareness of quality on-line preventable health problems sources of health information − Earlier intervention − Use the community websites and

electronic media to promote the Indian Head PHC District’s “culture of healthy living” Staff Education − Access to Telehealth − Ensure that all RQHR staff has a solid understanding of primary health care and the area plan. Youth − Working as a team (health promotions, PVSD, schools, Public Health, EMS, Child and Youth Services, Addictions, the youth & others) develop linkages and a “healthy living” education strategy and action plan.

ACTION PLAN The CCC terms of references establishes that the committee will be in place until the written plan has been presented to and approved by the RQHR’s senior leadership. The CCC developed the following action plan to transition the plan to the CPC in the fall of 2009. The action plan is as follows:

1. Mid July, 2009 - a synopsis of the planning process and an overview of the Indian Head District PHC plan will be sent to the councils of the participating communities and RMs. The synopsis and overview will speak the process used to develop the plan, the plan’s contents and the next steps.

Indian Head District Primary Health Care Plan Page 19 2. Late August to late September, 2009 - a multifaceted awareness and/or education program will be developed and implemented to: • Increase the publics understanding of primary health care and the roles of the various health care professionals and services i.e. nurse practitioner, chronic condition nurse educator, public health; health promotions. • Educate local health care professionals about primary health care.

This will include: • Publishing a series of articles in the local papers • Making presentations to various councils, organizations and service groups • Attending local events to promote primary health care • Hosting a Health Fair in the various communities • Hosting a forum to present the Indian Head District PHC Plan

3. Early September – presentation of the plan to RQHR senior leadership

4. October, 2009 – the district Community Participation Committee will be struck to assist RQHR with the ongoing development of the Indian Head District PHC Plan.

CONCLUSION The CCC acknowledged the communities responsibility and role in fulfilling the PHC vision for their district, however they recognized their limitations and that of the current health services. Working together with RQHR to achieve the vision has been a key focus throughout the development of the Indian Head District PHC Plan. To fulfill the vision(s) and strategies as established there will be a need to identify the areas that the community will be responsible for, the areas that the RQHR will be responsible for and where there will be shared responsibilities.

The formation of a Community Participation Committee (CPC) is the next step and will be essential to bring this plan to fruition. The CPC will be responsible for putting the strategies into actions and achieving the vision(s) over the next ten years. A role of the CPC will be to undertake on-going consultations with all of the partners to ensure that the plan remains relevant to the current realities.

The recommendation of the CCC is that the membership of the CPC includes community champions for PHC, youth, RQHR health services staff, intersectoral partners and others.

Indian Head District Primary Health Care Plan Page 20 APPENDIX 1: LIST OF PARTICIPANTS

Appointed Council Representatives Lyla Grad Village of McLean Allan Arthur, Mayor Town of Qu'Appelle Al Hubbs, Mayor Town of Indian Head Al Karpa RM of Indian Head Anita Ryder Town of Sintaluta Rod Baumgartner RM of Montmartre Cal Abrahamson, Mayor* Town of Montmartre Stephen Kotylak RM of Montmartre John Boehmer District of Katepwa

Community Services, Organizations & Other Representatives Aria Saulteaux, Youth Rep Indian Head High School George Dragan, Pharmacist Dragan's Drugs (1990) Ltd. Dr. Brian Baker, Dentist Indian Head Dr. Don Pebane, Physician Indian Head Regional Medical Clinic Dr. B Zimmermann Physician Indian Head Medical Clinic

RQHR Representatives Maureen Anderson Nurse Practitioner Claudette Bugiera, Manager Golden Prairie Home Heather Dorgan, Manager Rural Community Health Brad Dusyk, Manager Montmartre Health Centre Maggie Petrychyn, Manager* Rural Primary Health Care Ross Reaburn, Manager Rural Emergency Medical Services Kim Vancaeseele, PH Nurse Public Health Myrna Weisbrod, Manager Indian Head Union Hospital Patti Williams, Coordinator Health Promotion

Others Consulted – provided or received information Jeff Eashappie Carry the Kettle First Nation Roxanne Thompson Carry the Kettle First Nation Cindy Focht, Consultant PVSD School Service Kim Kinnear, Prairie Valley School Division Superintendent of Student Services Wanda Hollinger, Care Coordinator RQHR Home Care R.A. Moar, Staff Sergeant Indian Head RCMP Detachment

* Co-Chairpersons of the Community Consultation Committee

Indian Head District Primary Health Care Plan Page 21 APPENDIX 2 COMMUNITY CONSULTATION COMMITTEE MEETING DATES, LOCATIONS AND PURPOSE / TASKS

Date Location Purpose/Tasks

October 4, 2007 Sintaluta Initial meeting between RQHR and Community reps. Interest expressed in proceeding with development of a primary health care plan. October 20, 2008 Indian Head Primary Health Care Presentation, Review of PHC Community Consultation Committees Terms of Reference, Review of Community Profile, The Planning Process and Future Meetings

December 3, 2008 Montmartre Cancelled due to weather December 9, 2008 Montmartre Getting to know each other & Community Strengths, Weaknesses & Challenges January 14, 2009 Katepwa Cancelled due to weather January 24, 2009 Indian Head Completed Community Strengths, etc Visioning February 11, 2009 Katepwa Cancelled due to weather February 18, 2009 Indian Head Visioning con’t March 5, 2009 Katepwa Review of Vision statements & started outcomes March 11, 2009 Montmartre Outcomes and Measures March 18, 2009 Indian Head Completed Outcomes/Measure, Reviewed the Current State March 25, 2009 Indian Head Identified Gaps, Strengths and Obstacles Finalized Strategies June 23rd, 2009 Indian Head Final approval of draft plan, create an action plan for the Community Participation Committee, etc.

Indian Head District Primary Health Care Plan Page 22 APPENDIX 3 – COMMUNITY PROFILE

The following Community Profile provides a summary of Health Services provided by RQHR and those services provided on Carry the Kettle First Nations. Other information includes services, programs, organizations, and general information about each of the participating communities. The information was gathered through a number of sources i.e. community websites, community representatives, RQHR website and program managers, etc.

Indian Head District Primary Health Care Plan Page 23 HEALTH SERVICES Hospital Indian Head Union Hospital: − 15-bed in-patient: provides acute, emergency and palliative care, as well as observation and emergency respite. − Emergency services - 24 hours per day − Laboratory & X-ray -- regular hours, or by physician's order − Minor surgery -- by appointment − Pharmacy - Health Centre accesses RQHR Pharmacy Services through Moosomin − Average Daily Census: 7 Health Centre Montmartre & District Health Centre − Integrated Facility: 4 respite beds for palliative, convalescent, transition and family respite − Ambulatory Care - 8:00 am to 4:00 pm except weekends and stats − Laboratory & X-ray --by physician's order − Pharmacy - Health Centre accesses RQHR Pharmacy Services through Indian Head Long-term Golden Prairie Home Care Beds − 37 Long term care beds and 1 short stay bed for respite or transition − Adult Day Support - 'Day Away Program' - 10 spaces - Monday, Wednesday and Friday Montmartre & District Health Centre − 13 long term care beds, 3 respite beds & Adult Day Support Program. Medical Clinic Indian Head Medical Clinic − Dr. B. Zimmermann - holds clinic one day/week in Montmartre Indian Head Regional Medical Clinic – − Dr. D. Pebane - holds clinic one day/week in Montmartre Medicine House − Carry the Kettle General Dr. Bruce Zimmermann Practitioner − operates private medical clinic (Primary Dr. Don Pebane Care Nurse − moved into community clinic in October 2008 Practitioner) − 5 FTE NP attached to Dr. Pebane's practice since October 2008. Emergency Based out of Indian Head Medical − regionally operated service. Services -EMS Public Health PHN's services include: immunization both community and school based; health education; infection control; & prenatal, baby & early Nurse childhood clinics. Child Health Clinic are held in Indian Head Hospital, Montmartre Health Centre & Qu'Appelle; school age immunization clinics are held in Indian Head, Qu'Appelle, McLean and Montmartre Schools. PHN works with the schools on a request basis to act as a resource for and/or provide health education programs; and jointly with other professional to meet community needs. Community Carry the Kettle Health Nurse − Nurse provides services within the community

Indian Head District Primary Health Care Plan Page 24

Home Care RQHR Home Care services are determined based on the client’s assessed need and provided based on the availability of resources. − Assessments are completed for Home Care, and for program access to respite, convalescence, palliative, transition, and long term Care. − Home Support Services may include personal care, in home respite for usual care provider, in home meal preparation, housekeeping . . . − Nursing Services are provided based on the assessed need per a physician’s order. HC RN’s may do an “assignment of task” to a home health aide. Nursing services includes wellness clinics. − Wellness Clinics are held in Indian Head and Montmartre on a monthly or as needed basis. Foot care is primary service. − Meals on Wheels are available within the towns or Qu'Appelle, Indian Head and Montmartre. − Palliative Care provided within client's home in cooperation with family - 24 hour nursing not available. Home Care will attempt to provide on-call nursing care for a client requesting end care supports. − Carry the Kettle First Nation - Home care services are provided on Carry the Kettle -- federally funded program Infection Control & Based out of Regina. If an issue is identified the Medical Health Officer will provide guidance to Public Health Office, specific Communicable Diseases Facility Manager and/or other professionals. Chronic Condition Holds joint diabetes clinics with Dietitian in Indian Head. CCNE assists with and/or delivers programs in the area Nurse Educator of health promotion. Health Promotion Works with the community and schools in the area of health promotion. HPC accesses community resource people with expertise in Coordinator specific areas. Projects focus on active living and injury prevention, and are delivered to interested communities throughout the area. Community Dietitian Holds clinics in Indian Head one day per week or as needed Physiotherapy Outpatients are seen at Indian Head Union Hospital 2 - 3 days per week. Clients are seen on a priority basis. Occupational Therapy Based out of Regina - Outpatient appointments scheduled based on number of referrals - May work out of Indian Head Hospital, and makes home visits/assessments. Speech Language Services are provided in Grenfell or Regina - Services primarily focused on preschool children. Children will transfer to the school Pathology system SLP program once school age. Podiatry Services provided in Regina, Grenfell and Fort Qu'Appelle. Audiologist Clients travel to Regina for service. Acquired Brain Injury Services are based out of Regina - will travel out to area in certain situations. Mental Health Services Clinics held at the Indian Head Hospital: Adult Clinics held 2 days per week and Child & Youth Clinics held 1 day per week. Adult Clinics held in Montmartre as needed. Addictions Service Clinics held at the Indian Head Hospital one day per week or as needed. Communicable Clients travel into city to access services. CD/SH provide support to facilities and programs throughout the area. Disease/Sexual Health CD/SH works with other health professionals in the area to provide treatments/interventions. Public Health PHIs assigned to provide services throughout area. PHIs are responsible for reducing or eliminating health hazards as defined under Inspectors the Public Health Act. PHI delivers services by consultation, education, inspection, and if necessary, enforcement. (Environmental Health Department, RQHR)

Indian Head District Primary Health Care Plan Page 25 OTHER SERVICES, PROGRAMS, ORGANIZATIONS, & GENERAL INFORMATION Pharmacy Retail Pharmacy located in Indian Head Dental Dentist office is located in Indian Head. Open 4 days per week. Optometry Satellite clinic which provides services in Indian Head one day per week Pine Lodge Provincial funded program - residential multidisciplinary addictions treatment program Massage Therapist Therapists located in various communities. Chiropractor Office is in Indian Head. Naturopath Office is in District of Katepwa. Schools McLean: Kindergarten to Grade 8 Qu'Appelle: Kindergarten to Grade 9 Indian Head: − Pre-kindergarten program − Elementary: Kindergarten to Grade 6 − High School: Grade 7 to 12 Montmartre: Kindergarten to Grade 12 Carry the Kettle: Nakoda Oyade Education Centre - Kindergarten to Grade 12 Preschool McLean: Children ages 3 to 4 years Qu'Appelle: Preschool program Indian Head: Children ages 3 to 4 Montmartre: Children 3.5 years to 5 years Day Care McLean: Prairie Dreams Learning Centre Qu'Appelle: Private Day Care & have been approved for licensed day care spaces Indian Head: Day Care (licensed) Kendal: Carol's Day Care Montmartre: In process of setting up licensed day care Carry the Kettle: Nakora Lodge - provides regular and emergency day care Early Childhood In home services for children 0-6 yrs. - Services provided by Regina or Weyburn ECIP Intervention Program Kids First Kids First Community Developer available as a resource to communities and groups within the area which are developing programs for children 0-5 years Parenting Plus Provides voluntary intensive home visiting services for vulnerable families to the whole area

Indian Head District Primary Health Care Plan Page 26 Seniors Centres/ Qu'Appelle: Qu'Appelle Pensioner's and Seniors Org. Programs Indian Head: Heritage Club Sintaluta: Silver Horizons Montmartre: Golden Age Centre Carry the Kettle: Nakota Lodge Transportation – in Indian Head: Handivan town Carry the Kettle: offered through Medicine House S E Regional Library Montmartre District of Katepwa Policing McLean, Qu'Appelle, Indian Head, RM of Indian Head & Sintaluta: Indian Head RCMP Detachment Kendal, Montmartre, & RM of Montmartre: Montmartre Community RCMP Detachment District of Katepwa: Fort Qu'Appelle and Indian Head RCMP Detachments Carry the Kettle: File Hills First Nations Police Service First Responders McLean Qu'Appelle Kendal, Montmartre, & RM of Montmartre Carry the Kettle Fire Department McLean (volunteer) Qu'Appelle Indian Head & RM of Indian Head Kendal, Montmartre & RM of Montmartre District of Katepwa: Balcarres & Indian Head Carry the Kettle Churches McLean: Roman Catholic, Anglican, United, Qu'Appelle: Anglican, Presbyterian; Roman Catholic, United Indian Head: Evangelical, United, Roman Catholic, Lutheran Kendal: Roman Catholic Montmartre: Roman Catholic, Ukrainian Orthodox, Ukranian Catholic, Postal Services McLean: Outlet Qu'Appelle: Outlet Indian Head: Office Sintaluta: Outlet Kendal: Outlet Montmartre: Office

Indian Head District Primary Health Care Plan Page 27 OTHER SERVICES, PROGRAMS, ORGANIZATIONS & GENERAL INFORMATION Recreation/Clubs/ McLean: Community Hall; Recreation Association; Outdoor Rink; Sports Grounds; Ball Diamond; Multiple 4H Club; Quilting Guild; Women’s Club, Doomsday Players; Beavers/Cubs/Scouts/Venturers; Riding Club; Snowmobile Club; Cap Program Qu'Appelle: CARE; Communities in Bloom; Forever Friends of Hope Foundation; Banner Project; Lions Club; Lioness Club; 4H; Riding Club; Seniors Organization; Creakside Gardens; School Community Council Indian Head & RM of Indian Head: Arena; Badminton; Barrel Racing; Minor Baseball; Bridge; Carpet Bowling; School, Community Council; Canoe Club; Chief's Hockey Club; Children's Dance; Curling Club; Fitness Club; Swimming Pool; Minor Hockey; Recreational Hockey: Achievers, Saints & Wreckers; Skating Club; Slow Pitch League; Soccer Assoc.; Band Parents Assoc; Horticultural Society; Community Theatre; Night Hawk Theatre; Bell Barn Society; Museum Society; Friendly Neighbours; Rural Sports Hall of Fame; Elks; Masonic Lodge; Legion; Royal Purple; Shriners Club. Lions; Toastmasters; Air Cadets, Kidsport; Indian Head Research Farm; Sparks/Brownies/Guides; Beavers/Cubs/Boy Scouts; Wildlife Federation; Orange Benevolent Society; Child Action Committee; Chamber of Commerce; Heritage Club; Indian Head & District Ambulance; Communities in Bloom; Community Development; Donor's Choice, EMS Association; Hospital Support Foundation; Library; Tourist Information; Sintaluta: Memorial Hall Association; Legion; Lions; Snowmobile Club; Board of Trade; Museum Association; Silver Horizons, Rink Board Kendal: Kidsport; Recreation Board; Knights of Columbus; Montmartre & RM of Montmartre: Cadets; Hall Board; Kidsport; Knights of Columbus; Legion; Lions; Arts Council; Recreation Board; Redhatters; CWL; Economic Development; Farmer's Market; Beach Volleyball; Curling; Dance; Disc Golf; Kemoca Regional Park: Swimming Pool; Golf; Hockey; Minor Ball; Running Club; Skating; Soccer; Kindemusich Program; Centre 48; School Community Council; District of Katepwa: Provincial Park; Lions Club; Golf Course (2); Nature Trail Committee; Campgrounds; Cultural/Social Centre; Recreation Committee

Indian Head District Primary Health Care Plan Page 28 APPENDIX 4 – 2008 RQHR RURAL HEALTH STATUS REPORT

A summary of the Rural Health Status Report was presented by Heather Dorgan, Manager, Rural Community Health Services. The report was released by the RQHR in February 2009 and provided an overview of findings regarding the health status of rural residents of the RQHR. The full report is available at: http://www.rqhealth.ca/programs/comm_hlth_services/pubhealth/pubhealth_rural_hlthstatusreport.shtml

Compared to the City of Regina - Rural Saskatchewan has: • A higher aboriginal population (19% vs. 9%) • A slightly higher % of seniors 65 years and older (15.4% vs. 12.8%) • A slightly higher % of children under the age of 19 o < 10 yrs. 12% vs. 11.4% o 10-19 yrs.16% vs. 13.8% • A higher % of male lone parents (27.5% vs. 18.1%) • Teen pregnancy rates are lower however birth rates are higher • 17% of all births between 2001 and 2005 were high birth weight compared to 15% in the City of Regina • Over all age standardized mortality rates was consistently lower • Leading cause of death was cardiovascular and neoplasm • Annual age standardized hospitalization rates for diabetes were higher (2001-05) • Injuries were particularly high in terms of falls & transportation • From 2001-05 deaths from sites for which screening is available accounted for 30% of all cancers – (urban is 26%) (colorectal, breast, prostrate and cervical)

Additional information: • Stats Canada (2004) reported that overweight and obesity rates for age 2-17 years of age was 26.2% in Canada and the Saskatchewan rate was 29.1% • RQHR immunization rates for children 2 years old in 2008 hovered around the 68- 69% for illnesses such as measles, mumps, diphtheria, whooping cough and tetanus.

Indian Head District Primary Health Care Plan Page 29 APPENDIX 5 - DIABETES

In 2004, the rate of diabetes was estimated at 6.1% for non-aboriginal adults 15 years and older and as being 3 – 5 times as high for aboriginal adults 15 years and older.

Rough estimation of the number of people in the Indian Head PHC District who may have diabetes using 2008 covered population figures:

Non aboriginal population (15 year & older): 3515 people @ 6.1% = 214 people Aboriginal population (15 years & older): 586 people @ 18.3% = 107 people 321 people

Indian Head District Primary Health Care Plan Page 30 APPENDIX 6 – HEALTHLINE

John Masters, HealthLine, provided information on the projected usage of HealthLine.

Provincially in 2008, the use of HealthLine by rural residents varied from 27 to 30% of the total call received. A user experience survey completed in 2008 found that rural residents may/may not remember the number when they require services. At this time, it is very difficult for HealthLine to provide information by individual community(s). Information was provided for the month of January 2009.

The number of actual calls to HealthLine from postal codes in the Indian Head PHC District was 79 calls, or 1.4% of the total covered population in the district contacted HealthLine in that month. The 1.4% was felt to be in keeping with the provincial standards.

Indian Head District Primary Health Care Plan Page 31 APPENDIX 7 – PATTERNS OF CARE

The following information is taken from the Ministry of Health’s Patterns of Care for 2006- 2007. The 2007-2008 figures had not been released prior to drafting this report.

Percentage of each community’s Discrete Patient Community population seeking care in Count Indian Head McLean 8.93% 52 Qu’Appelle 31.29% 243 Indian Head 72.74% 1314 RM of Indian Head 59.81% 161 Sintaluta 56.69% 53 Kendal 42.52% 31 Montmartre 52.31% 257 RM of Montmartre 31.60% 141 District of Katepwa 39.22% 13 Carry the Kettle FN *21.87% 558

*According to the Carry the Kettle website they have 2041 band members of whom 625 resided in Carry the Kettle. The total number of band members was used in calculating the above percentages. Using the 625 actual residents to calculate pattern of care or care seeking patterns would result in 89% of the community’s population having sought medical care from a physician in Indian Head at least once in 2006-2007.

Indian Head District Primary Health Care Plan Page 32 APPENDIX 8 - OUTPATIENT VISITS

Montmartre Health Centre – Summary of information presented by Brad Dusyk, Manager, Montmartre Health Centre

Outpatients 2007-2008 2006-2007 2005-2006 Level I 1 0 Level II 4 4 Level III 12 13 Level IV 25 42 Level V 317 330 Special Procedures 7 9 Emergent 3 Urgent 16 Elective 358 Total Outpatient Visits 330 321 377

Indian Head Union Hospital (IHUH) -summary of information provided by Myrna Weisbrod, Manager, Indian Head Union Hospital

Outpatients 2007-2008 2006-2007 2005-2006 Level I 253 76 Level II 267 390 Level III 1,356 2,657 Level IV 332 0 Level V 599 0 Special Procedures 0 0 Emergent 23 Urgent 105 Elective 3028 Total Outpatient Visits 2,807 3,123 3,156

Observations • Between April 1, 2008 and February 28th, 2009, there were 559 visits to outpatients at the Montmartre Health Centre. 532 of the visits were for procedures that are usually provided by the Home Care Nurse. • Indian Head Union Hospital numbers may be down from June 2007 to October 2008 due to there only being one Physician in town. • Nurse Practitioners are unable to admit other than for 24-hour observation. • Following assessment and consultation with the Physician/NP, some people presenting during the day from Monday to Friday to outpatients at IHUH are being referred to the medical clinics. • New reporting criteria was adopted between 2005/06 & 2006/07. Indian Head Union Hospital figures for 2006-2007 may not accurately reflect the numbers in each category, as they have needed to synchronise coding.

Indian Head District Primary Health Care Plan Page 33

APPENDIX 9 - INDIAN HEAD EMS CALL REPORT – APRIL 1, 2007 TO MARCH 31, 2008

Summary of information provided by Ross Reaburn, Manager, Rural EMS

Total pick ups by Indian Head EMS by location for April 1, 2007 – March 31, 2008 Total Pick-ups Pick-up area 176 Indian Head Union Hospital 11 Montmartre Health Centre/SCH 68 Carry the Kettle First Nation (Assiniboine #76) 5 RM of Montmartre 2 Village of Kendal 13 Village of Montmartre 29 Golden Prairie Home, Indian Head 23 R.M. of Indian Head 113 Town of Indian Head 6 Town of Sintaluta 13 Town of Qu’Appelle 8 Village of McLean 67 Other locations within the City of Regina 89 Other 623 Total Pick-ups

Total pickups by other EMS between April, 2007 to March, 2008 Total Pick-ups Pick-up area 11 Village of Katepwa Beach 17 R.M. of South Qu’Appelle 14 Village of Lebret 35 R.M. of North Qu’Appelle 77 Total Pickups - other Ambulance Services

Total pickups per month by Indian Head EMS between April, 2007 to March, 2008 Month Number of Patient Call Reports April 2007 64 Average monthly call: 52 May 2007 48 June, 2007 53 Daily average calls: 1.71 July, 2007 48 August, 2007 65 Number of times responded with September, 2007 45 lights and sirens: 198 times October, 2007 65 November, 2007 42 Once on scene responded to the December, 2007 40 hospital with lights and sirens: 58 January, 2008 55 February, 2008 43 March, 2008 55 Total 623

Indian Head District Primary Health Care Plan Page 34