Working It Out Together Pikangikum First Nation’s DRAFT Community Health Needs Assessment December 2013 Acknowledgments Chi Miigwetch, a great thank you to all the 574 community members who have participated in our community health planning process so far (all names listed on next pages). Your willingness to share your stories, experiences, ideas, and perspectives is what has made this process a success and a true reflection of our community health. Thank you also to the many individuals and staff in our health system who contributed their time and experience in interviews as part of this process. Thank you to the leadership of Pikangikum, our Chief and Council, our community Elders, and the Pikangikum Health Authority under the leadership of Billy Joe Strang, for initiating, supporting, and guiding this process. Thank you to our funders (Health Canada, Aboriginal Affairs and Northern Development, and the Province of Ontario) for supporting this important community planning process. Thank you to the Pikangikum Community Health Planning Team: Thank you to members of the Pikangikum Working Group: Samson Keeper (Project Manager) Samson Keeper Kyle Peters Gloria Keeper Lawrence Peters Penny Peters Rex King Paddy Peters Alex Quill Greg Pascal Don Quill Billy Joe Strang Alex Quill Lloyd Quill Thank you to additional SHEE committee members and agency representatives: Thank you to our team of translators: Robin Aitken Hilary Blain Ursula King Dianne Bjorn Kristen Carroll Dean Peters Bernadette Cook Grace Lugo Irwin Keeper Rachael Manson-Smith Deborah Odhiambo Hillary Suggashie Susan Pilatze Tony Prudori
Jan Puddy Mark Sheen Hanita Tiefenback Jeff Werner Thank you to Brian Keeper, Amos Pascal, Yana Sobiski, Laura Loewen, Mike Lovett, and Dr. Anthon Meyer for your assistance and support of this needs assessment process. And thank you to the Beringia Community Planning team of Jeff Cook, Gaye Hanson, Marena Brinkhurst, and Sarah Gillett for your support, guidance, and dedication to this process.
Copyright © 2013 by Pikangikum First Nation and Beringia Community Planning Inc. All rights reserved. This plan or any portion thereof including any photographs, visual process tools, and diagrams may not be reproduced or used in any manner whatsoever without the express written permission of the Pikangikum First Nation and Beringia 1 Community Planning Inc. Community Participation (We apologize for any missing or misspelled names) Farman Black Annalee Keeper Krissy Keeper Mary King Murphy D. Owen Charlie Peters Alex Quill Garry Black Ardelle Keeper Lindale Keeper Rex King Nelson Owen Danae Peters Alexander Quill Gary Black Ashley Keeper Lora Keeper Roxanne King Roy Owen Danny Peters Amanda Quill Isaiah Black Austin Keeper Lucas Keeper Sunny King Gloria Owill Dean Peters Ashley Quill Joshua Black Brian Keeper Lyle Keeper Sylvena King Donny P Doris Peters Boris Quill Keisha Black Brianna Keeper Malcolm Keeper Tyra King Alyssa Pascal Ethan Peters Boyd Quill Leon Black Brooke Keeper Max Keeper Vatia King Amos Pascal Faith Peters Chasity Quill Paris Black Calvin Keeper Memphis Keeper Verna King Cameron Pascal Geneva Peters Cheslie Quill Samantha Black Chrissy Keeper Neebin Keeper Buster Kurhara Carita Pascal Geordan Peters Chuck Quill Whyderman Black Corvin Keeper Nicholas Keeper Ariel Moose Catherine Pascal Georga Peters Connie Quill Jermaine Deter Cynthia Keeper Nora Keeper Brentyn Moose Chantal Pascal Gideon Peters Corvis Quill Agnes Rita Daeden Keeper Nora Jane Keeper Brian Moose Charlie Pascal Gina Peters Crosby Quill Dunsford Daniel Keeper Penny Keeper Delayna Moose Conrad Pascal Ginger Peters Dakota Quill Antonia Dunsford Darrell Keeper Rainelle Keeper Delena Moose Devona Pascal Hailey Peters Daniea Quill Arabella Dunsford David Keeper Rhoda Keeper Delerena Moose Donald Pascal, Jr. Heaven Peters Daniel Quill Carla Dunsford Delinah Keeper Ringo Keeper Draytin Moose Donna Pascal Ilya Peters Darien Quill Cecily Dunsford Denise R. Keeper Rose Keeper Gabriel Moose Edith Pascal Jayde Peters Desire Quill Connie Dunsford Diane Keeper Rosemary Keeper Jarrius Moose Eliza Pascal Jenniah Peters Desmond Quill Dreama Dunsford Donathan Keeper Roylena Keeper Jean Moose Faith Pascal Jennifer Peters Dinisha Quill Francine Dunsford Dremin Keeper Samantha Keeper Joe Moose Greg Pascal Joseph Peters Don Quill Isaiah Dunsford Eddie Keeper Sarah Keeper Kirsten Moose Isaac Pascal Keenan Peters Dorothy Quill K. Dunsford Edna Keeper Sharona Keeper Loushus Moose Isaiah Pascal Kerrie Peters Durren Quill Kavara Dunsford Ellen Keeper Silas Keeper Nandy Moose Jemima Pascal Kyle Peters Eddy Quill Kelly C. Dunsford Eric Keeper Smith Keeper Nolen Moose Kyle Pascal Larissa Peters Ellie Quill Lionel Dunsford Ethan Keeper Taylene Keeper Raya Moose Lisa Pascal Lawrence Peters Georgina Quill Penelope Dunsford Eveleen Keeper Violet Keeper Rona Moose Madison Pascal Martha Peters Harry Quill Petra Dunsford Garnet Keeper Annalu Keesick Samantha Moose Max Pascal Martillia Peters Hermoine Quill Ranford Dunsford Gloria Keeper Kristy Keyper Sunrise Moose Nolan Pascal Mathis Peters Isaialt Quill Tristen Dunsford Harold Keeper Aipi King Violet Moose Raylene Pascal Monique Peters Jake I. Quill Diana Gray Jacob Keeper Andrena King Barbara Rhoda Pascal Noreen Peters Janet Quill Wanda Gray Jade Keeper Annafern King Oskineegish Risa Pascal Paddy Peters Janna Quill Joe Henry Jake Keeper AzarIah King Akera Owen Roman Pascal Penny Peters Jayven Quill Destiny Hill Jalan Keeper Eli King Barry Owen Ruby Pascal Raphuel Peters Jerome Quill Randy Hill Jason Keeper Enos King Betty Owen Tyler Pascal Rodine Peters Jonah Quill Julia Jardine Jaynan Keeper Ethan King Charlotte Owen Valerie Pascal Shawn Peters June Quill Adrian Keeper Jean Keeper Gavin King Daphane Owen William Pascal Starlyn Peters Justin E. Quill Alden Keeper Jenessa Keeper Jarrett King Dean Owen Abias Peters Sylvia Peters Kavarah Quill Alex Keeper Jeremiah Keeper Jeremiah King Elizabeth Owen Amberlee Peters Talyn Peters Kerisha Quill Alvin Keeper Jewel Keeper Katie King Jeanielle Owen Amerlee Peters Tia Peters Kerrie Quill Andrew Keeper Jodina Keeper Kenneth King Melody Owen Charity Peters Alaria Quill Kerry Quill 2 Kestin Quill Violet Quill Julitha Strang Albert Suggashie Louie Suggashie Daniel Turtle Ronald Turtle Kristian Quill Randy Ross Katie Strang Alex Suggashie Maggie Suggashie Davius Turtle Shakira Turtle Kurri Quill Yana Sobiski Kelsey Strang Alicia Suggashie Marlene Suggashie Deborah C. Turtle Shanalene Turtle Leo Quill Aaliyah Strang Ken Strang Angelica Suggashie Martha Suggashie Delores Turtle Shania Turtle Lewis Quill Ailanis Strang Kimberly Strang Anton Suggashie Mary Suggashie Delorna Turtle Shannon Turtle Liam Quill Billy Joe Strang Kurri Strang Ashanti Suggashie Nellie Suggashie Dillon Turtle Shanra Turtle Lloyd Quill Bondlee Strang Laney Strang Ashton Suggashie Nick Suggashie Dino Turtle Sharon Vanna Turtle Lorena Quill Boydlee Strang Leslie Strang Benita Suggashie Ovide Suggashie Dontel Turtle Shaundine Turtle Makayla Quill Brenda Strang Lucy Strang Carlene Suggashie Ovide Suggashie Douglas Turtle Shawn Turtle Margarita Quill Carmelia Strang Marly Strang Cassidy Suggashie Philip Suggashie Edna Turtle Shayna Turtle Martillia Quill Caroline Strang Marvin Ryan Strang Cherish Suggashie Piandon Suggashie Ernest Turtle Sheline Turtle Mary Quill Cecily Strang Matthew Strang Cindy Suggashie Plily Suggashie Ernest K Turtle Shelly Turtle Michelle Quill Cequin Strang Monita Strang Collin Suggashie Pyvillia Suggashie Felix Turtle Shiela Turtle Mylia Quill Chad Strang Nadine Strang Curtis Suggashie Robinson Suggashie Gabriel Turtle Shinniah Turtle Nathan Quill Charity Strang Nena Strang Dayanara Suggashie Shanine Suggashie Gabriella Turtle Shirley Turtle Onochia Quill Ciara Strang Nisely Strang Delerena Suggashie Sheldon Suggashie Gary Turtle Solomon Turtle Paula Quill Conner Strang Patricia Strang Delvin Suggashie Shelton Jake Georgie Turtle Sonny Turtle Peter Quill Corryton Strang Rachel Strang Dura Suggashie Suggashie Glinda Turtle Sophie Turtle Randall Quill Crystal Strang Raymond Strang Elijah Suggashie Sonny Suggashie Jackson Turtle Stephen Turtle Raniea Quill Curtis Strang Ricquel Strang George Suggashie Sophia Suggashie Jacqueline Turtle Susan Turtle Renee Quill Darrelina Strang Robert Strang George M. Stanley Suggashie James Turtle Teri Turtle Robin Quill Ddot Strang Ronald Strang Suggashie Tamilsca Suggashie Janet Turtle Tina Turtle Ronica Quill Delroy Strang Ronnie Strang Haleen Suggashie Terika Suggashie Joey Turtle Tyson T Turtle Samantha Quill Don Strang Rudy Strang Hillary Suggashie Tristen Suggashie Jonsson Turtle Vernie Turtle Samuel Quill Eli Strang Ruth Strang Hillery Suggashie Yurl Suggashie Julian Turtle Vince Turtle Sasha Quill Erin Strang Sally-ann Strang J. Suggashie Rocky T Kendriya Turtle Wallace Turtle Serenity Quill Gilbert Strang Shamus Strang Jaylene Suggashie Shania T Kirsten Turtle Eveleen Wesley Shaneli Amber Quill Gladys Strang Sharmell Strang Juliette Suggashie Adeline Turtle L. Turtle Margaret Wesley Shanice Quill Harriet Strang Sidler Strang Justin Suggashie Alexander Turtle Latisha Turtle Anonymous, Sharla Quill Howard Strang Steven A. Strang Kanina Suggashie Bess Turtle Laureen Turtle Ardelle, Arianna, Shorty Quill Inez Strang Stevenson Strang Kansas Suggashie Betty Turtle Lome Turtle Ashley, Ashlyn, Stephanie Quill Jarilyn Strang Susan Strang Kay Suggashie Braydon Turtle Marcus Turtle Ashton, B., Brenda, Steve Quill Jatden Strang Susan D. Strang Kitty Suggashie Cecilia R. Turtle Margaret Turtle Brooke, Carol, Chad, Sunshine Quill Jayden Strang Tamara Strang Kristen Suggashie Chantel Turtle Michael Turtle Charlotte, Cheryl, Sykora Quill Jaylene Strang Todd Strang Levi Suggashie Charlie Turtle Mick Turtle Clavis, Colleen, Tom Quill Jeff Strang Trudy Strang Lilah Suggashie Cheryl Turtle Montel Turtle Dante, Evannah, Tom Quill, Sr. Jeffrey Strang Virginia Strang Lily Suggashie Chris Turtle Priscilla Turtle Eveleen, Forrest, Trex Quill Jerry Strang William Strang Linden Suggashie Cody Turtle Ralph Turtle Harriet, Jim, Kelsey, Trey Quill Joylene Strang Jim Strong Lita Suggashie Corry Turtle Renalda Turtle Liam, Matthew, Victoria Quill Judy Strang Abram Suggashie Lola Suggashie Crystaleen Turtle Rocky Turtle Randon, Reign, Shelton, Shiker, Tori 3 Summary
Introduction The Pikangikum First Nation is undertaking a process of coming together to strengthen our community’s health by identifying and assessing our health needs and planning for a stronger future. This Community Health Needs Assessment (CHNA) is a major step in this process and a tool to assist our community in its journey of health. Executive Summary
Our community health planning process is one way that we are responding to the serious and ongoing inequalities in health, education, employment, and income that our community members face, compared to the average Canadian. We are coming together to identify, understand, and address our individual, family, and community health strengths and challenges with the leadership and guidance of our Chief and Council, Elders, the Pikangikum Health Authority, and the Social, Housing, Education, and Elders Committee (SHEE). This CHNA is the foundation for our plan of action that we are developing in our Comprehensive Community Health Plan (CCHP).
We take a holistic approach to health that considers both determinants and outcomes of health. We do not focus solely on treatment; we include the whole continuum of health, from health promotion and prevention, to treatment and rehabilitation, to aftercare and ongoing health support. Our approach is different from standard health needs assessments because it was initiated and driven by the community and the central importance of community voices.
Our CHNA emphasizes that understanding and strengthening health requires a holistic understanding of individual, family and community health and as a result, we take a broad community development approach to health that includes environmental, economic, social, cultural, spiritual, and governance factors. The overarching objectives of our CHNA are:
1. Understand and document health status and health and wellness patterns 2. Profile community strengths and assets that can help improve community health 3. Undertake an initial assessment of health system and health-related programs 4. Prioritize and document community health needs in user friendly ways
4 5 Executive Summary community-driven process isbasedonfivepillarsandtenprinciples: From thestart,ourcommunitywascommittedtousingaholisticandparticipatoryapproach toourCHNA.Our Process Highlights There were three overarching phasestoourCHNAprocess: community membershaveparticipated. Elders, Youth, womenandgirls,health staff. Intotal,574 activities, andworkingdirectly withspecificgroups, suchas a diversityofopportunitiesforin-personparticipation,group in whichtoengageandcommunicatewithmembers,including We alsorecognized thatweneededtouseadiversityoftools • Assessinformationneededandplanforcollection • Finalizeworkplan • Organize localplanners,meetandorganize Working Group • ChiefandCouncilEldersapproval andwelcome • Project launch Phase 1:BuildingtheRelationship • Document and share results -Final Report • Needsprioritization • Summary reports • Datagatheringandanalysis • Communityengagement eventsandsummaryreports (Openhouses,interviews,focusgroups) Phase 3:AssessingCommunity Needs 5. 4. 3. 2. 1. Integrative Culturally-relevant Community-based Strength-based Capacity-driven Pillars 5. 4. 3. 2. 1. Diverse,inclusiveparticipation Makeplanningfun Honourlocalknowledge Strong relationships Youth &Elderinvolvement Principles • Engagement&communicationsstrategy • Research reports completed • Background research • Communityengagementsurvey • Welcome feastandopenhouse Phase 2:GettingReadytoPlan 10. 9. 8. 7. 6. Communicate&share Respectlocalculture Communitydevelopment Allthingsare connected Ceremony &celebration Community Health Needs The main findings of our Health Needs Assessment are organized into seven overarching categories: physical health, mental health, safety, community and health governance, social and cultural health, infrastructure, and livelihoods. This process has identified 23 main community health needs and 117 sub-needs (3-6 sub-needs per main need). Each category contains several main health needs, each of which is summarized in this report, including details on the need, community perspectives, specific sub-needs, community strengths and resources that can help us address the needs, and an illustration of connections to other health issues and needs. Executive Summary Using a prioritization framework that examined the popularity, urgency and strategic advantage of each of our needs, we have determined an initial listing of needs by priority rank and assigned each need one of three priority levels: critical, high priority or supporting. This analysis is continuing through community discussions and exercises as part of our CCHP process. At this stage, we have identified the following summary health needs and priority categories:
Priority Category Needs (# of sub-needs in parentheses)
The most Mental Health & Addictions Care (5) Safe Water Supply (6) Critical critical needs Diverse Education & Training (5) Food & Nutrition (4) to address Quality Housing & Utilities (6) Supports for Children & Youth (5) Access to Culture* (6) Very Support for Parents & Families (5) Reduction & Prevention of Addictions (4) important High Suicide Prevention (6) Opportunities to Support Ourselves (4) Priority needs to address Community Supports (6) Comprehensive Health Care (6) Peacekeeping & Safe Places (5) Counselling & Social Supports (6) Accessible Health Services (5) Crucial to supporting Prevention of Violence & Harm (5) Promotion & Prevention (4) Supporting efforts to Coordination of Health Services* (5) Strong Health Governance* (5) address other Transportation & Connectivity (6) Clean Community (4) health needs Community Engagement* (4)
All of these main needs are detailed in this report, including explanation of each main need’s specific sub-needs as identified through our community planning process.
* Indicates a Need that are considered to be ‘cross-cutting’ and should be considered when addressing any of our other health needs. 6 Table of Contents Acknowledgements ...... 1 Part 1 Executive Summary ...... 4 Part 2 Introduction ...... 8 Part 3 Methodology ...... 20 Part 4 Community Profile ...... 38 Part 5 Health System Profile ...... 46 Part 6 Community Health Issues Analysis ...... 51 Part 7 Community Health Needs Assessment ...... 61 Part 8 Conclusion ...... 116 Figures #1 Community definitions health ... 13 #13 Pikangikum’s Community Strengths ... 44 #2 Actors & Interactions in Our CHNA ... 15 #14 Pikangikum’s Health Service Providers ... 46 #3 CHNA Framework of Knowledge Gathering ... 16 #15 Roles of Health Service Providers ... 47 #4 Our CHNA Pillars & Principles ... 21 #16 Continuum of Health ... 48 #5 Our CHNA Phases ... 22 #17 Utilization Data - Reason for Seeking Health Care Service ... 50 #6 Scales of Engagement ... 24 #18 Utilization Data - Source of Health Care Service ... 50 #7 Participation & Engagement Tools & Techniques ... 26 #19 Community Health Needs and Sub-Needs ... 62 #8 CHNA Engagement Activities ... 27 #20 Comparative diabetes rates for adults over 20 years old ... 71 #9 Community Health Needs Framework ... 32 #21 Suicides & suicide attempts in Pikangikum 2001-2012 ... 79 #10 Evolving Categorization of Health Needs ... 35 #22 Mental Health cases per month, 2009-2012 ... 83 #11 Map of Ontario and Pikangikum ... 38 #23 Violent crime incidents in Pikangikum 2001-2012 ... 87 #12 Pikangikum’s projected population growth ... 39 #24 Average people per dwelling (comparison) ... 90
Tables #1 Our CHNA Objectives ... 17 #7 Health programs in Pikangikum, by type ... 48 #2 Product Deliverables ... 28 #8 Support Options for Our Members’ Health ... 49 #3 Quantitative Data Sources ... 29 #9 Pikangikum’s Community Health Status Indicators ... 55 #4 Qualitative Data Sources ... 30 #10 Pikangikum’s Community Health Issues Summary ... 58 #5 Prioritization Criteria and Descriptions ... 36 #11 Community Health Needs and Sub-Needs ... 63 #6 Pikangikum’s Community Strengths - Details ... 45 #12 Community Health Needs by Priority Category ... 65 For list of Appendices, please see the last page of this report and the accompanying 7 Pikangikum CHNA Appendices Binder. Introduction 8 in the Sioux Lookout in the Sioux Lookout * that successfully mobilized ** (Community session 3) become stronger and we are One.” and we are become stronger “Pikangikum – Let’s work together, we will work together, “Pikangikum – Let’s
Whitefeather Forest Initiative. (June 2006). “Keeping the Land: A Land Use Strategy”, Pikangikum First Nation and Ontario Ministry of Natural Resources. Initiative. (June 2006). “Keeping the Land: Whitefeather Forest AANDC Pikangikum Community Profile: Registered Population (September, 2013) Population (September, Registered AANDC Pikangikum Community Profile: ** * We begin with an introduction, first providing an overview of First Nations health in Canada and defining health in Canada and defining an overview of First Nations first providing begin with an introduction, We We for our community. the purpose of doing one explaining what is a CHNA and Secondly, community health. we Finally, outcomes for this process. as our objectives and desired as well the context to this project then provide we can use this report. includes and how outline what this report District of Northwestern Ontario. Our Pikangikum Health Authority is leading a process of coming together to a process Health Authority is leading Ontario. Our Pikangikum District of Northwestern needs and planning for a stronger and assessing our health health by identifying our community’s strengthen in its journey of health. tool to assist our community is one This CHNA process future. Our CHNA is one part of a unique story of our community coming Our CHNA is one part of a unique health. Building on an our community’s together to strengthen winning land use strategy process award Context
Aanii, Boozhoo, Welcome to Pikangikum First Nation’s (PFN) Community Health Needs Assessment (CHNA) report. Needs Assessment (CHNA) (PFN) Community Health to Pikangikum First Nation’s Welcome Aanii, Boozhoo, 2,600 members community of approximately an Anishinaabe, Ojibway-speaking are We Welcome community members and built community consensus, PFN is community members and built facilitating its community health through improving proactively complete a CHNA and to a holistic and participatory approach (CCHP). Community Health Plan Comprehensive 9 Introduction + **** *** ** * teachings andaplanto carry ways, ourculturalvalues, ourElders the Land,articulatesourcustomary future. Ourlanduseplan,Keeping taking aleadonplanningforour This wasanimportantstepinPFN resource stewardship initiative. community economicrenewal and Whitefeather Forest Initiative,a leaders amandatetodevelopthe In 1996,ourEldersgave payments. programs, andsocialassistance health services,childwelfare residential schools,western-style directly inourcommunitythrough government intervenedmore the 1950sand1960s,federal since timeimmemorial.Startingin hunting, fishing,andgatheringfood land andpracticedtraditionsof Our peoplehavelivedoff this community-based planningcapacity. recent initiativestodeveloplocal community development,including local governanceoverhealthand builds onalonghistoryofreclaiming Pikangikum’s healthplanningjourney Our HealthPlanningJourney PFN.(2012). Request forProposals forANeeds Assessment and Comprehensive Community Health Planto Support aCommunity Development Strategy. SeePikangikum HealthHisotryreport for details,Appendix7 Toronto Sun. (Sept.16,2011).www.torontosun.com/2011/09/16/remote-reserve-plagued-by-epidemic-of-youth-suicides Office oftheChief Coroner forOntario.(2011). DeathReview ofthe Youth Suicidesatthe PikangikumFirst Nation, 2006-2008. Maclean’s. (Mar. 30,2012) www2.macleans.ca/2012/03/30/canada-home-to-the-suicide-capital-of-the-world * decade committed suicideinthepast reported that60teenagershave has beenstrugglingwith.Itwas Youth suicidethatourcommunity attention onthehighlevelof triggered awaveofnegativemedia a seriesoftragediesinPikangikum our future, between2006and2012 significant stridesinplanningfor While wehavebeenmaking responsibilities. forward ourancestralstewardship community health.PFN’s leaders Pikangikum’s individual,family, and challenges thatwere undermining attention totheneeds and on thenegatives,theydiddraw While theseinvestigationsfocused development. and obstaclestoeconomic gaps inhealthcare andeducation, addictions, inadequatehousing, of thecommunity’s challenges with reported onthenegativeimpacts the ChiefCoroner ofOntario,which The situationtriggered aninquestby “the suicidecapitaloftheworld.” ** and thatPikangikumwas **** *** and developmentofimportant created interruptionsofdelivery with unpredictable fundinghave and resource challengescombined members. However, localcapacity to improve thehealthofour through anumberofinitiatives been contributingtotheeffort PHA staff andmanyothershave mental healthworkers,PFNand Community nurses,teachers,local and addictionscounselling. and supportsforsuicideprevention acute andchronic healthcare needs, childhood development,servicesfor for maternalhealthandearly challenges, includingprogramming tirelessly toaddress community and communitystaff haveworked Introduction 10 philosophy informed and guided guided and informed philosophy Specifically, process. our CHNA Elders and community by having and by lead the way, experts to build opportunities providing and community involvement planning the consensus throughout process. a historical After negotiating agreement tripartite funding Canada (HC), between Health and Northern Aboriginal Affairs Development Canada (AANDC), of Ontario (PO), and the Province with the PHA launched the process a call for planning support. PHA Beringia Community Planning hired Inc. in collaboration with Hanson two and Associates to facilitate the planning processes. extensive team brought Beringia’s experience in rural northern communities, familiarity with the policy context of First Nations health, and specializations in Indigenous planning, community capacity building, and participatory that hands on planning and learning embraces celebration and ceremony. + The SHEE (Social, The SHEE (Social, + In response to these needs, and needs, and to these In response with on past success building planning, community-based for the a mandate PFN provided Authority Pikangikum Health to a process (PHA) to carry out Health complete a Community (CHNA) and a Needs Assessment Health Community Comprehensive Plan (CCHP). Health, Education, and Elders) Health, Education, and Elders) Committee was established with community from representation and leadership, agencies/partners, both the federal and provincial and governments to help oversee guide the CHNA, including working the with a local committee called Group. Pikangikum Working The PHA initiated a CHNA process in the Chief as recommended Report. The PHA wanted Coroner’s to build on the groundbreaking success of the Whitefeather Initiative (WFI) community Forest Given the engagement process. of the WFI, success and strength its community driven engagement model and culturally integrated social, health, education, and Elder Elder and education, health, social, programming. 11 Introduction **** *** ** * § +++ North SouthPartnership forChildren. (2008).Mamow Sha-way-gi-kay-win ++ Medicine Creek Solutions.(2010). CommunityHealth AssetMap.Pikangikum Health Authority. + Office oftheChiefCoroner forOntario.(2011).DeathReviewof the Youth SuicidesatthePikangikum FirstNation,2006-2008.
HealthCanada,FirstNationsand InuitHealthhttp://www.hc-sc.gc.ca/fniah-spnia/index-eng.php
non-First Nationscommunity health.ThisCHNAisapartofourcommunity’s worktodojust that. These situationshighlight thathard workisrequired to lessenandremove thegap betweenFirstNationsand • house. • • • • There are significantgapsinoverallhealthstatusofFirstNationcommunitiescompared totheCanadianpopulation. First NationsHealth
inequalities inhealth,education,employment,andincome.Here are highlights A 2008-2010FirstNationsNationalHealthSurveyrevealed thatpeopleinFirstNationscommunitiesfaceserious • • • NWLHIN(2010)Aboriginal HealthPrograms andServicesAnalysisStrategyFinal Report HealthCanadaCommunity BasedReporting,Pikangikum 2009-2010 Pikangikum First Nation. (2011).Capital Planning Study. First NationsInformation GovernanceCentre. (2012).FirstNationsRegionalHealth Survey2008/10:Nationalreport onadults,youthandchildren livinginFirstNationscommunities. Ottawa:FNIGC. 2040 tomeetfuture demand. In Pikangikum,over540householdsare onsocialassistance,livingoff about$10,000/year. for drinkingyearround. Over90%ofhomesinPikangikumare notconnectedtowaterandsewage systems. Safe watersupply:More thanone-third (35.8%)ofFirstNationadultsdonotthinktheirmainwatersupplyissafe while intheCanadianpopulationthisisonly 7%ofadults.InPikangikum,onaverage,almostfivepeopleshare a Housing: Approximately one-quarterofFirstNationsadultsliveinover-crowded housing(23.4%), than ahighschooleducationcompared to23.8%ofadultsinCanadagenerally. Education: More thanone-third (39.9%)ofFirstNationsadults(18yearsandup)report havingless Poverty: Approximately 58%ofFirstNationsadultsreported anannualincomeofless food-insecure. Inourregion, highcostoffoodseriouslyimpactshealth. Food security:More thanhalf(54.2%)ofFirstNationshouseholdswere moderatelytoseverely Ontario curriculumistaughtbutourcurrent age/gradegapisabout3 years. three ofpeopleolderthan20wasaffected bydiabetes(33%). than thatintheCanadianadultpopulation(20.7%vs.6.2%).In2010Pikangikum,one Diabetes: Prevalence ofdiabetesamongFirstNationsadultsover25wassignificantlyhigher identified byFirstNationspeoplelivingon reserves isalcoholanddrugabuse. Addictions andmentalhealth:Thetopconcernchallengeforcommunitywellness Overall health:Only44.1%ofFirstNationsadultsreported theirhealthasthriving,compared to60%ofCanadians. +++ We mustbuildorrepair 200housestoaddress overcrowding, andneedalmost400 newhousesbefore § household incomecontinue,andtheymustbeaddressed.” “inequalities ineducation,employment,andpersonal *** **** *** ** andcomparisonstoPikangikum: ** In Pikangikum,the than $20,000. +
§ ** *
Introduction 12 (Community session 2) (Community steps in getting there.” getting there.” steps in “Having a goal in life and taking and taking a goal in life “Having We also invited community members to submit ideas for also invited community members We and individual, family, our logo (opposite) to symbolize community health and healing. The winning entry was by Duran Suggashie and emphasizes connection between and our community strength, people, working together, this logo on our have shared with the land. We relationship newsletters, and on t-shirts for community members. reports, Collectively, community members define community health community Collectively, spiritual and emotional as a balance of physical, mental, and the community as a health for individuals, families, in community life, doing fun whole. It involves participating eating well and being sobriety, activities, learning together, support, trust the safety, active. Community health requires loving, peaceful, proud to be strong, required and respect and happy. presents community perspectives on health in a four on health in a four community perspectives 1 presents Figure physical, four parts represent levels. The with three part circle health, for emotional, and cultural & spiritual mental, social & members discussed: the four parts of the self that community levels of the circle and spirit. The three mind, heart, body, and community health. Community for individual, family, are the reflects section that best placed in the circle ideas are placement of the original responses. Defining ‘Community Health’ ‘Community Defining is made health, family and individual health, like Community between different interactions complex web of up of a CHNA was asking piece for our A foundational factors. what we to the community to inform what ‘health’ means their ideas at members shared assessing. Community were informed the engagement sessions which various community 1. diagram in Figure of the summary creation 13 Introduction What DoesHealth Emotional Cultural & Mean For You? Mean Spiritual Spiritual Social & Social Health Health Pow wow together Working whole Volunteers as a Unity activities Cultural another for one Being with Being Love Love friends Games Hanging out Sports Community gatherings Religion Vacations Church Respect more positive Not staying home, Socializing traditions in bed, isolated Attitude is Sharing Sharing energetic Going toGoing Trust Participating Excited, church Visits in things Love Balance Spiritual guidanceSpiritual Smiling, laughing School families Strong Learning Supporting Supporting loved ones Traditional culture Proud beliefs community Values Not lonely, Being a Being person good sad, shy Clean Health Sleeping Not drinking Someone toSomeone in eyes the land See it See outside needles, gas, Out on Out well healthy food No alcohol, Being Being Eating well, Taking care talk to Being in Being of people school drugs outings Family Strong Safe house Live free! eyesight food for all Good Good part healthcircle summary individual, family, andcommunityhealthinfour Figure 1:Pikangikumcommunitydefinitionsof Stress-free Learning No violence, better More, Elders from Privacy Sports exercise active, abuse Being Being Baseball Traditional No bullying Talking food things about cookies Mom’s Being Being open Act nicelyAct Safety Not scared housing Better, new Helping, people A better place to Legend Physical help Mental Mental Health out Health live Community Family & Friends Individual Introduction 14 together” There are many are There Our approach for this Our approach ** ** grandchildren” grandchildren” look forward to” look forward (Community session 1) “To be more kind to my be more “To “It gives hope, something to “It gives hope, something “See the community working “See the community working Health Needs Assessments became popular regional and popular regional became Assessments Health Needs 1980s tools in the health planning local-level and health by communities now used and are world. the around organizations approaches to CHNAs, from technical assessments technical from to CHNAs, approaches to participatory bottom-up by health professionals, CHNAs use a variety Typically, processes. community-led including data (e.g. sources, of information health indicators, socio-economic demographics, and health service utilization data) information, and input. some form of community CHNA is a community development approach, described described development approach, CHNA is a community in the next section. A CHNA is the foundation for a plan of action in a foundation for a plan of action A CHNA is the care and support, and more safety and involvement in the community. safety and involvement and support, and more care and goals. hope, ‘a brighter future,’ ‘a sense of belonging.’ and give members plan for the future, organized, housing. solvent abuse, and has good * Inspire a positive and better future to make ‘a better life in the future,’ better life in the future,’ to make ‘a a positive and better future Inspire be better to help one another, Help us work together as a community of alcohol and in a community that is free Assist people to be healthier having better access to things people being employed, Support better livelihoods and connection through community activities. need, and participating in more Make a difference for Youth so they can have better education, better so for Youth Make a difference Martin, Debbie H., Valcour, James E., Bull, Julie R., Graham, John R., Paul, Melita, and Wall, Darlene. 2012. NunatuKavut Community Health Needs Assessment: A Community-Based Research Project. Community Health Needs Assessment: A Community-Based Research Darlene. 2012. NunatuKavut James E., Bull, Julie R., Graham, John R., Paul, Melita, and Wall, Martin, Debbie H., Valcour, • • • • • Adapted from Manitoba Health, Community Health Needs Assessment Guidelines Manitoba Health, Community Health Needs Adapted from A Community Health Needs Assessment (CHNA) is a (CHNA) is Assessment Health Needs A Community issues strengths, to identify health process dynamic establishment enable the of a community, and needs action facilitate collaborative priorities, and of health health status and quality community planning to improve of life. What is a CHNA and Why Do It? Why and a CHNA is What The Needs Assessment process looks at conditions and looks at conditions and process The Needs Assessment family scales: community, at three of health circumstances challenges Analysis considers strengths, and individual. identify at various scales and may and opportunities priorities for planning and action. comprehensive community health plan. (See our CHNA health plan. (See our CHNA community comprehensive on CHNA terminology.) 1 for more glossary in Appendix When we asked Pikangikum community members in July 2012 what they thought was important in defining community members in July 2012 what they thought was important When we asked Pikangikum community do for their ideas about what it would health vision, 99 members shared a long-term health needs and creating were: responses Pikangikum. Major themes in ** * 15 Introduction NPStrategyWhatisaHealthSystemApril242007.pdf ** * World Bank. (2007).HealthyDevelopment: World bank Strategy forHMPResults. AnnexL.siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1154048816360/AnnexLH Saskatchewan Population Health& Evaluation Research Unit. (2006). FirstNations Health Development: Tools for Program Planning &Evaluation. University ofRegina andUniversity ofSaskatchewan. community individualsandorganizations inaparticipatory anditerativeprocess. than relying on acommitteeofhealth experts,acommunity developmentapproach focusesonmobilizing key approach tohealththatincludesenvironmental, economic,social,cultural, andgovernancefactors.Rather understanding ofindividual, familyandcommunityhealthasa result, wetakeabroad communitydevelopment strengths andneeds.Aswell,ourCHNAemphasizes thatunderstandingandstrengthening healthrequires aholistic We also placedacentralimportanceonthevoices ofEldersandYouth inguidingtheprocess andidentifyinghealth making, healthservicedelivery, program design,managementand financing. services asanextensive,interconnected systemmadeupofmanyplayersinavarietyroles includingpolicy do notfocussolelyontreatment; weincludethewholecontinuumofhealth(seepg.46).We alsoconsiderhealth In ourCHNA,wetakeaholisticapproach tohealththatconsidersbothdeterminantsandoutcomesofhealth.We A UniqueApproach and oversightbylocalleadershipateamofplanners,visualizedinFigure 2below: empowerment asapathtohealing.Thisprocess wasinitiatedanddrivenbythecommunity, includingtheguidance from standard healthneedsassessmentsandstudiesbecauseofitsemphasisoncapacitybuilding,inclusion providing theirideas,suggestions,andfeedback. to thisprocess –receiving informationfrom theplannersand Community: Allthemembersofourcommunityare connected to guideitandtheSHEECommittee. have supportedthedevelopmentofthisprocess andcontinue Leadership &Management:ChiefCouncil,Elders,andstaff advises ourplanningprocess. Pikangikum HealthAuthority(PHA):ThePHAassistsand and federalgovernments. SHEE includesrepresentatives from PFNandtheprovincial dedicated toassistingandoverseeingthisplanningprocess. Committee isthePikangikumWorking Group, whichis SHEE: Partofthe‘SocialHousingEducationandElders’ SHEE, thePHA,leadership,andcommunity. helps toguideandsupporttheprocess. Theplannersreport to design andfacilitateourplanningprocess. TheWorking Group Planning workswithourteamoflocalcommunityplannersto Planners &PikangikumWorking Group: BeringiaCommunity Figure 2:Actors&Interactions inOurCHNA * Our approach toCHNAisdifferent ** Diagram Legend
who who Ahneesheenahbay Kahnahwayndahn Kahnahwayndahn arted this Initiative. weland; are keeping the Ahneesheenahbek . Elder Ellen Peters (in translation) translation) (in Peters Ellen Elder ngs of our ancestors. It ancestors. It of our ngs e and e the will land, our support Cheekahnahwaydahmahnk Cheekahnahwaydahmahnk the Whitefeather Forest and Adjacent Areas Oliver Hill, Liaison (in translation) Elder for the for the Forest Whitefeather Planning 16 , who created the lands, the water, the the the water, lands, the created who , the created also . The overall design symbolises and design symbolises . The overall First Nations Protected Areas Workshop, Winnipeg, September 28, 2005 28, Winnipeg,September Workshop, Areas Protected Nations First the land. This is why land. the eep the land, why we st m (give content to) and be guided by our overall overall our by guided be and to) content (give m Introduction ). hood, the way we have lived on the land. The land land The land. the on lived have we way the hood, will not occur in the management of the Whitefeather the Whitefeather of in the management occur not will left on the image the produced has Nation First Pikangikum for our vision to express Keetahkeemeenahn teachi ancient the of speaks Creator, for our deep respect our expresses Keeshaymahneetoo that everything every flying creature and different creatures, exists. Keeshaymahneetoo of way a sustainable to maintain lands these on were placed ( to Keep the Land the land, life from Keetahkeem of these three aspects of our vision for vision for our of aspects of these three to the land.Eldersthe to Our It back land. us the to before have gone all every tree was created differently, so beautiful. Each one was created ionship between Pikangikum peopl between Pikangikum ionship Cheekahnahwaydahmahnk Keetahkeemeenahn contribute to our protection approach our contribute to Landscape Community is a continuous process. That the land.” is why we are keeping people. The Elders havepeople. The Elders spoken; everything to understand. is there for us We have lived land on this for generations. we will return When we are finished to daysthese of one we goingare back helped ushelped to onevery remember be I active… day werewe firewood cutting lookingwas I the and at trees. I just looked at those trees; taught k to were we why is This way. ownunique its in ontohold Let’s these the from gifts Creator. have We been richly blessed; especially the land where everything that we have been blessed with is found.” “This is a people’s plan to preserve the land. life, for the survival of It is the way of the land“Keeping a gift, our means to receive liveli livelihood goals, and will All activities, whether customary All or whether activities, new, will both infor customary Separation Land. the Keeping for vision Cheekahnahwaydahmahnk Keetahkeemeenahn will activities All integrated. and holistic be will management and planning Area; Forest Planning relat the contribute to supporting our vision for Area. This is Page 6 Keeping the Land: A Land Use Strategy for
Health Health Mental Physical Physical Individual & Friends Family
MEN WOMEN Figure 3: CHNA Framework of Knowledge Gathering 3: CHNA Framework Figure
ELDERS YOUTH Health Health Social & Spiritual Cultural & Cultural Emotional to Strength Need share share in our health plan. uses the The diagram illustrates four levels of health with coloured rings, starting with the individual (dark blue), (dark blue), the individual starting with rings, health with coloured four levels of 3 illustrates Figure of the energy Creative green). landscape (dark and (light green), blue), community family (light yellow ring. surrounding middle and the in the the yellow circle by is represented or God Creator point to four Four lines men, women, Elders, and Youth. four pillars of our community: the represent The four feathers and cultural & spiritual. mental, social & emotional, of health: physical, areas Much like with the Whitefeather Forest Initiative, our CHNA process draws from a traditional traditional a from draws process CHNA our Initiative, Forest Whitefeather the with like Much the process, guide Elders to God, or of the Creator energy creative the that values philosophy unity. and strength people’s the Pikangikum on and a focus land, past and the respects berries image of gathering our CHNA to explain how of our gathers knowledge and Needs. health Strengths by berries, Represented and our health Strengths Needs exist at all four levels of health and in different of health. Strengths areas different and Needs are people for different CHNA Our community. gathers information process about all these Strengths and Needs so we can and identify what things in our address 17 Introduction Outcomes Table 1:OurCHNAObjectives CHNA informedthedesignofourprocess. Table 1belowsummarizesourobjectives: The overallobjectives(whatweare doing)andthemeansobjectives(howweare doingit)fortheoutputsofour Objectives ofOurCHNAProcess reclaiming ourculture and community voiceare essential themes inour documentation and sharing ofresults. and engaging individualsandgroups todirectly influence,and participateinthecommunity-based process. As well, and techniques. Thisoutcomeis reflected inourapproach and desire inemphasizingthe inclusionoflocalplanners that includedthetraining anduseofdozensinformationgathering, communicationanddecisionmakingtools Another outcomeofthis process isstrengthening andcelebratinglocalplanning capacitythrough ‘learningbydoing’ and voicesofcommunity membersandreflects whathealthmeanstothecommunity. strengths, issuesandasetofprioritizedcommunity healthneeds.Thisoutcomeisrooted intheprocess, perspectives The primarypurposeofthisprocess isawell-researched andanalyzedsynthesisofPikangikum’s major health Objectives ways health needsinuserfriendly 4. Documentcommunity (ongoing) programs andservices system andhealth-related assessment ofcurrent health 3. Undertakeaninitial community health help Pikangikumimprove strengths andassetsthatcan 2. Profile community wellness patterns health statusand 1. Understandanddocument How? (MeansObjectives) • • • • • • andrelated programs andservices(e.g.awareness, accessibility, satisfaction) • health-related programs andservicesthroughout thecontinuumofcare • • • • holisticsocial,cultural,environmental indicators • • • Report onhowNeedsemerged from informationcollectedthrough process Produce aninitialprioritizationofNeeds(High,Medium,Low) Produce manageable,conciselistofNeedsbygrouping informationbytheme Validate listofCommunityHealth Needswithcommunitymembers Capture fullrangeofcommunityvoicesandperspectivesinfinalCHNA report Engage thecommunitytoidentifyissuesandneeds Collect andsummarizecommunityperspectivesutilizationofcurrent health Collect andsummarizeinformationutilizationdataforcurrent healthand Collect andsummarizecommunityperspectivesonPikangikum’s assets Collect andsummarizedataonassets Document communityperspectivesoncurrent healthandwellnesspatterns Develop indicatorstomeasure healthstatusincludingdeterminantsand Collect, analyzeandsummarizebaselinedatafrom existingsources Review existingrelevant healthandcommunityplanningdocumentation “How wecanmakePikangikumabetterplace– for existingpeopleandfuture people?” (Chief andCouncil,May2012) Introduction 18 Evaluation tool Health and government agencies Other First Nations looking CHNA for culturally-appropriate and models approaches Use as a baseline with which Use as a baseline progress to measure for Use frameworks assessments and future evaluations program • • º º º º Communications tool Communications Health Staff Pikangikum Chief & Council Funders community Increases our health needs understanding funding for program Reference and for annual plans Reference º º º • • • º º proposals º reporting Decision making tool Decision making Identifies top priorities when Identifies top about funding, making decisions and programming policy, next phase of Helps inform the health planning Members of the planning team Members of the planning team and local working group Pikangikum Health Authority Community members º º º º • • • Different readers will use this report differently. We provide a short guide for different ways to use this report and its this report ways to use a short guide for different provide We differently. will use this report readers Different include: in Appendix 2. Some of the readers results How to Use this CHNA this Use to How we Therefore, system improvements. community health effective strategic and for planning is a foundation A CHNA next phase guide for the to be a tool and but also CHNA process of our findings share not only to this report designed ways: in the following can help us Our CHNA process. planning of our community 19 Introduction Organization ofReport summaries of data,andthefullversions ofallreports, newsletters, andtoolsgenerated duringthisCHNA process. The accompanying Appendicesbinder containsadditional detailsaboutour process andspecificmethodologies, Our report endswithareflection onourprocess and next stepsforournewphaseofhealthplanning. Needs. perspectives, specific sub-needs related tothe need,andimportantconnectionstoother Health Each mainHealthNeedissummarizedintwo pagesthatincludedetailsontheneed,community that weidentifiedandprioritizedinthecategories of‘Critical’,‘HighPriority’,and‘Supporting.’ health, andcommunityhealthgovernance. EachcategorycontainsseveralmainHealthNeeds categories: physicalhealth,mentalsafety, infrastructure, livelihoods,socialandcultural The mainfindingsofourHealthNeedsAssessment are organized intosevenoverarching collection. Examiningtheseissueshelpsusunderstand ourcommunityhealthneeds. our analysisofcommunity, family, and individualhealthissuesidentifiedduringdata available forourmembers.TheHealthIssuesAnalysissectionpresents asummaryof the communityofPikangikum,andcurrent healthservicesandprograms Profile sectionspresent background andcontextualinformationaboutourprocess, The Approach &Methodology, CommunityProfile &Strengths, andHealthSystem This report isorganized intoeightmainsections: 8) Conclusion. 7) CommunityHealthNeeds;and 6) HealthIssuesAnalysis; 5) HealthSystemProfile; 4) CommunityProfile &Strengths; 3) Approach &Methodology; 2) Introduction 1) ExecutiveSummary Methodology 20
to maximize community participation, designed are Community-based: Planning activities and tools voice. empowerment, and community control, tools, local health planning capacity through Capacity-driven: As much as possible, we build learning-by-doing and relationships. and assets and acknowledge start with a focus on community strengths based: We Strength issues and gaps. activities and customs in all planning protocols our local culture, respect : We Culturally-relevant participation. translation support to maximize and provide development perspective which mobilizes community a holistic community from Integrative: Health is approached of health includes all parts of a health system including the full continuum and members in a participatory process cultural and governance aspects. economic, social, as well as environmental, care 1. 2. 3. 4. 5.
Principles illustrated - these are and guided our CHNA process principles informed our approach In addition to these pillars, ten community-based planning on PFN’s build 4 on the next page. These pillars and principles of our approach in Figure priorities of inclusion, consultation and Initiative and our community’s experience with the Whitefeather Forest mobilization of community members. The design of process and community engagement is the foundation for community-driven health planning. Our health planning. Our is the foundation for community-driven community engagement and The design of process five pillars: based on community-driven process emphasizes a approach Process Methodology Process In this section, we outline the methods we used to complete our process design, data collection and analysis. design, data to complete our process we outline the methods we used In this section, engagement, as well as specific community principles and process our overall approach include discussion of We strategies and steps. and analysis research communications, Methodology: Our Process Our Methodology: 21 Methodology Development Community Are Connected Respect Local CultureRespect Figure 4:OurCHNAPillars&Principles All Things Communicate &Share Integrative Ceremony &Celebration Culturally-relevant Capacity-driven Participatory Community Principles Planning Health Diverse, InclusiveParticipation Community-based Youth &ElderInvolvement Strength-based Strong Relationships Make Planning FunMake Honour Local Knowledge Methodology 22 Phase 3: CHNA - Assessing Needs Plan Part 3: Health Phase 4: CCHP - Getting Ready to Plan Phase 4: CCHP - Getting Ready Community Comprehensive Phase 2: CHNA - Getting Ready to Plan Phase 2: CHNA - Getting Ready Phase 5: CCHP - Where are we now? are Phase 5: CCHP - Where Needs Part 2: Health Health Community Assessment Planning Phase 1: Building the Relationship Community The other parts identified were a health needs assessment followed by a a health The other parts identified were * Part 1: Health Asset Map (Complete) Community Phase 6: CCHP - Where are we going? are Phase 6: CCHP - Where Phase 9: Community Celebration Phase 7: CCHP - Implementation Plan Phase 7: CCHP - Implementation PFN. (2012). Request for Proposals for A Needs Assessment and Comprehensive Community Health Plan to Support a Community Development Strategy. and Comprehensive for A Needs Assessment PFN. (2012). Request for Proposals Phase 8: CCHP - Monitoring Results Medicine Creek Solutions. (2010). Community Health Asset Map. Pikangikum Health Authority. Solutions. (2010). Community Health Asset Medicine Creek Figure 5: Our CHNA Phases 5: Figure ** * In 2010-2011, Pikangikum retained a consultant to undertake an asset mapping exercise as the first part of the as an asset mapping exercise a consultant to undertake retained In 2010-2011, Pikangikum Community Development Strategy. Our CHNA process began as a result of the recommendations from the 2011 report by the Chief Coroner’s Office of Office Coroner’s Chief by the report the 2011 from recommendations of the as a result began process CHNA Our building a did not focus on it recommendations, and valuable information had collected While the inquest Ontario. study and comprehensive health needs to oversee the the PHA Council authorized them. Chief and address plan to a to support was established Committee and Elders) Health, Education The SHEE (Social, health plan. community parts: of three Strategy comprised Development Community Project Background and Phases and Background Project comprehensive community health plan. Therefore, this present Community Health Needs Assessment is one piece of a present this Therefore, community health plan. comprehensive is the first 5. The Needs Assessment as illustrated in Figure Health Planning process, many phased Community larger, for the next six phases of health planning. and is a foundation phases of the process three 23 Methodology Strong health governance next phase ofplanning. implementation plan.Thiswillinvolve reflecting ontheprocess sofarand refining our engagementstrategy forthe our CCHPprocess whichwillleadto the developmentofa CommunityHealthvision, directions, strategies and Building onourworkin thesefirstthree phases ofCommunityHealthPlanning,ournextstep istoprepare for The firstthree phases,thosespecifictoourCHNA, are describedasfollows: nutrition Food & Comprehensive Phase 3:AssessingCommunityNeeds Phase 2:GettingReadytoPlan Phase 1:BuildingtheRelationship health care Governance Community & Health Promotion & Physical prevention Health engagement Community health services Accessible Access to Coordination culture of health services Mental health Mental & addictions & addictions & socialsupports care Counselling Cultural Social & Social Health Needs Community Mental Mental Health Community supports for children Supports Supports of addictions & prevention Supports for Supports & Youth Reduction Reduction & families parents prevention Suicide housing & Livelihoods utilities Quality Quality community Safety Clean = Sub-need Critical Critical Infrastructure education & training Diverse & connectivity Transportation Peacekeeping Prevention of & safe places Opportunities Opportunities Supporting Priority High violence & to support to support ourselves harm Safe water supply • Assessinformationneeded • Finalizeworkplan introduce toworkinggroup • Organize localplannersand approval andwelcome • ChiefandCouncilElders • Project launch • FinalReport • Documentandshare results • Needsprioritization • Summaryreports • Dataanalysis houses,interviews,focusgroups) andsummaryreports (Open • Communityengagementevents strategy • Engagement&communications • Research reports completed • Background research • Communityengagementsurvey • Welcome feast from pastcommunityengagement experience. seek guidanceontheprocess, protocol andgaininsight planning teammetwithChiefandCouncilEldersto sources withinthecommunity were identified.The information needed.Relevantdocumentsanddata definition ofhealth,wedeterminedthescope visits andproject launchmeetings. Usingaholistic Community Planning.We heldaseriesofcommunity was assembledandtrainedwithsupportfrom Beringia A localproject leaderandteamofcommunityplanners needs assessments.) described inAppendix3 asatoolforfuture community prioritization. (Phase3canbebroken downinto8steps, final summaryofcommunityhealthneedsandinitial community forfeedbackandranking.Thisreport isour information andpresented summariesbacktothe Elders, Teachers, Women, Staff). We analyzed this needs. We didinterviewsandfocusgroups (Youth, to collectideasoncommunitystrengths, issuesand We heldadiversityofcommunityengagementsessions community engagementandcommunicationsstrategy. on thesepreferences, theplanningteamfinalizeda engagement preferences through asurvey. Based was heldwhere wegathered informationoncommunity Report. ACommunityOpenHouseandwelcomefeast Trends AnalysisandaCommunity HealthSystems Community HealthStatusReport preparation ofaCommunity HealthHistoryReport, Background research wascompletedincludingthe Methodology 24
Online (Facebook) Meetings with agencies and funders
• Improved understanding of community issues and needs • Improved • Recognition of traditional knowledge Women, Staff) Women, (Elders, Teachers, Youth, Youth, (Elders, Teachers, Small Group Sessions Small Group Meetings Project Leadership Meetings Project Large Group Community Open House Sessions Community Group Large Working Group and Executive Director, and Executive Director, Group Working (Chief & Council, SHEE committee, PFN One-on-One Interviews and Elders, Project Leader, Community Planners) Leader, Elders, Project Figure 6: Scales of Engagement 6: Figure • Increased confidence • Increased • Healing through providing multiple opportunities not only to participate, but also to learn but also to learn not only to participate, multiple opportunities providing through skill base of membership • Increase with fun public events where participation was rewarded. participation was rewarded. events where with fun public celebrate community involvement • Recognize and from large-group open events to small, private groups and interviews to share and interviews to share private groups open events to small, large-group of participation from • Multiple scales 6). in Figure (illustrated sensitive information appropriately specialized or to create many opportunities for a wide range of community members to members to of community a wide range opportunities for many to create methods of engagement • Diversity participate. We started our community engagement efforts by asking our membership how they wanted to build a community a community build to they wanted how our membership asking by efforts engagement community our started We our from survey and guidance Based on this in July 2012. first open house survey at our a through based process were: for engagement our strategies and local planners, (Samson Keeper) Leader our Project Chief and Council, Elders, Vision Engagement Community for stay involved, allowing members to the process, to get involved throughout • Continuous ongoing opportunities or jump in even if it is their first time participating. scale up their involvement, about community planning and the health needs of our community by engaging with a wide variety of worksheets, with a wide variety of needs of our community by engaging planning and the health about community surveys and tools.
Outcomes of our community engagement strategy were: 25 Methodology during communitysessionsincluding: We alsorecognized thatweneededtouseadiversityoftoolsinwhichengagemembers.We usedamixoftools Community EngagementTools activities. members haveparticipated intheprocess. Figure 8illustratesourcalendar of an onlineFacebookgroup (228members).Intotal, 574different community sessions, 22smallgroup sessions,64oneon interviews,andthrough the planningteamhasengagedcommunity membersinthree large community started transitioningfrom theCHNAprocess totheCCHPprocess. Atthispoint, support ofChiefandCouncilcommunity Elders.InOctober2013we The planningprocess wasofficially launchedinJuly2012withtheformal Process Deliverables tools usedthroughout theneedsassessmentprocess. using toolssuchasFacebook,newslettersandradio.Figure 7provides anoverviewofthedifferent engagement list orrankinganswers.Throughout theprocess, weshared results withcommunitymembersandaskedforfeedback approached surveyquestionsfrom anumberofanglesincludingopen-endedquestions,choosinganswersfrom a The localplanningteamplayedanimportantrole insuggestingwhatquestionstoaskcommunitysurveys.We • • • • • • • • • Completing fourpartsofhealthcircle (mental,emotionalspiritual,physical) Adding toawheelofcommunitystrengths Adding tocommunityhistorytimeline Writing ideasonapostcard Sharing ideasonvideo Creating comicstrips Drawing Writing stories Open discussionandbrainstorms Methodology 26 Interviews Radio announcements and discussions Top Five Things Five Things Top Much and Too Not Enough ning health Defi using four parts of health circle Brainstorms on community health issues and needs
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#2 Aug 2012 July 2012 Methodology 28 Products CHNA Main Report 19) Issues Analysis Report (Appendix Review Report (Appendix 20) Program Appendices Binder Planners’ Binder 6) (Appendix Community Health System Profile 7) (Appendix Community Health History Profile (Appendix 8) Analysis Report Trends 5) Health Status Report (Appendix Report (Appendix 9) Community Participation Survey Reports (3) (Appendices 12, 16, 18) Staff (Appendix 13) Report Youth Elders Report (Appendix 14) (Appendix 17) Key Informant Interviews Report (July 2012) (Appendix 10) Community Session 1 Report (October 2012) (Appendix 11) Community Session 2 Report (June 2013) (Appendix 15) Community Session 3 Report Newsletters (6) (Appendix 21) Facebook page T-shirts Type Needs Assessment Capacity Building Tools Community Profiles Reports Research Public Engagement Reports Community Session Reports Communication Tools Communications Strategy Communications Table 2: Product Deliverables 2: Product Table A guide to what is in all of these reports and how to use them is found in Appendix 4. Find full versions of reports and 4. Find full versions of reports use them is found in Appendix and how to is in all of these reports A guide to what 21. newsletters in Appendix Throughout the process, the importance of communicating information and findings back to the community was the community back to and findings information communicating of importance the the process, Throughout brand our to help We had a logo contest and easy to access. visual, fun to make findings strategy was Our clear. updated We members. to community distributed were on t-shirts that was printed The winning logo health process. summaries radio announcements, reports, newsletters, regular through of our process on the progress members product all of the 2 summarizes Table spoken Anishinaabe. into written and all of these and translating at events, assessment process. as part of this health needs findings with the community so far to share deliverables produced 29 Methodology Table 3:QuantitativeDataSources Community Session3survey Ontario Works records PFN CapitalPlan Children, Assessmentreport North SouthPartnershipfor Authority Pikangikum Education Integration Network North West LocalHealth Health Canada AmDocs Police records of Ontarioreport Office oftheChiefCoroner PFN Chronic Care register PFN MentalHealthrecords PFN TikinaganClientregister PFN Probation visitsregister PFN Deathbook Nursing Stationrecords Pikangikum HealthAuthority AANDC and 4summarizeourinformationsources. some ofwhichwascollectedfrom existingsources andtherest wasoriginaldatacollectedforthisprocess. Tables 3 was anongoingprocess ofgatheringandanalyzing.ThisCHNAisbasedonquantitativedataqualitativedata, community healthneedsassessmentwastodecidewhatinformationweneededcollectandfrom where. This After buildingrelationships andthecommunitydecidingonapproach andprocess goals,thenextstepinour Research Methodology Source important needs. Health Needs rankings(High,Medium, Low)anddotvoting process toidentifymost Social assistanceandemployment assistancecaseload connected tothegrid, populationprojection, social assistancerates Number ofhouses,hosing shortfall,road conditions, waterandsewageservices,units Employment distribution,hosingdemand,number ofsolventabusers School enrollment, educationstaff distribution Regional lifeexpectancy, mortalityrates,diabetesself-reported healthstatus Population distribution,healthbudget,school attendance,diabetesrate Medevacs, Opiodprescription abuse crimeincidents,reportedViolent suicides,suicideattempts,mental healthpolicecalls Number ofsolventusers,crimerates,suicides,suicideattempts Numbers andnature ofchronic conditions Number ofmentalhealthvisitsandtheirnature Nature ofchildwelfare cases Nature ofprobation visits Causes ofdeath Patient visits,numberandnature ofdeaths,numberbirths Local healthstaff distribution,healthbudget Registered reserve population Quantitative Data Methodology 30 Qualitative Data Qualitative Community loves and strengths, community history strengths, loves and Community health needs satisfaction, vision, health health, health defining Youth, Role of issues needs and health of family, role knowledge, Elders and traditional Role of role of culture, defining health, and services, needs, gaps in programs Health issues and community strengths gaps in services for healthy strengths, needs and issues, community specific health Women parenting health role of culture, community history, health needs, health satisfaction, Defining health, service experiences role of culture and services, gaps in programs needs by gender/age, Health needs, specific strengths need prioritization, community Health vision, health Source Community Session 1 Community (3) sessions Youth (3) Elder sessions sessions (4) Staff (1) Circle Women’s 2 Community Session 3 Community Session Interviews Qualitative information was also collected through extensive review of background research and existing reports. and existing research of background extensive review collected through Qualitative information was also Note: We recognize the many gaps that exist in currently available community health data. currently the many gaps that exist in recognize Note: We unable 5) we discuss the information gaps that we were (Appendix In the Health Status report data, the experiences and gaps, particularly in quantitative were While there to address. sessions, small group group in large gathered perspectives of community members informed our analysis of community health needs. sessions, meetings and interviews, The quantitative and qualitative data available from existing sources and collected early in the existing sources data available from The quantitative and qualitative and about community health status, including strengths gave us a baseline of information process was to ask community members and this baseline, our process challenges. As we developed We collected new evolved. as the process their experiences how well this data reflected staff and and questionnaires, surveys group large of interviews, an iterative process data through this information, we took summaries back workshops. As we collected group small and large and participants to validate and expand upon the findings to community members and other accuracy. analysis to ensure Table 4: Qualitative Data Sources Data Qualitative 4: Table 31 Methodology constraints of theproject. while alsorespecting thegoalsand from communityinformationandinput, health needsandconcerns thatemerged tailor ourframeworkto thepatternsof within agenericmodel.We wantedto Pikangikum facesare notallgoingtofit that thechallengesandhealthneeds Toolkit (2006).However, werespected and theFirstNationsHealthDevelopment frameworks from ManitobaHealth(2009) We referred tohealthassessment health, likesocialconnectionsandculture. but alsobroader categoriesthatimpact indicators forphysicalandmentalhealth, We considerconventionalhealth our information. broad andholisticframeworktoorganize health andhealingmeansthatweneeda Our holisticapproach tounderstanding Our Framework inform ourassessmentofcommunityhealthneeds. project team.Inthissection,weexplainhowusedcommunityinformationto information collected,basedonthedataavailableandapproach ofthe Generally, healthneedsassessmentusea widevarietyofmethodstoanalyze Analysis Methodology them together. community healthemerges from allof and indirectly, andthatindividual are connectedinmanyways,directly all oftheselarge-group categories art becauseitservestoremind usthat circles andlinesinspired byAnishinaabe We represent thisframeworkwith energy illustrated inFigure 9onthenextpage. The finalversionofthisframeworkis findings inaclearandaccessibleway. categories toorganize ouranalysisand an overallframeworkoflarge group members, wegraduallydeveloped knowledge andinputfrom community data wecouldcollect,combinedwith Status report, Appendix5).Usingthe strive toinclude(discussedinHealth We developedaseriesofindicatorsto Methodology 32 Infrastructure Safety Livelihoods Health Mental Community Community Health Needs Social & Cultural Health Physical Physical & Health Community Community Governance Figure 9: Community Health Needs Framework Needs Health 9: Community Figure 33 Methodology
employment.
• • • • • • •
In ourframework: supports forparents. support goodhealth,suchassocialnetworks,culturalcontinuity, and members tolivehealthylives,suchaseducation, learning,skills,and coordination andmanagement. safe andfeelingsecure. Community &HealthGovernance Livelihoods Infrastructure Social andcultural Safety Mental Physical reduction ofmentalhealthissues. prevention supports(likehealthyfood). housing andwater. focusesonconcernsofviolenceandkeepingcommunitymembers healthincludestreatment andsupportaswellprevention and healthincludesmedicalandtreatment servicesaswell similarlyincludesthingsthatsupportandenablecommunity looksatbasicinfrastructure andenvironmental needs, aspects ofhealthincludearangethingsthat includesleadership,overallhealth like Methodology 34 *
** Current community efforts and programs to address to address and programs community efforts Current health needs health improve Opportunities to substantially being – what strategies are effectiveness Program working, and why used, which are • • •
* women) and perspectives of staff women) and perspectives of staff Major and recurring themes/concerns Major and recurring between general community Differences of specific groups perspectives and perspectives (Elders, Youth, members and health professionals and promote disease and injury, to prevent Key areas health and well-being www.naccho. (2000). Health Authorities.; National Association of County and City Health Officials. Health Canada. (2000). Community Health Needs Assessment: A Guide for First Nations and Inuit • • • Manitoba Health. (2009). Community Health Assessment Guidelines. As we collected information from various sources, we identified themes and labelled information under different different we identified themes and labelled information under sources, various As we collected information from the data, from a question we allowed themes to emerge from categories. When analyzing responses large-group we As the list of labels and categories grew, category it would fit with, if any. only then determining which large-group labels together. similar and closely-related grouped * ** Like with our framework, our identification and organization of health needs also grew and evolved during our and evolved during of health needs also grew and organization Like with our framework, our identification guided were We the assessment process. to analysis throughout but we did use a consistent approach process, Health Canada (2000) and recommendations from from clear findings and we drew by the need for practical and recommend Planning and Partnerships’ model, both of which for Action through the NACCHO (2000) ‘Mobilizing issues into a manageable number of categories. related consolidating overlapping and Identifying Health Needs Health Identifying 5) as well as data (discussed in Appendix on available existing quantitative Given limitations our assessment and community-driven, this CHNA be community-based our focus on having When our process. throughout the community collected from information from draws primarily we analyzed it for: working with this information, Our methods for identifying community health needs from the data and community data and community the from health needs community for identifying Our methods existing and present analyze We source. varied by data we collected knowledge Status in our Health sources and external other agencies from data collected quantitative and report in this Needs sections Issues and Health in the Health (summarized report we looked these quantitative data, in Appendix 5). When we analyzed included in full issues documented by different common health needs and over time, for health trends and the and genders, age groups of death and disease for different leading causes sources, used this information to services. We members using medical for community main reasons data. a baseline of quantitative and provide of community information, inform our analysis org/topics/infrastructure/mapp/framework/index.cfm This process of growth and grouping of health needs is visualized in Figure 10, which shows the lists of health needs that we identified at various periods during the assessment. Figure: Evolving Categorization of Health Needs Figure 10: Evolving Categorization of Health Needs
Number of Community Health Needs Identi ed Total Period 1: Early Engagement (Community session 1, Youth and Elder sessions) 26 Period 2: Expanded Engagement (Community session 2, Youth and Elder sessions, Sta sessions, 43 women’s circle, interviews)
Period 3: Internal analysis of themes (all reports, 137 notes, and engagement activities to date) Time Period 4: Veri cation, Prioritization, and Additions (Community session 3, Sta sessions, interviews) 76
Synthesis: Final needs listing and framework 23 based on ranking and review of all resources
(Subneeds) (117)
Social & Cultural Health Livelihoods Mental Health Community & Health Governance Infrastructure Physical Health Safety Infrastructure/Livelihoods
Period 4 of our analysis was a community health needs ranking survey in June 2013. This survey was designed to present and verify the draft 137 needs (organized into six categories) that we had identified so far and begin identifying priorities. We asked respondents to rank the priority and importance of all the health needs. Respondents chose whether a need was High, Medium, or Low priority and distributed 15 dots among the list of needs in each category to indicate which were the most important. We combined these quantitative data to determine the top ten needs from each of the six categories. Although our final list of health needs was shaped by the results from our community ranking exercise, these results were not conclusive. In Period 4 and the final Synthesis, additional needs were added to reflect the full results of our research and current knowledge of PFN’s community health needs (including from interviews, small group sessions with staff from the PHA, Band, and Ontario Works, and previous reports). Our final list of 23 main health needs and 117 sub-needsis described in this report. Each of the 23 main health needs also includes 3 to 6 sub-needs that detail specific aspects of each need. 35 Methodology 36 Description How high did the community rank this need in our community ranking exercise? community rank this need How high did the key informant interviews? was this need mentioned during How many times and surveys? sessions identify this need during staff did staff How consistently status review and health need identified in our literature is this How prominently report? How drastically is this need worsening? cause ability to lead a healthy life or need limit people’s what extent does this To loss of life? preventable other needs can be? before to be addressed Is this need something that needs need? this to address resources Do we have adequate human this need? How long will it take to address Criterion
Urgency Connections Key Informant Interviews Key Informant Voice Staff and Data Literature Severity Feasibility - capacity Feasibility - time Community Voice
Strategic Urgency Popularity Note that the unequal number of critera per category results in a greater emphasis on popularity; this differential on popularity; this differential emphasis in a greater Note that the unequal number of critera per category results of our and so emphasizes the results weighting is intentional as our CHNA is meant to be community-driven for the criteria in the urgency assessments required technical and intuitive information gathering, rather than the more and strategic categories. These criteria were based on a review of other health needs assessments and balancing the need to assess popular health needs assessments and balancing the need to assess of other based on a review These criteria were criteria assess how widely the need considerations in our prioritization. The four popularity and strategic voice, urgency, the need criteria assess how urgently The two urgency research. and community engagement is identified through strategic criteria assess ability to lead healthy lives. The three people’s it affects and how severely should be addressed much time it would considering how other needs, and how easily it could be addressed how connected the need is to criteria tell us how important the popularity criteria and the urgency Both and resources. take and our existing capacity need (for a particular considers the strategic advantage of starting to address the strategic criteria a need is to address; lower). scored missing capacity and are needs that take a long time to address the feasibility scores, Table 5: Prioritization Criteria and Descriptions Criteria 5: Prioritization Table Prioritization After condensing our list of community health needs, the final analysis was to assign a level of priority to the main main to the of priority a level assign was to analysis final the needs, health community list of our condensing After first. focused on and should be other needs addressing to priority or foundational top are help show which needs to and health needs our first in addressing to start highlight where to help ranking were preliminary of this The objectives 5): criteria (Table of prioritization categories by three influenced decision-making inform wise 37 Methodology to ourworkaddressing anyandallofourneeds. foundation foraddressing otherneeds.Someneedsare identifiedascrosscutting needsbecausetheyare foundational and are alsocrucialtoachievingourhealth.Supportingneedsare importantbecauseaddressing themwouldcreate a strategic advantageforaddressing itearly. Highpriorityneedsrankedinthetoptenofouroverallrankingexercise Critical needsare strongly identifiedincommunityengagement,score highonurgency andseverity, andhavea ranking exercise, eachneedisidentifiedaseitheracritical,highpriority orsupportingneed. all oftheneedsdescribedinthisreport canbeconsidered priorityneeds,tohelpdistinguishwhere needsfallafterthe The results ofourpreliminary prioritizationrankingare presented onpage65ofthisreport andAppendix26.Although individually scored. scale describedindetailAppendix25.Sub-needswere considered intheevaluationofeachmainneedbutwere not literature/data review. Foreachprioritization criteria(Table 5),eachneedwasgivenascore according toafivepoint different needsidentifiedbycommunitymembers.Next,we reviewed all results from ourstaff sessions,interviewsand The communityrankingsurveydoneinJune2013wasourstartingpointforassessingthe prioritylevelofallthe agencies, staff, andprograms makedecisionsonwhichneedstostartwith. different thanourcurrent list.Inaworldoflimitedresources, thepurposeofprioritizingneedsatthisstageistoassist including howwellactionswilladdress ourHealthPlan’s objectives.Thiswillresult inalistofpriorityactionsthatlooks phase ofplanning,wewillrankspecificactionsandstrategiestoaddress theseneedsconsideringothercriteria based onacareful considerationoftheprioritizationcriteria.Asourunderstandingcontinuestodeepeninnext strongly onotherneeds.Thispreliminary rankingrepresents ourcurrent understandingofourpriorityhealthneeds Given theinterconnected nature ofourmainhealthneeds,allcommunityneedsare importantanddepend
Community Profile 38
the Whitefeather Forest and Adjacent Areas Strategic direction for Forest Whitefeather the both The Whitefeather Forest, a portion of the ancestral land use area of land use ancestral of the a portion Forest, Whitefeather The Area (WFPA) includes the Whitefeather Forest and three Adjacent Adjacent three and Forest Whitefeather the includes (WFPA) Area Figure 11: Map of Ontario and Pikangikum traditional territory. and Pikangikum traditional territory. 11: Map of Ontario Figure PFN, 2006 Source: PART THREE: THE WHITEFEATHER THE THREE: PART FOREST PLANNING AREA NeeSeen:Wah-Bee-Mee-Gwan Noh-Pee-Mah-Kah-Mik Oh-Nah-Chee-Kay-Win Ah-Kee Page 20 Keeping the Land: A Land Use Strategy for The Whitefeather Forest Planning The Whitefeather hectares. million Areas, totalling 1.2 Pikangikum First Nation, is the core of the WFPA. WFPA. the of core the is Nation, First Pikangikum approach. a seamless in be implemented will and complementary be will Areas Adjacent the and map: overview following shown in the of the WFPA is location The ** Our people belong to the * **** The Pikangikum reserve is currently 1,808 is currently The Pikangikum reserve ***
AANDC. (2013). Community Profiles - Pikangikum. pse5-esd5.ainc-inac.gc.ca/FNP/Main/Search/FNReserves.aspx?BAND_NUMBER=208&lang=eng AANDC. (2013). Community Profiles Royal Ontario Museum. (2013). Ontario’s Species at Risk - Regions. www.rom.on.ca/ontario/risk.php Royal Ontario Museum. (2013). Ontario’s Nishnawbe Aski Nation Member Nations, www.nanbroadband.ca/article/about-nishnawbe-aski-nation-nan-6.asp Municipality of Sioux Lookout. (2009). www.siouxlookout.ca/community/profile/businessesorganizations hectares in area. hectares We are a member of the Nishnawbe Aski Nation, a a member of the Nishnawbe Aski Nation, are We 49 First representing political territorial organization Nation communities within Northern Ontario. Overview community PFN is an Anishinaabe, Ojibway-speaking is one of 29 2,600 members and of approximately Lookout District of First Nations located in the Sioux Northwestern Ontario.
Our community profile summarizes key demographic, social-economic and historical facts about PFN. Its purpose is facts about PFN. Its purpose social-economic and historical summarizes key demographic, profile Our community of the starting understanding so that we have a shared information with the community important baseline to share and staff is a tool for PFN leadership, community profile A Health Planning process. point for our Community writing and referencing. proposal members, decision making, It can be used for informing community members. PFN Health Health History and reports PFN Community can be found in the information complete profile More these two documents. highlights from provides 7 and 5. The following section Status Report in Appendices Community Profile Community Our location and traditional territory is illustrated Our location and traditional territory 11. The Anishinaabe traditional territory in Figure Lakes and the Great spans the landscape between mixed forest, deciduous forest, including Hudson Bay, tundra, and coastal barrens, boreal forest, boreal landscapes. larger Anishinaabe family, which includes the Odawa, Anishinaabe family, larger Ojibway and Algonquin peoples. *** **** * ** 39 Community Profile people). to be1.5timeslarger thanourcurrent population(3,838 by 2028,16yearsfrom now, ourpopulationisprojected population overthenext20years.AsFigure 12shows, plan hasprojected asteadyincrease intheon-Reserve each yearinPFN. This meansthatthere are about70-90babiesborn housing, servicesandfacilitiesforallagegroups. 2,133). 2008 ourpopulationhasgrown by26%(from 1,690to District, andiscontinuingtogrow. Between1998and one ofthelargest FirstNationsintheSiouxLookout We are growing: Ourcommunityhasgrown tobe Demographics **** *** ** * PFN.(2011).Capital PlanningStudy, p.2-1 Office oftheChiefCoroner forOntario.(2011).DeathReviewofthe Youth SuicidesatthePikangikum FirstNation,2006-2008.p.106. AANDC. (2012).Community Profiles. pse5-esd5.aincinac.gc.ca/fnp/Main/Search/FNRegPopulation.aspx?BAND_NUMBER=208&lang=eng Medicine Creek Solutions.(2010). CommunityHealth AssetMap.Pikangikum HealthAuthority. * Onaverageweare growing by2.4%eachyear. * Asourpopulationgrows, wewillneedmore ** Ourrecent physicaldevelopment Projected pop.2028:3,838 Babies eachyear: 70-90 Annual growth rate:2.4% Current population:2,600 Population QuickFacts staffing, medical,andemploymentneeds. that ourpopulationneeds,includinghousing, education, significant implicationstothetypesofservices andprograms members are livingonreserve. Most ofusliveon-reserve: Approximately 95%ofour years ofageand35%islessthan15 age. population (3outofevery4people)isunder thirty-five Our populationisveryyoung:Anestimated75%ofour membership isestimatedatbetween30%-50%. communities across Canadawhere theaverageoff-reserve living off-reserve issignificantlylowerthanotherFirstNation Source: PFN,2011 Figure 12:Pikangikum’s projected populationgrowth. 1000 2000 3000 4000 1998 1998 1690 1911* 2003, 2003 , On-Reserve Population 2008 2008 2133 2010, 2400 , *** 2676 2013, 2013 Ourpercentage ofmembers % ofpop.underage15: % ofpop.underage35: % ofpop.on-reserve: *
3021* 2018, 2018
*Projecon **** 3411* 2023, 2023 * Thishas 3838 2028, 2028 35% 75% 95% *
Community Profile 40
University of Manitoba. p.ii. Source: Shearer, J.M. (2008). Shearer, Source: Cultural Landscape, Northwestern Ontario. Reading the Signs in the Whitefeather Forest Forest Reading the Signs in the Whitefeather Our relationships as caretakers and members of this and as caretakers Our relationships with Ohneesheesheen , meaning “to landscape begin health, spiritual, physical, emotional have good mental, on the land to create properly and practice activities and in your actions.” wellbeing in yourself , Cheemeenooweecheeteeyaung Then we must practice with family, good relationships meaning “to build and to form partnerships the Creator and community, be everything must other cultures, with people from good.” it possible to is what makes Having these relationships have Oohnuhcheekayween, meaning “planning for the that and making decisions for the community future, and environmental will have positive social, economic, outcomes.” we planning and community decision-making Through that Ahneesheenahbayweepeemahteeseeween ensure and the land it is based “the Pikangikum way of life,” should. on, can and will continue as it Traditional Principles of our Land Use Strategy of our Principles Traditional Our community is fortunate to have the strength have the strength Our community is fortunate to 100% with an almost of our Anishinaabe culture, rate of Ojibway fluency. retention Our relationship with the land is deeply rooted rooted with the land is deeply Our relationship is located our community Today in our culture. We of Pikangikum Lake. on the eastern shores and many of our forest by Boreal surrounded are Anishinaabeg community members continue and gathering. traditions of hunting, trapping Land and Culture: As well, our Elders and increasingly our Youth our Youth and increasingly As well, our Elders guidance on community our leaders with provide including social and health priorities and issues, managed bodies that are issues. Other governing the Pikangikum Education separately include and the school) Pikangikum’s Authority (governs of Authority (governs many Pikangikum Health local health services). Pikangikum’s We are governed by a Chief, Deputy Chief, and Deputy Chief, by a Chief, governed are We community selected by the members nine Council elections. custom through Governance: Socio-Economic 41 Community Profile jobs. between 20and59yearsold,only130ofusholdpermanent Although about1,000ofourcommunitymembersare 300). generate asignificantnumberofjobs(between150and covers muchofourtraditionalterritory. It isexpectedto project basedonforestry inasectionofboreal forest that The WhitefeatherForestry Project isapotentiallarge-scale members. and fishing,provide foodandincomeforourcommunity Some ofthesecustomarylanduses,suchastrapping hunting, fishing)andotherhistoricallivelihoodactivities. Aboriginal rights,(includingbutnotlimitedtotrapping, protected bytreaty and include traditionalpursuits Customary landuses Economy: households. in ourcommunityare receiving socialassistance,over540 million ingovernmentbenefits. about $5.5millioninincomefrom thesejobsandabout$8 summer months.Itisestimatedthatourcommunityreceives low-income andreceive lessthan$10,000peryear. +++ ++ + **** *** ** * WhitefeatherForest Initiative.(June2006). “KeepingtheLand:ALandUseStrategy”, PikangikumFirstNationand Ontario MinistryofNaturalResources. NorthSouthPartnership forChildren. (2008). MamowSha-way-gi-kay-win Annual incomefrom governmentbenefits: Annual jobincome: Jobs heldbynon-members: Seasonal jobs: Permanent jobs: Economy QuickFacts Whitefeather Forest Initiative.www.whitefeatherforest.com Office oftheChief Coroner forOntario.(2011). DeathReview ofthe Youth Suicidesatthe PikangikumFirst Nation, 2006-2008. p.106. Medicine Creek Solutions. (2010).Community Health Asset Map.Pikangikum HealthAuthority. Keewatin-Aski Ltd.August 2013.PFN School Capital Planning Study. Health CanadaCommunity BasedReporting,Pikangikum 2009-2010 ** **** OurEldersinspired theinitiativein1996. Anadditional60seasonaljobsexistduringthe * ++ Mostfamiliesinourcommunityare considered + Themajorityoffamilies *** $8 million $5.5 million 50 60 130 children inourcommunityare notcurrently inschool. in 2007. of ourkidswere enrolled inschool,downfrom 750 Birchstick Schoolburneddownin2007.In2011,619 School enrollment hasdropped sinceourEenchokay Education: distribution systemownedandoperatedby PFN. comes from adieselpowergeneratingstationandlocal service disruptions.Electricityfor469outof 487 homes but theseare prone tofreezing, contamination, and eight waterdistributionpointsordelivered intrucks, and sewagesystems.Mostpeoplegetwaterfrom Pikangikum’s 487housesare notconnectedtowater at least200homestoaddress overcrowding. 447of members share ahome.We needtobuildorrepair 487 housesinPikangikum.Onaverage,fivecommunity round andwaterorwinterroad seasonally. There are We are aremote communitywithaccessbyairyear Infrastructure: Pikangikum isabout3years. are transferable;however, theage/gradegapin grade 12.TheOntariocurriculumistaughtandcredits Our schooloffers juniorkindergarten through to Houses withelectricity: Houses withwater/sewage systems: New housesneeded: Average people/house: Current numberofhouses: Infrastructure QuickFacts +++ Itisestimatedthat300-500school-aged + 469 40 200 5 487 + Community Profile 42
2020 15 2010 When did these events occur? did these events When 05 What are the important events that happened in our community? in our happened that events the important are What 2000 95 1990 85 1980 75 1970 65 1960 55 1950 45 Pikangikum First Nation Historical Timeline Historical Nation Pikangikum First 1940 35 1930 25 1920 15 economy, to a wider and more cash-based economy. wider and more to a economy, Our people have lived off this land and practiced traditions of hunting, this land and practiced traditions lived off Our people have own health traditions on our was minimal and we relied Europeans Initial contact with well into the mid-1900s. first mission in PFN in 1925, along with the trading post was established The Hudson Bay Western-style more grew, community As our on-reserve influence. teachers and Church health infrastructure was set up. was health infrastructure a local, subsistence-based gradually shifted from Starting in the 1940s, our community involved with directly Government became more the 1950s and 1960s the Federal Around schools, delivery of such things as residential through individual and community life, social assistance payments. and programs, health services, child welfare Western-style in Pikangikum and other First Nations began advocating strongly Starting in the 1970s, leaders including local health planning and service provision. local authority, for increased in 1988. education programs PFN begins to deliver its own is formed. steering group Initiative In 2000, the Whitefeather Forest services as an to deliver and manage health care was empowered In 2008, Pikangikum Health Authority by Chief and Council. overall governance authority exercised independent body linked to the our local health improving over our health system and are control to increase our community continues Today and resources. infrastructure, capacity, 1910 • immemorial. gathering wild foods since time fishing, and • • • • • • • • •
05 Our community health today is influenced by our collective, family, and individual and individual family, by our collective, today is influenced health Our community ours today from was different to contact way of life prior Our ancestors’ histories. things have at once. Many not happen all changes did ways, but these in many in PFN over the life and health and community individual and impacted influenced in Appendix 7). Health History report list in Appendix 23 and full last century (see History
When did these events occur? did these events When 1900 What are the important events that happened in our community? in our happened that events the important are What 43 Community Profile facilities (seeHealth SystemProfile report in Appendix22 forlistof healthrelated infrastructure). As well,we havelocalhealthinfrastructure andhealth-related infrastructure, aswelltoaccess toregional health “there are animalslikemoose,ducks “a strong communityiselders who important thingandnotlosingour teaches ustheoldways,howthey “helping oneanother makesour Pikangikum andourstrengths: strengths shared. Beloware asampleofquotesshared bycommunitymembersaboutwhattheylove community assummarizedinFigure 13andTable 6onthenextpages.SeeAppendix24fora fulllistofcommunity community engagementsessions,shared manycommunitystrengths andthingstheyloveabouttheir provided informallybyfamilymembers,friends,Elders,andothercommunitymembers.In Many ofthehealth,healing,andsocialsupportsthathelpourcommunitymembersare community assetsmappingthatwasthefirststeptowards thisassessment. as oneofthefoundationsourcommunity-drivenhealthplanandtobuildoff the approach. We collectedinformationonourcommunitystrengths throughout theprocess Throughout ourCHNAprocess, weapproached ourhealthneedsfrom astrength-based Community Strengths “communicates through walkie- “I thinkourculture isthe most talkies andthrough relatives” live andhowtohunt” community strong” language” to eat” “people prayingforourcommunity it hasabeautifulviewsandforests” “The beautyoftrees, grass,water- “I likeworkingforthecommunity” “kids goingtoschoolgettingtheir “Chief andCouncilhasgreat “people standingtogether” that makesusstrong” leadership” education” playground andotheractivities for “the Eldersthattrytochangeand “Our languageisbeingtaughtin “All myfriendsandrelatives are “Having anursingstationhere how tohaveabetter future” “Children havingtheirnew “play sportswithfriends” in thereserve” living here” school” them”
Community Profile 44
& ceremonies &
Strength
Healing & & Healing
Healing circles Healing
Cultural gatherings gatherings Cultural
Church programs & programs Church with Land with
Elders
Relationship Relationship Elders’ teachings
Livingknowledge cultural
Beautiful Wildlife Our care of the Land the of care Our Places of worship
healing
Clean air, air, Clean Peaceful water, land water, Land-based Cultural education
Gospel
Hunting
Fellowship connection
Youth Fishing & & Fishing economy
Activities Community Community
Traditional Traditional
Medicine Culture break
Food Prayer Art & Music
Tent meetings Initiative
Resources Language Social programs
Tourism
Working together Working
Whitefeather Forest Forest Whitefeather Events
Our
People Youth
Jobs Family
Employment other each
Elders Helping Helping
Support Peacekeepers School Leaders
Teachers
Training models Role Houses
Adult programs Women
Sta Council
Chief & & Chief
plant
Teamwork
Water Water
treatment treatment
buildings
Health Health
governance Community Community Love of education volunteers &
Men
Increasing graduates involvement
Learning fromChild Elders & programsYouth Community
Pikangikum’s Community Strengths Community Pikangikum’s Roads Electricity Airport
internet)
Communications
(radio, cellphones, Figure 13: Pikangikum’s 13: Pikangikum’s Figure Strengths Community 45 Community Profile Social families inculturalprogramming. Ourland-basedapproach tohealingispracticedwithourYouth camp. out ontheland,huntingandfishing.Everyyear, weparticipateinaculture break where wehavetheopportunitytoengageas music, andlivingculturalknowledgeenrichourlives.Youth are learningmore ofourtraditionalways.We liveourculture bybeing Our people,ourstrong culture andourlanguageretention are allimportantstrengths. Ourcommunityculturalevents,artand Cultural places ofworship,gospeljamborees, church programs, healingcircles, culturalgatherings,ceremonies, andtentmeetings. We havethestrength ofprayer, spiritualpracticesandhealingopportunities.Ourcommunityhasmanyresources suchas Spirituality water andanimalsallowsustocare forthem.We are activeontheland,hunting,fishing,walking,boatingandswimming. land isrooted instrong culturalvaluesandweare proud tolivewhere ourancestorslived.Ourtraditionalknowledgeaboutland, Our forest, water, andbeautifulplacesgiveusstrength. Ourlandprovides traditionalmedicineandfood.Ourrelationship with Landscape living cultural knowledge and traditions, which driveour traditional economy. training initiatives toourcommunity. We havethestrength ofour existingjobsandemployment supportprograms. We alsohave Our Whitefeather Forest Initiativeisa community-driveneconomic developmentproject thatwillhelpbringmore jobsand Livelihoods education programs, andadulteducationprograms. We loveourchildren and Youth andbelieveintheirstrengths andpotential. and Englishgoodteachers. Enrollment andgraduation are increasing. We haveopportunitiestolearnfrom Elders,early Our kidslovetheirschool, whichwehavebeenrunningsince1988andwill soonhaveanewbuilding.We teachinOjibway Learning and communicationstechnology. Ourcarpenters, constructionworkers,buildingmanagersandcaretakers helpmaintainthese. Community membersappreciate existinghousing,communitybuildings, and ourroads, electricity, airport, watertreatment plant Infrastructure health governanceandhaveahistoryofsuccessful planningprocess. Teamwork, communication andtraininghelpourstaff. passionate aboutstrengthening ourcommunityandwanttogetinvolved tohelp.We havereclaimed ourauthorityover local work hard toincrease involvementofmembersingovernance.We havemanychildren, Youth, men,women,andElderswhoare We havethestrength ofourChiefandCouncil,Elders,thePHA,PEASHEEcommittee.Memberswithleadershipskills Leadership Members withexperienceofovercoming addictionsandmentalhealthchallengescanrelate topeoplestillstrugglingwithissues. such asYouth camp,crisissupport,communityhealthinitiativesandfamilyservices.We are growing, resilient andstrong. neighbours. We are strongest whenworkingtogetherandhelpingeachother. We haveanumberofsupportivesocialprograms Our people,includingourEldersandYouth, makeusstrong. We haveaclose-knitandconnectednetworkoffamilies,friends Table 6:Pikangikum’s CommunityStrengths -Details Health System Profile 46 * (2) (5) NWHU) National Regional (FNIHB, AANDC) (SLFNHA, Nodin, NW-LHIN, Tikinagan, The different parts of a health system connect parts of a health system The different * - (2) (4) Local (PHA, FNIHB) Provincial Aboriginal Affairs) (Ministries: Health; vices; Children & Youth, & Youth, vices; Children Community & Social Ser Figure 14: Pikangikum’s Pikangikum’s 14: Figure Health Service Providers (Number of agencies) This section provides a snapshot of our current health system. It describes who is involved and what roles they play. they play. and what roles It describes who is involved health system. snapshot of our current a This section provides community potentially accessible to our or currently are and services that the many programs It also catalogues Appendix 6. in Community Health System Profile PFN details can be found in the report members. Full and activities “whose organizations, individuals, resources, is made up of many relationships, A ‘health system’ and maintain health.” restore, is to promote, primary purpose Health System Profile System Health through functions and roles, including policy making, health service provision, financing, and managing resources. financing, and managing provision, policy making, health service including functions and roles, through Given challenges of identifying current, specific programs and the differences between types of program, there may be additional programs and services that we did not specifically identify. and services that we did not specifically identify. may be additional programs there between types of program, and the differences specific programs Given challenges of identifying current, Office of the Chief Coroner for Ontario. (2011). Death Review of the Youth Suicides at the Pikangikum First Nation, 2006-2008. p.47. for Ontario. (2011). Death Review of the of the Chief Coroner Office bank Strategy for HMP Results. Annex L. siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1154048816360/ Bank. (2007). Healthy Development: World World *** * ** AnnexLHNPStrategyWhatisaHealthSystemApril242007.pdf 47 Health System Profile While there are efforts tocoordinate andcollaborate,manyproviders continuetodeliverservices“insilos.” others workthrough partnershipsandshared responsibility agreements, andmanyoverlapintheirareas offocus. summarized inFigure 15belowanddetailedinAppendix6.Someagenciesgroups worklargely independently, system governance,planning,coordination, andresearch, andsomeare activeinalloftheseareas. Theseroles are Some are direct serviceproviders, somerunhealthandhealth-related programs, someare activeprimarilyinhealth provincial, andnationallevels,asdepictedinFigure 14(seeAppendix22forafulllist). our members.We identified25groups andagencieswhoare involvedwithourhealthsystem,from local, regional, however there are manyagenciesandgroups thatparticipateinthedeliveryofhealthservicesandprograms to The PikangikumFirstNationisresponsible foroverseeingthehealthandwellbeingofitson-Reservemembers, potentially use,thoughonly44are availablelocallywithinPikangikum. total, weestimatethatthere are closeto70healthandrelated programs andservicesthatourmemberscurrently or Figure 15:RolesofHealth ServiceProviders ***
** In Health System Profile 48 * 9 4 0 3 1 10 11 13 Number of in Programs Pikangikum Short-term Treatment Prevention Assessment & Diagnosis Long-term Treatment Rehabilitation & Support Aftercare e.g. Addictions treatment e.g. Addictions treatment centre for e.g. MHC: Aftercare post-treatment Palliative Care e.g. HCC: Home and visits community care e.g. CHP/IP: Public health e.g. CHP/IP: Public clinics e.g. BHC-SAP: activities Recreational e.g. HBHC: Pre/post-natal screening e.g. Crisis team intervention e.g. ADI: education for diabetes Type of Care of Type Health Promotion Health programs in Pikangikum, by type in Pikangikum, programs 7: Health Table Treatment Treatment (Acute, Short-term) (Acute, Diagnosis Assessment & Assessment Treatment Treatment (Chronic, Long-term) (Chronic, & addiction and Prevention Care Care of illness, injury, injury, of illness, Health Cycle of Cycle Rehabilitation Health Promotion Aftercare Aftercare & Support Care Palliative Figure 16: Continuum of Health 16: Continuum Figure Different programs and agencies address different stages within the continuum of care of health promotion, promotion, of health care of continuum the within stages different address agencies and programs Different in Figure illustrated maintenance, health ongoing and and support, aftercare rehabilitation, treatment, prevention, (it does care of areas different that address in Pikangikum programs of the number 7 summarizes Table 16 below. as building services such support or program of Pikangikum available outside and services programs not include or security). maintenance Given challenges of identifying current, specific programs and the differences between types of program, there may be additional programs that we did not specifically identify that should be added to this list. that we did not specifically identify that should be added to this list. may be additional programs there between types of program, and the differences specific programs Given challenges of identifying current, * 49 Health System Profile Table 8:SupportOptionsforOurMembers’Health Services Support Patient medical Non- Addictions Health & Mental Support Crisis Care & Emergency Services Specialist Services Clinical where theyare available,andwhodeliversthem.AfulllistofservicescanbefoundinAppendix6. Table 8beloworganizes thehealthservicesandprograms availabletoourmembersby10categoriesandsummaries • • • accommodations • • Program • • Worker, Trauma Teams • • • • Nodin,Trauma Tikinagan, Teams) • • • • Regionalhealthcentres &hospitals • • hygienists • • • • • Traditional health services(Meno-Ya-Win Home orin-community care: PFN/PHA SLFNHA/Men-Ya-Win ClientServices NIHB fundsforhealthtravel, Counselling (Tikinagan, Nodin) Counselling (Tikinagan, National NativeAlcohol&DrugAbuse Regional treatment centres &hospitals PHA: MentalHealthworkers,SolventAbuse Nursing Station,Police NAN Victim QuickResponseprogramNAN Victim Meno-Ya-Win AssaultCare Treatment Crisis counselling(MentalHealthworkers, PHA CrisisTeam Regional healthcentres & hospitals Nursing Station,Police,Medevac Diagnostic servicesandadvancedcare: careVision assistant Oral health:visitingdentists,dental Regional healthcentres & hospitals Meno-Ya-Win HealthCentre (SiouxLookout) clinicalspecialists Visiting Nurses andPhysiciansatNursingStation Supports & Cultural Spiritual Advocacy Planning, & Research, Health Supports Community Social & Services Welfare Child Health & Public Community (hunting,trapping, fishing,crafting, story-telling) • dance) • • • • • • watertreatment trainingandmaintenance) initiatives(CHMChousing,newplayground, • Works; SocialAssistance • (LifeSkillsprogram) • • • support • • • • • HealthyBabies,Children • • Nutrition;DiseaseandInjuryprevention) Control &Immunizations; Sexualhealth; NWHU,online(e.g.CommunicableDisease Centre, School,Meno-Ya-Win, SLFNHA,NAN, • Traditional knowledge andactivities Cultural practices(drumming, artwork,music, Ceremonies (grieving,tentcircles) Churches andspiritualcommunities Government: MCSS;MOAA;FNIH Regional: NAN;SLFNHA;NW-LHIN Local: PHA,Chief&Council,SHEEcommittee Housing andinfrastructure improvement Ontario DisabilitySupportProgram; Ontario MamowOshkiPimagihowin Tikinagan School programming; Youth drop-ins Family andfriends Customary community-basedchildcare, Early ChildhoodDevelopment&daycare Brighter Futures program Nodin ChildandFamilyInterventionServices Child&FamilyServicesworkers Tikinagan Maternal ChildHealth,Prenatal Nutrition; Aboriginal DiabetesInitiative Information: PHA,NursingStation,Community Health System Profile 50
24) (
(31%) 23) Nurse ( Of those: *** ctor (29%) Do (7) (9%) Other or 11) ( rker (14%) Mental Addictions Wo (8) or Drug
(10%) (2) 3) ( Treatment k Program Pi (3%) Alcohol (4%) Dentist Hospital outside Figure 18: Utilization Data - Source of Health Care Service of Health Care Utilization Data - Source 18: Figure o 4% were for emergencies o 4% were care for prenatal o 4% were for Medevacs o 1% were
* (2%) (1) (39%) Having baby Sickness (17) ** (16%) (7) (1) treatment Addictions (2%) issue Surgery 6) ( (14%) 2) ( Family (5%) ealth Mental h to (3) to (2) (3) (2) (7%)
up ry % were for health education o 45% were medication to receive o 29% were conditions for chronic o 17% were talk (4%) (4%) Someone eck (7%) Inju Ch North West Local Health Integration Network. (2010). Aboriginal Health Programs and Services Analysis & Strategies: Final Report. DPRA Canada. Health Programs Local Health Integration Network. (2010). Aboriginal North West PFN Nursing Station logbooks (incomplete reporting, numbers are approximate) are numbers PFN Nursing Station logbooks (incomplete reporting, Interviews suggested that the high use of agency nurses effects nurses’ ability to build trust with patients nurses’ ability to build nurses effects that the high use of agency Interviews suggested 1560 patients. our nursing station saw approximately is a busy place. In 2010, Our nursing station While programs, services and resources might be available, members may not be accessing them because of them because be accessing may not available, members might be services and resources While programs, other barriers. or lack of information In October 2012, as part of our second community session, 44 members described the last time they needed the last time they needed session, 44 members described as part of our second community In October 2012, 39%), followed by (17 responses, (earache, pneumonia, asthma) sought help due to sickness help. Most of us (6 16%) and family issues (abuse, child welfare) abuse) (7 responses, (alcohol and solvent addictions treatment 17). 14%) (Figure responses, responses, did you visit for help? Most of us visited with a nurse (24 the question Who 78 members answered 18). 14%) (Figure by a mental or addictions worker (11 responses, 29%) followed 31%) or doctor (23 responses, challenge Infrastructure • • • • • Office of the Chief Coroner for Ontario. (2011). Death Review of the Youth Suicides at the Pikangikum First Nation, 2006-2008. p.140 for Ontario. (2011). Death Review of the of the Chief Coroner Office . *** * ** In 2011, an assessment of health care in Pikangikum found that while most of our community members can access can members community of our while most that found in Pikangikum care health of assessment an In 2011, and access to abuse services such as addiction/substance other services health services, some mental and care primary limited. are professionals mental health specialist Utilization Figure 17: Utilization Data - Reason for Seeking Health Care Service Utilization Data - Reason for Seeking Health Care 17: Figure 51 Health Issues Analysis information onalonglistofhealthindicators. health holisticallyandbroadly, welookedfor Pikangikum. Becauseweare examiningcommunity well ashealthorganizations andagenciesoutsideof data from program andstaff withinthecommunityas by collectingavailablehealthandhealth-related To assessourcommunityhealthissues,westarted assessment. and negativeimpactsare includedinourhealthneeds issues are tomakesure thatallpressing healthconcerns start withaclearsenseofwhatourcommunity’s health a steptowards defininghealthneeds.Itisimportantto concerns thatourmembersandfamiliesare facing,as process focusedonidentifyingthehealthissuesand A majorpartofourcommunityhealthneedsassessment Community HealthIssuesAnalysis issues inPikangikum. of previous reports andassessmentsofhealthsocial perspectives onhealthissuesandconcernsreview available andsupplementedthesewithcommunity available forPikangikum,soweusedthedatathatwere However, formanyindicatorsthere are nodatacurrently making comparisonswithotherpopulations. tracking changesinhealthstatusovertimeandfor factors thataffect health. Indicators allowsfor characteristics ofapopulation,eventsorother Health Indicator:describesormeasures particular (Manitoba Health,2009) Health Issues Analysis 52
Needs opportunities for staff. • On the job training communication, organization More • Communication: collaboration and coordination. and work planning, and a • Information sharing, case management, to health and healing. approach coordinated sensitivity including staff, • Counselling and support for outside community. from guidance for staff to increase staff committed and reliable • More of programs. effectiveness program and tools and equipment such as office • More computers. space, vehicles, materials and and programs. consistent funding for salaries • More participants, communication with program • More and more of available programs, awareness increased health fields. to work in Youth from interest available. community activities and programs • More volunteers and community involvement in • More and Elders. especially parents programs, center for family-based • Local healing and resource and aftercare. counselling, treatment Issues experience and training. reliability, capacity, • Staff confusion and between programs • Lack of coordination services. health care Lack of comprehensive of roles. response. • Delays in medical emergency people unaware because • Low participation in programs or do not trust program. and reporting, • Inconsistent information management, evaluation of programs. not being effectively • Needs of solvent abusers (sniffers) programming. met by current not always reached. of the program • Intended recipients Strengths to engage in opportunities for members • Different especially on the land. and activities, programs and communication. • Teamwork • Relationships with clients. programs. • Witnessing from results tangible • Land-based camp for Youth. Our program review was based primarily on sessions with our local health and Band staff, as well as data on programs, programs, well as data on as staff, and Band our local health on sessions with based primarily was review Our program issues strengths, to share we asked staff sessions staff available. In our three that were utilization funding, and program (see our our initial review from summary of the main themes The following is a high-level programs. and needs of their details). for more in Appendix 20 Review report full Program As part of our CHNA process and issues analysis, we undertook a review of the health programs that are managed locally. locally. managed that are health programs of the a review we undertook issues analysis, and process CHNA of our As part challenges and their exist, their successes, currently programs of what and analysis is an overview review A program opportunities. needs, gaps and health programming of some overarching an analysis It also provides needs. Initial Program Review Program Initial 53 Health Issues Analysis “The addictionofsniffers -itstopspeoplefrom going “Almost alltheyouthdrinkandnooneishere tostop “Kids are inthecampfor10daysbutthentheycome the drinking,violenceandthingslikegassniffing. community sessionsandinterviews. surveys, storytelling,andgroup brainstorms.Belowisasampleofquotesabouthealthissuescollectedfrom collected theseideasusingavarietyoftoolsincommunitysessions,smallgroup sessions,andinterviews,including the community, andwhichissuestheyare mostconcernedabout.AsdescribedinourMethodologysection,we A centralpartofourissuesanalysiswasaskingcommunitymembersabouttheirhealthissues,theyseein It’s likeatornado ofdrugs,alcoholandviolence.” “Kids turntosniffing whenthere’s lotsofdrinking “Whenlosshappens, peopleare notallowedto express anger/griefsoit’s bottledup–leadsto they do,voicingoutwhatisinthem,[it’s] rage” “Look atyouthgraffiti, actingout,thisiswhat “Dark forces among us-fear, shame, guilt” back tothesamesituationthattheyleft to sleepatnight,sotheymissschool” “Kidsdon’t feelsafeatnightsothey violence. Havetostay numb.” sleep duringthedayinstead” - weneedaftercare” (Women’s circle) (Women’s circle) (Staff session1) (Staff session1) in theirhome.” (Interview) (Interview) (Interview) (Interview) “Trauma andguilt-prevents peoplefrom helping.The family tohelp,there isnotevenroom tohelpothers” together andwork indealingwithclients” intent isthere –butitistoomuchtogooutsideof “[Health]Workers don’t havesomeonetotalkto” “There isn’t asysteminplace tobringprograms “Lack offoodinhomes,mainlyduetoalcohol” “Our tragedywithouryouthiscripplingus” “Suicide isthekeyelementofstrugglesin “People resistant toconnectwithservices “[People] Don’t seekmedicalhelpunless due toconfidentiality.” they are verysick” (Staff session2) (Staff session1) (Elders session) last 20years” (Interview) (Interview) (Interview) (Interview) (Interview) Health Issues Analysis 54 (Interview) (Interview) (Interview) (Interview) (Interview) (Staff session 1) (Staff (Staff session 1) (Staff awful things that job to addictions.” kids are exposed to.” kids are sexual abuse at home, (Ontario Works staff session) staff (Ontario Works “We have bad drinking water” “We to go home, sometimes there’s to go home, sometimes there’s a 2 bedroom house – no privacy” a 2 bedroom exhaustion, a lot of kids don’t have exhaustion, a lot of kids don’t their own beds …People don’t want their own beds …People don’t “People can’t keep jobs, they lose their keep jobs, they lose their “People can’t “Overcrowding – [there are] 20 people in are] – [there “Overcrowding “Because of overcrowding kids don’t have kids don’t “Because of overcrowding “There are not many opportunities for fun” for not many opportunities are “There a sense of their own space. There is a lot of is a a sense of their own space. There “Lots of damage, broken windows, garbage” broken “Lots of damage, “Lack of jobs leads to drinking and bootlegging” to drinking and bootlegging” “Lack of jobs leads “alternative, traditional ways [are] not here now.” now.” not here ways [are] “alternative, traditional
(Interview) (Interview) (Interview) (Interview) (Interview) (Interview) (Interview) (Staff session 2) (Staff (Staff session 1) (Staff clients to which program.” program.” clients to which collapsing - volunteerism is low” 4,5,6 days before cheques arrive.” cheques 4,5,6 days before expected to be stay at home Moms.” expected to be stay at home to care for yourself, can’t help others” for yourself, can’t to care gobbles up money. Can go hungry for gobbles up money. Youth, of their gifts and achievements” Youth, “Parents don’t know how to be parents” know how to be parents” don’t “Parents “Lack of parenting leads kids to sniffing” leads kids to sniffing” “Lack of parenting “Sniffing is a way of dealing with hunger” is a way of dealing “Sniffing “it is confusing how and who should refer refer who should how and “it is confusing “Initiatives get overwhelmed, projects end up projects “Initiatives get overwhelmed, resources they have, they are not given credit, not given credit, they have, they are resources “Women are not appreciated for intellect and not appreciated are “Women “There is very little identification of gifts within “There “Welfare cheques are not enough. Packaged foods not are cheques “Welfare “When you don’t sleep, eat, you don’t have energy have energy sleep, eat, you don’t “When you don’t 55 Health Issues Analysis included intheHealthStatusreport. important toaddress withmore datainthenearfuture. Alistofadditionalindicatorsthatweshouldconsidertrackingis (see Appendix5fordetails).Ourdataprovide apreliminary assessmentofcommunityhealthbutthegapswillbe We usevisualsymbolstoshowifthedatapointsanimproving situation,astaticorworseningsituation report, butforfulldetailsseetheHealthStatusReport. data sources, seeHealthStatusReport).Someofthesedataare includedintheHealthNeedssummarylaterthis able tocollectdatafor17indicators,9HealthDeterminantsand8Outcomes,summarized inTable 9below(for Due todatalimitations,wewere notabletocollectdataforthefullrangeofindicatorsasinitiallydesigned.We were and Determinantindicatorstoconsider. health (e.g.waterquality, aholisticperspectiveonhealththere isawiderangeofOutcome housing,education). With health (e.g.ratesofdiabetes,causesdeath)orHealthDeterminantsthatreport underlyingfactorsthatinfluence a seriesofindicators.IndicatorscanbeeitherHealthOutcomesthatreport onthestatusofindividualandcommunity individuals thatare partofPikangikum’s healthsystemaswellotherexternalsources. Thedataare summarizedinto health data.OurHealthStatusReport(Appendix5)detailsthedatathatwewere abletocollectfrom agenciesand The mainpartofourHealthIssuesAnalysiswasbasedonthecollection,analysis,andsummarycurrently available Table 9:Pikangikum’s CommunityHealthStatusIndicators 400 more by2040. 200units nowandneed • We needto build orrepair overcrowded. lowquality, unsafe, and • Muchofourhousing is Housing servicesandfacilities. weneedtoplanformore • Asourpopulationgrows, are belowtheageof35. rapidly:3outof4people • Ourpopulationisgrowing Population Sitution orTrend Improving/Positive
Health Determinants our lives,school andwork. otherruralcommunities. from more infectionsthan • Ourcommunitysuffers andsewagesystem. notconnectedtothewater frequent and interfere with • Poweroutages are operatingbeyondcapacity. stationisout-dated and • Ourlocalpowergeneration Heat &Energy • Over90%ofourhomesare Water Sitution orTrend Static/Not worsening
Sitution orTrend Concerning/Worsening receive social assistance. • Over 540 of our households permanentjobs. workingagemembers hold • Only130of1,000 Employment qualityofourhealthcare. seriousimplicationstothe • Thevolatilityoffundinghas since2008/2009. hasdecreased by14% • HealthCanadafunding Health Funding
Health Issues Analysis 56 Grief is high demand for • There grief counselling, related to the number of deaths and suicides in our community. grief can lead to • Chronic and addiction. depression Chronic Conditions Chronic have high rates • We chronic of preventable conditions in our especially community, diabetes and high blood pressure. Language & Culture & Language a 97% has • Our community of Ojiway rate retention is the first language and it of our children. for most and • Cultural continuity help protect language can against suicide.
Other Substance Abuse & Addictions • Solvent abuse is on the rise. and 4th graders in Pikangikum self • 27% of 3rd gasoline. that they have tried sniffing reported
Health Outcomes Suicide is over 40 • Our suicide rate Ontario’s. than times higher • In 2000, we had the world’s highest suicide rate. • Many suicides have been young people and have happened close together. Mental Well-being • Between 2009 and 2012, in was an increase there mental health visits. • Grief and addictions are the most common reasons for people to seek mental health help. Crime & Violence Crime 2001 and 2012 • Between crime of violent incidents since 2011 but increased, a decrease. has been there members • Many of our are who go to prison offenders. repeat Health Determinants continued Determinants Health
Alcohol • 97% of all our Tikinagan cases are child welfare Diabetes • 1 in 3 of our members over and infant deaths. • Many deaths in our associated community are 20 years old has diabetes. • Diabetes is often a result lack of of eating unhealthy, and chronic exercise stress. alcohol related. in our community are • 90% of all probations to with alcohol abuse. related cases and is that child welfare • A hopeful trend have been declining since 2011. probations Causes of Death have unusually high • We of deaths percentages failure suicides, organ from with our living conditions. Education has enrollment • School 2007, it since dropped that 300-500 is estimated not in school. are children gap is • Our age/grade to compared about 3 years Ontario schools generally. Ontario schools 57 Health Issues Analysis and root causesisacomplexand issues exist.Exploringreasons or reasons forwhythesedifferent issues isexploringpossiblecauses Another pieceofanalyzinghealth Appendices 5and19. data foreachissueare availablein the nextsection).Fulldetailsand least onehealthneed(detailedin Each healthissueislinkedtoat and economy. health tocommunityinfrastructure of areas, from physicalandmental health issuesspanawiderange perspectives wecollected.These the healthdataandcommunity identified from ouranalysisof community healthissuesthatwe summarizes the15summary Table 10onthenextpage source ofinformationused This issuesanalysiswasone other needs. separately withoutconsiderationof together andcannotbefixed health issuesandneedsare tangled is connected–theroots ofallour happening andshowhoweverything to explainwhycertainissuesare reasons forhealthissueshelps action onthem.Exploringthe issues andneedshowtotake relationships betweendifferent issues helpsustounderstandthe Discussing causesofhealth Planning. Comprehensive CommunityHealth members aspartofourphase2 these discussionswithcommunity ongoing process. We are continuing and needs. relationship betweenissues,causes table foreachneedshowingthe 5) allowedustocreate asummary and HealthStatusReport(Appendix Health IssuesAnalysis(Appendix19) causes identifiedinourCommunity A careful review oftheissuesand needs framework(Figure 9). to create ourfinalcommunityhealth Health Issues Analysis 58 Contamination from sewage lagoon Contamination from Lack of cemetery/burial planning Limited connection to cellphones and internet Trauma of victims and perpetrators of Trauma of justice system Failings Repeat offenders response long-term No coordinated, Lack of safe places Attempted suicides and prevention Lack of screening sleep Lack of exercise, (transportation, Barriers to access cultural) cost, privacy, care Low maternal and pregnancy Gaps in continuum of care Low availability of healthy food Lack of access to traditional foods Inadequate education infrastructure Low educational attainment Lack of access to training for cultural and land-based activities Lack of volunteers Patriarchy Low participation rates in programs Loss of pride in community Garbage, poor waste management gap Intergenerational pride in culture Loss of identity, Loss of traditional economy and livelihoods utilities Inadequate residential Fetal alcohol spectrum disorder spectrum alcohol Fetal Bootleggers Smoking Details Lack of sewage systems Limited transportation options accessing services Difficulty Violent crime Graffiti Vandalism, Fear Shame mental illness Stigmatization of suicides suicides, Cluster Youth failure organ High rates diabetes, Injuries and accidents and evaluation Lack of reporting of programs Low awareness services Lack of dental care response Delays in emergency Lack of nutritional knowledge poor nutrition Illness from Limited guidance/counselling Low school attendance Low school completion Child apprehension Lack of trust Lack of communication Lack of fun events opportunities Lack of recreation Lack of cultural opportunities Lack of spiritual guidance Lack of training opportunities Rapid population growth Houses in disrepair Youth Addictions Youth Lack of aftercare Lack of running water Unsafe water Inadequate, unsafe roads lighting Lack of street Community conflict Vandalism Colonialism and racism Loss of traditions Lack of jobs Poverty Overcrowding Unsafe housing Lack of resources, services Lack of resources, capacity Limited local staff Duplication, delays Lack of coordination Unhealthy food High cost of food Youth Harm to children, Poor parenting discouragement Boredom, models Lack of role Loneliness Lack of help Bullying, Youth violence Youth Bullying, abuse Abuse, Sexual Lack of safe havens Loss Grief, Trauma, Depression High suicide rate Low life expectancy conditions Chronic Alcoholism Abuse Solvent Drug Addiction Issue Table 10: Pikangikum’s Community Health Issues Summary Issues Health Community Pikangikum’s 10: Table 15. Transportation and 15. Transportation Connections 13. Inadequate, Unsafe Housing 14. Lack of Access to and Sanitation Water 12. Poverty and Lack of Jobs or Livelihoods 11. Loss of Cultural Connection 10. Loss of Community Pride and Involvement 9. Breakdown of 9. Breakdown Community Supports 7. Food Insecurity 8. Lack of Education, Skills, and Supports for and Youth Children 6. Lack of Health Care Care 6. Lack of Health and Supports 4. Suicide Conditions 5. Chronic Deaths and Preventable 3. Mental Health 3. Mental Health Concerns 2. Crime and Violence2. Crime 1. Substance Abuse and Abuse 1. Substance Addictions 59 60 61 Community Health Needs Assessment greater detailonspecificneeds. two andsixsub-needsthatprovide Each mainhealthneedhasbetween of needs(illustratedinFigure 10). collection, summarizing,andranking gradual process ofinformation These needsemerged outofa in Table 11onthefollowingpage). on thenextpageandsummarized categories (illustratedinFigure 19 117 sub-needs,organized intoseven identified 23mainhealthneedsand Our CHNAprocess ultimately community healthneeds. current healthissuestoidentifyour strengths, ourhealthsystem,and our knowledgeofcommunity results ofourCHNA,applying In thissection,wepresent the Community HealthNeedsAssessment prioritization approach helpsusto for ourcommunityhealth,but all healthneedsare veryimportant It isimportanttoremember that orange, andSupportinginyellow. are showninred, HighPriorityin our CHNA.Criticalhealthneeds health needhasbeenassignedin show whatcategoryofprioritythe the upperleftcornerisusedto The colourofthesmallcircle in to otherissuesandneeds. specific sub-needs,andconnections need, communityperspectives, pages thatincludedetailsonthe health needissummarizedintwo on thesidemargin. Eachmain categories ofneedsiscolourcoded In thissection,eachoftheseven summary. our community’s voicesinto each sessions, andsurveys.Thesebring sessions, interviews,smallgroup need summaryare from community The quotesonthemargins ofeach address ourhealthneeds. use andexpandwhenweworkto strengths andassetsthatwecan information istoremind usofour strengths andresources. This a sectiononrelated community Each needsummaryalsoincludes improving ourhealth. most urgent orfoundationalfor identify theneedsthatare the Figure 19: Community Health Needs and Sub-Needs (dots) = Sub-need High Priority Critical Supporting
Mental health Promotion & & addictions Suicide Peacekeeping prevention care prevention & safe places
Food & Mental Prevention of nutrition Health Safety violence & harm Physical Health Reduction Counselling & prevention & social supports of addictions Safe water Quality supply Comprehensive Accessible housing & health care health services Community utilities Infrastructure Strong health Health Needs governance Coordination Clean Community of health community services & Health Community Transportation Governance supports & connectivity
Opportunities Social & Supports for Livelihoods to support Community parents ourselves engagement Cultural & families
Access to Supports Diverse culture for children education & Youth & training 62 Table 11: Community Health NeedsCommunity and Sub-Needs Health Needs Organized and intoSub-Needs 7 Categories Organized in 7 Categories Needs: Food & nutrition Promotion & prevention Accessible health services Comprehensive health care • Access to aff ordable, healthy food • Recreation/sports activities & events • Culturally appropriate services • More doctors & nurses Physical • Access to traditional foods • Land-based acitivites • Understanding of pathways to health • Training & support for local health staff Health • Knowledge about healthy eating • Healthy lifestyle education • Transportation support for patients • Regular check-ups and screening
Sub-needs • Community supports for food • Prevention of injury • Specialist services more locally available • More local health resources • Increased privacy • Better medical emergency response • Rehabilitation services Needs: Mental health & addictions care Suicide prevention Reduction & prevention of addictions Counselling & social supports • Local treatment facility & program • Suicide prevention programs • Prevention of bootlegging • Grief & healing support groups Mental • More mental health & addictions staff • Suicide education & awareness • Laws against solvents/alcohol/drugs • Community counselling & support • Accessible counsellors • Risk assessment • Reduction of intoxicant supply • Support for getting help Health • Sustained aftercare support • Safe places for at-risk individuals • Education & prevention programs • Cultural & land-based options Sub-needs • Comprehensive mental health • Local treatment & aftercare options • Post-suicide supports & addictions care • Support for healthy grieving • Palliative care Needs: Peacekeeping & safe places Prevention of violence & harm • Community laws to stop & prevent abuse • Community awareness of bullying & abuse Safety • Improved response by police/peacekeepers • Chief and Council leadership on community safety • Safe places and homes • Safety for women & children • Larger team of peacekeepers • Help off enders when they come home from jail Sub-needs • Look out for each other • Support for victims & off enders of crime Needs: Quality housing & utilities Safe water supply Transportation & connectivity Clean community • Quality housing • Safe drinking water • Good quality, safe roads • Reduce graffi ti and damaged • Availability of housing • Running water for all houses • Transportation supports buildings Infrastructure • Diff erent housing options • Sewage systems for all houses • Internet access • Reduce vandalism • Reliable electricity & heat • Water treatment plant upgrades • Community communication tools • Manage garbage & junk
Sub-needs • Indoor plumbing • Lagoon upgrades • Staff resources • Make our community beautiful • Enough reserve land for developments • Cemetery/burial planning • Walking access
HEALTH CATEGORIES HEALTH Needs: Opportunities to support ourselves Diverse education & training • Good job opportunities • Quality teaching, education resources and • Access to higher education opportunities Livelihoods • Job & trade skills training school buildings • Access to knowledge-keepers of cultural & • Supports for traditional economy • Help for Youth to stay in school land-based skills
Sub-needs • Career planning & mentorship • Help for adults to return to school Needs: Community supports Supports for parents & families Supports for children & Youth Access to culture • Community groups & social networks • Programs for healthy parenting • Celebrate our children & Youth • Bring Elders & Youth together Social & • Gathering places • Programs for healthy pregnancy • Role models and life guidance • Elder teachings & involvement • Spiritual activities & programming & babies • Jobs & training oppotunities for Youth • Cultural programs & events Cultural • Community conversations & sharing • Resources for parents & families • Fun things for young people to do • Land-based activities & healing
Sub-needs • Events & celebrations • Role models & mentors for parents • Train & support Youth leaders • Traditional healers, medicines • Resources to support people in need • Safety for all children at home & mentors • Cultural & land-based programs & camps Needs: Community engagement Strong health governance Coordination of health services Community • Opportunities for community dialogue • Leadership on health issues & governance • Communication & sharing • Participation in events & programs • Health funding & resources • Clarity on roles & responsibilities & Health • Participation in decision-making • Monitoring & evaluation of services & programs • Coordinated case management
Governance Sub-needs • Community volunteers • Health data management • Cooperation & partnerships • Privacy & confi dentiality of health records • Clear communication and access supports for members 63 Prioritization Results Given the interconnected nature of our health needs, all community health needs are important and depend strongly on other needs. However, it is also helpful to define which Community Health Needs Assessment needs should be addressed first. To do this, we assigned a score for each need considering nine criteria under the three themes of popularity, urgency and strategic advantage. Each needs popularity score considers how often or how strongly the need is identified in 1) our community health needs ranking exercise, 2) interviews, 3) staff reports, 4) literature and data. The urgency score considers 1) how quickly this need is worsening or improving, and 2) how severely this need limits members ability to live a healthy life. Finally the strategic advantage score considers 1) how quickly this need could be addressed, 2) our existing capacity to address this need, and 3) how many other needs depend on this need being addressed first. See the methodology section and Appendix 25 for a detailed description of how each need was evaluated. Table 12 on the next page lists our 23 health needs from highest score to lowest based on our initial ranking exercise. A more detailed ranking can be found in Appendix 26 and Appendix 27 provides a document that highlights differences in ranking results when looking at each criterion individually. Although all of the needs are priority needs, to distinguish between the needs, we have identified each need as either critical, high priority or supporting. Although all of the needs described in this report can be considered priority needs, to help distinguish between them we have identified them as either critical, high priority or supporting needs:
Critical Needs are those that make sense to start with given how strongly the need is identified in community engagement, the urgency and severity of the need, and the strategic advantage to starting with addressing this need first. They ranked in the top five in our overall ranking exercise.
High Priority Needs ranked in the top ten of our overall ranking exercise and are also crucial to achieving our overall health vision. They may have ranked lower on any or all of our three evaluation criteria of popularity, severity and strategic advantage.
Supporting Needs represent the rest of our health needs. Although these needs ranked lower, they are similarly crucial to meeting our health needs and supporting the success of addressing other needs. They set the foundation for other needs being addressed. Some of the needs in this category are crosscutting needs that are foundational to our work addressing any and all of our needs. For example, the need for strong health governance, better coordination and public engagement will be important in work to address our health needs.
Prioritization tools like this initial framework will help to encourage implementation and results in our Health Plan. 64 65 Community Health Needs Assessment other health needs. * Indicates a Needthatare considered to be‘cross-cutting’ andshould beconsidered when addressing anyofour Critical Category Supporting High Priority Table 12:CommunityHealthMainNeedsbyPriorityCategory critical needstoaddress. ranking. Theseare themost scoring needsbasedonoverall These are inthetopfive highest other healthneeds. supporting efforts toaddress But theseare stillcrucialto on ourinitialoverallranking. highest scoringneedsbased These are notinthetopten important needstoaddress. overall ranking.Theseare very scoring needsbasedon These are inthetoptenhighest Safe Water Supply Quality Housing&Utilities Diverse Education&Training Mental Health&AddictionsCare Need Community Engagement* Clean Community Transportation & Connectivity Strong HealthGovernance* Coordination ofHealthServices* Promotion &Prevention Prevention &Harm ofViolence Accessible HealthServices Counselling &SocialSupports Peacekeeping &SafePlaces Comprehensive HealthCare Community Supports Opportunities toSupportOurselves Suicide Prevention Reduction &Prevention of Addictions Support forParents &Families Access toCulture* Supports forChildren &Youth Food &Nutrition Score 210 210 225 230 245 245 260 260 265 290 290 295 295 300 315 320 320 325 330 335 360 370 385 Prioritization Guide In the following pages of this section that describe each of our health needs in detail, each need is labeled as red,
orange or yellow to reflect the need’s priority category. Here we summarize the five critical priorities identified, Community Health Needs Assessment including the rationale that led to these needs being identified as critical priority. Critical Health Needs 1. Mental Health & Addictions Care The need for mental health and addictions care includes the sub-needs for a local healing facility, increased mental health and addictions programing and staff, comprehensive mental health and addictions care including sustained aftercare support. This need ranked high in our prioritization ranking due to the following considerations. The need was consistently identified across numerous information sources including community engagement sessions, interviews, staff sessions and our literature and data review. The urgency of our mental health and addictions needs is evident. The number of solvent abusers in our community is rising, (8.4% of the population in 1997, 16.5% in 2008)* and our suicide rate per 100,000 residents that is over 40 times higher than the rest of Ontario.** Mental health challenges and addictions significantly limit member’s ability to lead a healthy life, in some cases causing death. Although significant human resources and time will be required to address this need, it is a strategic place to start because so many of our other health needs depend on healing our community’s mental health challenges and addictions. 2. Diverse Education & Training Our need for education includes quality teaching and education resources, parenting help for Youth to stay in school longer, and help for adults to return to school. Our need for education includes access to higher education opportunities, but also access to our knowledge-keepers of cultural and land based skills. Education was in the top 10 most highly ranked needs in our community health needs ranking exercise and also identified consistently in interviews, staff surveys and in the literature and data. This need ranked highly in urgency as it is it is estimated that 300 - 500 school-aged children in our community are currently not going to school,*** and because we currently have a 3 year age/grade gap between our school and Ontario schools generally.**** The Chief Coroner’s report identifies education as one of the most powerful social determinants of health, so this need ranked high in severity. We are working on a new school building and we have the capacity of our existing teachers and education staff to build on, so this need ranked well in feasibility. Many of our other health needs depend on our need for quality education.
* Pikangikum Health Status Report, Appendix 5 ** Office of the Chief Coroner for Ontario. (2011). Death Review of the Youth Suicides at the Pikangikum First Nation, 2006-2008. *** North South Partnership for Children. (2008). Mamow Sha-way-gi-kay-win 66 **** Health Canada Community Based Reporting, Pikangikum 2009-2010. 67 Community Health Needs Assessment ** * Pikangikum CapitalPlanning Study. (2011). Pikangikum Health Status Report, Appendix 5 because somanyofourotherneedsdependonmeetingcurrent needforadequatehousing. and constructioncapacitytimetoplanbuildthenecessaryhouses.Addressing thisneedfirstisstrategic damages health,thisneedratedhighinseverity. Meetingthisneedrequires buildingonour existingcarpentry identifies that90%ofourhomesare notconnectedtothewaterandsewagesystem. was strongly identifiedasaneedinourhealthstatus report andtrends analysis.Our2011CapitalPlanningstudy Increasing thesupplyofcleanandrunningwaterrankedintop10needsourcommunityrankingexercise and lagoon upgradesandcemetery/burialplanningtoprevent watercontaminationandallowforinfrastructure. Our needforsafedrinkingwaterincludesrunningandsewagesystemsallhouses, watertreatment and 4. SafeWater Supply growing population. address overcrowding andthisdoesnotincludethe400homeswewillneedforourrapidly our 2011CapitalPlanningStudy. Thisneed isurgent: 200homesneed tobebuiltnow the toprecommendations from the2011ChiefCoroner’s report, andwasemphasizedin was thenumberoneneedidentifiedinourcommunityrankingexercise, wasalsooneof and heat,indoorplumbinghavingenoughreserve landfordevelopment.Thisneed and free ofmold.Itinvolvestheavailabilitydifferent housingoptions,reliable electricity The needforqualityhousingandutilitiesincludesensuringhomesare warmer, higherquality, 3. QualityHousing&Utilities the prevalence oflifestylerelated chronic conditions(diabetes, highbloodpressure, heartconditions), lack ofhealthyfoodlimits ourabilitytoliveahealthylife,thusfood andnutritionscored high inseverity. Considering need forfoodandnutritionwasidentifiedconsistently across information sources. Foodisanother basicneed,and increasing knowledgeabouthealthyeatingandstrengthening communitysupportsforaccessing healthyfood.The Our needforfoodandnutritionincludesaccess toaffordable, healthyandtraditionalfoods.It also includes 5. Food&Nutrition and foodhamper programs). Manyof ourotherhealthneeds dependonourneed forfoodandnutrition tobemet. be implementedrelatively quicklyandbuildon existing capacityandprograms (suchastheschoolfoodprogram ranked highinurgency. Strengthening supportstohelpwithfoodsecurity (foodbanks,communitykitchens)could other needsdependonhavingaccesstoasafe watersupply. supply willhaveimmediatehealthbenefits and canbuildonourexistingwatermonitoringcapacity. Manyofour is abasicneedfoundationaltogoodhealth.Intermsofstrategicadvantage,addressing theneedforsafewater growing population,theneedforasafewatersupplyrankedhighinurgency. Italsoranked high inseverity, aswater * Sincehousingisoneofourmostbasicneedsandovercrowding significantly * Giventhis,andourrapidly ** thisneed High Priority Health Needs Nine of our health needs are in the high priority category. Although their overall scores may be lower, in some cases they ranked very highly under one of our Community Health Needs Assessment criteria (popularity, urgency, or strategic advantage). For example, “Suicide Prevention” although mentioned less frequently during community engagement rated very high in urgency given the elevated suicide rate recorded and the severity of the consequences on individuals and families. “Access to Culture” rated very high in popularity, especially because culture is emphasized as a foundation for healing by interviewees and the literature. Culture can be seen as a cross- cutting need that needs to be considered when addressing any of our other health needs. “Community Supports” ranked very high in strategic advantage given the relative ease in which more community events and activities could be planned and existing capacity for event planning. Our nine high priority needs are: Supports for parents & families Supports for children & Youth Comprehensive health care Reduction & prevention of addictions Community supports Suicide prevention Opportunities to support ourselves Access to culture Peacekeeping & safe places
Supporting Health Needs Nine more of our health needs fall in the supporting category. Although they ranked lower overall, their importance should not be underestimated. These needs are necessary to address to ensure the success of efforts to address our other health needs. As with our high priority needs, some of these needs did very well in one specific criterion. For example, “Clean Community” ranked very high in strategic advantage due to the relative ease with which a community cleanup effort could be implemented, building on existing capacity. The results of addressing this need are a ‘quick win’ that could help build momentum for other efforts. Similarly, focusing on “community engagement” could be strategic given the demonstrated interest in more community involvement and our growing capacity of the staff to hold public engagement events. Our supporting health needs include some very important crosscutting needs such as health governance, community engagement and coordination, which should be considered when addressing any of our other health needs. Our nine supporting needs are: Counselling & social supports Promotion & prevention Transportation & connectivity Accessible medical services Coordination of health services Strong health governance Prevention of violence and harm Clean community Community engagement 68 Physical “ [There is] no expiry date on food from the land. (Interview) Health Food & Nutrition ”
Proper nourishment is a basic need no one should be denied. The World Health Organization defines food security as Critical existing when “all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life.”* Food security involves three elements: food availability (sufficient quantity), adequate access to food (sufficient resources to access, affordability) and appropriate use (adequate water, sanitation and nutritional knowledge).
Community Perspectives Keep the “teachings on Overwhelmingly and consistently, community of traditional foods” were how to live members have identified access to healthy, affordable both chosen to be in the and hunt. ” and traditional food as one of Pikangikum’s top health top five most important (Staff session 2) needs. Over all our community engagement activities, health priorities. During “more healthy and traditional food” was mentioned the same workshop, 29% of more than any other health need. In one session, 108 participants said that “More when Youth were asked to define being healthy, their greatest health is food traditional “eating healthy food” was one of their top responses, (including healthy food, food available and when asked what they do not have enough of 55% more food, and traditional for the of the 82 participants said “food” and 48% said they food). A review of current health programs revealed whole were getting too much “junk food.” Food was also a that food programs such as the Prenatal Nutrition family. ” (Community session 2) topic when asked about the roles that culture plays in Program, there are challenges with transportation and health: most respondents identified hunting and food getting food to the people who need it. As well, the skills as main ways that culture supports health. In our demand for food support programs exceeds current June 2013 Community Health Needs Ranking exercise capacity. “Children “better access to healthy foods” and “increase use need to be exposed to healthy foods Issues Possible Reasons Needs at an early »» Unhealthy food ~~ Lack of income available for food • Access to affordable, healthy foods age. ” »» Lack of nutritional knowledge ~~ Addictions, Trauma, Mental Health • Access to traditional foods (Staff session 1) »» Low availability of food ~~ Remoteness • Knowledge about healthy eating »» High cost of food ~~ Limited options for purchasing food • Community supports for food »» Lack of access to traditional foods ~~ Loss of traditional knowledge »» Illness from poor nutrition
69 * World Health Organization Glossary: http://www.who.int/trade/glossary/story028/en/ Food and nutrition was prioritized as a critical need given that it was consistently identified as important across information sources and ranked as one of our most urgent needs. The following specific needs were identified “ I like to eat through our process: healthy food.” (Youth session) Access to affordable, healthy food so that everyone can get the nutritious food they need, including supports to overcome addictions (which can use up money for food).
Access to traditional foods through knowledge and opportunities for hunting, trapping, “ Educating the fishing, and gathering and access to traditional foods through other community members. community on healthy eating Knowledge about healthy eating so members know how to prepare healthy and and making affordable meals and parents can teach their children healthy eating habits. healthy food available and Community supports for food such as improving and expanding existing programs supporting access to affordable.” food, and launching new supports like community kitchens or emergency food banks to improve food security. (Interview) Community Strengths & Resources • Skills and traditional food knowledge of our Elders, • Maternal Child Health Program: supports expecting hunters, and trappers. and new mothers with food hampers and resources. “ We could • Our land is home to moose, duck, geese, fish, rabbits • Prenatal Nutrition and Healthy Babies: focuses on lease out and other sources of healthy food. nutrition for expecting and new mothers, providing food the kitchen in the hotel • Our parents and school play important roles in hampers to 60-75 expecting mothers every month. to women to providing healthy nutrition for babies and children. • School food program provides hot breakfast and lunch feed people.” • Aboriginal Diabetes Initiative: health promotion, for children attending school. (Interview) diabetes prevention, and supports to manage diabetes.
Connections: Why are food and nutrition important for health? ~~Nourishment is necessary for healthy pregnancies and babies, and growing children. “ [We need ] a and learn. Children and Youth need good food to focus and learn in school. Food Bank. Honour ~~Nutrition is defense against infections and chronic health issues like diabetes and obesity. everyone. Or ~~Hunting, trapping, and fishing are a part of our cultural identity and get our members out a Food co-op, our own store on the land. with basic ~~Healthy food helps people participate in jobs and the community which supports livelihoods and governance. staples. ” ~~Hunger can cause cravings for alcohol, drugs or solvents and can worsen addiction. Poor nutrition and unstable (Interview) blood sugar can cause symptoms like “being out of it,” low energy, apathy, or agitation, which can be mistaken for, or contribute to, other mental health issues. 70 Need more healthy exercises for Physical Promotion & Prevention “adults and kids. (Interview) Health ”
Health promotion aims to facilitate individual and community empowerment so that all people, both ill and well, are able to Supporting achieve a greater sense of control over the many complex factors that affect their health.* Health Canada’s health promotion and disease prevention programs aim to 1) improve health outcomes associated with chronic diseases and injuries, 2) promote healthy behaviours in the areas of healthy eating, food security and physical activity, and 3) address chronic disease prevention, screening and management.** These programs are crucial in our community given that many of us our suffering or dying from preventable causes and conditions such as accidents or lifestyle related illnesses.*** Among First Nations and Inuit in Canada, chronic diseases now constitute the major causes of morbidity, mortality and disability. First Nations and Inuit populations “Youth and are at higher risk than the Canadian population for several major chronic diseases, such as diabetes, chronic obstructive children need pulmonary disease, cardiovascular diseases and more training Figure 20: Comparative diabetes rates for adults over 20 years old. cancer.**** Diabetes and high blood pressure account about Source: PFN Health Status Report healthy for the vast majority (66.2% and 18.1% respectively) of lifestyles.” 40% chronic conditions recorded in our community.*** Our (Community 30% diabetes rate is much higher than in other communities session 3) 20% (Figure 20). Our need for health promotion includes 10% encouraging and supporting physical activity, cultural “Need to 0% activities on the land, and health education such as get out on Pikangikum (Populaon Kenora District (excluding Ontario (Populaon 20+: nutrition and lifestyle workshops. Prevention includes the land, 20+: 1104) Kenora and Dryden, 9,283,154) education such as safety training, and help for Populaon 20+: 15,392) promote members to get the rest they need to stay healthy. wellness and spirituality. Community Perspectives ” Many people in our community love playing sports and active and exercising are main supports of good health, (interview) other outdoor cultural activities. In an overall tally of the but they feel they do not have enough sports and games. health needs mentioned in community engagement Staff are concerned that not getting enough exercise “Encourage being active.” activities, “recreational activities/sports” was among is contributing to high rates of diabetes and Youth (Interview) the top three most mentioned health needs. In all being bored. However, prevention is more than being community sessions, surveys and exercises people active. Throughout sessions and interviews, it was often identified that they want to see more opportunities for discussed that there is a need for more encouragement “Injury on the land because physical activity and recreation, for all ages. Being active for, and education on, healthy lifestyle choices such as they are not was a major part of how people defined physical health. stress management and nutrition workshops. Members taught what Community members recognize that our cultural heritage also mention the importance of getting enough sleep to do before involves being active on the land, hiking, walking, and having safe, healthy places to sleep. Interviewees they go out. ” (Interview) canoeing, swimming, and camping. In Youth sessions and also highlight the need to better prevent injuries when staff sessions, members emphasized that being physically people are out on the land and being active.
* Barr, V, Robinson, S, Marin-Link B, Underhill, L, Dotts, A, Ravensdale, D, Salivaras, S (2003) The Expanded Chronic Care Model: An Integration of Concepts and Strategies from Population Health Promotion and the Chronic Care Model. Hospital Quarterly Vol. 7, No. 1 ** Health Canada. (2011). First Nations and Inuit Health: Program Compendium 2011/2012. 71 *** See Issues Analysis Report in Appendix 19. **** FNIHM (2013) Chronic Disease Prevention and Management Model Project Concept Paper. Issues Possible Reasons Needs »» Low life expectancy ~~ Unhealthy lifestyles • Recreation/sports and events »» Chronic conditions (Diabetes, ~~ Mental health issues, trauma • Land based activities “Have more tournaments Cancer Asthma, Eczema) ~~ Poverty, other barriers to services • Healthy lifestyle education and sports days »» Organ Failure ~~ Lack of safety training, equipment • Prevention of injury for everyone. ” »» Injuries and accidents ~~ Violence (Community »» Lack of exercise ~~ Limited local health resources session 1) »» Lack of sleep Health promotion and prevention of illness and injury were prioritized as supporting needs given that many deaths are preventable and the relatively high strategic advantage of building on existing health promotion and illness “ Need outdoor prevention programs. The following specific needs were identified through our process: education for Youth. ” Recreation/sports activities and events for all ages, indoor and outdoor, all year. (Interview) Land-based activities and outdoor education to help people get out on the land. Healthy lifestyle education such as workshops and school classes that promote health, support healthy choices, and increase knowledge on health and preventing illness. “They should Prevention of injury through safety measures and education. play games Community Strengths & Resources every • Our love of sports and numerous sports teams, • Community programs focused on Mental Health and weekend. ” including hockey, soccer, baseball, and volleyball. Addictions prevention such NNADAP, Building Healthy (Community session 1) • Our hunters and trappers who can teach others to be Communities and Brighter Futures safe on the land and access traditional foods. • Community programs focused on Healthy Pregnancy • Community programs that support healthy lifestyle and Early Infancy such as Canada Prenatal Nutrition Do more choices such as Healthy Babies, Healthy Children and Program, FASD and Maternal Child Health “ outdoor Aboriginal Diabetes Initiative activities. ” (Community session 1) Connections: Why are promotion & prevention important for health? ~~Recreational opportunities help support mental health by relieving boredom and depression, encouraging positive coping, and developing social networks. ~~Preventing injury keeps you healthy and avoids boredom, depression, and negative work and social impacts. ~~Being physically active helps maintain good health and prevent chronic conditions like diabetes and heart “More workshops on health issues. disease. Being physically active, access to nutritious food, and getting enough sleep are important for keeping ” (Ontario Works survey) our body strong and able to fight off infections. ~~Sports help children and Youth develop confidence, positive goals, and team skills and can replace potentially harmful activities. 72 Combine western medicine and Physical Accessible Health Services “ medicine from the land. (Interview) Health ”
Barriers to accessing health services is a leading cause of poor health among Anishinaabe populations and as in many Supporting remote communities, many health services are available only outside Pikangikum.* Accessibility means: • Physically: location and hours are accessible, people with disabilities or those unable to travel can still get care. • Socially: people do not feel stigmatized for using the service, it is confidential and private. • Economically: people can afford to access and use the service. • Culturally: services are culturally appropriate and sensitive (like women having access to female staff), traditional medicine and healers are available to people who want them. • Communication: staff communicate effectively with patients, patients understand, and translation is available.** • Understanding: People can understand how to access services and where to get help.
Community Perspectives Health staff are concerned about barriers limiting and some members struggle participation in programs and workshops. In focus to access services outside of groups, they identify needs to better connect with the community. At our third members and to improve access to programs. Access community session, ‘transportation “Traditional barriers identified by staff include lack of understanding support services for patients’ healing of programs, lack of trust, privacy or confidentiality, and was voted as being important program- counselling, lack of knowledge as to how to connect to the program. to address. Youth and Staff are ceremony, Staff say that they are most worried about barriers for concerned that people do not know where to get medicine, sense of who Youth (especially sniffers and young parents), Elders, help. The lack of private places to meet creates a need they are. ” single parents, addicts, pre-school aged children, for better privacy and confidentiality for patients. In (Interview) people with mental health concerns and low income interviews, many people identify the need for culturally families. As well, specialist services are limited locally appropriate services.
Issues Possible Reasons Needs “Culturally- »» Lack of transportation to services ~~ Remoteness • Culturally appropriate services appropriate »» Lack of confidentiality for patients ~~ Barriers to access (e.g. poverty, • Increased understanding of counselling.” »» Limited culturally appropriate cultural differences, language) pathways to health (Interview) services and counselling ~~ Lack of trust, communication • Transportation support for patients »» Poor participation and low ~~ Cultural differences between • Specialist services locally available awareness of available programs health systems • Increased privacy
73 * SLFNHA, 2006, Anishinabe Health Plan, p.30, 47. ** NWLHIN Aboriginal Forum Summary Report 2009, p.11. Accessible medical services was prioritized as a supporting health priority given the strategic advantage to building existing staff capacity and developing resources to make existing services more accessible. The following specific needs were identified through our process: “Treatment closer to Culturally appropriate services including traditional healers, medicines, foods, and a local healing centre. home.” Increased understanding of pathways to health with programs that are understood by community (Interview) members and readily available. This includes support for self-management of chronic conditions, like appropriate guidance and education resources. Transportation support for patients to access health resources within and outside of the community. Specialist services more locally available such as dentists, eye doctors, and pre-natal services. Increased privacy in places where programs and services are offered so people can access health supports confidentially, and through operational polices and procedures to ensure confidentiality of health information. “ Properly trained Community Strengths & Resources counsellors and better • We have dedicated staff and leadership committed • Medical transportation support program confidentiality. ” to providing accessible health services. helps community members (Staff session 1) • Some of our community members have traditional access medical services outside health and medicine knowledge and could help our community. create culturally accessible health services. • Visiting specialists provide local • We have many community members who can oral health services (every 6 translate Ojibway and English. weeks) and dental hygienists (during the school year)
Connections: Why are accessible health services important for health? ~~Improving access to care has a positive impact on the prevention and management of chronic disease.* “ More Barriers to health services can mean that people do not seek the help they need and cause preventable specialist health complications services in Pik.” (Community ~~Barriers to health services can be very stressful and have negative mental health consequences session 3) ~~We currently lack data on who is accessing what programs. Tracking utilization and access rates will help us make important health governance decisions and allow us to adapt programming that does not seem to be meeting our community’s needs. 74 We need our people to get healthy Physical “ Comprehensive Health Care and strong. (Community session 1) Health ”
High Health care is comprised of a broad range of activities along a continuum of care including health promotion, prevention, Priority assessment, acute treatment, chronic treatment, rehabilitation and aftercare. A comprehensive health care system ensures that patients are being served effectively in all stages of this continuum. In our community specifically, this means ensuring that not only are health services culturally and socially accessible (see previous) but that we also have access to well-trained staff, adequate health resources and materials and regular health check-ups so that members receive long- term and consistent care that follows them through different health stage needs. The scale and urgency of these health care needs are compounded by a rapidly growing population and increasing rates of complicated health conditions.* “[We need] Good medical Community Perspectives service. ” (Community Our program review revealed that while many programs the 17 participants over 40). Young session 2) focus on health promotion and prevention, fewer parents are concerned about the lack programs offer chronic care treatment, rehabilitation and of medicine and doctors for their kids. aftercare.** While members seem somewhat satisfied with Band and Health staff are generally “More the quality of care they are receiving, there are concerns happy with quality of nursing services funding to about lack of health resources, inadequate staff and but identified needs for more reliable adequately train all inconsistent check-ups and follow-up. Suggestions from and capable Health staff; more staff. ” our first community session focused on resources such training, funding, materials, and counselling for Health (Staff session 1) as a new nursing station, more health care professionals, staff; and more community volunteers. Staff suggested and more flu-shots. At the second community session, that main gaps in our health system are counselling, members were split when asked to rate the quality of traditional healing, and medical emergency response. At “More workers the health care they are receiving. Of the 75 participants, our third community session, the Physical Health Need and a better building to fit 33% ranked it as Very Good, 27% Good, 33% Okay, 3% voted most important was ‘More nurses and doctors.’ everyone in.” Bad, and 4% Very Bad. When asked to score how well Other concerns raised in interviews were preventative (Staff session 1) they felt their physical health needs are being met, of measures such as better screening, more home visits, the 90 participants, the average score was 72% (63% for and more regular check-ups and doctor visits. “Need to Issues Possible Reasons Needs implement »» Lack of local health resources ~~ Lack of staff, resources, and funding • More doctors and nurses better »» Lack of resources to support staff ~~ Inadequate education, training • Training and counselling support screening programs. »» Insufficient staff ~~ Remoteness for local health staff ” »» Inexperienced staff ~~ Limited data collection/evaluation • Regular check-ups and screening (Interview) »» Lack of coordination ~~ Lack of communication between • More local health resources »» Delay in air ambulance staff, programs, organizations • Rehabilitation services ~~ Overlapping, unclear jurisdictions • Better medical emergency response 75 * See Pikangikum Health Status Report in Appendix 5. ** See Pikangikum Health Program Review in Appendix 20. Comprehensive care was prioritized as a high priority need given the significant limits lack of comprehensive health care puts on our member’s ability to live a healthy life. The following specific needs were identified through “ More our process: information More doctors and nurses and local health staff to meet community needs. on issues that are coming up Training and supports for local health staff such as buildings, counselling, with Youth.” volunteers, up-to-date information, resources and materials to make sure programs (Staff session 1) are properly implemented and to address health needs. Regular check-ups and screening to help prevent illness and chronic conditions. More local health resources including funding, medicine, dental care services, “ [We need more] information resources, and equipment such as defibrillators, computers and vehicles. Defibrillators - only at Rehabilitation services such as physiotherapy, home visits, and monitoring after people recieve care. nursing station Better medical emergency response to help prevent deaths and improve recovery rates. and Northern [Store]. ” Community Strengths & Resources (Staff session 1) • Local planning, health governance, and leadership - Home Care program: provides in-home supports • Members with traditional health knowledge - Healthy pregnancy and early infancy programs on “ [We need] • Nursing Station with nurses and doctors, as well as nutrition, FASD and early childhood development More visiting specialists. - Dental and Oral health care programs training… • Pikangikum Health Authority staff and its community • Regional health planning and advocacy agencies a program staffed with health programs, including: • Regional hospitals and treatment center such as dedicated, - Chronic disease prevention and management Thunder Bay Regional Health Sciences Centre professional programs such as the Aboriginal Diabetes Initiative and • Provincial and federal programs that provide health staff. Build capacity Healthy Babies, Healthy Children resources and funding within - Mental Health and Addictions programs that focus on community. ” mental health, solvent abuse, and crisis support (Interview)
Connections: Why is comprehensive health care important for health? ~~Health programs and services help prevent and heal illness and injury so we can stay active and live healthy lives. [We need] “ proper ~~Not having access to adequate, good quality health care is stressful and frustrating for individuals and families implementation ~~Quality health care is not the only thing needed for good community health. Other aspects of health build a of programs foundation of health that health care can support and improve. Health care cannot remedy root causes like that are available. poverty, poor nutrition, unsafe housing or lack of safety. ” (Staff session 1) ~~Health care that includes traditional healing remedies and medicines can support our culture and traditions. ~~Increasing local authority and control over health resources is part of improving the quality of health care. 76 Mental Stop drinking because people Mental Health & Addictions Care “get hurt. (Community session 2) Health ”
Mental health is defined by the Mental Health Commission of Canada as ”a state of well-being in which the individual Critical realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his own community.”* Unresolved mental health and addictions issues have the potential to cripple individuals, families and entire communities and can lead to violence and sexual abuse. Addictions have serious physical and mental health effects and negatively affect almost every part of community life including parenting, ability to go to school, ability to work, violence and crime. Trauma is one of the main causes of addictions. Addictions are often complicated by grief, depression, anxiety and other mental health issues that have not been healed. “Somewhere to send Community Perspectives families for Community members clearly identified addictions as alcohol shortens life. Band staff and Ontario Works staff time away for family the top health issue facing our people. The need for also identified alcoholism and gas sniffing as the top counselling treatment for addictions and related mental health social issues facing our community, which is supported and problems was mentioned in all sessions and interviews by evidence in the data that shows an increase in solvent multiple *** issues. activities and is supported by the community data on abuse. Youth gas sniffers were consistently identified as ” ** (Interview) alcohol, substance abuse and addictions. In an overall a group of particular concern. When members were asked tally of health issues mentioned in engagement activities, to rank 26 Mental Health and Addictions Needs, some “More “addictions” was overwhelmingly the most common. of the top needs identified were: more mental health training in 53% of 82 Youth respondents identify drugs/alcohol/gas and addictions staff and more community support and place for as something they are getting too much of. In June 2013 activities. Participants ranked treatment services within the addictions and mental when people were asked what is stopping them from community and outside of Pikangikum as similar priority health support improving our community health, a fifth of respondents and importance, suggesting that there is a need for both system.” said “substance abuse.” Our Elders shared their worries options. A local land-based treatment center was often (Interview) that children are drinking and that this is a serious threat suggested by members, and is one of the 2011 Chief to children’s development. Elders also spoke of how Coroner’s top recommendations for addressing suicide. “Sending people out Issues Possible Reasons Needs for treatment »» Alcoholism, solvent abuse, drugs ~~ Grief and trauma, residential school • Local treatment facility and program – aftercare »» Child/Youth addictions, FASD ~~ Depression, shame • More mental health/addictions staff problems lead »» Bootleggers ~~ Family issues • Accessible counsellors them back to »» Mental health issues, Suicide ~~ Poverty, frustration, hopelessness • Sustained aftercare support it. Need long »» Stigmatization of mental illness ~~ Lack of opportunities, boredom • Comprehensive mental health and term aftercare. ” »» Sexual abuse, violence ~~ Peer pressure addictions care (Interview) »» Lack of coordinated, long-term ~~ Availability of intoxicants resources, funding, and support.
* World Health Organization. (2001). Strengthening mental health promotion [Fact sheet No. 220]. Retrieved from https://apps.who.int/inf-fs/en/fact220.html. ** See Pikangikum Health Status Report in Appendix 5. 77 *** See Health Issues Analysis Report in Appendix 19. Alcohol and Solvent Abuse Quick Facts from Health Status Report “ Kids and • 97% of child welfare cases in Pikangikum are alcohol related. 90% of all our probations are associated with alcohol abuse. youth having • The number of solvent abusers in our community has risen from 142 in 1997 (8.4% of the population to 352 in 2008 (16.5%). trouble with solvent abuse • A survey in 2010 showed that 27% of 3rd and 4th graders in Pikangikum said they had previously tried sniffing gasoline. need something Mental health and addictions care was prioritized as a critical health need given how consistently this need was more identified in community engagement and research and the urgency and severity of our mental health and addictions therapeutic and lasting challenges.The following specific needs were identified through our process: than the Local treatment facility and program including community-based treatment with a focus on cultural, current camp. The kids just family-based, land-based, and Youth specific programs. come right More mental health and addictions staff so there are enough people in our community to provide back. A big contributor services like counselling and risk assessment. is boredom – kids just have Accessible counsellors who are culturally-appropriate, build trust and can ensure confidentiality. nothing to Sustained aftercare support in our community that coordinates closely with treatment programs to do. ” support people returning from treatment to help prevent relapse. (Interview) Comprehensive mental health and addictions care that coordinate efforts on the full continuum of care. “ With AA… Community Strengths & Resources It’s good • People who have healed from addictions and trauma • Local crisis and trauma teams. because it is can provide guidance and encouragement to others. • Our nursing station staff who work regularly with community- based and • Our mental health and solvent abuse workers. members with mental health and addictions concerns. people can • Community programs for health promotion, prevention • Friends, family, and groups in our community (like AA) go to learn and assessment such as NNADAP, Solvent Abuse who support those healing from trauma and addictions. about and follow the Program, Crisis Management and Brighter Futures. • Youth Gas Patrol to reduce and prevent solvent abuse. path that • Interagency cooperation between programs. • Land-based Solvent Abuse Program and camp. others have taken. ” Connections: Why is care for addictions and mental health important for health? (Interview) ~~Addictions negatively affect our physical health by compromising our immune system and damaging our bodies and minds. This is especially true for children, babies, and unborn children. “ Adults need aftercare too ~~Addictions worsen our mental health and vice versa and can contribute to our risk of suicide. following ~~Addictions and mental health issues can lead to violence and crime which hurt the safety of our community. treatment for ~~Freedom from addictions and mental health challenges will help us and our families succeed at school and at addiction.” work. Addictions compromise our ability to go to school, work and participate in community life. (Staff session 1) ~~Additions and mental health challenges can damage our relationships, often leading to violence, abuse, and families breaking up or broken friendships. 78 Mental Stop suicide. (Community session 2) Health Suicide Prevention “ ”
High Suicide is a tragedy for any community, especially when a young person takes their own life. First Nations communities in Priority particular experience a higher suicide rate than the Canadian population generally.* First Nations Youth commit suicide about five to six times more than non-Aboriginal Youth.** The prevalence of suicide is not evenly distributed across First Nations communities: some communities, like ours, struggle with high numbers of suicides every year. However, research suggests that there are things that First Nations communities can do and are doing to reduce and prevent suicide, such as promoting culture and supporting healthy grieving.*** Between 2001 and 2012, 70 of our community members killed themselves (see Figure 21). Compared to the rest of Ontario, Pikangikum’s suicide rate per 100,000 residents is over 40 “Talk to our times higher. A string of Youth suicides between 2006-2008 led to a specialized inquiry from the Chief Coroner of Ontario Youth to which highlighted the need for improved infrastructure, a community healing treatment centre and a comprehensive prevent mental health and addictions program. suicide. ” (Community session 2) Community Perspectives Although it is a painful and sensitive Figure 21: Reported suicides and suicide attempts in Pikangikum 2001-2012. Source: Pikangikum Police records, 2001-2012 topic to discuss, many community members talked about suicide as being 120 98 The lives of a top community health concern for our 97 “ 100 89 88 Youth are at community. At every session a strong theme 78 stake. ” has been the need to prevent suicide, and 80 (Elders session, especially Youth suicide. Elders shared May 2012) 56 their deep concern about suicide in the 60 48 40 41 community and the well-being of our 40 35 children and Youth. They describe Youth 17 27 Nurses need “ suicide as something that is crippling the 20 8 10 8 someone to do 3 7 4 5 6 7 4 7 3 suicide risk community and suggest that there is a assessments, need for young people to receive teachings 0 has to be a and guidance from Elders and parents. 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 medical Suicides Aempted Suicides person. The Pikangikum Health staff members also need for risk identify suicide as one of the most important health issues in Pikangikum and are concerned at how bullying assessment is seems to make it worse. Interviewees speak of the importance of suicide prevention programming, especially ones a fact. ” that support cultural continuity and self-determination. During our June 2013 ranking of community health needs, (Interview) “more suicide prevention programs” was a highly ranked community health need.
* Government of Canada. (2006). The human face of mental health and mental illness in Canada (Chapter 12). Ottawa: Minister of Public Works and Government Services Canada. ** Mental Health Commission of Canada. (2012). Changing Directions, Changing Lives. The Mental Health Strategy for Canada. 79 *** Chandler, M and Lalonde, C. (2008). Cultural Continuity as a moderator of suicide risk among Canada’s First Nations. University of British Columbia Press. Issues Possible Reasons Needs »» High suicide rate ~~ Depression, addictions, other • Suicide prevention programs »» Youth suicide mental health issues • Suicide education and awareness “ there’s no »» Attempted suicide ~~ Trauma, violence, abuse, bullying • Risk assessment teachings »» Cluster suicides ~~ Loss, grief, frustration, anger, • Safe places for high risk individuals from the »» Trauma and grief from losing loved isolation, hopelessness, boredom • Local treatment and aftercare parents, and ones to suicide ~~ Exposure to suicide options no listening ~~ People unsure/afraid to get help • Supports for healthy grieving from the kids, and kids don’t know how to Suicide prevention was prioritized as a high priority need given our high suicide rate and the severe consequences take what the suicide has on our members and families. The following specific needs were identified through our process: world has to offer. Suicide prevention programs addressing root causes of suicide, cultural connection, and self-determination. ” (Elders session, Suicide education and awareness so more people know suicide warning signs and can help each other. June 2013) Risk assessment so those at risk can be connected with support for healing. Safe places for at-risk individuals to go for help within or close to our community. Local treatment and aftercare options to support those recovering from or at “ Suicide risk for attempting suicide. prevention - Supports for healthy grieving so people who have lost a loved one to suicide can get people think of a suicide support to heal and recover and not contemplate suicide themselves. of someone Community Strengths & Resources else, and they end up doing • Friends, families and community networks that each • Our health governance and programs, mental health it as well.” other during crisis and mental health challenges. workers, counsellors, and crisis and trauma teams. (Interview) • Our resilience and strength in overcoming tragedy. • Regional treatment and healing centres and programs. • Mental health counsellors, Nodin counsellors, and • Support, ideas, and resources from other communities. school counsellors.
Connections: Why is suicide prevention important for health? ~~People at risk for suicide often struggle with mental health challenges like depression, grief, or addictions. For “ Someone with an unhealthy family and friends of suicide victims, trauma and grief can cause or worsen addictions or mental health issues. mind needs to ~~Grieving after losing someone to suicide takes time. People may need to stop going to school, work, or other be helped.” community involvement. Support for family, friends, and community is very important for people in crisis. (Elders session, ~~Poverty and the lack of livelihood opportunities can contribute to feelings of hopelessness and depression. April 2013) Not finishing school can also hurt the mental well-being of our young people. ~~Many cases of suicide are linked to cases of alcohol or solvent use addiction. ~~Violence and bullying are a contributing factor to Youth suicide. 80 Mental Stop the bootlegging. “(Community session 1) ” Health Reduction & Prevention of Addictions
High The United Nations reports that for every dollar spent on prevention of addictions, at least ten can be saved in reduced Priority future health, social and crime costs.* Globally, prevention and reducing access are often part of intervention strategies. This is done by trying to reduce the supply of intoxicants and prevent people from using addictive intoxicants through education and community rules. Providing support and treatment for those with addictions is profiled separately in this report (see Mental Health and Addictions Treatment). This need specifically explores how addictions can be prevented before they start. Reducing the supply of intoxicants and changing attitudes about alcohol, gas sniffing, and other drugs are not easy, but are critical to improving our health.
“No selling Community Perspectives booze. ” Community members of all ages are concerned Elders and Staff all agree that (Community session 1) about substance abuse and see a need for reducing alcohol, drugs and gas sniffing access and preventing addictions. The desire to stop are damaging their community solvent, alcohol and drug abuse is loud and clear and more needs to be done to across all community sessions. Members specify that prevent addictions. Elders in “Stop ways of doing so include limiting supply by targeting particular speak of the need for alcohol bootleggers, strengthening laws to prevent substance teaching values that will help from coming to abuse and providing Youth with more substance prevent addictions. Interviewees the abuse education and prevention programs. At our speak of the need for more programs for Youth to help community. ” first community session members said that the top prevent addictions such as getting Youth on the land (Community session 1) thing they want to change in our community is to stop intergenerational cultural programs where Youth learn solvent, alcohol and drug abuse, including stopping values from Elders. When community members were bootlegging. At our second session, when asked what asked to rank 26 Mental Health and Addictions Needs, the top thing there is too much of in Pikangikum, the top priorities identified included “stop bootleggers members identified alcohol, gas, and drugs. Youth, from operating” and “increase gas sniffing laws.” “Stop the gas Issues Possible Reasons Needs sniffing right now. ” »» Alcoholism, solvent abuse, drugs ~~ Grief, trauma, violence, abuse • Prevention of bootlegging (Community session 2) »» Children and Youth with ~~ Depression, shame • Laws against solvents, alcohol, addictions ~~ Family issues drugs »» Bootleggers ~~ Poverty, hunger, hopelessness • Reduction of intoxicant supply »» Fetal Alcohol Spectrum Disorder ~~ Lack of opportunities, boredom • Education and prevention (FASD) ~~ Peer pressure programs ~~ Availability of intoxicants
81 * United Nations Office on Drugs and Crime (2013) International Standards on Drug Use Prevention Reduction and prevention of addictions was prioritized as a high priority need given that the rate of substance abuse is rising and the significant limits addictions puts on our members’ ability to lead a “ Increase drug healthy life. The following specific needs were identified through our process: and alcohol laws. ” (Community Prevention of bootlegging with appropriate laws, enforcement and deterrents. session 3) Laws against solvents, alcohol, and drugs that are consistently enforced. Reduction of intoxicant supply such as alcohol, gas, and drugs. Education and prevention programs especially for Youth, such as awareness about the impacts of substance abuse on unborn babies and how Stop smoking “ and sniffing. mental health issues and addictions are related. (Community session” 3)
Community Strengths & Resources • Teachings from our Elders. • Building Healthy Communities - Solvent Abuse • Community rules about selling alcohol. Program: solvent abuse prevention programs through • Jobs that support people so they do not feel they have education, recreation and activities on the land. “ You have to to bootleg or turn to their addictions. • National Native Alcohol and Drug Abuse Program talk to sniffers in a gentle • Pikangikum Youth Patrol and Gas Patrol to reduce and teaches about alcohol and its damaging effects. way, they prevent Youth solvent abuse. • FASD and Child Nutrition program to reduce the are gentle • Case manager whose goal is to provide holistic case number of babies with FASD and prevent alcohol use people. ” management to Youth who abuse solvents and to during pregnancy. (Elders session, April 2013) those who are at high risk of abusing solvents • Brighter Futures program to increase awareness of child development and mental health.
Connections: Why is reducing and preventing addictions important for health? ~~Money for food and other basic needs is too often spent on substance abuse addictions, creating a vicious “ [My vision is] To see cycle where people turn to their addictions to try to cope with hunger, poverty, and depression. Pikangikum ~~Kids with substance abuse challenges in their lives (themselves or their families) are at greater risk for mental alcohol free health issues and suicide. They also are more likely to drop out of school. and solvent free.” ~~Substance abuse and selling alcohol, drugs, and gasoline for sniffing contributes to more violence, abuse, and (Community accidents. Substance abuse is contributing to more of our people committing crimes and going to jail. session 3) ~~Good governance with strong community laws and a supportive, connected community will help us to address substance abuse reduction and prevention. 82 Mental “ I get my strength from people and Counselling & Social Supports friends that talk to me. (Community session 3) Health ”
For mental health issues like depression, addiction, psychological trauma, stress, anxiety, bullying, grieving or suicidal Supporting thoughts, often an important part of healing is having someone to talk to and feeling connected to a social support system. For Aboriginal people specifically, best practices in therapeutic practice point to the need to connect healing efforts to a strong community support network.* The need for such support in our community has risen between 2009-2012 as mental health cases are on the rise as seen in Figure 22.** Counselling and social supports can help members struggling with mental health issues. Different support options, such as clinical counselling, help from friends or family, or cultural and community-based programs can connect people with mental health issues to the supports they need during their healing. “Helping one another Community Perspectives Figure 22: Mental Health cases per month, 2009-2012. makes our A consistent theme in our community sessions has 50 community 40 strong. been the need for more and stronger support systems 30 ” 20 (Community for mental health and well-being. At our first and third 10 session 1) sessions, participants said they want to see members 0 9 9 9 0 0 0 0 0 1 1 1 1 1 2 2 9 9 9 0 1 - 0 - 0 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 1 - 0 - 0 - 0 - 1 - 1 l - 0 l - 1 l - 1 p p p
working together, sharing and communicating, helping u u u J J J Jan Jan Jan Jan S e S e S e N ov N ov N ov Ma r Ma r Ma r Ma r “Listen to others, and supporting each other. This included Ma y Ma y Ma y one another help for Elders and Youth, those with addictions, and Works staff are concerned about the social impacts of and help each other be those being bullied. In our second session, participants suicide and losing family members and want to see more a supportive identified that there is too much bullying and addictions in supports available for people who are grieving. Band community.” our community and that we need to help each other more and Health Authority Staff want to see more counselling, (Community session 2) and increase communication, emotional support, and both for community members and community staff. counselling. Youth agree – many said they feel bullied, Staff suggest there should be many types of counselling “Helping each angry, sad, and lonely and do not have enough people available, including group sessions, land-based healing, other, talking to talk to about it. Elders stressed the importance of the confidential sessions, support groups, and healing circles together. ” teachings and guidance they received when young and so that we can share, listen, and support each other. This (Community session 1) fear that Youth today are not getting this support. Ontario is also important for people returning from treatment. Issues Possible Reasons Needs “ Properly »» Grief ~~ Tragedies, grief • Grief and healing support groups trained »» Trauma ~~ Violence, abuse • Community counselling and counsellors »» Depression ~~ Residential school support and better »» Shame ~~ Addictions • Support for getting help confidentiality. ” »» Stigmatization of mental health ~~ Poverty, frustration • Cultural and land based options (Staff session 1) issues ~~ Lack of opportunities, boredom • Post-suicide supports »» Loss of trust and communication ~~ Community conflict • Palliative care »» Loneliness ~~ Lack of trust and communication 83 * Waldram, James (2008) Aboriginal Healing in Canada: Studies in Therapeutic Meaning and Practice. National Network for Aboriginal Mental Health Research and Aboriginal Healing Foundation. ** See Health Issues Analysis Report in Appendix 19. Counselling and social supports was prioritized as a supporting health need given that mental health visits are on “Talk to those the rise and the supporting role that this need plays in addressing our other mental health who have addictions. needs. The following specific needs were identified through our process: ” (Community session 2) Grief and healing support groups such as healing circles or family-based counselling to bring people together to support each other. Community counselling and support such as church groups, women’s or “ Get into men’s support groups, or AA meetings that can support people in tough times groups, talk and strengthen individual and family coping skills. about how we feel and what Support for getting help from others through better community awareness of we need to do to. mental health issues and accessible information about how to get appropriate help. ” (Staff session 1) Cultural and land-based options for healing and support. Post-suicide supports such as grief counselling and support for families and friends of suicide victims. Palliative care to support people and their families when they are at the end of their life. More needs “ to be in place Community Strengths & Resources for helping men. Very • Community Mental Health workers, Tikinagan Child and • Brighter Futures’ community-based approaches to little support. Family Services, Nodin Child and Family Intervention mental health crisis management. People are Services, Trauma Teams and Pikangikum Health • People who have overcome trauma, mental health ‘crying out for help’, not Authority Crisis Team. challenges or addictions and can relate to other’s getting it • Teachers and school counsellors. struggles and provide support and inspiration. which can • Programs that support families in crisis. • People who want to help others, like support groups lead to violence. • Our sense of community and networks of friends, family. such as church groups or addictions support groups. ” (Interview)
Connections: Why are counselling and social supports for mental health important for health? ~~People need help dealing with things causing them stress, pain, or grief in their lives, such as poor living “ In a state of trauma, your conditions, domestic violence, poverty, addictions, or the death of a loved one. Without help, people may turn spirit is out to suicide, substance abuse, or hurting others. We need supports to manage stress and grief because they there, acts of can add to other problems we might have. Ongoing grief without a chance to recover can lead to depression, kindness bring the spirit back addiction, or suicide. Grief can also have serious impacts on physical health. to its place. ” ~~Mental health challenges can severely disrupt peoples’ lives, including going to school or work, taking care of a (Interview) family, or being involved in the community. ~~Mental health and addictions problems often occur together and are more complex to treat when they do. ~~People who need help are often limited in how much they can help and support other people. 84 “ Mental health patients end up in prison cells Peacekeeping & Safe Places because there is no safe place. (Interview) Safety ”
High Feeling safe is crucial to mental and physical health and is often discussed as one of our most basic needs.* There is a Priority need to prevent violence as described in the need “Prevention of Violence and Harm”, but when violence does occur, appropriate laws, human resources and infrastructure are needed to limit the damage. Keeping our community safe involves keeping peace between members, enforcing laws, protecting vulnerable people when needed, and resolving conflicts when they do happen. Our laws and infrastructure need to keep people, especially women and children, safe from abuse and violence. It involves specific infrastructure to provide safe havens for people in danger, a strong presence of well-trained peacekeepers, and appropriate laws and policies to allow peacekeepers to respond effectively. “Sexual abusers still live in Community Perspectives same house Consistently across many of our community sessions a need for places where - need safe haven. ” (July 2012, October 2012, June 2013), community people who are committing (Interview) members voiced concerns about the need for more violence can go for peacekeeping resources such as more and better intervention and help, like police/peacekeepers and more houses and safe places a place where men who are “Youth need to separate victims and offenders. In a ranking of 23 abusing their partners can confidence ** to use the safety needs, community members “better/faster get help to stop. Staff also system to response by police/peacekeepers”, “stronger laws to identify the need for better protect stop and prevent abuse” and “look out for each other” relations with police officers themselves, have to get as some of the most important safety needs. Similarly, and more police involvement in the community. They security in staff identify violence as one of our top health issues also identify the need for more effective responsive from community. ” (8% of 71 responses). Interviewees mention specifically police when incidents occur and capacity building for (Interview) the need for safe places for people in crisis and victims police and local peacekeepers to help them work better of abuse especially women and Youth. There is also together and be more effective in their role. “ Police get Issues Possible Reasons Needs involved with »» Bullying ~~ Anger, frustration • Community laws to stop and community. »» Violent crime ~~ Trauma, abuse prevent violence and abuse Be positive »» Abuse ~~ Addictions • Improved response by police and role models. ” »» Lack of safe places ~~ Mental health challenges peacekeepers to crises and (Interview) »» Inadequate policing or justice ~~ Housing shortage emergencies ~~ Legal system and high numbers of • Safe places and homes members going to jail • Larger team of peacekeepers • Look out for each other * Maslow’s hierarchy of needs (1943) as described on Wikipedia: http://en.wikipedia.org/wiki/Maslow’s_hierarchy_of_needs ** Participatory Assessment of Pikangikum (2008) 85 *** Pikangikum OPP officer receives international award (October 8th, 2009) Wawatay News Peacekeeping and safe places was prioritized as a high priority need given rising rates of violent crime and the many other needs that depend on peacekeeping and safe places to be addressed first. The following specific “ More training for needs were identified through our process: peacekeepers is needed to Community laws to stop and prevent abuse that are enforced and effective. support them on how to deal Improved response by police and peacekeepers to incidents and with violence. ” emergencies. (Interview) Safe places and homes such as drop-ins and safe houses for victims of abuse, women, Youth or anyone feeling unsafe, as well as having enough housing so that “ [We need] victims and offenders do not live together. more training for Larger team of peacekeepers so they can be more responsive to safety needs in our community. peacekeepers, like knowledge Look out for each other in our neighbourhoods, like a neighbourhood watch program. about working with violence. ” (Interview)
Community Strengths & Resources Sexual • We have strong leadership to guide us in our efforts to • The award winning ‘North of 50 Cops and Kids’ “ assault on improve community safety. program*** provides our Youth the opportunity to have children and • We also have our Elders’ guidance on justice. positive interaction with local police. youth [is] so common – • We have teams of local peacekeepers, Youth patrol, • We have access to the Canadian justice system through there are few security personnel, as well as Ontario Provincial Police. community courts. real penalties. ” (Interview) Connections: Why are peacekeeping and safe places important for health? ~~Most immediately, peacekeeping and safe places are about keeping people physically safe from harm. Feeling safe is necessary to be able to sleep and to be free from chronic stress, and both are necessary for good health. “ Police and ~~Peacekeeping and safe places are important for protecting people from and reducing mental and emotional Peacekeepers should work trauma that is caused by violence or abuse. Peacekeeping and safe places also support mental health and better addictions care because peacekeepers and police are often first responders to emergency situations. together. ” ~~Our need for safe places is related to our need for more housing options, as it would help avoid having victims (Interview) and offenders living under the same roof. ~~Strengthening laws to prevent abuse will help community members build more trust and confidence in the justice system that is designed to protect them. ~~Peacekeeping and safe places help everyone in the community by increasing the feeling of community safety. 86 “ [The] community does not feel safe.” Safety Prevention of Violence & Harm (Community session 3)
Feeling safe is an important part of mental, emotional, and physical health. To feel safe it takes more than laws and Supporting police. Community safety is also a product of effectively preventing violence and abuse, supporting healing of both victims and offenders, and community involvement in improving and protecting safety. This needs a unified community voice against bullying and violence and working actively with families to prevent violence against women and children. Community Perspectives From the beginning of our planning process and and harm. Ontario Works staff are particularly concerned throughout, community members have voiced concerns about bullying as a social issue in our community and about safety in Pikangikum, in particular about bullying its impacts on self-esteem and motivation. At our third “How [do] we keep and violence. This concern is supported by police data community session, 10% of participants said that bad people that shows a rise in violent crime incidents between things happening in the community are stopping them safe as families? 2001-2012 (see Figure 23). In an overall tally of the from improving our community’s health. Interviewees ” health issues mentioned in community engagement highlight that for women especially, freedom from (Interview) activities, “bullying” was the second most common violence in the form of physical and sexual abuse is an health issue mentioned followed by “violence.” At our unmet health need. In a ranking of 23 safety needs, first community session, the answer “Stop violence” community member ranked “increase chief and council was the fourth most common answer to the question involvement with safety”, “more community awareness “Leadership, support for “What would you like to change in our community of bullying” and “help offenders when they come home justice. ” today?” At our second community session, participants from jail” as some of the most important safety needs. (Interview) again answered that the lack of feeling safe and high Interviewees highlighted the need for counselling levels of bullying and violence are hurting their mental, and approach to justice that support both victims and emotional, and physical health. In Youth sessions, they offenders. They also emphasized that freedom from expressed that they are worried about safety and that violence and physical and sexual abuse is a high priority “There is bullying, anger, and violence are major sources of stress for women and children especially. violence within the Figure 23: Violent crime incidents (total reported) in Pikangikum 2001-2012. Source: Pikangikum Police records, 2001-2012 family, people don’t have 800 645 635 644 561 506 508 enough 600 outlets for 357 their anger. ” 400 246 238 (Interview) 206 207 200 98 0
87 Issues Possible Reasons Needs »» Bullying, Violence, Vandalism ~~ Anger, frustration, boredom • Community awareness of bullying »» Abuse ~~ Trauma, abuse • Chief and council leadership on “ Kids need »» Crime ~~ Addictions, mental health issues community safety sense of safety »» Failings of justice system ~~ Poverty, lack of opportunities • Safety for women & children and peace. ” »» Repeat offenders ~~ Many members going to jail • Help offenders when home from jail (Interview) »» Trauma of victims and perpetrators • Supports for victims & offenders Prevention of violence and harm was prioritized as a supporting need given the disruptive nature of abuse and violence and the limits it puts on peoples’ ability to lead a healthy life. The following specific needs were identified through our process: Community awareness of bullying and abuse so people can recognize them and help people get help. Chief and Council leadership on community safety showing safety is a priority. Stop teen Safety for women and children who are most often victims of violence and abuse. “ violence against Help offenders when they come home from jail to help them heal and to other teens.” prevent repeat offenders. (Community session 1) Support for victims and offenders of crime to support justice and healing. Community Strengths & Resources • Our Peacekeepers and the Ontario Provincial Police. • Meno-Ya-Win Health Centre • Successful past community safety programs such as the Assault Care Treatment program: assists individuals Youth Patrol and Gas Patrol. who have recently been sexually assaulted or • Our networks of families, friends and neighbours. experienced partner violence. • Resources of the justice system (courts, lawyers, judges). • Nodin Child and Family Intervention Services • Crisis and Trauma Teams: supports during crises. • Tikinagan: First Nations child protection agency with • Mental health counsellors and Youth counsellors. community-based approach to child protection. We are Connections: Why is prevention of violence and harm important for health? “responsible ~~Mental health issues, like depression or suicide, can be related to people suffering from violence or bullying. for creating a safe ~~Underlying health issues such as addictions, anger or hurt from past trauma or abuse, or desperation from environment poverty can be part of why people do violent things. Many cases of violence in Pikangikum are related to for our alcohol or solvents. community.” (Interview) ~~Not feeling safe causes stress and can make people afraid to be active and social. It can also hurt peoples’ ability to go to school or work. Violence causes physical injury, disability and trauma. ~~Both victims and offenders of violence and offenders involved in crime need support and healing. People that hurt other people are often hurt themselves too. Helping offenders to heal and come back to their community, especially if they have been in jail, is an important way to prevent future violence. 88 Every family needs a home. (Interview) Infrastructure Quality Housing & Utilities “ ”
On reserves across Canada there are housing shortages. The situation is most extreme in northern, remote communities Critical like Pikangikum where individual and family health is severely undermined by overcrowding, unsafe housing, and the lack of energy, water, and sewage infrastructure. The 2011 Chief Coroner’s report identifies Pikangikum’s housing shortage as a top priority.* Figure 24 illustrates the average number of people per dwelling in Pikangikum, in Aboriginal communities and the Canadian average.*** It is estimated that we need to build or repair 200 homes right now to address overcrowding.*** This does not account for our rapidly growing population which will require even more housing in the future.** By improving housing conditions, we will address roots of many other health and social issues in our community. “ We need more Community Perspectives electricity. ” Pikangikum members know that safe housing is critical for an important condition for health, (Staff session 1) good mental and physical health. At our first community and teens in particular are stressed session, members expressed pride about new houses by overcrowding in their homes. being built, but also that many more are needed. ‘More Elders emphasized the importance of “ We need every house and better housing’ was the fifth most common response children spending time at home so to have to what people wanted to change in Pikangikum. they can learn from parents, and they running Members want “clean living conditions,” “houses expressed concern that children and Youth today often water. ” (Community for everyone,” and indoor plumbing. Improving and do not want to spend time at home. Band and Health session 2) increasing housing has consistently been among the top Staff chose housing as the second most important health priorities for community health improvements throughout issue, specifically overcrowding and the lack of enough “Families need our community sessions and interviews. In October 2012, electricity and indoor plumbing. Ontario Works staff also their own homes members again identified “good housing” as part of think that housing is one of the top social issues in our so young parents have to learn to what physical health means to them, and that many of community. At our third community session, members parent. ” their health problems are caused by the lack of adequate, chose ‘More housing’ as the top priority and most (Interview) safe housing. Youth also recognized good housing as important of all community infrastructure needs.
“[I want] a Issues Possible Reasons Needs house that me and my kids »» Overcrowding (leads to increased ~~ Rapidly growing population • Quality housing (warmer, less mold) can live [in]. ” stress, risk of violence, and ~~ High costs for infrastructure • Availability of housing (Youth session, infectious diseases) ~~ Limited Band funding or personal • Different housing options October 2012) »» Unsafe housing (mold, fire risk, resources for housing or repairs • Reliable electricity and heat need for major repairs) ~~ Limited suitable land • Indoor plumbing »» Inadequate residential utilities ~~ Power, water systems at capacity • Enough reserve land for (power, heat, indoor plumbing) ~~ Capacity damaged by addictions, developments mental health issues, poverty * Office of the Chief Coroner for Ontario. (2011). Death Review of the Youth Suicides at the Pikangikum First Nation, 2006-2008. p.140 89 ** See Health Issues Analysis Report in Appendix 19. *** PFN. (2011). Capital Planning Study. Figure 24: Average number of people per dwelling in PFN, Canadian Aboriginals and Canada
“ I need a new house for my kids.” (Community Quality housing was prioritized as a critical need given the urgency created by current overcrowding and rapid session 2) population growth. Also because of the severe limits inadequate housing puts on members’ ability to live a healthy life. The following specific needs were identified through our process: Quality housing through repairs and good construction make houses warm, ventilated, secure, and mold-free. “new buildings Availability of housing to address lack of housing and overcrowding, and prepare for population growth. being built making our Different housing options such as apartments or shared living arrangements (e.g. Elders’ complex) for community members who do not want or need their own house as well as large houses to accommodate large families. a better place to Reliable electricity and heat to properly and consistently provide heat and electricity without exceeding live. ” the capacity of our utilities infrastructure. (Community session 1) Indoor plumbing to provide clean, running water to all houses. Enough reserve land for developments to address land shortage and expand suitable areas for housing. Community Strengths & Resources “ Make more apartments • Existing new houses and housing developments • Capital works, infrastructure staff for people.” • Members with carpentry/construction/repair skills • Water treatment plant and (Community • Pikangikum Housing Authority trained operators session 1) • Funding from federal government and CMHC • Power generating station
Connections: Why is quality housing important for health? ~~Overcrowding is stressful and damages people’s mental and physical health. It negatively affects our sleep, how “Some people have no we take care of ourselves, and our relationships. Unsafe housing (moldy, cold, at risk of fire) also damages health. place to ~~Stress and health damage from poor housing can lead to alcoholism, substance abuse and violence. live. We all need more ~~The negative physical and mental health impacts of poor housing negatively impact our work and livelihoods. housing, ~~Under stressful conditions such as unsafe and overcrowded housing, children and Youth are less likely to learn running well. As well, electrical power outages often close the school which hurts students’ learning. water, clean water. ” ~~When people are struggling with physical and mental health stresses from inadequate housing it makes it (Women’s Circle) difficult for them to participate in community programs and help others. ~~Lack of houses means that victims of abuse feel trapped. Overcrowding can increase potential for violence because people cannot give each other space, and Youth may not want to spend time at home, even at night. 90 Infrastructure Safe Water Supply “ My greatest health need is clean water. ” (Community session 3)
The United Nations recognizes the right of every human being to have access to sufficient water for personal and Critical domestic uses, which must be safe and physically accessible.* The Royal Commission on Aboriginal Peoples highlights that access to potable water and adequate sanitation has been routine for so long in Canada that most Canadians take them for granted; however, the same access is not guaranteed for Aboriginal people and their health suffers as a result.** The use of water includes water for drinking, cooking, bathing, washing and other purposes. For Pikangikum, 90% of our homes are not connected to the water system.*** Increasing household access to indoor plumbing and sewage systems was one of the key recommendations from the 2011 Chief Coroner’s Report. “ Need to get Community Perspectives indoor Community members consistently identify access to getting enough water to care plumbing. ” safe water as one of their top health needs. In an overall for one’s family and home (Staff session 1) tally of the health needs mentioned in community every day, especially when it engagement activities, “safe water supply” was one of involves carrying water and the top five needs identified. At our third community getting water in the winter. session, participants ranked “increase supply of clean Youth identified “clean water” and running water” as one of the top five most important as the number one thing infrastructure needs. In interviews with staff, many they did not have enough “[We need] Running individuals commented on how the lack of reliable access of (57% of 82 Youth). Other concerns about our water water in our to clean water is negatively impacting physical health, system were highlighted in interviews, such as concerns houses. ” causing stress, and hurting peoples’ self-esteem. People about leakage and contamination from the sewage (Community session 1) were particularly concerned about how limited access to lagoon and outhouses, and the need for upgrades to our water makes personal hygiene, such as brushing teeth water treatment plant. Our 2011 Capital Plan identified and cleaning skin, difficult and contributes to other, challenges with expanding water infrastructure, including more serious health conditions. In our women’s circle how many houses are not designed for plumbing, the lack discussion, several mothers expressed the challenges of of burial planning, and the need for more suitable sites. I need more Issues Possible Reasons Needs “water at my home. ” »» Lack of running water ~~ High costs for infrastructure • Safe drinking water (Community »» Unsafe water ~~ Limited Band funding • Running water for all houses session 2) »» Lack of connection to sewage ~~ Power infrastructure at capacity • Sewage systems for all houses systems ~~ Many existing houses not • Water treatment plant upgrades »» Leakage from sewage lagoon designed for indoor plumbing • Lagoon upgrades »» Lack of cemetery/burial planning ~~ Water contamination • Cemetery/Burial planning ~~ Traditions concerning burials * United Nations Global Issues: www.un.org/en/globalissues/water 91 ** Royal Commission on Aboriginal Peoples (1996) Volume3: Gathering Strength *** PFN. (2011). Capital Planning Study. Safe water supply was prioritized as a critical need given that water is a basic need required for health and that Good addressing this basic need with have immediate and tangible results on our members health. The following “ housing specific needs were identified through our process: with running water and washroom.” Safe drinking water to ensure safe, reliable, and accessible drinking water for all. (Community Running water for all houses through upgrades to provide water for session 2) drinking, cooking, bathing, and washing. Sewage systems for all houses either servicing or septic systems to “ We need to eliminate need for outhouses. clean our water and Water treatment plant upgrades to maintain and expand capacity. to keep our Lagoon upgrades to address capacity and contamination concerns. land clean.” (Community Cemetery and burial planning to uphold religious and cultural protocols, prevent water contamination, session 1) and limit complications for building new water infrastructure.
Community Strengths & Resources “ I need more help • Abundant fresh water in our lakes, rivers, and rain • Water treatment plant and trained operators for running water. ” • Many of our people spend lots of time on the water • Capital works, infrastructure management staff (Community and know it well session 2) • Local water monitoring program
Connections: Why is a safe water supply important for health? “Our water treatment ~~Water is a basic necessity for sustaining life and good health. Bad water quality can lead to a number of health needs a new problems including skin rashes and infections, diarrhea and other gastrointestinal illnesses. Access to a reliable system – the source of water is needed for daily hygiene, cooking healthy meals, taking care of teeth and sanitation. Many of automatic system broke us enjoy swimming for recreation and eating fish from the lake, so we need to protect our water quality. down and ~~Limited access to clean water for drinking and washing can harm self-esteem and self-image, especially when it the water reservoir is negatively impacts personal hygiene. Carrying water is a challenge for some, such as single parents and Elders. too low.” ~~Poor personal hygiene and reduced confidence can hurt individual’s efforts to apply for training and job (Interview) opportunities. Some people support their family with fishing so we need to keep our waters clean and safe. ~~Fewer boil-water advisories means less school closures, providing more consistent learning in school.
92 “ We need to fix our roads.” Infrastructure Transportation & Connectivity (Community session 1)
Transportation and communications infrastructure allow us to connect with people and resources within and outside Supporting of our community. Without adequate transportation, mobility supports, and connectivity infrastructure, our community members are can be isolated and unable to access services, opportunities, and supports they need. Our 2011 Capital Planning Study concludes that our roads are in substandard condition.* Just as roads and transportation options physically connect us, our communications infrastructure is also vital to access resources, opportunities and information.
Community Perspectives “ We need an “Increase the safety of our roads” was identified as a top community members. Interviewees all season priority during our Community Health Needs Ranking highlighted the challenge that road for the Survey. People are also concerned about the overall the community is not easy to cost of food to come quality of roads and the toll that poor road quality walk around, further limiting the down. ” takes on our safety and vehicles. Challenges associated mobility of members who do not (Staff session 1) with transportation also factor into many other issues have access to a vehicle. In our first discussed by community members, such as the high cost community session, community of food, the high cost of travelling out of the community, members identified community radio, Facebook and and limited training and employment opportunities. walkie-talkies as important ways to share community “ Need to provide In sessions and interviews with health staff, individuals information and keep members connected. Despite the transportation identified that some community members cannot popularity of Facebook and other online communication so people access the services and programs that would benefit tools, only 43% of 92 respondents said they have can go to meetings and them because they do not have transportation. When access to a computer. Ontario Works staff also identify workshops. ” 128 members were asked if they had transportation technology as a tool that can be used to access training (Interview) to access community engagement events, 53% said and employment opportunities. Band and Health Staff “No.” Ontario works staff identified transportation as identified that better access to computers and online one of the employment and training issues faced by resources would help them do their jobs. Issues Possible Reasons Needs “The roads need street »» Limited transportation options ~~ Remoteness, location, climate • Good quality, safe roads lights. ” »» Inadequate road infrastructure ~~ High cost of infrastructure and • Transportation supports (Staff session 1) »» Lack of lighting, unsafe roads unclear jurisdiction • Internet access »» Lack of transportation to services ~~ Lack of road maintenance • Community communication tools »» Limited access to cellphones, ~~ Poverty, high cost resources • Staff resources internet ~~ Limited funding for staff resources • Walking access »» Lack of resources, funding ~~ Some people are not very familiar with using computers, cellphones 93 * PFN. (2011). Capital Planning Study. Transportation and connectivity was prioritized as a supporting need given its popularity and its role in supporting efforts to address other health needs. The following specific needs were identified through our process: “ Road programming – we need to Good quality, safe roads to keep people safe, reduce damage, and include all-season access to improve improve mobility. roads.” Transportation supports for people to access health services or essential resources like food. (Interview) Internet access to access tools like email and Facebook as well as online health resources or education. Community communication tools like radio, Facebook, or web calendars to share information about events or programs and build pride and unity. Staff resources such as reliable access to email, computers, and vehicles to “ We need a improve efficiency and effectiveness. better road Walking access to make it better to walk to access resources and programs. because people’s vehicles keep Community Strengths & Resources breaking down and they have • Community radio station • Winter road, our local roads to buy a new • K-Net internet network and cellphone service • People do have vehicles and help others who do not one. ” • Our walkie-talkie network which does not rely on cell • Pikangikum Public Works Department (Youth session 1) service and is highly accessible • Medical Transportation support program (NIHB) • Community airport and dock
Connections: Why are transportation and connectivity connections important for health? ~~Limited transportation options negatively affect individuals’ abilities to access job and education opportunities off reserve or online, as well as members’ access to the land or water needed for land-based livelihoods. ~~Transportation and communications give access to health resources and information (within and outside of Pik). “More ~~Poor roads and no all-season road complicate transport of food, medical supplies, and emergency response. equipment to keep our ~~Well-lit and properly maintained roads are needed to ensure pedestrian, cyclist, and driver safety. roads safe.” ~~Difficult transportation of materials impacts our building of new housing and other infrastructure improvements. (Staff session 1) ~~Internet access allows members access to social networks, information about events or programs, cultural resources, and even counselling resources. It can have challenges such as addictions and cyber-bullying. ~~Reliable access to computers and the internet are important tools to support the work of staff in the community.
94 Clean community, bring back pride of young people. Infrastructure “ Clean Community (Community session 3) ”
Just as having a clean and well taken care of home can make someone happy and reduce stress, research shows that Supporting having a clean community can positively influence community safety, social networks and health.* A clean community involves managing our garbage, taking care of our environment and built environment and investing in things that make our community beautiful. Although our new community centre and daycare building is only a few years old, it is covered in graffiti and broken windows. Our Capital Planning study identifies concerns with our current solid waste disposal system and lack of organized collection of solid waste.** Addressing these issues could help increase pride in our community and positively influence our mental and physical health. “ Pick up garbage Community Perspectives every week. ” When community members were first asked about what they want a clean school and that (Community session 1) they want to change in their community, one theme there is too much garbage and litter was to clean up our community by cleaning up garbage in the community, and too many and pollution in the environment, removing and broken windows and vandalized preventing graffiti, and stopping vandalism. Participants buildings. At our third community suggested putting garbage cans around the community, session, community participants encouraging people to not litter, and cleaning up vote results showed that “Make “No graffiti the beach. Suggestions mostly came from younger our community beautiful (gardens, buildings, repairs)” on houses members (under 30). In our October 2012 community and “Clean up community (graffiti, garbage, old cars)” and session, participants again said that for families to be were both in the top 10 highest priority community buildings. ” (Community healthy, we need a clean environment and community. health needs overall, and they also scored highly for session 1) At Youth and Women’s sessions participants also said importance in the category of infrastructure needs. Issues Possible Reasons Needs »» Vandalism of community buildings ~~ Anger, frustration, boredom • Reduce graffiti or damaged and houses ~~ Lack of parenting, responsibility buildings we need to “ clean our »» Garbage ~~ Lack of building security or lighting • Reduce vandalism water and to »» Houses in disrepair ~~ Lack of community infrastructure • Manage garbage and junk keep our land »» Loss of pride in community and services • Make our community beautiful clean. ” »» Poor waste management ~~ Lack of resources to do repairs or (gardens, buildings) (Community build new amenities session 1) ~~ Worrying about repeat vandalism ~~ Capacity limited by addictions, depression, grief
* James Q. Wilson and George L. Kelling. (1982). Broken Windows: The police and neighborhood safety. The Atlantic; George L. Kelling and Catharine Coles. (1996). Fixing Broken Windows: Restoring 95 Order and Reducing Crime in Our Communities. Martin Kessler Books. ** PFN. (2011). Capital Planning Study. A clean community was prioritized as a supporting need given the relative ease with which a community cleanup effort could be implemented, thus building momentum for further health planning efforts. The following specific needs were identified through our process: “ [Our strength is from] Reduce graffiti and damaged buildings, fix vandalism and damage to our community buildings and help keeping our people remove graffiti from their homes. community clean and Reduce vandalism and work with children, Youth, and parents to teach about negative healthy.” impacts of vandalism, provide other things to do, and improve building security. (Community session 1) Manage garbage and junk by collecting litter and junk and setting up garbage collection. Make our community beautiful using gardens, new buildings or repairs to buildings, and community spaces like our new playground.
Community Strengths & Resources • Our beautiful land, water, and sky • Building managers and “Clean the beaches. • Our children and Youth care about cleaning up the caretakers ” (Community community and want to make a difference • Successful initiatives to session 1) • Local knowledge of our land and resources build community amenities • Many of us spend a lot of time outside in and around like our new playground our community and we know it well • Capital works, infrastructure management staff
Connections: Why is a clean community important for health? ~~Garbage and litter can be a safety hazard if it contains things that could hurt people or cause pollution. ~~Negative environments cause stress and reduce feelings of safety and social connection. If vandalism and “Paint the graffiti targets people this is bullying and can be mentally and emotionally damaging to the people targeted. school since ~~The physical condition of our community impacts feelings of pride and self-worth and when these are reduced there’s too much it impacts how much people want to connect with others and engage with our community. graffiti.” ~~Graffiti on school buildings creates a negative atmosphere and does not celebrate learning. (Youth session 1) ~~We could support jobs in our community to repair and prevent vandalism and clean up garbage. ~~Vandalism of public buildings (school, community centre, daycare, nursing station) can be expensive to repair and uses funding that could be used for other community health needs. 96 “I want to see more jobs Opportunities to Support Ourselves opening. (Community session 1) Livelihoods ”
High Economic status is consistently identified in the literature as a powerful determinant of health.* A recent report from the Priority Canadian Medical Association identified poverty as the single most important issue to address to support the health of Aboriginal people and communities.** A person’s livelihood refers to their “means of securing the basic necessities -food, water, shelter and clothing- of life.”*** Livelihoods include the set of skills and capacity required to meet the basic needs of themselves and their household with dignity. Our ancestors ensured their livelihoods through skills such as hunting and trapping. Today, many of us work towards developing skills and finding opportunities to earn sufficient income to provide basic needs for our families and ourselves. However, not enough of us find opportunities to work in our community. Only 130 of us hold permanent jobs although 1,000 of our members are between 20 and 59 years old.**** “ Good jobs for kids in future. ” Community Perspectives (Community In all community sessions, members voiced clearly that planning is a plan for increasing session 1) creating more and better jobs was an important change job and training opportunities, needed to make Pikangikum a healthier and stronger particularly for young adults and “ I want to community. Members also said that jobs and training Youth. In sessions with Youth, see a opportunities they have are among the things they they included employment in training centre for love about Pikangikum and are community strengths. their definition of what it means the youth. ” However, Ontario Works staff identify lack of job to be healthy. Elders also want (Elders session, opportunities, lack of training opportunities and lack of to see more training for young June 2013) experience as serious threats to members’ livelihoods. people. Community members who are working voiced Ontario Works data shows that the numbers of members the need for more on-the-job training. It was also clear “ [opportunities receiving subsidies are steadily rising even though the from community discussions that job creation should for] Providing + healthy meats majority of those members are considered employable. include working in the traditional economy – primarily through They see a need for more job opportunities, on the job hunting, trapping, and fishing. Members would like to hunting and training, job readiness and adult education. A major part see more support for livelihoods based on traditional fishing. ” of what members want to see come out of community skills and knowledge of the land. (Interview) Issues Possible Reasons Needs “ Getting »» Lack of jobs ~~ Remoteness and isolation • Good job opportunities education »» Lack of training opportunities ~~ Lack of access to markets • Job and trade skills training through »» Poverty ~~ Dependency • Supports for traditional economy Whitefeather. ” (Community »» Loss of traditional economy ~~ Education levels • Career planning and mentorship session 1) * Royal Commission on Aboriginal Peoples (1996) Volume 3: Gathering Strength ** Canadian Medical Association (2013) Health Care in Canada: What Makes us Sick? *** Oxford Dictionary of English. Oxford University Press, 2010. Oxford Reference Online. Oxford University Press. Malmo hogskola. 31 January 2011 **** Health Canada. (2010). Community Based Reporting, Pikangikum 2009-2010. + Ontario Works. (2012). Subsidy Claim Form Statistics Totals 2008-2012. 97 ++ NSPC (2009), Participatory Assessment in Pikangikum, p.13 +++ Enchokay Birchstick School, www.ebs-school.org Opportunities to support ourselves was prioritized as a high priority need given how often it was mentioned in “ [We need an] community engagement and the role it plays in preventing poverty, which is identified in the literature as a powerful On-the-job determinant of health. The following specific needs were identified through our training process: program.” (Ontario Works Good job opportunities, especially local opportunities for employment survey) that will ensure sufficient income to meet basic needs. “ I like Job and trade skills training to help people gain skills needed to working for the secure and succeed at employment. community, like building Supports for the traditional economy and activities like hunting, houses. ” fishing, trapping, and crafts. (Community session 1) Career planning and mentorship to help people plan their education and training, set goals, and succeed in their livelihood choices. “ Show what Community Strengths & Resources you are capable of • Ontario Works supports people who are unemployed • There have been successful training initiatives in the and use your • Whitefeather Forestry Project is a forest management past that we can learn from and build onto, such as knowledge project in the Whitefeather Forest, a section of forest the successful Wood Shop program that focused on and skills. ” ++ (Ontario Works in our traditional territory, is expected to generate developing employable skills for Youth. staff session) between 150 and 300 jobs for our members.++ • Our land, its fish and animals, our knowledge of the • Potential for tourism+ and the school is offering a High land, and traditional skills help to support us and Skills Major in Hospitality and Tourism, including an we can further encourage and support a revival of our “ People have to learn +++ outdoor education course. traditional and land-based skills. to help themselves. ” Connections: Why are livelihood opportunities and skills important for health? (Interview) ~~Employment is a ‘social determinant of health’ which means that it is part of the foundation that determines how “ Women need people live and stay healthy. Working (formally or informally) help people access healthier food, resources, and to be better living conditions. liberated - ~~Working provides people with a sense of identity and purpose and gets them interacting and building networks. they need to stand up on ~~Barriers to employment include other issues, like poor physical health, addictions, or mental health challenges. their own two ~~Barriers to employment also include low levels of completed education, limited access to suitable training feet.” opportunities in the community and the lack of support necessary for individuals to move out of the community (Interview) for periods of time to complete post-secondary and trades related training or educational programs. 98 Knowledge is power. No one can take Diverse Education & Training “ education back. (Interview) Livelihoods ”
* Critical Education is one of the most important and powerful social determinants of health. Completing high school reduces the rate of suicide, mental illness and substance abuse.* Children and Youth also need connection to culture and community to build their identity and pride in who they are and where they belong in the community. Youth in school need the support of their families and community, and they do better in school if parents and others actively encourage them in their education.** Lasting improvements in physical and mental health in Pikangikum depends on educating our Youth in all aspects of life, including school and preparation for life’s challenges and opportunities.
Community Perspectives Pikangikum community members are passionate about school, but also from Elders, “ I love how education. From the start, members were excited parents, and other community these that community planning would be an opportunity to members who have skills and kids go to school support better education. While the existing school experience. At the third session, everyday. ” and education system in Pikangikum is a community our young people showed (Community strength (as voiced by 20% of respondents in June their committed to helping session 1) 2012), members want to see improvements - particularly the community and desire for a larger and better new school building. This theme an education that will support continued in all community sessions. At the October them to do so. Ontario works 2012 session, a major theme about hopes for the staff identify lack of education future was more education for young people. In Youth as the top employment and training issue facing our “ We need sessions, Youth identified going to school to be a sign community. They identify the need for better education, students to of good health and that it helps keep you healthy. They improved educational facilities, increased graduation finish school said they enjoy school but want more education. As rates and adult education opportunities. and go to college so well, education is identified as not only happening in they can get their Issues Possible Reasons Needs diplomas. ” »» Low school attendance ~~ Lack of educational funding and • Quality education resources (Community session 1) »» Low school completion resources • Help for Youth to stay in school »» Inadequate education infrastructure ~~ Lack of opportunities • Help for adults to return to school »» Low educational attainment ~~ Lack of cultural and local relevance • Access to higher education »» Lack of access to training, in curriculum opportunities knowledge, and skills for cultural ~~ Addictions, mental health issues • Access to knowledge-keepers of and land-based activities ~~ Poor physical health cultural and land-based skills ~~ Family issues
99 * Chief Coroner’s Report, 2011 ** Minosa et al., 1990 Education and learning was prioritized as a critical priority given that it is identified in the literature as a powerful determinant of health and that our current infrastructure is inadequate in meeting our current education needs. The following specific needs were identified through our process: “ Community needs to Quality teaching, education resources, and school buildings to provide the best education possible. develop value Help for Youth stay in school longer with supports such as childcare for teenage parents and more of consistent education and encouragement for Youth who stay in school and complete high school. being in school – reason for Help for adults to return to school by helping them access options getting up in and providing supports such as childcare. morning.” Access to higher education opportunities with more options and (Interview) supports for those who would like to pursue higher education. Access to knowledge-keepers of cultural and land-based skills so more young people can learn about traditional skills and explore new ways to apply them. “ Get more Community Strengths & Resources teenagers to • Pikangikum Education Authority • Members working get education they are our • Our own primary to grade 12 school with teachers so instruction is available in English future. ” • Support and cultural courses offered by Elders and and Ojibway. (Community other community members, such as: Culture Break, • Federal funding for building a new school session 2) Literacy Program, and Homework Classes. • We have hosted four Youth conferences and • Our Elders and skilled knowledge-keepers. improved recreational programming to empower Youth.
Connections: Why is education important for health? ~~Education is crucial for mental health by empowering young people and supporting healthy social interactions. ~~A lot of health education and programming is delivered through the school, like workshops that teach about suicide, abuse, relationships, sex education, nutrition, and more. “ Listening to ~~The school is an important gathering place and a cultural centre for our community Elders stories, ~~A strong education increases an individual’s employment opportunities thus improving their quality of life learning from them.” ~~While school is important, informal community and cultural education (outside of school) is also central to (Community health. This includes teachings from Elders and parents and learning traditional knowledge on the land. session 2) ~~Education is also impacted by other health issues. Even young children may drop out of school if there is alcohol abuse or other addictions at home. Lack of sleep, healthy food, personal hygiene, and healthcare make it difficult for children and Youth to come to school and learn. 100 We are all of one mind - we can Social & Community Supports “ help heal together. (Elders session) Cultural ”
High In community development, people often refer to “social capital” as “the quality of the relationships and the cohesion Priority that exists among its citizens.”* The strength of these relations is identified as key to solving problems collectively.** Community members have expressed this idea, that their relationships to each other are important in building a healthy community.
Community Perspectives “ Need Community members consistently identified grief and trauma modeling community events and activities as a top health which can prevent or of healthy need priority. In an overall tally of all health needs damage interpersonal behaviours. ” mentioned in community engagement activities up to relationships. They also (Interview) June 2013, “recreational activities/sports” (mentioned identify the need to help 219 times) followed by “community/social support” each other, find support “ Have more (mentioned 218 times) were the second and third most from one another and community frequently mentioned health need after “more healthy talk to each other gatherings. ” and traditional food” (mentioned 220 times). They more. Many individuals (Staff session 1) identify a need for more opportunities for community mention the need for community members to get members to gather and share cultural, spiritual, together and participate in events and activities. Youth church sponsored and social events and activities as in particular identify fun activities with friends and “ Build new buildings a way to deal with issues such as addictions, violence, families as an important part of being healthy. like pool halls, coffee Issues Possible Reasons Needs shops for all ages to »» Loneliness and lack of help ~~ Addiction, depression, mental • Community groups and social hang out. ” »» Community conflict health issues networks (Community »» Lack of trust and communication ~~ Past trauma, hurt, abuse • Gathering places session 1) »» Patriarchy ~~ Poverty and stress • Spiritual activities and programs »» Lack of volunteers ~~ Feeling discouraged, frustrated, • Community conversations and »» Poverty ashamed, overwhelmed sharing “ need little, consistent ~~ Loss of traditional gatherings, • Events and celebrations activities that events, shared activities • Resources to support people in people will ~~ Lack of meeting places need like. ” ~~ Damage by colonialism (Staff session 1) ~~ Missionaries undermined traditional support systems
101 * Putnam, Robert. (2000) Bowling Alone. Simon & Schuster, New York. ** Brehm, John, and W Rahn. 1997. ‘Individual-Level Evidence for the Causes and Consequences of Social Capital.’American Journal of Political Science 41: 999 – 1023. Community supports were prioritized as a high priority need given how consistently the need for more community Being there “ for each event and activities was mentioned through community engagement, and the relative ease with which these could other. ” be implemented to create immediate results. The following specific needs were identified through our process: (Community session 2)
Community groups and social networks to gather people to share interests, activities and work together. Gathering places where people can get together and where community events can be hosted. More sharing “ to talk about Spiritual activities and programming diversity of options to help with spiritual guidance and health. problems in Community conversations and sharing opportunities to build openness, trust, and healing. life. ” (Community Events and celebrations to encourage interaction and community-building. session 3) Resources to support people in need so people can have energy and time to connect with others.
Community “ members to know one Community Strengths & Resources another more. • Strong networks of family, friends, and colleagues • Sports teams (hockey, soccer) ” (Community • Teachings and guidance of our Elders • Ontario Works programs session 1) • Our community centre • Community events (like fishing derbies) • Local artists, spiritual leaders, musicians and athletes • Programs like the food hampers and community than can lead activities volunteers helping members meet their basic needs. “ Get • Four churches and their programs community • Our community radio together for feasts. ” (Interview) Connections: Why are community supports important for health? ~~Engagement in activities can help counter depression and loneliness and build emotional and social support. ~~Social support systems can help individuals deal with mental health issues and grief and move through challenges. “ People ~~Safe indoor public places can create safe havens for individuals who do not feel safe at home. together ~~Stronger personal networks can help individuals access economic opportunities, engage in community life and - it will spread: learn about new opportunities thus contributing to our livelihoods and governance health needs. talking, ~~Relationships between members makes our community stronger and better able to address community problems. teaching, drumming. ~~Having activities to participate in helps Youth avoid boredom and depression. ” (Interview) ~~Spiritual and cultural events help individuals develop a sense of identity and learn traditional skills. ~~Access to cultural activities can help people heal, give guidance, and help build positive feelings and confidence. 102 Young couples need parenting skills, both Social & “ Supports for Parents & Families traditional and mainstream. (Interview) Cultural ”
High The Royal Commission on Aboriginal Peoples (1996) identifies family as the crux of personal and community healing.* Priority The time from before a baby is born until they are five years old is critically important for a child’s healthy development and has a very strong influence on children’s health and success as they grow up.** Raising children can be very stressful and demanding, so it is important that parents, families, and caregivers get enough support.*** Often, parents can learn the most from connecting with other experienced parents and learning from their valuable life experiences.****
Community Perspectives “ [Kids need] For parents People in Pikangikum have a lot of love for their children and Youth need to show their families and children, but they need more support. better parenting, good role children more love, caring. ” Participants at our first community session said they model parents, and family (Staff session 1) need more supports like daycare or babysitters for relationships that are loving, taking care of their kids. At our second session, the supportive, and open. Staff “women main theme for improving family health was giving are concerned that parents should take prenatal and receiving support from family, loved ones, friends, need parenting skills because classes, if we community members and programs and services. “they didn’t learn parenting ever have This includes emotional support, help with child care, skills from their parents and people are caught in the one. ” counselling and guidance, helping each other, and ‘cycle’.” Staff recommend that families spend more (Women’s circle) helping families stay together. Elders are concerned time together and with other families, share with each “[We need] Good that parents today do not have teachings to give other, and support each other. Staff want to see more support services their children and that children are not listening or people attending programs for parents and families, available for the spending enough time with parents. Young parents especially single, young, and low-income parents. At family. ” (Community session 2) want to spend more time with their kids and be there session 3, many people said they want to improve our to support them. Band and Health Authority staff think community by being better parents. “ Need traditional couples to mentor Issues Possible Reasons Needs young couples in »» Poor parenting ~~ Lack of parenting skills and mentors • Programs for healthy parenting family life. ” »» Lack of resources and supports for ~~ Breakdown of social networks and • Programs for healthy pregnancy (Interview) individuals and families community supports and babies “[We need] »» Substance abuse ~~ Poverty • Resources for parents and families Good parent »» Children taken away from parents ~~ Past trauma, hurt, and abuse (daycare, family centre) role models. ” »» Violence and domestic abuse ~~ Mental health issues • Role models, mentors for parents (Staff session 1) »» Poor nutrition for families ~~ Addictions • Safety for all children at home
* Report of the Royal Commission on Aboriginal Peoples (1996) Volume 3 Gathering Strength. ** Winnipeg Health Region Authority. www.wrha.mb.ca/community/publichealth/services-healthy-parenting.php *** www.circleofparents.org; Center For The Study Of Social Policy, ‘Strengthening Families’, www.cssp.org/reform/strengthening-families/messaging-at-the-intersection/Messaging-at-the-Intersections_Primary-Health.pdf 103 **** parentsanonymous.org/about-us/mission-history “ I need more Supports for parents and families was prioritized as a high priority need given how often this was mentioned in help from family members. key informant interviews and the urgency created by our rising population rate and prevalence of young parents. ” (Community session 2) The following specific needs were identified through our process: “ Need to learn Programs for healthy parenting so parents can learn skills, connect, help their children, and stay healthy. how to raise kids in proper way - Programs for healthy pregnancy and babies so young parents know how to avoid things that can Elders could help harm unborn babies and how to support healthy child development. teach healthy parenting. ” Resources for parents and families like daycare and child care and places for family programs (Staff session 1) and services, including family healing and treatment programs. I like thinking about Role models and mentors for parents in the community so parents can learn skills and get advice “how to help the and support from other parents and Elders. Elders and the Youth to go in the right Safety for all children at home so that fewer children are taken away from their path so they can homes and community. show their children how to help others.” (Community session 2) Community Strengths & Resources • Family members and friends help take care of children • Early Childhood “ Teach skills so families • Tikinagan: Band Family Service Worker program, Development program and can learn to Residential Care Worker, foster parent supports daycare understand • Nodin Child and Family Intervention Services • Family treatment centres and programs each of their children. • Aboriginal Healthy Babies, Health Children Program • Crisis teams to support to families in crisis ” (Interview) and Prenatal Nutrition and Maternal Child Health • Income assistance and programs to prevent child poverty and support low income families [Need] “ Opportunities for healthy Connections: Why are supports for parents and families important for health? relationships between ~~Families are the foundation of our community, and our community health. From strong, healthy families we have husband and strong, healthy community members who are active in our community and want to help others. wife.” ~~Children first learn about how to live from their families, including eating habits, exercise, how to have good (Interview) relationships, and how to cope with difficulties. If our parents and families are struggling, it negatively impacts need family therapy the physical and mental health of our children and Youth, and their children in the future. “not just youth in ~~Many aspects of community health impact families directly such as access to healthy food, good housing, clean separate place.” water, and safety. Without these things, families and parents are under a lot of stress and need support from (Interview) others and the community to keep their families healthy. 104 Youth are the ones who in ten years Social & “ Supports for Children & Youth will lead the community. (Community session 1) Cultural ”
High The 1989 UN Convention on the Rights of the Child establishes Youth’s basic right to education and to a standard of Priority living that meets their physical and mental needs. In addition they have the right to be actors in their own development and to express their views on all matters affecting their lives.* In addition to all the other community health needs profiled here, our children and Youth need specific supports for their health and development.
Community Perspectives Our members want to help our children and Youth but have enough people to talk to “Elders need to often feel lost about how to help. Many people want and want to have more school connect to Youth and better to see a better future for young people where there and sports. They also said that understand are more opportunities, including fun activities. At our they need more love and caring what Youth second community session, participants said they want and less boredom, anger, and need. ” to see more people talking with Youth to learn about loneliness. Older Youth spoke (Staff session 1) their challenges. Band and Health Authority staff want about wanting more counselling “ Kids need to see more help for young people, especially better and support programs, wanting someone to counselling and aftercare. Staff want young people get to finish school, and needing talk to. ” training to help their family, friends, and community. guidance. Younger Youth and children told us how (Interview) They want opportunities for Youth to be leaders. important it was for them to play, have fun, and spend “Teenagers to Staff think there needs to be more understanding time with family and Elders. All the groups of children be involved in between Youth and Elders. Elders said that they want and Youth told us that they want more things to do, community events. ” to understand the needs of young people to support especially in the evenings, and want to learn about (Community session 1) them. They are trying to help by offering teachings, Youth in other communities, visit other places, and have but realize that Youth may need to hear different speakers and musicians from other places come share “We love our young people messages. Children and Youth told us that they do not with them. and want to help them. ” Issues Possible Reasons Needs (Elders session) »» Poor parenting, lack of role models ~~ Disconnect from culture, traditions • Celebrate our children and Youth “Youth need to »» Boredom, discouragement ~~ Trauma, impacts of residential school • Youth role models, life guidance be shown what’s »» Harm (violence, abuse, addictions) ~~ Lack of parenting skills • Jobs and training opportunities good instead of »» Youth mental health issues ~~ Disconnect from parents, family, for Youth what’s on T.V. ” (Community (depression, suicide) friends, and other people to talk to • Fun things for young people to do session 1) ~~ Poverty • Train and support Youth leaders ~~ Lack of local activities, opportunities and mentors ~~ Racism, lack of pride
105 *UNICEF (1989) Youth and children Supports for children and Youth was prioritized as a high priority given the high percentage of our population “ have great ideas that are Youth and the strategic advantage of investing them and setting them up for a healthy life. The following that need to be specific needs were identified through our process: heard.” Celebrate our children and Youth in ways like ceremonies, gatherings, and community news to (Community session 1) encourage our young people and show them that we love them and are proud of them. “ [Get] Youth Role models and life guidance for Youth to learn about positive, healthy living and relationships. together with Elders to talk Jobs and training opportunities for Youth to develop self-esteem and skills to support their about values. ” futures. (Interview) Fun things for young people to do such as a drop-in center, sports, and clubs, to prevent boredom and encourage healthy behaviour, self-esteem, and friendship. My life would be “ better if I go out Train and support Youth leaders and mentors to be leaders for their peers and the community. more, instead of staying home.” Community Strengths & Resources (Youth session, July 2012) • Our young people – they are resilient, brave, caring, • Past Youth conferences to smart, and hopeful. build confidence, purpose, “ Kids love to be • Our love for our children and Youth and believing in hope, and coping skills. seen and praised in activities. their strengths and potential. • Sport teams, clubs, and ” (Interview) • Our parents, family, Elders, friends, neighbours, and recreation opportunities community leaders who want to build a better future. for young people. • Teachers and community members helping in school. • Youth patrol to prevent and reduce solvent abuse and Elders in • Organizations and staff working with children and Youth provide positive role models for other Youth. “ school - open, to keep them safe, provide counselling, and help them. • Youth Land-Based Healing Camp to help heal substance listen to Youth. Recognize • Pikangikum Daycare to support child development. abuse and mental health concerns. how world has changed Connections: Why are supports for children and Youth important for health? - open ~~Children and Youth today are our future adults, parents, employees, professionals, and leaders. dialogue.” (Interview) ~~Healthy habits (like eating well, being active, not using alcohol and drugs, and coping skills) begin in childhood. ~~Encouragement and motivation from the community help support children and Youth to stay in school longer, “ Youth need and this gives them skills and strong foundations for their lives. reaffirmation, ~~Young people who are supported and encouraged can use their energy to help other people in the community loved, to be and make our community stronger, healthier, more connected, and safer. honoured.” (Elders session, ~~Community members feel joy and hope from seeing our young people happy, energized, and healthy. April 2013) ~~Youth should be active members in shaping our community’s future - they have unique perspectives and strengths. *UNICEF (1989) 106 Social & Access to Culture “Go back to land and get our roots back. ” (Staff session 1) Cultural
High A loss of language or knowledge or disconnection from culture, land and traditional practices can undermine strong Priority identity and cultural continuity which negatively impacts mental and physical health and well-being.* Many community members want to revitalize culture and revive traditional practices.** There are signs that traditional knowledge is beginning to help guide healthcare initiatives and there are many Anishinaabe teachings and practices that can support health and healing.***
Community Perspectives “Reconnection From the start of our community sessions culture, in programs because they to our language, traditions, and teachings have been some think that reconnecting traditional of our greatest strengths and are highly valued. People to our traditions would ways, what we were especially enjoy hunting and fishing, though as one support health by meant staff member suggested, “we need to broaden what teaching values, reduce to do as we are trying to learn or re-learn - we need people addictions, encouraging Anishinaabe. ” to be story tellers, medicine men, dancers, singers… more traditional diets and (Staff session 1) we don’t just need hunters.” Generally, members are remedies, support people concerned that there are not enough opportunities coming together with love “A strong for traditional and cultural activities in the community, and respect, and giving people a better sense of self- community is + Elders who including learning from Elders. Elders have very worth. At our second community session, ‘talking to teaches us the important voices for wisdom and leadership in Elders’ was one of the top suggestions for how to old ways, how community and Elders expressed a desire for more stop mental health problems. At session 3, one of the they live and how intergenerational teaching to help families and Youth. common visions for our community health was keeping to hunt. ” (Community session 1) Band and Health staff want more Elder involvement traditions and teachings alive.
Issues Possible Reasons Needs “ Teach traditional life skills, survival »» Loss of traditions ~~ Reduction in traditional and • Bring Elders and Youth together and bush skills, »» Lack of cultural opportunities land-based economy, skills • Elder teachings and involvement navigational »» Lack of spiritual guidance ~~ Colonialism and racism • Cultural programs and events skills, traditional »» Intergenerational gap ~~ Residential school • Land-based activities and healing foods, »» Loss of identity ~~ Damage by Churches, missionaries • Traditional healers and medicines medicine. ” »» Loss of pride in culture ~~ Elders passing away • Cultural and land-based training (Interview) ~~ Family issues and breakdown programs and camps ~~ Influences of other cultures, media
* Hallett, D., Chandler, M. J., & Lalonde, C. (2007). Aboriginal Language Knowledge and Youth Suicide. Cognitive Development 22 (3), p.. 392–399; Cheechoo et al. (2006). ** Cheechoo et al. (2006); Participatory Assessment in Pikangikum (2008). 107 *** Auger, 2001, 84-85, 114. + Being a community ‘Elder’ does not depend solely on age, the status is also based on knowledge and leadership Access to culture was prioritized as a high priority as it rated very high in popularity, especially due to the importance that key informants and the literature identified in culture as a foundation for Family “ traditional healing. The following specific needs were identified through our process: values get families to be Bring Elders and Youth together to pass on traditional teachings and skills to more sociable towards other future generations, such as hunting and practices for good relationships and healing. family members Elder teachings and involvement to share guidance, language, and and community members.” traditions. (Staff session 1) Cultural programs and events in different ways and venues to celebrate people who practice traditional skills and crafts and so others can learn about them. “ We need our Land-based activities and healing to support individual and community well-being. people who know our teachings.” Traditional healers and medicines from our community and others, for members who want them. (Elders session) Cultural and land-based training programs and camps to teach knowledge and skills. Community Strengths & Resources “ I think our culture is • Our living traditional knowledge, culture, and • Annual Culture Break for our entire community. the most land-based activities (hunting, trapping, fishing, • Land-based Youth camp for those struggling with important thing and not crafting, story-telling). addictions or mental health issues. losing our • Elders, Hunters, Trappers, Fishers, Artists, Musicians, • Partnership to develop a curriculum with Elders language.” Dancers, Healers, Spiritual teachers, and Storytellers. teachings with college in Thunder Bay. (Community session 1) from within our community and other communities. • Traditional Healing, Medicine, Foods & Support • Eenchokay Birchstick school: language programming, Program (Meno-Ya-Win Health Centre, Sioux Lookout). Elders program, and cultural crafts programming. “ Elders need to teach children and Connections: Why is access to culture important for health? youth about ~~Community members defined mental and spiritual health to include learning from Elders and sharing hunting. ” traditional beliefs. Loss of cultural knowledge and identity can negatively impact mental well-being. (Staff session 1) ~~Traditional knowledge, including traditional foods and healers, can help heal and prevent illness and injury. ~~Traditional teachings and practices, such as grieving ceremonies, can help some individuals and families to “ Going to trap heal from trauma and grief and help restore balance in their lives. line to get healed. ~~Skills like hunting, fishing, trapping, and arts support our livelihoods, economy, and ability to stay healthy. ” (Staff session 1) ~~Teachings about respect for land and other people support our goals of having a clean, beautiful, safe and supportive community. 108 Community “We need more community & Health Community Engagement involvement. (Staff session 2) Governance ”
Part of good governance and a strong, healthy community is actively involved community members. Children, Youth, Supporting Elders, men, women, staff members – everyone can be involved in community leadership, decision-making, and events. Whether they are part of formal leadership, on a committee, volunteering in the community, or attending and participating in programs, more involvement from our community members will improve our community governance and our community health.
Community Perspectives “Get everyone Throughout our process, hundreds of community more support for Chief involved. ” (Community members have participated and expressed joy at and Council efforts. At session 1) coming together and having opportunities to work our second staff session, together. Community members want more ways to Health Authority staff said support each other and increase opportunities and they want to support more Need more “ directing by activities for everyone. People want to see more participation and need more community.” community participation in events and more people volunteers and community (Interview) getting involved in the community. Youth especially support. Staff again want more community activities and opportunities to identified Elders as the people they would most like to get involved. Elders want to understand needs of Youth have more involved in programs. In interviews, people more and help where they can. In our first staff sessions, emphasized that we need a strong volunteer base [We need] a “better staff said they want more members to work together and more encouragement of community involvement, understanding and get involved with programs. They think that more especially Youth and women. At our third community of the needs volunteers, especially Elders volunteering their time session, 60% of participants thought it is high priority to of the people of and knowledge, will help to make their programs and increase community communications (radio, newsletters, Pik. ” (Ontario Works session) services better. Staff would also like to see community websites etc.) and 56% thought it is high priority to members get more involved with leadership and show increase community participation in decision-making. “Chief and Issues Possible Reasons Needs Council need »» Lack of trust and communication ~~ Trauma, abuse, violence, and hurt • Opportunities for community more communication »» Community conflict ~~ Addictions, depression, and other dialogue with community. ” »» Lack of volunteers mental health issues • Participation in events and (Interview) »» Patriarchy ~~ Poverty programs »» Lack of fun events and recreation ~~ Poor health • Participation in decision-making opportunities ~~ Other commitments (child care, • Community volunteers »» Low participation rates in programs caring for family members, work) ~~ Discouragement, frustration, fear, 109109 shame, feeling overwhelmed Community engagement was prioritized as a supporting need given to its role in supporting health initiatives and the opportunity to build on the current momentum created by this planning process. The following specific needs I would like for “ people to share were identified through our process: their thoughts.” (Community Opportunities for community dialogue to improve our communication, session 1) help heal hurt and conflicts, build trust and unity, and help leadership and staff know more about what is important for community members. Participation in events and programs to help community members connect and build a sense of community and encourage organizers “ I like to see people helping to do future events. each other. ” Participation in decision-making for more input in community decisions, (Community session 1) Youth and women especially. Community volunteers to support community events and programs, give volunteers opportunities to learn and get involved, and to improve community connection and pride. I would like Community Strengths & Resources “ to see more • We have many children, Youth, men, women, and • Program administrators and staff participation from Elders who are passionate about strengthening our • Community media (radio, websites etc.) community community and want to help • Staff and leadership who want more community members.” • Close-knit community and families involvement (Community session 2) • Community leaders and role-models • Members with event planning experience
Connections: Why is community engagement important for health? ~~Community engagement helps improve our governance and planning for the community. ~~Community input and participation helps us make our programs and services better. “ Good ~~Volunteers support our programs, give staff encouragement in their work, and help staff run more programs. communication ~~Being involved in the community is a great way for individuals to improve their feelings of social connection from the people [would and emotional and mental well-being. help me do ~~Volunteering teaches new skills and empowers people to make positive changes in others’ lives and our my job community. better].” ~~Community involvement, participation in decisions and discussions, and volunteering helps empower our (Staff session 2) Youth and teaches them many skills to use in their lives.
110 Community “ [Improve] leadership - the way things & Health Strong Health Governance are run. (Community session 1) Governance ”
Health Governance refers to the administration of health care and the overarching political decision-making related to health.* For many First Nations, health governance is the responsibility of the federal and provincial governments, but Supporting starting in the mid-1980s many First Nations began to reclaim their health governance. In 2008, the Pikangikum Health Authority was empowered to deliver and manage many of our local health programs and in 2010, the Pikangikum Social Health, Education and Elders (SHEE) Committee was formed to provide guidance to our social, health, and education governance. We are growing our local health governance capacity and improving our organization and governance systems to improve the quality of our health and health-related services.**
“ Build case Community Perspectives management Many staff members as well as community members help secure more funding, capacity. ” identified the need for more leadership on health resources, and facilities. As well, (Interview) and healing. Generally, community members want staff identified the need to have to see more health services and programs available, better accountability through and to support this we need better local governance regular reporting, monitoring, in our health system. In October 2012, Band and and evaluation. Ontario Health Authority staff identified the need for more Works staff added that they “ We need proper training and the potential to improve implementation want a better understanding program of many existing programs. In June and July 2013, of community health needs delivery, more Health Authority staff identified that health governance through more workshops, presentations and research. resources for could be improved through better organization and In interviews, individuals identified the need for better each program.” (Staff session 1) work planning and administrative support. They also staff management with tools such as work plans, clear reemphasized the need for more staff training to build job descriptions, and better systems for patient records skills, capacity, confidence, and reliability. Staff want to and confidentiality. Interviewees recommended more see leadership be more involved with programs and training, leadership, and supervision.
“ [We need] a Issues Possible Reasons Needs strong community and good leaders »» High rates of preventable health issues ~~ Lack of resources and staff • Leadership on health issues to help people »» Delays in services, emergencies ~~ Inexperienced staff and governance to rise above. ” »» Gaps, duplication in programs ~~ Access issues for services, programs • Health funding and resources (Interview) »» Limited local health resources, staff ~~ Lack of coordination • Monitoring and evaluation of »» Lack of confidentiality for patients ~~ Limited data collection, monitoring services and programs »» Poor participation in programming ~~ Confusion over roles, responsibilities • Health data management ~~ Cultural differences between systems • Privacy, confidential records
111111 * First Nations Health Council of British Columbia. 2011. www.fnhc.ca/index.php/health_governance ** Chief Coroner’s Report, 2011 Health governance was prioritized as a supporting need given its crucial role in supporting our overall health planning efforts. The following specific needs were identified through our process: “ [We need] positive action Leadership on health issues and governance to give our staff and community from band council. members encouragement, motivation, and vision to continue their work on health ” (Community and healing. session 1) Health funding and resources to meet our community health needs. Monitoring and evaluation of services and programs so that we can learn from what is working well and identify things to improve. “ punch clock Health data management to improve accountability of staff and programs and track our progress. to better track hours. Privacy and confidentiality of recordsto manage our data and ensure that people feel comfortable ” (Staff session 2) using services.
Community Strengths & Resources • Pikangikum Health Authority and our authority over our • Programs that have regular reporting procedures could “ Create local health governance help other programs and staff to set up systems role models • Chief and Council • We have many members with experience in leadership at leadership level. • SHEE committee and governance in our community ” (Staff session 1) • Many of our staff have done training and our local • Partnerships with regional, provincial, and federal health governance capacity is increasing agencies and programs
Connections: Why is strong health governance important for health? “ [We need ~~Health governance problems negatively impact the availability and quality of services and programs more] ~~Strong health leadership is inspiring and motivating for community members who want to see issues resolved. Accountability, for people at ~~Many of our community staff members struggle with the same issues as our community members generally work to be (addictions, limited access to education and training, family trauma and loss, food insecurity) and they need responsible, support and encouragement from their organizations and management. We need to support our health and present, more productive, community staff so that they feel empowered and energized to help others in our community. and ~~Regular reporting, monitoring, and evaluation help us to improve our health services and programs and make effective.” sure we are effectively addressing community health needs. (Interview) ~~Data management and confidentiality makes people more comfortable with getting help and using programs.
* First Nations Health Council of British Columbia. 2011. www.fnhc.ca/index.php/health_governance 112 ** Chief Coroner’s Report, 2011 Community [We need to] know who does & Health “ Coordination of Health Services what, why, how. (Interview) Governance ”
Coordination, organization, and communication help people get things done together. In our health system, these Supporting are very important because there are many staff, programs, and organizations to coordinate. In 2012, the Mental Health Commission of Canada identified that more coordination, sharing, and partnerships among mental health organizations are needed to promote understanding and effective action.* And the Sioux Lookout First Nations Health Authority has identified the need for better coordination and integration of health services in our region because our health system is difficult to understand and this prevents us from working together effectively.** Tools like case management use a team approach to help staff coordinate and increase access to programs and services.*** “ Remind staff of role and job Community Perspectives description. ” For in-depth discussions about health and health- was better coordination and (Staff session 2) related programs and services, we had five sessions with collaboration. In September Band staff, Health Authority staff, and Ontario Works 2013, Ontario Works staff staff as well as many one-on-one interviews. At our first identified the need to share “ There’s no sessions in October 2012, the most common thing that costs for programs and coordination, too much staff said would help them meet community needs was activities run by different duplication. better communication and working together with all departments and identified We need an programs and organizations in the community. Staff needs for more teamwork independent coordinator. wanted to see more unity, resource coordination, and and communication. Interviewees also discussed the We’re not sure efficient implementation of programs. At our second need to better understand who does what and the who is in what round of sessions in June and July 2013, staff again need for information sharing. role, whose objectives, job stressed that the most common need across programs responsibilities. ” Issues Possible Reasons Needs (Interview) »» High rates of preventable ~~ Lack of resources and staff • Communication and information health issues ~~ Inexperienced staff sharing between staff, programs complete »» Delays in services, emergencies ~~ Access issues for services, • Clarity on roles and responsibilities “ information of everything my »» Gaps, duplication in programs programs of health staff and programs job is related to.” »» Limited local health resources ~~ Lack of coordination • Coordinated case management (Staff session 1) and staff ~~ Confusion over roles, • Cooperation and partnerships »» Lack of confidentiality for patients responsibilities, and jurisdictions between agencies and »» Poor participation in ~~ Cultural differences between organizations programming systems • Clear communication and access supports for members
* Mental Health Commission of Canada, 2012, p.113 113113 ** SLFNHA Anishinabe Health Plan 2006, p.6 *** Conrad N. Hilton Foundation. 2011. “Step by Step: A Comprehensive Approach to Case Management.” www.familyhomelessness.org/media/237.pdf Coordination of health services was prioritized as a supporting need given the prevalence with which it is “ [We need to] identified in staff interviews and surveys and given the many needs that could be better addressed by better learn to work coordination of health services. The following specific needs were identified through our process: together with other Communication and information sharing between staff, programs, and organizations, including on organizations planning, events and programs, information, resources, and data management. in the community. ” Clarity on roles and responsibilities of health staff and programs to ensure staff understand how (Staff session 1) they and others fit into our health system and how to work together. Coordinated case management so services and supports are organized and consistent. “ Get all resources Cooperation and partnerships between agencies and organizations at all levels so that programs [and] workers and services support each other instead of competing for resources and duplicating effort. together. ” (Staff session 1) Clear communication and access supports for members so they know what is available and what supports can help them to access them (e.g. transportation help, or finding child care to attend a workshop). “ [We need] Workers to show Community Strengths & Resources their faces or show up where • Pikangikum Health Authority staff, Nursing station • Connections with external needed. ” staff, Band staff, and Ontario Works staff agencies and organizations (Community • Trained and experienced staff and administrators with guidance and tools (e.g. session 2) • Existing tools for staff teamwork and communication Sioux Lookout First Nation • Staff and programs that are well coordinated could Health Authority, NAN, IFNA “ Clearly help provide guidance to other programs. Health Services Coordinator) defined roles – can be responsive Connections: Why is coordination of health services important for health? and complementary ~~Staff within and outside of the community need to know what their roles and responsibilities are, and how service.” to work with other staff and programs, in order to be most effective in their work to improve individual and (Interview) community health. ~~Lack of teamwork and communication between governments, administrators, staff, and programs negatively “ communication affects the availability and quality of resources and services for our community health. /collaboration ~~Overlap and duplication wastes resources and funding that could be used to address other health needs. protocol on working ~~Community members experience lack of coordination as a lack of availability, low quality services, and together. ” confusion about where to go and how to get help. (Interview) ~~Using cooperative approaches like case management, staff and support people within the community can * Mental Health Commission of Canada, 2012, p.113 come together and work to help individuals and families in ways that best suit their healing and support needs. ** SLFNHA Anishinabe Health Plan 2006, p.6 114 *** Conrad N. Hilton Foundation. 2011. “Step by Step: A Comprehensive Approach to Case Management.” www.familyhomelessness.org/media/237.pdf 115 Community Health Needs Assessment (6sub-needs) • • our CHNAprocess hasidentifiedare: order toimprove ourhealth.Themostcriticalcommunityhealthneedsthat there are severalthatare extremely urgent andcriticalthatweaddress in While allthesehealthneedsare veryimportantforourcommunityhealth, community. and organized summaryofthehealthneedsourmembers,families,and These 23healthneedsandtheirsub-needsprovide acomprehensive, holistic, Needs AssessmentSummary and exercises aspartofourCCHPprocess. when, andhow. Analysisofourhealth needsandhowtoaddress themiscontinuingthrough communitydiscussions address ourcommunityhealthneeds,wewillhavetoconsidermanydifferent factorsinchoosingwhattoaddress, ing needsscored highlyonspecificcriteria,suchasfeasibilityorpopularity. Whendecidingwhatactionstotake to In addition,asdiscussedatthebeginningofthissection,manyhealthneedsthatranked ashighpriorityorsupport gent attentiontoaddress thesuffering theyare causingandtoprevent themfrom worsening. These communityhealthneedsare bothfoundationaltoourpresent andfuture communityhealth,andrequire ur Quality Housing&Utilities (5 sub-needs) Mental Health&AddictionsCare (4sub-needs) • (6sub-needs) • (5sub-needs) • Food &Nutrition Safe Water Supply Diverse Education&Training All thatmattersis where yourlifeis “It doesn’t matterwhere youcome from orwhat youdidinthepast. headed NOW.” - - Conclusion
What an exciting journey this has been so far! Over the last year and a half, so many of you have come out and shared your hopes and ideas for a healthier Pikangikum. After multiple rounds of engagement, data collection, research and analysis, we are ready to present our CHNA and all of the resources that support it. Starting with community strengths, our CHNA builds on our foundation of community planning and action. Shaped by community voices, our CHNA defines health based on our values and perceptions of health. The result of our process is an assessment that reflects the interconnected nature of our community health and wellness needs. Our CHNA reflects our understanding of Pikangikum’s health needs at a particular point in time based on the Conclusion information we collected over the past year and a half. Our understanding of our community health needs will evolve as we continue the process with our CCHP. Specifically, some information gaps that will continue to be filled include:
• Health data: As described in our Health Status Report (appendix 5), we were not able to find data for all of the indicators we initially identified. Any other data collected through the CCHP process will help shape our final plan. • Community strengths: We have started the process of gathering information on community strengths in our CHNA to set a foundation for our CCHP. Figure 13 and Appendix 24 list all of the community strengths shared thus far. This list will continue to be populated as more strengths are shared during our CCHP process. • Underlying causes: In our CHNA we proposed some possible causes for our community health needs. Exploring root causes is a complex and ongoing process and we will continue discussions with community members to better identify these as the process continues. • Prioritization: While understanding that all needs are connected and influence each other, our CHNA’s preliminary prioritization helped identify needs that are strategic to focus on based on our current understanding of PFN’s health needs. Our CCHP planning process will allow us to further work with the community to refine prioritization criteria, and explore and rank options for addressing our health needs. • Program review: Our initial program review drew from staff and key informant interviews and helped us identify some strengths, issues and needs relating to existing health programming. During our CCHP this analysis will be strengthened as we continue to gather information on how all of the programs and health players interact with each other in the overall health system.
116 117 Conclusion continuing thejourneywithyou! directions wewilltakeandthepathstogetthere are stilltobedetermined.We lookforward to Our healthneedshavebecomecleartous;our visionforahealthierPikangikumisbecomingclearer. The Next stepsofourCCHPinclude: needs, weare poisedtotakethenextstepofcreating aplantoaddress theseneeds. serve asthefoundationinnextphaseofourcommunitydevelopmentstrategy. Havingidentifiedourpriority Our CHNAwillbeapowerfultoolforfuture decision-making,communicationandevaluation.Immediately, itwill • • Packagingdifferent solutionactionstohavecommunitymembersrank • Gatheringideasforactionsorsolutionstoaddress ourhealthneeds • Developingasetofhealthdirections andpathstoguidedecisionmaking • Developingasetofhealthcare principlesthatwillguidePFN’s CCHPandfuture healthdecisions • Creating avisionstatementforPFN’s CCHPbasedoncommunityfeedbackdraftvisionstatements ImplementationStrategyandmonitoring evaluationplan change and tostopthissadness.” “It isreally great seeinglotsof people comingand tryingto (Community session3)
List of Appendices Please see the accompanying Appendices Binder for the following appendices: Number Appendix Title #1 CHNA Glossary #2 How to use this CHNA #3 Step by step needs assessment guide #4 Guide to Community Health Needs Assessment Supporting Reports #5 Health Status Report #6 Community Health System Profile #7 Community Health History #8 Community Health Trends Analysis #9 Community Participation Survey Report #10 Community Open House Report #1 #11 Community Open House Report #2 #12 Staff report #1 #13 Youth Report #14 Elders report #15 Community Open House Report #3 #16 Staff report #2 #17 Key informant interviews report #18 Staff report #3: Ontario works report #19 Issues Analysis Full Version #20 Program Review #21 Newsletters 1-6 #22 Full list of Community Health Providers and Infrastructure #23 History Quick Facts #24 Full list of Community Strengths #25 Guide to Prioritization #26 Overall Ranking Results #27 Top results based on focusing on one criteria 118 © Pikangikum First Nation 2013