ᐋᔑᑯᒻ ᐱᐳᓐᐦ ᑎ ᐹ ᒋᒨ ᓯᓂ ᐦᐄ ᑭ ᓐ annual report 2016 2017 ᒥᔪᐱᒫᑎᓰᐅᓐ ᐊᓈᓈᑭᒋᐦᑖᑭᓅᒡ cree board of health and social services of james bay 2016 2017 ᒥᔪᐱᒫᑎᓰᐅᓐ ᐋᔑᑯᒻ ᐱᐳᓐᐦ ᑎ ᐹ ᒋᒨ ᓯᓂ ᐦᐄ ᑭ ᓐ creeᐊᓈᓈᑭᒋᐦᑖᑭᓅᒡ board of health and annual social services of james bay report Photo credits Cover photo dreamcatcher (detail) taken by Tatiana Philiptchenko Table of contents Pages 8, 9, 10, 11 & 12 — Tatiana Philiptchenko Page 13 — Rodolphe Beaulieu Page 17 — (a) & (b) Tatiana Philiptchenko and (c) Katherine Morrow Page 19 — Paul Brindamour Pages 20, 25, 26, 27, 29 & 31 — Tatiana Philiptchenko 6-7 organigram & population map Page 35 — Robert Auclair Pages 39, 41 & 42 — Tatiana Philiptchenko Page 43 — Robert Carlin 9 group Pages 44, 45, 47 & 50 — Tatiana Philiptchenko 1 board & executive Page 51 — Katherine Morrow Page 54 — Carolyn Wall 27 Page 55 — Joshua Loon 2 pimuhteheu group Pages 57 & 60 — ­Tatiana Philiptchenko 30 Pre-hospital Emergency Services and Emergency Measures Page 61 — Joshua Loon Page 64 — Tatiana­ Philiptchenko 32 Youth Healing Services Page 67 — Katherine Morrow Page 69 — ­Tatiana Philiptchenko 35 Youth Protection Page 71 — Virginie Lubino Pages 73 — unknown 38 Program Development and Support Pages 74 & 75 — Tatiana Philiptchenko 42 Page 77 — (a) Tatiana Philiptchenko and (b) Catherine Godin Public Health Page 79 — (a) Tatiana Philiptchenko and (b) Katherine Morrow Page 81 — Joshua Loon Page 83 — (a) & (b) unknown 55 3 nishiiyuu miyupimaatisiiun group Page 87 — Tatiana Philiptchenko 58 Organizational Quality and Cultural Safety Page 89 — Maggie Etapp Page 91 — unknown Page 93 — Matthew Iserhoff 61 group Page 94 — Tatiana Philiptchenko 4 Miyupimaatisiiun Page 95 — Iain Cook 63 Medical Affairs and Services Page 97 — unknown Page 99 — Tatiana Philiptchenko 66 Nursing Page 101 — Chantal Vinet-Lanouette Page 103 — Iain Cook 67 Allied Health Page 104 — Katherine Morrow Pages 105, 106 & 118 — Tatiana Philiptchenko 68 Psychosocial 70 With the exception of all photographs, the information in this publication may be reproduced without charge or further Chisasibi Hospital permission, provided that the CBHSSJB is identified as the source. Download a copy at: creehealth.org 75 Community Miyupimaatisiiun Centres (CMCs) Editor — Katherine Morrow Copy Editors — Patrick McDonagh, Alison Scott Statistics — Pierre Lejeune 95 5 administrative resources group Layout & design — Alison Scott Design 97 Human Resources Annual Report of the Cree Board of Health and Social Services of James Bay, 2016-2017 © 2017 CBHSSJB 99 Financial Resources Box 250, Chisasibi, QC J0M 1E0 100 ISSN 11929-6983 (Print) Information Technology Resources ISSN 1929-6991 (Online) 102 Material Resources Legal deposit — 3rd trimester 2017 National Library of Canada 104 Wiichihiituwin (Cree Patient Services) Bibliothèque et Archives nationales du Québec, 2017 107 6 financial statements CBHSSJB organigram

council of chishaayiyuu (elders) ᐋ ᑎᐹᒋᒥᑭᐎᔮᐦᒡ council of physicians, dentists About the CBHSSJB board of and pharmacists directors Founded in 1978, the Cree Board of Health and In addition to CMCs, the CBHSSJB operates council of nurses Social Services of James Bay (CBHSSJB) is the 29-bed Chisasibi Regional Hospital, three SERVICE quality and complaints responsible for the administration of health and homes for youth at risk, a Regional Public COMMISSIONER social services for all persons residing either Health Department and program planning unit, permanently or temporarily in Region 18, the ­Wiichihiituwin (formerly Cree Patient Services) administrative region of the Ministry of Health liaison offices in Chibougamau, Val-d’Or and executive CORPORATE SERVICES and Social Services of Quebec corresponding Montreal, and a recruitment office in ­Montreal. direction to the Cree territory of James Bay. Our mandate The Head Office is in Chisasibi. is defined in Chapter S-5—An Act respecting health services and social services for Cree The CBHSSJB is governed by an elected ­Native persons. Board of ­Directors whose Chairperson is Bella M. ­Petawabano. Advisory Commit- In each of the nine communities of Eeyou tees and ­Councils report directly to the Office Istchee, the CBHSSJB operates a Community of the Chair, as do the Service Quality and Miyupimaatisiiun Centre (CMC), which is similar Complaints Commissioner and the Medical nishiiyuu pimuhteheu miyupimaatisiiun administrative miyupimaatisiiun to a CISSS elsewhere in Quebec. CMCs offer ­Examiner. The Interim­ Executive Director is resources services in general medicine, home care, Mr. Daniel St-Amour. ­dentistry, social services and ­allied health. ᐙᐱᒫᑯᔥᑐᐃ 990 Whapmagoostui 6 pre-hospital community medical affairs human resources 7 emergency services development and services 7 and emergency complimentary medicine financial measures services and resources programs dentistry eeyou istchee youth healing pharmacy information Population July 2016 services organizational technology 4,693 ᒋᓵᓰᐲ quality and nursing Chisasibi 17,810 cultural safety resources youth protection evaluation and allied health material accreditation program resources development and client midwifery support experience and 1,539 organizational wiichihiituwin Wemindᐐᒥᓂᒌji disability psychosocial (formerly cree performance patient services) services maanuuhiikuu chisasibi (mental health) 803 va l- d’o r Eaᐄᔅstᒣᐃmaiᓐn chisasibi community hosptial miyupimaatisiium chibougamau public health centres montreal awash (0-9 yrs) uschiniichisuu (10-29 yrs) 801 Nemᓀᒥᔅᑳaska 3,763 ᒥᔅᑎᓯᓃ chishaayiyuu (30+ yrs) chisasibi chisasibi 2,398 Mistissini hospital eastmain serc (surveillance, There is approximately an additional 5% regional mistissini of non-permanent residents who also evaluation, research, receive -services from the CBHSSJB. communications) clinical nemaska ᐙᔅWaskᑳᐦagᐄᑲanishᓂᔥ health oujé-bougoumou The 0 to 4 year-old age group size has services been corrected using the 2011-2013 births waskaganish 845 (+ 2014 and 2015 estimates) and 2011- OujᐅᒉÉ-Bougouᐴᑯᒨmou telehealth waswanipi 2014 deaths numbers from the MSSS. wemindji Sources: MSSS, JBNQA Cree beneficiary list, 2016; MSSS Births whapmagoostui 1,978 databases 2011-2013; MSSS Mortality ᐙᔅᐙᓂWaswanipᐲi databases 2011-2014; Statistics Canada 2011 National Household Survey. This chapter summarizes the activities of the governance functions of the CBHSSJB under the current Chairperson, Mrs. Bella Moses Petawabano, and the interim Executive Director, Mr. Daniel St-Amour. Reports from Councils and Committees that report to the Board are also included here, such as the Council of Physicians, Dentists and Pharmacists (CPDP), the newly constituted Council of Nurses, the Service Quality and Complaints Commissioner and the department of Corporate Services.

9

1

ᑳboard ᐱᒥᐱᔨᐦᑖᑦ and executive Message from Message from the the Chair Executive Director

When I was elected Chair of the Cree Health On September 14, 2016 I was sworn in to my It has been my honour to continue to serve the ●● Construction of Women’s Shelters in Board in 2012, I had already been with the second four-year term as the Chairperson Cree Nation of Eeyou Istchee as interim Execu- ­Waswanipi and Waskaganish; organization for many years—including service of the CBHSSJB. The next four years will be tive Director during the past year. People who ●● New respirology services to help people as a Board member. I identified a number of marked by major capital projects including a have worked with me know that I am passion- with breathing and sleep problems; objectives that I wanted to achieve during my new regional hospital in Chisasibi, and there ate about logistics. As a Colonel and Canadian ●● Expansion of on-Territory specialist care tenure. First of all, of course, I wanted to see will be a stronger role for Nishiiyuu, the Depart- Forces Field Hospital Commanding Officer, I and telehealth services to reduce the need the very best of health care being provided for ment responsible for ensuring that Eeyou and oversaw and streamlined the deployment of for travel; all Eeyouch and Eenouch. I knew that to make Eenou values and approaches are integrated military hospitals around the world, including in this happen, the Cree Health Board would need into every aspect of care. As Chairperson I conflict zones such as Bosnia and Rwanda. In ●● Significant progress towards the goal of a strong Board of Directors. I am proud of how will continue with my fellow members of the health and social services, every member of the bringing childbirth back to the Territory; we have evolved in this area. Since early 2013, Board of Directors to maintain a constant and team—from the back office to the frontline—is ●● Investing in our Cree workforce through we put in place training for Board members real dialogue to listen to and understand your important to patient care. When systems work the Cree Succession program and other that has enabled them to be more effective community’s needs. We will work closely with efficiently, our professionals can focus on their ­training programs. 10 advocates for the communities that they are the community to provide quality care that is jobs of caring and healing, and our clients can The new Chisasibi Regional Hospital will open 11 elected to represent. In 2014, we adopted a ­culturally adapted to the community. focus on getting well. in 2024. We are already working towards that new Governance Model that gives existing and goal with the Strategic Regional Plan as our I thank Daniel St-Amour for his capable and I first arrived in Chisasibi in 2009 as Director new Committees of the Board a stronger role. road map. This year’s accomplishments dem- dynamic stewardship as interim Executive of the Hospital, and later I became Assistant In recent months I have been invited to speak onstrate the best that we can do. With the Cree Director this year. He has worked tirelessly to Executive Director for Administrative Services. about our Governance Model to Indigenous values of compassion and teamwork at the improve the functioning of this organization for I was invited by the Board to assume interim groups across Canada. core of our organization, with the leadership of the benefit of our clients, making numerous leadership of the organization and I have worked an engaged Board of Directors, with users who Financial year 2016-2017 began with the improvements and keeping long term projects every day to earn the confidence of our staff, speak up and speak out to demand excellence, Eeyou Eenou Regional Assembly on Health in on track. Through his dedication he has shown our clients, and the Cree Nation as a whole. I’m we cannot fail to achieve our vision. ­Waskaganish. The purpose of this innovative himself to be a true friend of the Cree Nation. extremely proud of what we have accomplished meeting was to bring all parts of our Nation together in only twelve short months: together to identify the priorities that will guide our organization in years to come. Using the ●● Implementing a new and more logical Cree Way of Voting we came to a consensus ­organizational structure; Daniel St-Amour on the priorities that will be reflected in the next Bella M. Petwabano ●● Expansion of the charter service with Air Executive Director CBHSSJB Strategic Regional Plan. CBHSSJB Chair Creebec to serve inland communities; ●● Reforming Wiichihiituwin (formerly Cree Patient Services) with a focus on major improvements in Montreal and improved communication with clients; ●● Obtaining Ministry approval to proceed with capital projects including the new Chisasibi Regional Hospital and 121 new employee housing units, which will be built using local expertise and labour; ᑳ ᓃᑳᓂᐱᔥᑎᐦᒡ board of directors

Regular meetings: 4 | Conference calls: 2 | Special meetings: 3

MEMBERS BOARD COMMITTEES | meetings: AC: 6 | HR: 3 Chair and Cree Regional Authority Administrative & Human ­Resources Committees ­Representative Bella M. Petawabano ᑳ ᒫᒨᐱᒡ ᒋᔖᔨᔨᐅᒡ Bella M. Petawabano Daniel St-Amour Council of Chishaayiyuu­ Eva Louttit Executive Director of the CBHSSJB Dr. Darlene Kitty Daniel St-Amour (Interim) L. George Pachanos The Council of ­Chishaayiyuu (elders) provides Minnie Wapachee guidance to the Board of Directors and the Community Representatives organization based on their knowledge of Cree L. George Pachanos, Chisasibi Audit Committee | meetings: 6 ­history, values and ­traditional healing practices.­ Eva Louttit, Eastmain Susan Esau Christine Petawabano, Mistissini L. George Pachanos ᑳ ᒫᒨᐱᒡ ᒋᔖᔨᔨᐅᒡ ᒋᔅᒋᓄᐦᐅᒧᐙᐅᒡ ᑳ Stella Moar Wapachee, Nemaska Patricia George ᓃᑳᓂᔥᑭᒥᔨᒡᐦ ᓂᑐᐦᑯᔨᓐ ᐋᐱᑎᓰᐎᔨᐤ ᐅᐦᒋ ᐊᓂᔮ Minnie Wapachee, Oujé-Bougoumou ᐅᒋᔅᒑᔨᐦᑎᒧᐎᓂᐙᐤ ᑳ ᐃᔅᐱᔨᔨᒡᐦ ᐙᔥᑭᒡ ᐄᔨᔨᐤᐦ, Susan Esau, Waskaganish Vigilance Committee | meetings: 3 Jonathan Sutherland, Waswanipi Bella M. Petawabano ᐃᔑᐦᑣᐎᓐᐦ ᑭᔮ ᐄᔨᔨᐤ ᐋᓂᔅᒑᐤ ᓂᑐᐦᑯᐦᐄᐙᐎᓐᐦ᙮ Frank Atsynia, Wemindji Daniel St-Amour Patricia George, Whapmagoostui Stella Moar Wapachee Susan Mowatt, Observer for Washaw-Sibi Christine Petawabano 12 Louise Valiquette, Service Quality and Complaints 13 Clinical Staff Representative Commissioner Dr. Darlene Kitty Sarah Cowboy, Assistant Service Quality and Non-Clinical Staff Representative ­Complaints Commissioner

Reggie Tomatuk Moses Petawabano Advisory Committee | mtgs: 4 Bella M. Petawabano Eva Louttit Susan Esau Christine Petawabano

Standing (left to right): Earl Danyluk, Nancy Danyluk, Roderick Pachano, Elizabeth Dick, Robbie Dick, Jane Kitchen, Abel Kitchen. Seated: Laurie Petawabano, Robbie Matthew.

Left to right: Reggie Tomatuk, Stella Moar Wapachee, Frank Atsynia, Patricia George, Darlene Kitty, Bella M. Petawabano, Daniel St-Amour, Eva Louttit, Susan Esau, Minnie Wapachee, Chris Petawabano, Jonathan Sutherland, L. George Pachanos Facebook: more than doubled to 2,865 followers Twitter: increased by 706 to 1,861 followers executiveᑳ ᐱᒥᐱᔨᐦᑖᒡ and senior ᐋᐱᑎᓰᐎᓂᔨᐤ management Instagram: new @creehealth account has 513 followers Creehealth.org: up 26.6% to 44,000 user sessions. 47.3% use a mobile device—effort OFFICE OF THE CHAIR to make site more mobile-friendly would be Bella M. Petawabano Corporate recommended; most popular page: Careers Louise Valiquette, Service Quality and Complaints Commissioner (Interim) Services

Senior Management MIYUPIMAATISIIUN GROUP The Corporate Services Department led by A public tender process to identify an external Greta Visitor, AED (Interim) Laura Moses provides support to the Board of French-English translation firm resulted in the GENERAL MANAGEMENT Dr. François Charette, Director of Medical ­Affairs Directors and associated governance functions awarding of a three-year contract to the Mon- Daniel St-Amour, Executive Director (Interim) and Services of the CBHSSJB, and also oversees the corpo- treal-based Services Linguistiques Versacom. Paula Rickard, Assistant to ED (Interim) Philippe Lubino, Director of Hospital Services rate communications and translation units. The Selection Committee included an external Laura Moses, Director of Corporate ­Services (Interim) member from Niskamoon Corporation. Versa- Michelle Gray, Director of Professional Services With the re-election of Bella M. Petawabano to com will work with the in-house English-French PIMUHTEHEU GROUP and Quality Assurance (DPSQA) Health a new term as Chair, the momentum continued translator to meet the needs of the organiza- Adelina Feo, Assistant Executive Director Adelina Feo, DPSQA Allied Health (AED-Interim) around the strengthening of the Governance tion. A Cree translator position was created. Doreen Perreault, DPSQA Psychosocial Robert Auclair, Director of Youth ­Protection (DYP) Model. Many new Governance Policies and Gloria Ann Cozier, Assistant to AED, Services Marlene Kapashesit, Assistant DYP – Youth tools were adopted, and the Board Committees The Corporate Services Department provided Clarence Snowboy, Assistant to AED, Operations Criminal Justice Act and Foster Homes continue to be very active. The department was project management support to two strategic (Interim) Maria McLeod, Director of Youth ­Healing ­Services very involved in the April 2017 Regional General projects that are inter-departmental collabora- 14 Anne Foro, Director of Planning and Programming Local Directors - Community Assembly on Health in Waskaganish, which tions: editorial supervision of the Therapeutic 15 ­Miyupimaatisiiun Centres (CMCs) was livestreamed and broadcast on the radio, Guide and Collective Prescriptions and Project Public Health ­Department Jeannie Pelletier, Chisasibi (Interim) and which led to the identification of communi- IKA (Internal Knowledge Access)—a partner- Dr. Robert Carlin, Director of Public Health (Interim) Rita Gilpin, Eastmain ty priorities for the next Strategic Regional Plan ship with the IT Department to improve access Dany Gauthier, Assistant Director of ­Public Health Taria Matoush, Mistissini of the CBHSSJB. to internal administrative documents (forms, - Awash Miyupimaatisiiun and Uschiniichisuu­ Linda Orr, Nemaska (Interim) contacts) and to identify a suitable technology (Interim) Louise Wapachee, Oujé-Bougoumou In Communications, the two-person unit of platform to support a full-fledged Intranet or Paul Linton, Assistant Director of Public Health - Katherine Morrow and Tatiana Philiptchenko Chishaayiyuu Miyupimaatisiiun Bert Blackned, Waskaganish electronic document management system. collaborated with other communications Jill Torrie, Assistant Director of Public Health Alan Moar, Waswanipi personnel within departments to continue to In the coming year a newly created Cree Trans- - Surveillance, Evaluation, Research and Mary Shashaweskum, Wemindji (Interim) ­Communications (SERC) Charlotte Kawapit Pepabano, Whapmagoostui develop an impressive array of well-managed lator position will be staffed, the IKA project will (Interim) communications platforms. The CBHSSJB pursue a twofold strategy of building a struc- NISHIIYUU MIYUPIMAATISIIUN GROUP has fully embraced social media. In addition to tured collection of administrative documents Kathy Shecapio, (AED-Interim) ADMINISTRATIVE RESOURCES GROUP the website, the Facebook, Twitter, Instagram, and identifying a suitable software platform Liliane Groleau, Assistant Executive Director Flickr, SoundCloud and LinkedIn platforms are for the future Intranet, and the new corporate (AED-Interim) used to engage with different audiences. The visual identity will be adopted in preparation for Denis Tremblay, ­Director of Financial Resources photo collection grew to over 9000 catalogued the 40th Anniversary of the CBHSSJB in 2018. Jean-François Champigny, Assistant Director­ of images. Discussions with Public Health led to Financial Resources the reinvigoration of the regional radio show Liliane Groleau, Director of Human Resources ­Miyupimaatisiiun Dipajimoon, which is broad- Marie Blais, Assistant Director of Human Resources-Organizational Development and cast weekly on community radio stations in a Staffing new time slot of Thursday at 12:15pm. Thomas Ro, Director of Information Technology Resources Luc Laforest, Director of Material Resources Helen B. Shecapio Blacksmith, Director of Wiichihiituwin (Interim) Council of Physicians, Dentists and Pharmacists

The Executive Committee and Members of the ●● Collective Prescriptions: These therapeu- cpdp executive committee Council of Physicians, Dentists and Pharmacists tic tools continue to be developed to enable The CPDP works to Dr. Darlene Kitty, President (CPDP) have had another busy and productive a standardized approach to care by nurses Dr. Michael Lefson, Vice-President year in addressing concerns and advocating for following the therapeutic guide and associ- provide and improve Dr. Helen Smeja, Secretary services and resources. We continue to work ated prescriptions. Dr. Danie Bouchard, Treasurer with our health professionals to improve the The obligatory and mandated committees of medical, dental and Dr. Carole Laforest, Chief of Medicine health and social well-being of our patients, their the CPDP are working diligently on these priori- pharmaceutical care Dr. Lucie Papineau, Chief of Dentistry families and the communities of Eeyou Istchee. ties and other projects, and on ensuring the quality of medical, dental and pharmaceutical Mr. Pierre Caouette, Chief of Pharmacy (Interim The CPDP acts to ensure provision and quality offered to patients in until December, Ms. Anh Nguyen started care. For example, the Mental Health Commit- of medical, dental and pharmaceutical services, January 2017) tee is monitoring the implementation of mental as well as competence of its members. It also Cree Territor y. Mr. Marc-André Coursol-Tellier, Pharmacist health services, while the Editorial Committee gives recommendations on technical and scien- and Working Group are developing the Col- Dr. François Charette, Director of Medical tific aspects of the organization. In doing so, the ­Affairs and Services 16 lective Prescriptions and Therapeutic Guide 17 CPDP collaborates with the Board of Directors chapters. The Palliative Care Committee leads and general management of the CBHSSJB. the required activities respecting the Law 52 In addition to monitoring ongoing initiatives, the legislation that was passed last year. CPDP supports its members and committees in In addition, the Department of Medicine has their contribution and collaboration in planning been very active in recruiting family physicians and implementing the following priorities: and specialists. The Department of Pharmacy is ●● Mental Health: The needs of our patients, diligently working to improve medication stock- families and communities in Region 18 are ing and dispensing, hiring more permanent complex and resources are limited, which pharmacists and training pharmacy technician remains a priority for the CPDP and the staff. While the Department of Dentistry provides Board of Directors. Program planning, hir- good quality dental services, it hopes to recruit ing and training of staff in the Mental Health more permanent dentists. The CPDP will con- Department is helping to increase and tinue to support and advocate for improvements improve services. to the quality and capacity of these services.

●● Birthing and Midwifery: While still in the The CPDP works in partnership with the clinical early stages of development, this program departments, the Director of Medical Affairs aims to improve the prenatal and postpar- and Services and the CBHSSJB Board of Di- tum health of Cree women and, in the future, rectors to provide and improve medical, dental to ensure safe deliveries in low-risk cases. and pharmaceutical care offered to patients in ●● Telehealth: Since Teleopthalmology and Cree Territory. We also look forward to continu- Telepsychiatry have been successfully ing to contribute to new and ongoing initiatives implemented, Teleobstetrics in Chisasibi such as planning for the new Chisasibi Hospital has also been launched successfully. Other and health services. possible Telemedicine initiatives are being developed. CPDP Annual General Assembly, October 14-16, 2016 Council of nurses

A CONTINUING MISSION COMPOSITION ACCOMPLISHMENTS AND UPCOMING 2017-2018 UPCOMING PROJECTS In its second year of existence, the Executive The 2016 election took place in November. As PROJECTS ●● With the support of two active sub-com- Committee of the Council of Nurses (ECCN) there was only one nomination from the region- In 2016-2017, the ECCN was able to secure mittees, drafting a memorandum on Eeyou continues to uphold the standards of its man- al services, Patrice Larivée was re-elected by a seat on the Editorial Committee and has Istchee’s lack of long-term mental and date: to address issues related to the quality of acclamation for a two-year mandate. Similarly, become an official signatory of all collective physical care services and facilities for the nursing practice within the CBHSSJB (nurs- as there was only one nomination from Chisa- prescriptions and revised chapters of the Guide patients with mental health issues and for es, clinical nurses, nurse counselors, and nurse sibi Hospital, Alexandre Bui-Giroux was re- Thérapeutique. The ECCN has also become those experiencing loss of autonomy; practitioners), the legal framework of these elected by acclamation for a two-year mandate. an official signatory on all Nursing Care Direc- ●● Being mindful of the upcoming integration professions, the scientific and technical organi- The roles of the Executive Committee officers tives developed by the Regional Department of of midwives within some Awash depart- zation of the CBHSSJB, the ongoing education remained the same: Nursing. For the ECCN, obtaining this signatory ments and its repercussions on nursing and training of all nurses, and all other related power is a significant milestone because these activities and leadership; issues (OIIQ, 2016). The ECCN is responsible ●● President: Patrice Larivée documents have a direct impact on nursing ●● Taking a stand on the application and primarily for formulating recommendations (from regional services) practice as well as on the performance of our ­acculturation of the act respecting end of life to the Board of Directors on all these nursing ●● Vice-President: Marie-Josée Morin health care system. The ECCN is pleased that 18 care (RLRQ, c. S-32-0001) in Eeyou Istchee; 19 related issues. As such, the ECCN does not (from the inland communities) the CBHSSJB and its various committees ●● Reviewing the nature of the role élargi, its hold decision-making power, but its president ●● Secretary: Émilie Dufour eagerly welcomed the contribution of nurses to legal definition, and its implication within is the voice of all nurses when reporting at each (from the coastal communities) the development and revision of these tools. meeting of the Board of Directors. the organization of services in all CMCs; ●● Communication Agent: Alexandre ●● Deploying a multimedia platform that will ­Bui-Giroux (from Chisasibi Hospital) provide access to a vast scientific database of nursing and medical articles and a rich collection of online clinical tools to support and improve clinical nursing practice. The Obtaining signatory ECCN believes these tools will promote continuing education of nurses in all levels power on Nursing Care of the organization. Directives is a significant milestone Council of Nurses Executive Committee, from left to right: Alexandre Bui-Giroux, because these Patrice Larivée, Émilie Dufour, Marie-Josée Morin documents have a direct impact on nursing practice and the performance of our health care system. Service Quality and complaints

The title of the Commissioner is now Service The Commissioner participated in meetings MEDICAL EXAMINER Louise Valiquette Quality and Complaints Commissioner, with provincial counterparts and, along with the The role of the Medical Examiner is to analyze Service Quality and Complaints Commissioner (Interim) emphasizing quality of services. In August Assistant Commissioner, took part in a train- complaints referred by the Service Quality and Louise Valiquette is a lawyer with 2016, Sarah Cowboy from Waskaganish was ing session with other Commissioners’ offices Complaints Commissioner and that involve a Sogolex, an accredited mediator welcomed as Assistant Service Quality and throughout Quebec. The Assistant Commis- member of the Council of Physicians, Dentists specializing in workplace mediation, a Quebec Bar member and Complaints Commissioner. She has been with sioner participated for the first time in the Quality and Pharmacists (CPDP). Each complaint must President of the Seniors’ Rights the CBHSSJB since 1982 as a nurse and a of Services meeting. The Commissioner also be reviewed within a precise time frame and lead section of the Quebec division of manager. With her arrival came an increase in participates in the Vigilance Committee (which to a written report to the complainer. The Medi- the Canadian Bar Association. files, as users were able to discuss complaints includes the Chair, Executive Director and two cal Examiner is also the Director of Medical Af- or requests for assistance in their own lan- external Board members), meeting regularly fairs and Services, a dual role not uncommon in guage. The process for filing complaints is now to review the work of the Commissioner and smaller health care settings in Quebec. In cases well-known. 2016-2017 saw 174 files opened, support the Board on issues of relevance, qual- of apparent conflict of interest, a medical exam- compared to the 87 in 2015-2016: 103 were ity, safety, service effectiveness, enforcement iner from a neighboring region is asked to step Sarah Cowboy 20 complaints, 60 were requests for assistance, of user rights, and diligent handling of user in. The Medical Examiner continues to remain Assistant Service Quality and 21 and 11 were consultations. complaints. The Office of the Commissioner is available and on call to discuss issues, as well Complaints Commissioner also involved in creating a volunteer commit- as provide assistance to medical staff. There Complaints often lead to improvements in the tee of long-term Wiichihiituwin clients staying at were calls with the Head of the Medical Depart- quality of care and services. One example is the Espresso or living in Montreal. ment and the Director of Professional Services creation of a brochure to explain Wiichihiituwin to discuss problems involving physicians. services more clearly. Complaints due to 2016-2017 saw many recommendations interpersonal relationships are common, and for changes and improvements which, with There were only three formal complaints this clientele-oriented training has now begun. management and Board support, can be past year, although several consultations with

­Confidentiality is still an issue, especially in implemented. Information on Service Quality the Medical Examiner explored issues put Dr. François Charette, small communities. Social networks such as and Complaints continues to be updated on forward. Two of the complaints have been Medical Examiner and Director of Medical Affairs and Services Facebook must be used with care. www.creehealth.org. analyzed, and examination of the third has (DMAS) begun. Due to its seriousness, one complaint was referred to the CPDP Executive commit- FILES OPENED tee and resulted in a disciplinary committee—­a quasi-judicial board formed with members of 2015 2016 With the arrival of -2016 -2017 the CPDP. The disciplinary committee, under lawyer guidance, analyzed the complaint and Complaints 55 103 Sarah Cowboy came made a recommendation to the CBHSSJB. Requests for assistance 26 60 Consultation 5 11 an increase in files, Intervention 1 0 as users were able to Referred to Medical Examiner 2 3 Complaints The confidential, toll-free number for complaints Total - Files opened 87 174 discuss issues in their 1-866-923-2624 1-866-923-2624 is connected to voicemail, so it is [email protected] essential that the caller state their name, phone number, own language. creehealth.org/about-us/users-rights and community so that the Commissioner can call back. Population Health Profile

A portrait of the health and The region’s population experiences some neg- The following paragraphs summarize ative health and social factors at higher rates ­hospitalizations based on data from 2013 to An understanding ­well-being of Eeyouch/Eenouch when compared to Quebec. In 2014-15, 64.4% 2016. Overall, hospitalization numbers for phys- rests on two factors: the actual situa- of those 18 and older were obese (body weight ical care declined although, not unexpectedly, of short-term tion of health and wellbeing and our access to index of 30 or higher), compared to 19.3% for all remote regions continued to have the high- valid data to describe this situation. With the Quebec. One health risk with obesity is dia- est rates in Quebec. Residents of Eeyou Istchee hospitalizations exception of a sudden outbreak of serious infec- betes. At the end of 2014, 24.7% of those over were hospitalized 2.2 times more than those in tious disease, the health status of the popula- age 20 were diagnosed (Quebec: 9.6%). Adjust- Quebec. An average of 1,268 individuals were is important in tion changes slowly. Our region has very good ing the population to a similar age structure to hospitalized each year for physical care—an control of infectious diseases, so this has not that of Quebec shows almost four times more average of 2,160 hospitalizations. As in Quebec, determining where been a factor for a long time. General portraits diabetes than that for the province. women were more likely to be hospitalized than the CBHSSJB might of the population’s health in the 2014 to 2016 men, probably due to childbirth. Importantly, annual reports were quite similar, as is the case Between 2011 and 2015, mothers gave birth to individuals aged 18-24 were hospitalized three provide more services, 22 for 2016-17. By contrast, the report for next year an average of 343.6 live infants each year, many times more frequently than in Quebec, mostly 23 will use data from both the 2016 census and the of those young mothers. Between 2013 and related to injuries. at reduced costs, to 2014-15 Québec Population Health Survey, and 2015, 5.5 of every 100 births were to mothers we expect this will change our understanding of aged 14-17 (Quebec: 0.3/100), and 10.8 of every The category with the greatest number of benefit patients. the overall picture of health and wellbeing. 100 births were to mothers age 18-19 (Que- hospitalizations was pregnancy, childbirth bec: 1.4/100). In 2015, infection with chlamydia and the puerperium—the period immedi- This year’s portrait looks at the population was diagnosed in 204.4 out of every 10,000 ately after childbirth. Between 2000 and 2006, The second highest number of hospitalizations and health issues leading to hospitalizations, people (Quebec: 29.5) and with gonorrhea in the regional hospitalization rate (adjusted to was for respiratory system diseases. Although followed by focussed analyses of the five top- 24.4/10,000 (Quebec: 4.7). In 2013, 30.5% of the Quebec population) was 2.3 times higher annual hospitalization numbers are declining, ranked causes of short-term hospitalizations. youth in secondary school used marijuana than that of Quebec. From 2013 to 2016, this the region still has the second highest ranking With the exception of those at Chisasibi Hos- (Quebec: 7.8%) and 15.4% abused alcohol dropped to only 1.5 times higher, reflecting the among Quebec health regions. On average, pital, patients requiring hospitalization must (Québec: 9.9%). In 2015-16, Youth Protection sharp decline in the numbers of births: from 186 individuals—mostly children and those over travel, while ill, long distances to hospital—a Services received 878 signalements for youth 431 births in 2007 to 373 in 2011 and to (provi- 45—had 277 hospitalizations each year. Those tremendous burden on patients and their fami- and children under the age of 18, which is 13.7 sionally) 316 in 2015. The higher rate of hospi- aged 45 to 64 were hospitalized 3.6 times what lies that also adds greatly to the costs of pro- per 100 youth and children. (Quebec: 2.3). talizations is partially driven by the subcategory is observed in the rest of Quebec, and those viding care in our region. For these reasons, an of Other Maternal Disorders which is 8.9 times aged 65 and older were hospitalized 3.4 times understanding of short-term hospitalizations is higher than in the rest of Quebec. This is mainly more. Influenza, pneumonia and chronic lower important in determining where the CBHSSJB the result of the diagnosis of Diabetes Mellitus respiratory conditions are the principal reasons might provide more services inside our territory, in Pregnancy, which is 9.5 times higher than the for hospitalizations. Pulmonary fibrosis is a seri- at reduced costs, to benefit patients. rest of Quebec. Between 2013 and 2016, this ous disease, occurring much more frequently in resulted in an average of 90 hospitalizations In 2016, the population was 17,975—double that Eeyou Istchee than elsewhere. Over the three- per year, for a rate of 276.9 per 1000 live births of the mid 1980s. It grew by 15.7% between 2006 year period, 53 individuals were hospitalized for (Quebec: 76.1). and 2011, while that of Quebec grew only 4.7%. an average of 41 hospitalizations per year. Half of the population is 25 and younger so a high growth rate can be expected for coming years. The third ranked category for hospitalizations is 1998 to 2000 saw an average of 118 individuals for digestive system diseases. An average of hospitalized an average of 194 times annually for 161 individuals were hospitalized each year—an circulatory system diseases which ranked fifth average of 226 hospitalizations. Hospitalizations in number of hospitalizations. The crude rate of in this category are 2.6 times higher than in Que- hospitalizations almost doubled from 1994-1995 bec, and the 45-64 age group is hospitalized 2.8 to 1996-1997, but over the last three periods has time higher. The principal cause is for ‘Gallblad- been stable at around 112 per 10,000—still 2.3 der, Biliary tract and Pancreas’ which occurs 4.6 times higher than what is observed in Quebec. times more frequently than would be expected. In the early period, the average age of individuals from Eeyou Istchee was 62 compared to 65 for The fourth highest category for hospitalizations Quebec. Now, the average age is 59 compared is for conditions originating in the perinatal to 70 in Quebec. Half the individuals hospitalized period. However, the region ranks third low- have a secondary diagnosis of diabetes mellitus, Quilt made by members of 24 est of health regions in Quebec, and there was and the average age of those is 62 compared to the Regional Public Health 25 a significant drop in numbers of hospitaliza- 51 for those with no diabetes. team and assembled by tions from 1998 to 2000. On average there are Josée Quesnel. 205 hospitalizations annually with significant In examining the top five categories for variations between communities. The sub-cat- ­hospitalization, the role of diabetes mellitus egory of transitory disorder of carbohydrate cannot be ignored in driving the need for health metabolism, a diabetes-related condition in services. Detailed analyses of hospitalizations infants, resulted in an average of 17 hospital- can help us understand where to focus preven- izations per year and occurred 1.9 times more tion efforts and where there might be social than would be expected. and economic savings with more specialised regional services.

In examining the top five categories for hospitalization, the role of diabetes mellitus cannot be ignored in driving the need for health services. The Pimuhteheu Group has grown considerably following the implementation of a new organizational structure in June 2016. Pimuhteheu means “walking with” and the Group’s main mandate revolves around planning and support to primary care services. Thus, Youth Protection, Youth Healing Services and Regional Special Needs Services have joined a team that includes Public Health, Program Development and Support and Pre-Hospital and Emergency Services and Emergency Measures.

27

2

ᐱᒧᐦᑌᐦᐁᐤpimuhteheu group CBHSSJB organigram

board of directors Message from the AED Pimuhteheu Adelina Feo, Assistant Executive Director (Interim) executive direction The Pimuhteheu Department has grown consid- With all our new departments and partners, erably over the course of the year with the wel- Pimuhteheu continues to support, train and de- coming of the Department of Youth Protection, velop programs and services to better answer Youth Healing Services and Regional Special the needs of Eeyou and Eenou. The addition Needs Services. The reorganization of these of the Department of Youth Protection, Youth departments has allowed us to broaden our core Healing Services and Regional Special Needs function of providing support to primary care Services has emphasized the importance of our services in the community and to enlarge our focus on the health and well-being of children nishiiyuu pimuhteheu miyupimaatisiiun administrative scope of supporting a populational approach and youth. Through discussion, it becomes miyupimaatisiiun resources towards prevention and promotion of health. apparent that it is essential that we continue to support and invest in the youth of the region to Looking back, it is apparent that we continue to enable our vision of a healthy Eeyou Nation. forge solid bonds with other departments and 28 community partners, a collaboration explicit in Adelina Feo 29 pre-hospital a number of endeavors. Of note was the ap- Assistant Executive Director (Interim) emergency services proval of clinical plans for CMCs in Whapma- and emergency measures goostui, Oujé-Bougoumou, Waskaganish and the Chisasibi Health Regional Health Centre; for youth healing the CNG working group on access to nutritious services foods; the beginning of an interdepartmental youth protection working group on chronic diseases; the support of a life-affirming conference in Waswanipi; the program drafting of protocols between Youth Protection, development and Youth Healing Services and frontline services; support development of an addiction framework and disability services clinical plan for addiction centres; collaboration maanuuhiikuu with communities to implement the Triennial Plan Pimuhteheu continues (mental health) for Pre-hospital Services; collaboration of the Mental Health team with Nishiiyuu to develop to support, train and public health a framework for traditional healing, and many awash (0-9 yrs) more projects. Numerous trainings were given develop programs uschiniichisuu (10-29 yrs) to CMC staff such as the training on autism and and services to better chishaayiyuu (30+ yrs) behavioral difficulties, CHR training on smok- serc (surveillance, ing cessation, and support to implement the  evaluation, research, answer the needs of communications) Mashkûpimâtsît Awash program. The Pimuhte- heu department was also tasked with planning Eeyou and Eenou. services to improve perinatal care in the region and bring birthing back to Eeyou Istchee. Pre-hospital emergency services and emergency measures

PRE-HOSPITAL SERVICES the health of vulnerable segments of its popula- NUMBER OF CERTIFIED FIRST Pre-Hospital Services involves all steps of med- tion. This year has seen a rise in Post-Traumatic RESPONDERS PER COMMUNITY ical emergency interventions in Eeyou Istchee, Stress Disorder (PTSD) with First Responders, Chisasibi 16 and includes multiple partners such as police, the fire and police departments, as a result of Eastmain 18 fire fighters and ambulance services. The clini- repeated first responses to suicide cases and/ Mistissini 8 cal, operational and administrative efficiency of or other tragic accidents. Nemaska 7 First Responders, and the continuity of quality care and efficient patient transfer, is dependent 2016-2017 activities include responses to: Oujé-Bougoumou 8 on coordination with other organizations within ●● the forest fire in James Bay; Waskaganish 13 the health and social services network. ●● power failures in Eastmain, Nemaska, Waswanipi 7 ­Mistissini, Chisasibi, and Ouje-Bougoumou; Pre-hospital services and health care are pro- Wemindji 8 vided in compliance with good “first response” ●● infectious disease Ebola International Alert; Whapmagoostui 9 30 practices: respect of individuals, cooperation ●● major road wash-out affecting emergency Total 94 31 between the various workers, and the patient’s transportation; Upon successful completion of 72 hours MSSS training, First Responders are certified for three years. interest. Supported by the Public Health De- ●● missing persons in James Bay in summer partment, this unit’s training and quality assur- and fall; and ance are provided by the agency Pre-Hospital ●● accidents on the James Bay Highway and The Quality Improvement Program for First Experts who were, once again, contracted for la Route du Nord. Responders, through the review of AS-805 training for First Responders. The Director of forms, reviews the type, quality, and quantity Medical Pre-Hospital for the past year has been The coordinator of Pre-Hospital Services of service at operational and clinical levels, Dr Isis Migneault, who is responsible for the and Emergency Measures participated in the and implements the skills maintenance training overview of Pre-Hospital Services, ensuring MSSSQ Civil Security Mission Santé meetings program, the organization of the response sys- quality training, and facilitating improved rela- in Quebec City and the Organisation Régionale tem, and the development of a workplan. Some tionships between First Responders and CMC/ Securité Civile (ORSC) conference calls. Fire complaints were received regarding service in Chisasibi Hospital. Chiefs meet twice annually and provide up- Waswanipi, Waskaganish and Chisasibi. dates for Emergency Measures for James Bay. EMERGENCY MEASURES Additionally, CBHSSBJ provides updates to the Emergency Measures refers to the prompt fire chiefs and First Nation Councils. coordination of actions, persons or property in Emergency Measures On-Call Service is pro- order to protect the health, safety or welfare of vided at all times. Calls may be received for people, or to limit damage to property or to the road closures, forest fires, insufficient beds in a environment in the event of a present or im- southern hospital or ambulance breakdowns. All minent incident. Depending on the scale and calls are dealt with by providing necessary infor- type of civil emergency there may be a multiple mation or assistance to affected communities. partners involved from the community to the national level. The coordinator assists primary and supporting departments in coordinating re- sponse to civil emergencies (forest fires, floods) taking place in Eeyou Istchee that may affect youth healing services

Youth Healing Services (YHS) contributes to the YHS has 71 employees—childcare workers, CASE MANAGEMENT SCHOOLING WITHIN YHS protection, rehabilitation and well-being in all Bush Program childcare workers, director, coor- For every youth referred, there is an admission The Cree School Board provides a teacher for aspects (physical, mental, emotional and spiri- dinator of resources, intake and clinical advi- meeting between the Youth Protection Worker youth residing at the Reception Centre in Mis- tual) of all youth in our care, through programs sors, administration, maintenance and security and the YHS Intake worker. A case conference tissini to support school re-integration. While that provide safety, security and most impor- staff, and more than 20 occasional workers. The is then scheduled for each youth entering YHS, the program does not offer complete schooling tantly treatment. We are committed to providing psychologist position is presently vacant. The and a healing path plan, with goals and objec- or the ability to pass youth to the next grade a compassionate and effective family-oriented majority of employees received training through- tive set by the youth and parents, is developed. level, it does give them a greater opportunity program with respect to traditional values, Cree out the year, from food safety and ASIST suicide Weekly clinical meetings are held to update to succeed once they return to school. Clients cultural teaching and language, providing a prevention training to mental health. files, to discuss approaches and strategies, from the Reception Centre, and Upaachikush sense of acceptance and belonging for youth to review and determine when to move on to and Weesapou Group Homes attend the public experiencing a wide scope of difficulties. YHS YHS operates three facilities around the clock, the next objective, and to share information on school. The Cree School Board and Youth mentors in a highly structured setting, teaching seven days a week. In Mistissini the Upaachi- different topics. In addition, all reports, whether Healing Services have open discussions and appropriate social and living skills enabling youth kush Group Home has seven treatment beds, for court, incidents, observations or discharge, are working on a partnership agreement in 32 to achieve success outside the facility: and the Reception Centre has 12 treatment are shared with Youth Protection. order to improve services. 33 beds and three emergency beds; in Chisasibi, ●● providing an atmosphere of warmth, con- the Weespou Group Home has nine treatment sistency and predictability so youth have beds. YHS continues to work with Cree Justice an orderly and predictable view of their towards building another 12-bed Reception temporary environment; Centre in Mistissini in 2019. All placements are YOUTH HEALING SERVICES STATISTICS FOR 2016-2017 ●● strengthening family bonds by empowering referred from Youth Protection and come from Reception Upaachikush Weesapou Total youth with clinical tools and counseling; all nine Cree communities. The majority of the Centre Group Home Group Home region ●● developing within youth a new sense of self youth are placed under the Youth Protection Average Max Average Max Average Max Average worth and self awareness; Act (ordered or voluntary measures) and a few Total number of youth in placement 15.6 19 8.5 13 9.2 12 33.4 of them under the Youth Criminal Justice Act ●● developing professional training programs Youth Protection Act (Art.47-38-79-54) 15.3 19 8.5 13 9.2 12 33.1 (open custody). to enhance quality of services provided by Boys and girls 8-12 yrs 2.4 4 1.8 3 0.4 1 4.5 caring, reliable, competent, motivated and Boys and girls 13-17 yrs 13.2 18 6.9 11 8.8 11 29.0 engaged employees; Youth Criminal Justice Act - open custody 0.3 1 - - - - 0.3 ●● providing a referral system when needed; Bush Program Activity (days) 25.8 69 18.7 70 22.2 67 66.8 ●● advocating for rights and needs of all youth. Hospitalization 2.0 19 0.8 10 1.2 7 4.1 Outing with unit 4.4 42 0.2 2 2.2 19 6.8 Absence without authorization (AWOL) 12.2 34 4.8 20 6.2 20 23.1 Back-up Reception Centre/other centres 1.4 7 1.2 7 - - 2.6 Home Leaves 47.8 187 41.9 128 42.9 146 132.7 Total days presence 251.5 314 102.9 142 132.4 184 486.8 Number of youth discharged .8 2 0.6 3 1.5 3 3.0 Average number of youth in unit per day 11.3 13 5.3 6 5.6 7 22.2 Transfer to foster home/other centre 2.5 6 1.6 5 1.2 5 5.4 Operating permits 15 8 8 31 youth protection

BUSH PROGRAM/YHS ACTIVITIES YOUTH & FAMILY HEALING SERVICES The Youth Protection Act emphasizes the protec- The DYP participated in the Provincial Com- The Bush Program, an important component PILOT PROJECT tion of children as a collective responsibility, and mittee (Projet de Vie autochtones) on clinical of YHS, is a holistic land-based program that In collaboration with the Justice Department of youth protection intervention is guided by a le- criteria for the life plans of Indigenous children teaches cultural and traditional Cree life skills the Cree Nation Government, YHS conducted gally specific process under the Act. The Director in Quebec, an extensive reference manual at camps for both inland and coastal commu- a jointly funded pilot project. Beginning in July of Youth Protection (DYP) intervenes only when developed over the past three years. Under the nities. Cree elders are invited to participate in 2016, the six-week program out on the land children are in danger and when their safety and coordination of the MSSS, the goal of the com- guiding program development and delivering benefited nine families from both coastal and development is compromised, with criteria for in- mittee is to recognize by law the unique cultural traditional knowledge. This year many activi- inland communities, with youth and families re- volvement not breaching the fundamental human identity of Indigenous children as part of their ties had to be reorganized due to Reception ceiving support from interveners, Elders, local rights of children and their parents. Situations fundamental Indigenous rights. Centre renovations, bed bug issues at the counselors, Family Life workshops, and a pro- are characterized by the severity and complexity Group Home, and training for frontline workers. fessional therapist, as well as training on first of problems, the degree of children’s vulnerabil- The CBHSSJB Chair, Executive Director and ­Despite this, 13 successful activities were held: aid, boating license and canoe safety. There is ity, and the limitations/resistance of parents or Director of Youth Protection signed a joint a great need—and continuous demand—for this caregivers to recognise difficulties in mobilizing a collaboration protocol along with Cree School ●● Aboriginal Day Activity in Mistissini type of program within the Cree Nation. positive change. The Director and the CBHSSJB Board’s Chair, Director General and Director of 34 June 15, 2016 35 Chair presented a memoir at the National Assem- Schools. The purpose of the protocol is to work ●● Children Are Important Week YHS has experienced and will continue to bly of Quebec supporting proposed amendments together to develop individualized education Ottawa-Montreal, June 20-26, 2016 experience changes and challenges, as the which will recognize the cultural identity, language plans for youth protection clients who need ●● Mamoweedow Traditional Gathering program works towards its objectives of main- and culture of Cree children as a fundamental extra support in order to succeed in school. Chisasibi, July 10-24, 2016 taining best practices and ensuring quality ser- right (Section 3 of YPA in Bill 99). The links to Principals will work with YP Team Leaders, ●● Sonrise Teen Camp, Mistissini vices. All efforts to strengthen YHS are defined family, community and nation, and emphasis on children and parents to identify needs, provide July 25-29, 2016 in the YHS Action Plan. There had been a plan culture and tradition in the approach to life plans, support and guide children toward the best ●● Boating and Canoeing Activity, Mistissini to build a new facility in Chisasibi, but as most remain a priority for the department, which is the possible outcomes in their education journey. and Chisasibi, Aug 2-14, 2016 trained childcare staff are based in Mistissini, a voice of children who cannot protect or speak for A regional committee will meet twice a year to ●● Bear Hunt Activity, LG-3, Chisasibi move to Chisasibi would require building a new themselves. discuss recommendations and amendments to September 06-24, 2016 team to support the services there, and so this the protocol. ●● Moose Hunting, LG-3, Chisasibi plan is not currently being pursued. The CBHSSJB’s adoption of the Youth Protec- October 17-26, 2016 tion Bylaw (Article 37 of the YPA) sets out the

●● Bear Hunt LG-2, Chisasibi orientation to fully support the legal mandate of Youth Protection Training participants, January-February 2017 October 17-26, 2016 the DYP. The document was resubmitted to the ●● Caribou Hunt LG2, Chisasibi Human Rights Commission of Quebec, follow- January 25-29, 2017 ing the provincial integration of youth protec- ●● Moose Hunt RDN km 80, Mistissini tion centres and social services establishments February 14-19, 2017 under new ministerial-appointed Boards and ●● Justice Department WE Day invitation Directors General. The bylaw sets out account- Montreal, February 23-25, 2017 ability mechanisms and the scope of the legal ●● Moose Hunt and Ice Fishing Land M45 intervention of children. The DYP responds to March 25-April 1, 2017 needs with the help of family support structures, interveners in the child and parents’ life, and a network of services. Access to services (addic- tion, mental health, intellectual disability and physical disability)­ continue to be our priority. Amendments to the Adoption Act (PL-113) and sexual abuse or abandonment 1.7% ACTIVE FILES BY COMMUNITY The goal for youth who attend the Akwesasne risk of sexual Civil Code of Quebec will legally recognize abuse 7.2% Community No. % of 0-17* Youth Treatment Centre (IATC) is help with traditional adoption, a practice of the Cree Chisasibi 298 17.1 alcohol and drug abuse issues, improved cop- since time immemorial. This was achieved with Eastmain 25 8.4 ing skills, and informed choices upon return- the help of the CBHSSJB Chair, the Director ing back home. This year, 12 Cree youth went Mistissini 299 22.2 of Government Relations for the Cree Nation through the four-month intensive program Nemaska 36 13.5 Government (CNG) Melissa Brousseau, Gowl- psychological adapted to First Nation youth. It is important for ill-treatment 14.9% ing WLP lawyer Matthew Sherrard, former CB- Oujé-Bougoumou 50 15.1 Cree youth to have continued access to such HSSJB Chair James Bobbish, the First Nations neglect or risk of Waskaganish 232 25.8 services and programs. neglect 49.8% Commission of Health and Social Services of physical abuse or Waswanipi 217 28.4 Quebec and Labrador representatives, and risk of physical Wemindji 123 23.5 Improving the quality of services of the provin- abuse 14.5% cially and legally mandated Youth Protection representatives of the Inuit Health Board and Whapmagoostui 78 22.0 the Kativik Regional Government. The CNG, Department requires both a rigorous approach Total 1,358 20.8 and a realistic outlook on transition timelines 36 communities and elders will need to determine serious 37 behavioural *A child might be subject to more than one signalement given high employee turnover and lateral job ­customary implementation in today’s­ Cree disturbance context. Of significance, traditional adoptive 11.9% movement; accountability mechanisms are like Of the 1,358 active cases, 270 situations were parents’ names will be added to birth certifi- no other. Implementation of the Youth Protection subject to court proceedings. Others are cur- cates following a traditional adoption, allowing Action Plan is well underway, and key aspects to REASONS FOR ‘SIGNALEMENTS’ rently under the evaluation/orientation process, for signing authority of legal forms in schools, be developed involve internal and external col- and/or under provisional measures (30 days) hospitals and government institutions. Biologi- laborations such as those with the Cree Justice or voluntary measures (12 months or less). 112 cal parents’ names will remain. Under the Youth Department and the Cree Police EEPF, as well This year, 3,602 calls were received at the RTS emergency situation motions were presented Protection Act, traditional adoption can be con- as continued negotiations with the MSSS for Intake Services, with 2,301 treated as reports. to the youth tribunal through visio/video confer- sidered a legal option to the existing adoption the adaptation of Cree Foster Home criteria and Of these, 639 were retained and 1,662 were not ence hearings, preventing unnecessary travel to process as the situation warrants. subsequent increase in funding. Full support retained due to lack of facts presented, a per- Amos or Val-d’Or. from all levels of the CBHSSJB, the Cree Na- Based on the annual number of placement son protecting the child, or information trans- tion entities and the Cree people continue to be Participation in the PL-21 provincial committee days, the annual average of children placed ferred to YP workers for follow-up verification. required to adapt Youth Protection Services for resulted in the recognition of the equal impor- is equivalent to 228 children subject to foster The majority of situations reported requiring the benefit of Cree children and families. tance of ‘culturally specific knowledge’ and placement for one whole year. Some children intervention were related to alcohol and drug education for YP workers. Knowledge of life may be placed for a day, a week, a month or abuse of parents and/or youth (teenagers). experience, family histories, culture and values a full year depending on unique needs and cannot be underestimated. Workers’ skills will situations. This 15% increase from last year is be complimented with training and continu- mostly attributed to bringing back Cree children ous support and evaluation through ‘Precep- to be placed in Cree homes, after interven- tors’ (evaluators) towards full recognition of tion or temporary placement in other regions their acquired rights to evaluate situations by of Quebec. Close to half the children placed the designated Professional Order. Workers live(d) with their extended family member(s). As will be mentored and coached by experienced always, almost all foster families are Cree who colleagues to ensure ongoing improvement of live in Eeyou Istchee. ­services—including employee development— and their professional and respectful delivery. NUUHiI A KU a U M

program development and support ᒫ ᓅᐦᐄᑰ

DISABILITY SERVICES (SPECIAL NEEDS) MAANUUHIIKUU (MENTAL HEALTH) Consisting of professionals with expertise in ●● Development of three-day training for Case We continue to bring the Cree Mental Health We continued to offer training in communities to dealing with a range of disabilities, the regional Managers from all communities on services and Wellness Strategy to life, working to im- increase capacity in addressing mental health team provides support to communities and for special needs clients (intake, care plan, prove the delivery of mental health services. needs, including Mental Health First Aid (MHFA) those working with special needs clients to service implementation and follow-up); The Strategic Plan was officially adopted by the and Assisted Suicide Intervention Skills Training ensure the services and support required. The training is scheduled for fall 2017; Board in September 2016, and mental health (ASIST), as well as training to frontline workers team also manages the Cree Regional Fetal ●● Development of collaborative partnerships was identified as the second most pressing in all nine communities on how to respond to Alcohol Spectrum Disorder (FASD) Diagnostic with on-territory resources (school, daycare, issue at the April 2016 Assembly on Health and adult disclosure of sexual assault, and on Basic and Intervention Clinic, the only FASD diagnos- Head Start, DYP, mental health), as well as Social Services in Waskaganish. We continue Trauma Informed Approaches to Community tic clinic in Quebec. Although small in size with with resources outside of the ­community; to promote positive mental health through Work. Cree Cultural Sensitivity sessions were only nine members, our team is slowly growing prevention, intervention, treatment and ongo- also given to newly-hired nurses. Plans for the ●● Advocating for the development of the and meeting challenges. ing wholistic care so everyone can live full and upcoming year include increasing and improv- ­following services: balanced lives. ing collaboration with other departments, and With an increase in requests for support this • Parent support groups; continuing to develop and improve mental 38 year, the primary focus was on early diagno- • MSDCs: Increased inclusion of special Highlights include Juliana Matoush-Snowboy health programs and services. 39 sis and intervention, and developing services needs clients in day programming; becoming Regional Coordinator, replacing inter- on territory to minimize the need for external im coordinator Mary Louise Snowboy. We thank • Community-based long- and short-term resources. To accomplish this, training and Mary Louise for all her hard work, and we are respite; mentorship were prioritized for those working in happy that she has stayed on as clinical nurse in the community, with the following activities: • More positions for CBHSSJB and CSB child psychiatry. Diane George, who joined our rehabilitation professionals (OT, S-LP). team as a PPRO for Traditional Approaches, will ●● Mentorship of CMC staff who are case Our FASD and Intervention Clinic received 45 work closely with Nishiiyuu to support the de- managing special needs client files; referrals, 15 of which received diagnoses. The velopment of traditional approaches to positive ●● Community-based training on early signs of process is ongoing for 10 children and remain- mental health. Three of our team members have developmental delays, guiding the referral ing referrals will be processed next fiscal year. taken part in the Cree Succession Plan. and intervention process and evaluating Intervention strategies put in place for children quality of care; and their families are individualized and based ●● Troubleshooting crisis situations; on a multidisciplinary care plan that relies on ●● Mentorship of community-based profes- a close partnership between the FASD team, sionals (Occupational Therapists, Speech- families, the CMC, Youth Protection and Language Pathologists, Psycho-educators, schools. Social Workers, Physiotherapists); 2017-2018 will focus on respite and long-term ●● Development of two-day Autism/Behav- care in communities, and see the Diagnostic Mental Health nurses from left to right: Martine Vincent, Pauline Leblanc, Maryse iour Training, with five communities (250 and Intervention Clinic expand to include diag- Doyon, Adnan Bendada, Diane Blueboy, ­participants) receiving training so far; nosing and supporting local interventions for a Sandra Thibault, Sylvain Provencher, Mary Louise Snowboy. ●● Creation of community-based, multidis- broader range of developmental delay and dis- ciplinary Early Stimulation Groups, with ability services—including autism, behavioural support to the rehabilitation staff in order to management services—and support assistance provide optimal therapy services; for youth transitioning to adult services. Psychiatry Suicide Working Group MENTAL HEALTH OFF-TERRITORY Mental Health Policies and Procedures Child psychiatry is a new program this year. Strategy development for addressing suicide in APPOINTMENTS Policies and procedures, including drafts for In September 2016, Dr. Marchand and clini- communities continued—networking with youth access to telepsychiatry, telepsychology and cal nurse Mary Louise Snowboy toured all nine programs and collaborating with other Cree intensive therapy services, were developed to communities to assess needs and introduce entities such as the Iiyuu Ahtaawin Miyupimaa- standardize access to mental health. Others are support to children and their families. Next year tisiiun Planning (IAMP). Continued sponsorship being developed to provide off-territory psy- an additional child psychiatrist will be hired. A of Mental Health First Aid (MHFA) training saw 893 chosocial support for dialysis patients receiving committee, with representation from Maanuuhii- 39 participants trained in five communities. Ap- follow-ups medical care in the South, and to streamline kuu and the Douglas Hospital, has been created plied Suicide Intervention Skills Training (ASIST) 1,331 on-territory care, including suicide response for to oversee psychiatry on the Territory. was supported; five Cree trainees are active emergencies frontline workers. The development of policies or re-activating trainer status, and workshops and procedures for mental health care is com- Dr. Janique Harvey and Dr. Melissa Pickles con- were given to 54 participants in four communi- plex and continues to involve consultation and tinued to provide psychiatric care. One mental ties. The Suicide Working Group collaborated collaboration with frontline workers and health 40 health liaison nurse and three mental health with Mikw Chiyam, an arts education concen- care professionals on and off territory. 41 nurses (Nemaska, Chisasibi and Mistissini) tration interdisciplinary enrichment program, supported clients in conjunction with the psy- engaging students in developing posters for a Sexual Abuse Working Group Indian Residential Schools chiatrists. A liaison nurse continues to work from suicide prevention campaign. The group continued to highlight the difficult Coordinated by Daisy Bearskin-Herodier, the IRS the Douglas Mental Health Institute to provide topic of sexual violence in Eeyou Istchee, with program continues to provide support services support to Cree clients in the hospital and their a training program for frontline workers on how to Residential School survivors with the help of families. Video-conferencing is expanding into to use the Sexual Assault Response Protocol Resolution Health Support Workers (RHSWs) new communities and is used regularly for case (SARP) and accompanying Sexual Assault Re- and Cultural Support Providers (CSPs). The discussions and client follow-up. sponse Manual (SARM). The training provided program offered support at the First Regional the skills and confidence needed to implement ­Suicide Prevention Conference in Waswanipi 2016-2017 PSYCHOLOGY (CLIENT VISITS) Psychology SARP, covering basic requirements and infor- and at an IRS conference in Chisasibi, and Psychology services were offered in all nine Community 2015-2016 2016-2017 mation for support and intervention of men also ongoing support to former IRS students communities. With one full-time and two half- Chisasibi 307 269 and women who disclose sexual assault. The and their families, as well as people attending time psychologists, and one half-time psycho- program was offered to frontline workers in all 9 Eastmain 242 136* ­traditional gatherings and court hearings. therapist, services are stabilizing with more communities, with a total of 44 workers complet- Mistissini 255 200 frequent and consistent support to clients and ing Phases I and II: trained and ready to respond local teams. More support via tele-psychology Nemaska 100 104 to adult disclosure of sexual assault. Additional will be offered, and the CBHSSJB is also Oujé-Bougoumou 153 86 training sessions are planned for next year. collaborating with the Cree School Board to Waskaganish 197 167* provide psychology services to post-secondary Waswanipi 139 319 students outside the territory. Wemindji 89 92* Whapmagoostui 206 260 Eeyou Istchee 1,688 1,633 * Missing information from one psychologist public health Awash 0-9 department Promoting and improving the well-being of pregnant women, babies, children aged Robert Carlin 0 to 9 and their families via a culturally-safe and integrated services approach

Public health has always invested in promoting Intersectoral work is complex when we try to The  Mashkûpimâtsît Awash (AMA) The Maternal and Child Health Program Miyupimaatisiiun at the individual and com- collaborate with institutions with different man- ­umbrella program offers ongoing intensive ­offers support to local Awash teams to improve munity levels. Although health has always been dates and governance structures with different psychosocial follow-up tailored to the needs counseling and teaching skills, support home determined by a complex web of social deter- priorities. Yet evidence shows some approach- of families. AMA also develops partnerships at visits, and enhance promotion and prevention minants, this has become increasingly evident es are important when we look at health policy local, regional and provincial levels to better co- through evidence-based guidelines in maternal in a world plagued by a variety of chronic dis- development: ordinate existing services while complementing and child health interventions and activities. eases. Many health issues are preventable but them with new, community-based projects that The program mostly addresses basic medical absolutely require community-driven solutions. ●● synchronizing communications and encourage ‘family-friendly’ communities. This follow-up to women in preconception, dur- Miyupimaatisiiun depends on the engagement ­messages; past year, AMA continued to be fully offered in ing pregnancy and after delivery, as well as to of the community and the Eeyou nation. How- ●● putting in place accountability ­mechanisms; four communities (Mistissini, Oujé-Bougoumou, children up to nine years. This year, collabora- ever, the Public Health Department has a role to ●● coordinating financing and investments; Wemindji, and Waskaganish). Chisasibi and Ne- tion with the Eeyou Istchee Perinatal Midwifery encourage this type of collaboration. ●● integrating follow-up with evaluation and maska began implementation through interdis- Program and NIshiiyuu was at the heart of this research; ciplinary teamwork, and Waswanipi, Eastmain program’s clinical and teaching tool develop- 42 The Truth and Reconciliation Commission exam- and Whapmagoostui are in preparation phase, ment. Support and coaching in MCHP preven- 43 ined the many ways that Indigenous communities ●● developing and structuring intersectoral given staff and management instability. Clinical tive counseling was provided to approximately were disrupted by colonizing policies and racist actions; support and coaching were offered through on- 25 local CHRs and more than 30 nurses during attitudes. However, it also proposes actions and ●● reinforcing professional capacities; site visits every four to six weeks, and five train- five community visits. Awash-related collective principles to help us move forward including: ●● incorporating health into policy ings on AMA Guidelines and Interdisciplinarity prescriptions were developed and the review of ●● workers knowledgeable about culture, ­developments. were provided. AMA implementation tools were the MCHP manual and Parent Booklets con- community issues and language; In our current five-year plan, the regional simplified and reports of process evaluation tinued. A visit with a Guatemalan traditional were published. The Community Development midwife and doctor was organized in Mistissini ●● professional training for Indigenous workers; Public Health Department aims to foster these collaborative relationships, particularly at the component of AMA held one regional meeting to initiate an exchange of traditional practices ●● partnerships for work and business ­community level. for Community Organizers and five conference with Nishiiyuu. ­opportunities; calls. Collaboration with community partners ●● ownership of institutions by Indigenous Dr. Robert Carlin was maintained through joint activities such as communities; Director of Public Health (Interim) “Baby College” in Waskaganish, “Come-Unity” ●● reporting to communities on outcomes and in Waswanipi and “Fly Families” in Wemindji. performance; Regional partnerships were consolidated with the Mamuu Uhpichinaausuutaau Committee ●● participation of local communities. bringing together six entities with a special Regional participation and engagement were interest in child development and the well-being evidenced by the 2016 Eeyou/Eenou Regional of young children and their families, and Awash General Assembly on Health and Social Ser- Sibi, a network of Daycare Centres, met at least vices, Planning The Future of Miyupimaatisiiun three times a year to ensure collaboration. Together, held in Waskaganish in April as well as community reports from Iiyuu Ahtaahwiin Miyupimaatisiiun planning. The regional depart- ment has started to use some of this material to guide its actions and to align our work with regional and/or community priorities. Skin to Skin wraps given to new mothers this year to increase breastfeeding and attachment The goal of the Awash Nutrition Program The Breastfeeding Program’s goal is to The Public Health Immunization Program The Infectious Diseases Surveillance and (CPNP) is to improve birth outcomes by improv- implement the Baby-Friendly Initiative (BFI) aims to reduce the transmission of infectious Protection Program aims to improve popula- ing overall maternal and child health through in all communities and to increase the rate of diseases preventable by vaccination by offering tion health by reducing the incidence of infec- proper nutrition. By supporting and collaborating exclusive breastfeeding at six months, as well quality vaccines through effective vaccination tious diseases in the region. Priorities are to with local health care workers in the follow-up as the rate of total breastfeeding with added services in all nine communities. During the past support surveillance, prevention, control and of pregnant women, new mothers, babies and complementary foods up to two years and year, basic vaccination services were planned evidence-based management of infectious young children, the program aims to reduce beyond. The position of Planning, Programming and coordinated for delivery by CMCs. Both diseases. Work was carried out supporting the unhealthy birth weights, reduce nutritional prob- and Research Officer Breastfeeding was only components of the SI-PMI (management of im- control of clusters and outbreaks of infectious lems during pregnancy and childhood, promote filled at the end of 2016. In those few months, munization products and immunization registry) diseases as well as declarable infections. This healthy eating and breastfeeding, and increase six CHRs, nurses and nutritionists from two are now well implemented in the region. As of included, but was not limited to, responding to access to nutrition services for pregnant teens inland communities received training, 11 new March 31, 84.6% percent of the region’s children a tuberculosis case, a Salmonella cluster, and a and high risk pregnancies (e.g. GDM). In the past posts were published on the creebreastfeed- received first doses of DTaP-Polio-Hib-Hepatitis group A streptococcus cluster. Updated ver- year, the program provided training, continuing ing.com blog and the Facebook pages saw 54 B (Infanrix hexa) at 2 months of age, 52.2% sions of provincial protocols and regional tools 44 education and support to local Awash teams by new posts and links updates. The Breastfeed- received Meningococcal C vaccine at one year, were shared for public health physicians who 45 distributing nutrition educational tools, breast- ing Tradition Protection Act, the Answer Guide and 34.8% received RRO-VAR (Priorix Tetra) at are on call for the region. A draft procedure for feeding promotional items and the “Tiny Tot to to the Breastfeeding Nature`s Way flipchart and 18 months. Regional vaccination coverage for influenza and gastroenteritis outbreaks was pro- Toddler” guides to pregnant women. Twenty new the Breastfeeding section of the MCHP manual HBV in Grade 4 students is 79.9%, and 19.7% duced with regional partners. Collaboration with workers received nutrition training. Highlights of were all prepared for final editing. Breastfeed- for the HPV vaccination. This past March a joint the local communities and MAPAQ was encour- this year’s work include a training on infant nutri- ing Week activities were organized in three of call for tenders was developed, in collaboration aged for the northern dog vaccination program. tion offered to 30 future Cree early childhood the nine communities. with Sigma-Santé, for the selection of a com- educators. Also, a consultation with the INSPQ pany responsible for the management of immu- team, the Nunavik region and the Public Health The Cree Leukoencephalopathy and Cree nization products for our region. Environmental Health team, resulted in recom- Encephalitis Program (CLE-CE), otherwise mendations on lead contamination and game known as the Genetic Diseases Educational The Dental Health Program organizes pre- meat consumption that were added to the 2017 and Prevention Service, aims to improve aware- ventive services to improve oral hygiene habits edition of the Tiny Tots to Toddler. ness about CLE/CE through a program of in the region and to reduce the prevalence of education and carrier screening offered at the tooth decay and oral health problems through Nutritionist Stephanie Sicard and a patient at the CMC in Mistissini high school level and through prenatal services both public education and prevention activities in the Awash clinics. The position was vacant carried out by dental hygienists, CHRs, and until a Nurse Counselor was hired in November. other Awash professionals. In the absence of a In the last few months, high school students of public health dentist, school-based programs three communities were visited, 100 students are being supervised by the Clinical Depart- attended a presentation, of whom 28 accepted ment of Dentistry. The position of PPRO Dental to be screened. 26 of the 100 students had Health has been vacant since March 2016. A already been screened and 23 of them were review of the results of the dental health survey able to review their results. The evaluation of was initiated in collaboration with specialized the program continues in partnership with the services. genetics team from Sainte-Justine Hospital. Uschiniichisuu 10-29 Improving the health of youth through planning and implementation of appropriate health services in communities, clinics and schools and by addressing developmental needs in the transition to adulthood.

The new Healthy Eeyou Youth (HEY) Program with the CBHSSJB clinical partners. A multidis- The School Health Program aims to improve The Dependencies and Addictions will look into integrating clinical and psychoso- ciplinary meeting of health professionals, band effectiveness of health promotion and preven- ­Program’s mission is to address issues re- cial services with a strong outreach axis. A new office members, youth representatives, addic- tion interventions in schools by identifying and lated to substance abuse and dependencies Planning, Programming and Research Officer tions workers, Youth Protection workers, Elders implementing relevant best practices. As of in Eeyou Istchee and to foster transition to a was hired mid-year to lead this innovative proj- and leaders of faith-based organizations was March 31, 2017, school nurses were present in healthy Cree lifestyle with a focus on youth. ect. By March 31, the community consultations held in Nemaska on STI management and epi- all nine communities. Support was given to all The first draft of the proposal for an Addiction final report on the planning of Cree youth-friend- demic situations in Eeyou Istchee, the objective local coordinators and school nurses through Framework to guide planning development for ly health services was completed and distributed of which was to raise awareness to motivate monthly meetings and the development of a addiction programs and services was complet- in all nine communities. Recommendations local stakeholders to address the issue. school nurse performance appraisal tool. A to- ed. Information and material was provided to all included complementary clinical and psycho- This year there was continued monitoring and tal of seven meetings between the Cree School NNADAP addiction workers in each of the nine social outreach services for Uschiniichisuu and epidemiological investigations of all STIs and Board and Public Health resulted in collabora- Cree communities for use in youth prevention Awash clients. Community-oriented consulta- blood-borne infections in the region. Epide- tion on common projects related to health. Chii activities. Radio and community public informa- tions to redefine youth needs were held in a few miological investigation of approximately 50 N. Kayeh Iyaakwaamiih – “You too be careful”, a tion broadcasts on addiction and driving under 46 communities, and pilot projects are planned in gonorrhea infection cases and half of the 40 school-based module on healthy relationships the influence took place. For the holiday period, 47 two communities. Community presentations in cases of possible chronic Hepatitis C infec- and school health, saw local file holders (school messages were broadcast related to substance all nine communities on the HEY project will be tions across the territory was done. A collective nurse, CHR, community worker) in each com- abuse and risky behaviors, preventing addiction completed by the end of 2017. prescription for asymptomatic patients with munity provide support to teachers on topics relapses, and mental health. A working group chlamydia and/or gonorrhea was developed related to Cree culture, prevention of STIs and on the use of opioids was formed and meets Healthy sexuality and infectious diseases and approved, and a new STI memorandum unplanned pregnancies. Public Health worked regularly. As part of the overall Infectious Diseases Sur- was delivered and introduced to 42 nurses and closely with the Cree School Board to ensure veillance and Protection Service, this program 13 doctors during the first half of a community module delivery to all Secondary I-III students, focuses on reducing or eliminating sexually tour. Thirteen interviews for research “On Being with a focus group of six high school principals transmitted infections (STIs) and preventing un- Two-Spirited in Eeyou Istchee” were completed, as part of the evaluation process. wanted pregnancies, especially among teenag- and the Preventive Clinical Practice section of ers. This year the medical advisor had meetings the manual for the Youth Clinic was finalized. with the pharmacists to ensure accessibility of contraception and STI treatments in schools. The Sexual Health Nurse Counsellor received support with Hepatitis C, MADO investigation and STI management follow-up, and nursing staff reviews of STI regional memos, STI guide- lines provincial updates, and the Therapeutic Guide for STIs took place. Ongoing commu- nications continue with laboratory technicians and the RUIS microbiologist to support best practices application in lab STI testing. The 2016 update of the INSPQ Guide de rédaction d’ordonnance collective en contraception hor- monale et stérilet, a guide targeting nurses who don’t hold the right to prescribe, was shared Chishaayiyuu 30+ Promoting health and well-being for adults and Elders

The Iiyuu Ahtaawin Miyupimaatisiiun Plan- School Challenge Week. Once again, with the MAPAQ food safety certifications continue to Three Smoking Sucks Workshops were held: ning (IAMP) mandate is to support community funding from the Aboriginal Diabetes Initiative, be offered to those working in CBHSSJB food- December 2016 in Wemindji, January 2017 Miyupimaatisiiun strategic work planning and to public health can provide small grants to sup- service organizations, while training was offered in Chisasibi, and February 2017 in Mistissini. support regional alignment with these priorities. port regional and local activities on diabetes throughout the year: over 180 people have been Workshop format has evolved since start- This initiative is jointly managed with Nishiiyuu. prevention, and this year 39 small grants were certified with MAPAQ accreditation for food ing with high school youth, and now caters Although communities are moving at different awarded to various community groups who handling. Regional media continued to promote to CMC teams and Youth Councils. Smoking speeds in this process, all communities have requested financial assistance for projects. healthy nutrition, food safety and best practices Sucks Workshops are now integrated with NBTI drafted by-laws and determined memberships Diabetes Awareness Month saw healthy cook- for handling wild meats. Smoke-Free Challenges, as part of a more of Miyupimaatisiiun committees. At this point, ing in schools, community walks, after-school comprehensive community-based smoke-free community contribution agreements have been programs and other physical activity/nutrition No Butts To It! (NBTI), a three-year tobacco campaign. The Distance Education Program signed with all nine communities. projects organized by frontline workers and reduction project comprised of three parts—No (DEP) began with 14 participants in 2016, community organizations. Butts To It Smoke-Free Challenges, Smoking though five left due to maternity leave, medi- Each year health promotion activities are orga- Sucks Workshops for Cree youth leaders, and cal reasons, or resignation as a CHR. Several 48 nized, for the Promotion of Health and well- Iiyimiichim/Iyinimiichim—traditional food—is a Distance Education Program for CHRs—has participants played key leadership roles during 49 being and Prevention of chronic diseases. central to Cree nutrition and continues to be now completed its third year. Funding from the the Challenges and were able to implement Once again this year, the Public Health Depart- an integral part of Cree health and well-being. Federal Tobacco Control Strategy of Health aspects as part of their work on the Challenge ment launched several projects promoting MAPAQ agreements to serve wild meat con- Canada is confirmed for an additional year and, team. Integrating learning with action in a com- healthy living for schools, community members tinue to be part of the food service framework, following the March 2017 National Forum with munity health project has proved to be well and employees of the region. Support and and the traditional food workshops for Inland the Federal Minister of Health, there should be received; as one participant stated, “This is the encouragement is provided for communities to and Coastal communities, From the Bush to the further targeted funding to help reach Health first time we have had a training that actually organize various physical and nutrition-related Table, now bridge local Elder knowledge with Canada’s goal of reducing tobacco use to 5% results in something concrete that makes a activities throughout all seasons. Spring ac- current scientific knowledge. Two regional train- by 2035. Health Canada considers NBTI one of ­difference in the community.” tive campaigns (Active School Project, National ing conferences offered in early 2016 saw over their best-practice projects based on the scope Physical Activity Week) and summer active 80 Inland and Coastal participants complete of activities implemented and results achieved. Injury Prevention across Eeyou Istchee has in- campaigns were launched and the 100 Chal- training. The 2013 Regional Nutrition Policy con- volved initiatives addressing many social issues lenge was promoted throughout the region. tinues in CBHSSJB food services, and extends In January 2017, Wemindji joined the NBTI that have negative impacts on a community. Communities created a walking/running club in to boarding homes and hotels used by Wiichihi- Smoke-Free Challenge and Chisasibi and One devastating social issue that still requires the summer and some organized a 10km/20km ituwin patients travelling to Val-d’Or and Mon- Mistissini each implemented second challenges discussion is the different types of violence run. The fall active campaign Walk to School treal. A thorough evaluation of nutrition and food in January and February respectively. Results evident in Eeyou Istchee. Interested partner- Week was launched and schools were encour- services was done with quarterly assessments showed a significant increase in participa- ships, both at the local and regional level, are aged to organize and promote the campaign. in collaboration with Wiichihiituwin community tion compared to last year, and eventually all willing to address this issue. A working group Some communities organized a Walk to Work and social workers. Training, support and regular ­communities will be on board. on violence prevention within the public health (no vehicle) Day where a healthy breakfast was interventions continue to ensure best quality department, and the CHBSSJB more broadly, served to all participants. The Winter Active care for patients. Childcare centres were visited was formed. Injury prevention messages campaign was launched, with local and regional to ensure continued consultation of the 2010 continue on a yearly basis, from one season to radio encouraging community members to be Daycare Regional Nutrition Policy. Menu updates another, covering water safety, driving and road physically active during winter. January to March and training in nutrition, food allergies, and food safety, and firearm safety. communities organized weekly snowshoe walks safety and hygiene were provided, and nutrition and cross-country skiing events, which are now workshops, training and support continue to be very popular. Some communities set up tradi- offered in all 16 daycares. tional campsites with activities such as Family The Breast Cancer Screening Service is key to The Occupational Health and Safety Team Regarding Drinking Water Surveillance, the An interactive mercury map, developed breast cancer prevention, and a nurse responsi- is mandated regionally to protect the health quality of water in the community water distribu- from the most recent results of fish mercury ble for the program was hired to prepare for next of workers and to help prevent occupational tion system is the responsibility of First Nation monitoring from Hydro-Québec, provides fish year’s tour of the mobile screening program. injuries and illnesses in priority groups (I-II-III). Councils. The Public Health Department re- recommendations for each trap-line and is now Activities are planned on a yearly basis accord- ceives notification of abnormal results of drink- at www.creegeoportal.ca. The Environmen- The Train the Trainer Program is aimed at ing to provincial priorities. ing water testing that is sent to certified labs tal Health team met with the Cree Trappers’ increasing health care providers’ (HCPs) outside the region. The Environmental Health Association and the Cree Nation Government ­Diabetes management knowledge through Environmental Health not only informs about team reviewed all results of Chisasibi’s water Department of Environment and Remedial training, mentorship and support. In 2016-2017, and protects from the effects of harmful sub- testing done in a certified lab throughout 2016. Works on several occasions to discuss strate- three regional diabetes educators (CDEs) gave stances in outdoor air, indoor air, water, and Samples were sent out at least twice a week and gies for promoting a transition to non-lead initial training to all new nurses, CHRs and nu- food; it is also concerned with reducing nega- all results were normal, indicating an excellent ­ammunition. Presentations were made at sev- tritionists, before going to respective communi- tive health impacts of resource development quality of drinking water in that community. eral regional and local meetings, and articles ties. The CDEs traveled to communities at least projects, features of a community-built environ- were written in Cree Hunter and Trapper and 50 once a year to provide ongoing training to local ment, and environmental emergencies. Much Regarding environmental emergencies, the The Nation. A nutritionists and communications 51 HCPs, including doctors. For daily diabetes- of the work involves intersectoral collaboration CBHSSJB website provided information at the working group was organized within public related questions, local HCPs have access to with the Cree Nation Government (Environment beginning of the summer on how to prepare health to plan communications (poster and three phone assistance lines, managed by the and Remedial Works, and Capital Works de- for forest fires, and community meetings on radio) prior to the 2017 goose break season. CDEs and to culturally-adapted professional partments), the Cree Trappers’ Association, and emergency preparedness were held throughout A resolution supporting the elimination of lead tools. Constant development and updating of the James Bay Committee on the Environment. the year. Regular meetings have been set up ammunition in Eeyou Istchee was passed by on-line teaching and learning materials allow for between public health and regional emergency the Board of Directors at their March 2017 tailor-made support. Peer-to-peer support for The Environmental Health team completed a services. 1 meeting. Following warnings issued by other Eeyouch with diabetes and their families was radon testing project in CBHSSJB workspaces and dwellings where elevated radon levels had Ministries and other regions, a detailed assess- provided via a three-day diabetes camp and ment was carried out of the health risks from traditional walks for youth. previously been found in homes. They visited the community twice: to pick up monitors placed cadmium in moose kidneys. The Public Health Diabetes education materials several months previously, and to present testing Department’s evaluation concluded that risk results to the local director and staff. They also was minimal, and the most important source of presented a report to the Director of Material exposure to cadmium in the region was ciga- Resources and discussed the remedial work that rette smoking. This document was presented at is needed for a few CBHSSJB buildings. the provincial concertation table in environmen- tal health and shared with other Cree entities Regarding indoor air quality problems in and Quebec government departments. ­public buildings and social housing, the Envi- ronmental Health team answers frequent re- quests from the public and health professionals

about mould and indoor air quality. This year Interactive fish map on they were asked to contribute to two provincial- www.creegeoportal.ca level documents on housing.

1. Radon is a naturally occurring radioactive gas given off by some types of rock and soil, can accumulate in basements, and may cause lung cancer. Surveillance, Evaluation, Research, Communications, Clinical Preventive Practices and Public Health Competency Development

More planning is being done on how to report Axis 3 promotes population-based screen- The SERC Team is responsible for public health infrastructure and housing, natural environment, on the region’s growing social inequalities and ing and follow-up of chronic diseases with a surveillance—one of four primary functions of employment and economy, culture, physical how to track the impacts of climate change on focus on kidney disease. Technical support to public health—which is the ongoing systematic health and services, maternal and infant health population health. Year end saw the draft of the improve the Cree Diabetes Information System reporting on population health and its underly- (Axis 10), mental health and dependencies and larger report from the children’s dental survey, continued, and by year end the system was op- ing determinants. While surveillance is SERC’s society. From this report, other more popular and access to our Québec Population Health erating well and ready to be expanded to other principal independent function, it is carried out reports are made available in various formats Survey data was pending agreement between chronic diseases. As well as ongoing support to together with evaluation, research and commu- depending upon the need. We released infor- the CBHSSJB and the Institute de statistique the evaluation of genetic disease screening, we nications, which support the work of the other mation on diabetes within the region and each du Québec. This, along with lack of new data reviewed influenza coverage from the vaccina- teams in public health. The team’s expertise is community; diabetes in youth; cardiovascular on cancer from the Ministry, was our major tion registry and worked on the methodology also used outside of public health to support diseases; cancer; respiratory diseases; injuries problem concerning access to data. However, for a surveillance of dialysis. services: developing data gathering systems, and intoxication; hospitalizations; tuberculosis; the National Public Health Institute’s Infocentre special CBHSSJB activities such as the Cancer and infant deaths. As part of larger teams, we continued to make more regional data available Axis 4 promotes mental health services. We Project, and planning for electronic medical finalised research reports on pulmonary fibrosis for analysis. To help users of our reports, we spent a lot of time working on the Mistissini 52 records. and continued analyses and reports from the prepared a guide on understanding how we use ACCESS project for youth mental health, and 53 Environment and Health Study database on statistics when reporting on population health. began specific work on developing mental The work of the team follows two sets of ob- persistent organic pollutants, lead and human health terms for the Cree language lexicon jectives: those from the CBHSSJB Strategic health and nutrition. We also did special data Axis 2 has the goal of improving access to with the language working group. One project Regional Plan (SRP) and those of the surveil- requests for DMAS and the Department of services with a focus on community outreach, involved validating and adapting a widely-used lance theme within Québec’s Public Health Justice. All information was prepared for vari- improved vaccination coverage, STI prevention tool to detect depression in pregnant women; Plan. Axis 1 of the SRP is to improve the social ous purposes and audiences: some released and dental health. The team had major com- another involves a partnership with the Cree determinants of health, to promote healthy publically, others used internally. mitments in community outreach: the Cancer School Board and researchers to do the same lifestyles, and to prevent suicide and sexually Project and development of Cree language and for common tools used to assess the men- transmitted infections. The primary surveil- The team continued to develop data capturing tools to access the lexicon; evaluation of the tal health of youth. Planning also began for a lance function of SERC team falls within this systems and provide ongoing support in Allied regional initiative to promote and support local regional CBHSSJB study on prescriptions and axis. This also covers National Public Health Health, measuring units in the Mistissini CMC health planning; the research project to deter- the use of opioids. Plan objectives which include access to data Current Services, Awash services, and the mine integration of dental services into primary on population health, recurrent and planned pharmacy in Chisasibi, helping to improve avail- care; ongoing evaluation of the genetic diseas- reporting while responding to ad hoc requests, ability of surveillance data from local services. es screening and education program; continu- and reporting on emerging problems. Planning on how to capture youth mental health ing work to establish a local model and ap- services data is ongoing with the Mistissini proach for delivering appropriate youth mental Our work involves keeping databases up to CMC. Support was given to planning initiatives health services in Mistissini, within the ACCESS date, preparing reports from them, and devel- for midwifery, violence prevention, reportable research project partnership; and support oping and providing support for data-capturing infectious disease and women’s shelters; and for an outside project to review literature and systems within services. This year we contin- reviews were done on the quality of vaccine consult on how Elder participation can improve ued to draft our regional surveillance plan, and registry data and on STI screening data. indigenous community well-being. Other work participated in preparing the Public Health Plan. within this axis involved support and training for Our analysis of population health is kept up community organisers. to date in our Global Health Report for Eeyou Istchee, an internal report with ten thematic chapters covering demographics, quality of life, Nishiiyuu refers to the traditional ways of the Eeyou and Eenou people. The Nishiiyuu Miyupimaatisiiun Group is concerned with integration of Cree knowledge and values into CBHSSJB services and organizational culture. The new organizational structure reaffirms the central role of Nishiiyuu. The Group was expanded to include Organizational Quality and Cultural Safety. Nishiiyuu chairs the Clinical Coordination and Integration Committee (CCIC), which is the hub of multidisciplinary collaboration under the new structure. 55

3

ᐊᓂᔒᔨᔨᐤNishiiyuu Miyupimaatisiiun CBHSSJB organigram Kathy Shecapio, interim AED of Nishiyuu Miyupimaatisiiun Group

board of directors

executive direction This past year has seen much activity in the A number of specific projects are currently Nishiiyuu Miyupimaatisiiun Department, whose underway. The Department is at the first stages mandate is to promote health and miyupimaati- of addressing the Truth and Reconciliation siiun by drawing on traditional Cree knowledge Committee’s Calls to Action, identifying specific and practices in addressing the many different needs, and determining the scope of efforts factors that influence wellness. and projects involved in taking on the TRC’s recommendations. This will no doubt lead to Nishiiyuu revised its action plan to re-align further initiatives. nishiiyuu pimuhteheu miyupimaatisiiun administrative priorities and schedules. The new Strategic miyupimaatisiiun resources Regional Plan places greater emphasis on MIDWIFERY AND WAAPIMAAUSUN traditional knowledge and healing practices Nishiiyuu anticipates the full implementation of and on assuring cultural safety in all programs the Midwifery project in the coming year. This and services of the CBHSSJB, and Nishiiyuu past year saw drafting of the program plan and 56 Miyupimaatisiiun will play a critical role in the development of the program, with a book of 57 community success of this component of the SRP. development procedures in the process of being compiled. A complimentary The department established a Collaboration prenatal pathway has been developed for normal services and pregnancies, which will provide a clear structure programs and Contribution Agreement with the Nishi- iyuu Council of Elders, ratified by the Board for the program. The Midwifery project is closely organizational of Directors in March. This agreement defines connected to the Waapimaausun­-Traditional quality and Birthing Knowledge project, and is being inte- cultural safety the Department’s relationship with the Council grated with it. This project, led by Cree women evaluation and of Elders, our knowledge carriers and holders accreditation of traditional knowledge, including traditional elders, aims to (1) document and research client medicine, whose guidance is necessary for Cree women elder’s personal stories; (2) gather experience and the Department to achieve its mandate. The traditional knowledge on traditional birthing and organizational childrearing; (3) document men’s knowledge performance Nishiiyuu team will work in close and structured partnership with the Elders Council, building a on birthing practices; and (4) produce videos, constructive dialogue in order to develop Nishi- publications and other tools for education and iyuu programs and services. This first year will awareness. The Nishiiyuu team is conducting an involve a learning process for both parties. inventory of the Traditional Birthing Knowledge data of approximately 180 interviews with Cree Elders. Thus far over 20% of interviews have been inventoried; this effort will continue through The Nishiiyuu team is 2017-18. Much work remains to be done on tran- conducting an inventory of the scribing and translating interviews. In addition, we must establish a clear process for protecting Traditional Birthing Knowledge traditional knowledge. data of approximately 180 interviews with Cree Elders. Nishiiyuu participated in the visit of Maya K’iche’ health workers from Guatemala

organizational quality and cultural safety

An Executive Scan of the Waapimaausun Through the services of Matthew Mukash, BEST OF BOTH WORLDS RESEARCH PARTNERSHIPS AND COLLABORATIONS Program Manual was conducted by Anne Foro, consultant up to 2015-2016, and under the Nishiiyuu Miyupimaatsiiun collaborated in the The Nishiiyuu Department is working closely who has provided recommendations on ways guidance of the local Elders council and key Best of Both Worlds Research Program with with other partners within and beyond the to improve and re-organize the manual layout. community members representing other Cree the research team of Université de Montréal CBHSSJB, including the Nishiiyuu Council of entities and organizations serving the Whap- professor Pierre Haddad. The program aims to Elders; Midwifery and Cultural Safety Working The Nishiiyuu team collaborated with Public magoostui First Nation, a Five-Year Strategic develop safe and culturally appropriate ac- Group; Public Health Awash (Booklets, AMA, Health Awash on the integration of Nishiiyuu Plan was designed and developed to identify cess to traditional medicine for diabetes care CHR Awash Training); Regional Addictions material in that unit’s booklet project. Nishiiyuu Whapmagoostui priorities in traditional medi- in contemporary aboriginal primary health Working Group/Healing Lodge; Maanuuhiikuu is also refining its Nishiiyuu Miyuut – Baby Birth cine, helping, healing and traditional knowledge care. The project involved the Cree communi- (Mental Health); Indigenous Health Programs Package initiative; this initiative, piloted in three practices. This strategic plan has been com- ties of Chisasibi and Mistissini, as well as the (McGill University); and Best of Both Worlds communities, aims to support young mothers pleted and also served as a reference as the Innu community of Mashteuiatsh. The goal was (Pierre Haddad/Université du Montréal). during pregnancies, to help establish strong winter manual was being finished. to use participatory research methods that bonds between mothers, infants, and other engage Cree healers, community members 2016-2017 MILESTONES: 58 family members, and to help bring birthing back Whapmagoostui pilots have been launched and healthcare providers. 30 people from each ●● Whapmagoostui Land-Based Healing 59 to Eeyou Istchee. for developing land-based healing manuals community were interviewed: patients, healers, ­Program Manual for high-risk young men and for male-female elders, health workers and health managers. ●● Nishiiyuu Council of Elders Collaborative & NITAHUU ASCHII IHTUUN (LAND-BASED groups. In addition, the video projects of the Consent forms were signed for permission to Contribution Agreement HEALING) Nishiiyuu Walkers Journey and of elder inter- be taped, photographed, and/or videotaped. ●● Traditional Birthing Re-enactment at the As our ancestors knew, the Land heals, and views are underway, with inventories of video The study is a first step to building health care Annual Cree Nation Government Assembly this understanding provides the foundation for and audio materials. offering both traditional and modern approach- ●● Nishiiyuu Miyupimaatsiiun – Collaborating the Nitahuu Aschii Ihtuun (Land-Based Heal- es to medicine and eventually bring health staff Sun Dance – Healing ing) program. This past year saw the comple- CULTURAL SAFETY and healers to work together. tion of the Whapmagoostui Winter Land-Based Cultural Safety is a relatively new file for the ●● Allocation of new staff in Nemaska, ­Oujé-Bougoumou, Eastmain, Wemindji and Healing Program Manual (WLBHP), which lays Nishiiyuu Department and is in the preliminary EMPLOYEE AND FAMILY ASSISTANCE Whapmagoostui out key program goals, objectives, guidelines, stages of planning. The aim of Cultural Safety PROGRAM (EFAP) – CULTURAL COMPONENT values and expected outcomes for delivery of is to provide all services in accordance with the Nishiiyuu Miyupimaatsiiun was asked to provide ●● Development Positions in Nishiiyuu Land-Based Healing Programming. Nishiiyuu cultural values and realities of the Cree people. a responsive sensitive cultural component to the Miyupimaatsiiun will promote the use of this This process will be supported by key partners existing EFAP, based on Cree cultural values, winter manual to the other land-based commu- from the CBHSSJB’s new Clinical Coordina- beliefs and traditional practices. A working group nities as a guide to start initiate healing in all the tion and Integration Committee (CCIC) and the has outlined a process incorporating a culturally communities. Nishiiyuu Council of Elders. Nishiiyuu’s role on appropriate support system based on traditional the CCIC will be to ensure the cultural safety of The manual is a green document, meaning it ways of offering support, help, and healing to program and service delivery. Local CCICs will individuals and/or families. Consultations and a will be revised, edited, and added to as other be multidisciplinary teams including a Nishiiyuu communities develop programs and can con- survey have been conducted to identify and ad- representative, charged with advising local dress needs and help make improvements to the tribute their own knowledge, experiences and CMC directors. The Nishiiyuu Department is discoveries to the manual. CBHSSJB EFAP, and an action plan has been also developing education material related to drafted. This will lead to the implementation of the culturally safe and appropriate delivery of pilot programs for Cultural Healing Services for programs throughout the CHB. Employees and Families. Miyupimaatisiiun, meaning “being alive well” is the Cree word for “health”, but it has a holistic meaning that encompasses all aspects of wellness. Miyupimaatisiiun Group has two components: regional services under the leadership of Directors of Professional Services and Quality Assurance (DPSQAs) and the Director of Hospital Services, and nine Community Miyupimaatisiiun Centres (CMCs), where community members receive services on a day to day basis. Under the new organizational structure, the Miyupimaatisiiun Group has been rebalanced and a DPSQA for 61 Midwifery has been added to the organigram.

ᒥᔪᐱᒫᑎᓰᐎᓐMiyupimaatisiiun CBHSSJB organigram medical affairs and services board of The Department of Medical Affairs and Services (DMAS), headed by Dr. François directors Charette, regroups the three major clinical departments: Medicine (Regional Department of General and Specialized Medicine), Dentistry, and Pharmacy.

department of

executive medicine direction The Regional Department of General and Spe- COLLABORATION cialized Medicine includes all family physicians The department is pursuing strategies to and specialists working at the CBHSSJB. The improve quality of care, for which an interdisci- Head of the Department is Dr. Carole Laforest. plinary approach is essential. The medical team has worked closely with colleagues in other STAFFING departments on the Therapeutic Guide, Col- Medical staffing continues to move towards the lective Prescriptions, Palliative and End-of-Life goal of meeting frontline clinical needs, with 25 Care, Telehealth, and standardized laboratory nishiiyuu pimuhteheu miyupimaatisiiun administrative full-time physicians (from 22 last year), 31 half- testing. Two major projects stand out. The re- miyupimaatisiiun resources time physicians, and almost 80 locum physicians turn of birthing to the Territory—a longstanding who spend on average two weeks a year on vision—is becoming a reality, and the medical the Territory. Negotiations for specialist medical team supported the development of midwifery staffing resulted in 14 dedicated positions as of positions and is advising on how to imple- 62 2017: pediatrics (2), psychiatry (2), child psychia- ment this vision in a secure and culturally safe 63 medical affairs try (2), internal medicine (2), gynecology/obstet- manner. Secondly, as medical staff have long and services rics (1), ophthalmology (1), orthopedics (1), ear, recognized that the CBHSSJB’s IT infrastruc- medicine nose and throat (1), radiology (1), and nephrology ture is a barrier to quality care when medical dentistry (1). Five of these have been filled and the depart- information is dispersed, fragmented and dif- pharmacy ment is working to recruit the remainder and ne- ficult to access, work is underway to implement nursing gotiating partnership agreements with relevant an electronic medical file system. establishments outside the region. allied health PRIORITIES FOR 2016-2017 The department continues to develop an in- The department aims to provide the best possible midwifery tegrated specialized services program within medical services close to home, and is commit- RUIS McGill to provide total coverage and en- psychosocial ted to working with the entire CBHSSJB. A strong sure access to all specialist services: on-territo- team of family doctors supported by specialists ry consultations, consultations via corridors of and an ongoing collaboration with nursing col- service, telehealth consultations, and special- leagues will lead to continuous improvements in chisasibi community ist expertise in frontline personnel. Access to hosptial miyupimaatisiium care in Eeyou Istchee. In line with the Strategic centres pediatric, psychiatric and internal medicine care Regional Plan, a major project for the coming year is improving, and the priority is now shifting to is to improve support to patients with chronic areas such as ophthalmology. All these efforts chisasibi chisasibi diseases including diabetes, kidney failure, high hospital eastmain make a significant contribution to services for cholesterol and arterial hypertension; a working Eeyou Istchee, reducing clients travel outside regional mistissini group is researching a regional framework for clinical nemaska the region for medical care, which disrupts prevention and management of chronic diseases. health oujé-bougoumou school, work, and family life. However, recruit- services While there is much to do, the team is optimistic waskaganish ment and retention remain a challenge: recruits telehealth waswanipi about the future, and is particularly enthused must adapt to living and working in a remote wemindji by the possibilities offered by new equipment whapmagoostui region and a community setting very different (e.g. for scanning and respiration therapy) and, from that in the south. ­eventually, the new hospital in Chisasibi. Department of Department of Dentistry Pharmacy The Department of Dentistry’s mandate is to A major challenge for the department is recruit- Anh Nguyen joined the CBHSSJB as Head of The quantity and complexity of dispensed provide quality general and specialized dental ment: 2275 hours were not replaced in 2016- the Department of Pharmacy in January 2017. medication is increasing all the time, demand- services throughout the Eeyou Istchee territory. 2017, representing an 11% loss in services. As a pharmacist, she is an experienced man- ing great vigilance on the part of pharmacists Accomplishments for the past year include revi- The Chisasibi dental clinic is in a critical state ager with a passion for improving pharmacy and their assistants in order to avoid errors. To sion of the NIHB guidelines, policies and pro- (access, organization, equipment) and, until services. There are no private pharmacies in improve efficiency and security, the department cedures; the beginning of the dental assistant renovations occur and housing is resolved, Eeyou Istchee; all medication is dispensed by is working to acquire a software tool better training program; the addition of a third perma- improvement is unlikely. An additional challenge the CBHSSJB, and most medication costs adapted to the CBHSSJB’s needs: a tool that nent dentist and one team leader in Mistissini; is the continued absence of the public health are covered by the Cree Non-Insured Health is designed for an institutional setting as op- and the revision of the rules and regulations of dentist and the PPRO for Public Health Dentist- ­Benefits (CNIHB). posed to a a commercial one. The department the dental department. ry, which affects coordination efforts and public also hopes to have ‘Dispill’ blister pack tech- dental health program development. Training Ms Nguyen forsees reorganization and hiring of nology available in all communities, a system In 2016-2017, the Department of Dentistry staff needs are important and available resources additional staff in the pharmacy units in most which packages medication into clearly labelled treated 13,774 patients, of whom 2,833 were are limited—one of the biggest challenges for of the communities. The department aims to sheets of detachable blister packs. 64 children nine or under; a total of 5,452 different the department. Lack of proper training for sup- expand training for pharmacy technicians—­ 65 patients were seen. For general anesthesia, 216 port staff affects the department’s capacity to positions mainly staffed by members of the The number one prioity and overriding goal of children were seen in Montreal. Access to den- provide effective dental services. local community. In this effort, the department the department is to ­ensure all medically nec- tal services has improved in Mistissini, given a is partnering with Human Resources to recruit essary medications are available and that they third dentist and improved clinic organisation Plans for 2017-2018 include renovating the high quality candidates who are committed are dispensed in a secure manner. with the team leader position in place. However, Chisasibi dental clinic, implementing the to serving their community with diligence and the Chisasibi Dental Clinic is at a critical point Chisasibi team leader position and third dentist professionalism. Once the department is at due to lack of space, old equipment and poor position, implementing the purchasing template full strength, the issue of how to expand hours coordination processes. Access to services for dental orders, and beginning revision of the of service in Chisasibi and Mistissini will be remains mostly on an emergency basis, without policies and procedures manual. explored. planned dental appointments. DENTAL CONSULTATIONS IN THE COMMUNITIES Community 2015-2016 2016-2017 VISITS BY DENTAL SPECIALISTS Chisasibi 3,683 3,013 Eastmain 1,352 1,026 Number of days 38 Mistissini 4,608 3,726 Patients seen 1,878 Nemaska 762 529 Average travel cost/patient $65.70 Oujé-Bougoumou 813 665 Waskaganish 1,604 1,383 Waswanipi 1,616 1,371 Wemindji 1,240 1,264 Whapmagoostui 1,023 797 Eeyou Istchee 16,701 13,774

Children 0-9 3,177 2,833 Pulmonary function testing equipment used by Respiratory Therapy nursing allied health (DPSQA-HEALTH)

The CBHSSJB has experienced several chang- The 2016 annual training of CBHSSJB nurses Allied Health includes many different profes- In addition to the development of on-Territory es since summer 2016, beginning with the new was held in Montreal in November. Once again, sionals: nutritionists, occupational therapists, respiratory therapy services, we have also organigram structure which saw several team nurses attended key workshops to increase physical therapists, speech-language patholo- embarked on a needs assessment to deter- players moving to DPSQA-Health, including overall knowledge in health and renew certifi- gists, psychoeducators, psychologists, psy- mine steps towards an on-Territory clinical employees from Prevention and Control of cation in trauma and emergency care, with a chotherapists and, for the first time, respiratory pathway for Audiology. We are growing the Infections and Risk Management. Additionally, special emphasis on collective prescriptions therapists. We also work closely with rehab speech therapy services and referral corridors, the DPSQA-Health mandate was modified to this year. Presentations and workshops in monitors and education monitors who are es- and collaborating closely with rehab services align with the provincial mandate and to ensure areas such as depression (linking diabetes and sential partners in our work. offered by Regional Disability (Special Needs) quality and accessibility of frontline services—a depression), midwifery, telehealth and cultural Services to provide as much care as possible process requiring different partners within the safety were held. Training was very successful, It has been another year of tremendous growth close to home. We are also growing the per- organization to harmonize practices and offer with 109 dedicated health professionals learn- for Allied Health Services, with projects started manent team of psychologists (up to four now), services as a continuum of care. As a result, the ing many new skills. The first annual training for to implement best practices in dementia care, hoping this will help stabilize and enhance the DPSQA-Health is now referred to as the Direc- CHRs will take place in the next fiscal year. and training of, and investment in, rehabilita- psychosocial and emotional support provided tor of Professional Services and Quality Assur- tion monitors. The pool in Chisasibi is now fully to individuals and families in Eeyou Istchee. 66 th 67 ance-Health (and not the Director of Nursing), February 17 , 2017 marked the first official adapted to enable participation of individuals Nutrition has also had an extremely success- and includes different frontline workers such as general assembly of the Council of Nurses, with with reduced mobility. ful year. A big achievement was the joint Cree CHRs. four members elected according to the Coun- Nation Government–CBHSSJB “Call to Action cil’s adopted bylaws, and the creation of the to Improve Access to Nutritious Foods in Eeyou DPSQA-Health now counts on the support of first Executive Committee. Istchee”, which calls on the two entities to work six nurse counsellors working hard to improve We continue to support Cree nurses through an together to make healthy and nutritious foods the quality of services offered to the Eeyou more affordable and accessible in the region. Istchee population, and responsible for com- integration program. Seven received support petency, chronic illnesses, wound care, admin- through a two-year preceptorship program, istrative support, and training. Although each with four successfully completing the program ALLIED HEALTH: HOURS OF SERVICE PROVIDED and now part of the CBHSSJB nursing team. counsellor has a specific mandate, all work as Speech and Physio- Occupational Psycho- Language Total a team to cover various files that emerge ac- Finally, collaboration with multiple partners Community Nutritionists therapists Therapists educators Pathologists 2016-2017 Variation cording to the needs of the organization. One towards the stability of the nursing workforce Chisasibi 1,004 1,747 1,148 702 473 5,074 13.0% such counsellor is the CBHSSJB’s first full-time has seen the ongoing analysis of the needs nurse practitioner in primary care, and part of and structure of the local nursing teams, the Eastmain 423 - 261 - 40 724 709.8% her mandate is the integration of nurse practi- result of which will ensure quality service to our Mistissini 945 337 1,465 879 189 3,815 3.6% tioners into our communities. A short-term goal clientele. Nemaska - 111 - - 32 143 - 63.1% is to integrate nurse practitioners in Chisasibi Oujé-Bougoumou 255 746 365 312 37 1,715 14.4% within the framework of the new CMC-hospital Waskaganish 342 626 - - 1 969 -105.7% plan. We were also fortunate to have the Waswanipi 770 752 1,046 613 34 3,215 125.0% temporary support of a nurse practitioner in nephrology as consultant for the Cree Renal Wemindji 401 999 571 - 58 2,029 -20.8% Program and a specialized mental health nurse Whapmagoostui 179 36 62 - 1 278 -42.0% to work on some of our mental health files. Eeyou Istchee 4,319 5,355 4,918 2,506 865 17,963 5.6% psychosocial

After a six-year vacancy, DPSQA-Psychosocial To ensure quality service, all frontline social staff CBHSSJB has been represented on two national My role as a SW can be challenging, has been filled by Doreen Perreault, as has the must complete training: six modules of Psycho- coordination tables (general social services, position of Planning and Programming Research social Child and Family Intervention as well as support to elderly) and, in light of the new gov- as I balance between coaching/ Officer. With a mandate similar to Medical, the Charlie Training Program. The Mental Health ernmental action plan to combat elder abuse, accompanying the psychosocial Health and Allied Health, the focus is on frontline Department provides excellent training during a regional coordinator will soon be hired. Com- team (NNADAP and Community social services provided by community workers, the year to psychosocial workers, and staff ben- munication with the Professional Order of Social HR officers and social workers, ensuring that efit from the Douglas Mental Health University Workers (OPTSTCFQ), notably to advocate for workers), and providing quality quality services are accessible and meet the Institute’s Visio Training. Continuous and im- Eeyou Istchee, is ongoing. To ensure social services within a multi-disciplinary population’s needs. In this first year, the Direc- proved training is important. Chisasibi’s psycho- services representation within the CBHSSJB, tor visited all nine communities, introducing the social team received extra training on confiden- a Multidisciplinary Council with DPSQA-Allied team. I appreciate working for Crees mandate and hearing from CMC workers and tiality and record-keeping, and sessions in other Health will be created with a specific committee because of their welcoming nature, managers about the strengths and challenges of communities will take place in the coming year. on social services. motivation and openness to work delivering social services—an important step in Next year will see a first regional meeting, with 68 identifying local and regional priorities. professional training for all social workers and in collaboration with newcomers. 69 HR officers as well monthly conference calls to The social services provider in Likewise, as an immigrant of African Often physical and mental health issues are address the need for support. intertwined with social issues, hence the im- Val-d’Or is always good. She has the descent, I bring local/international, portance of assessing the social context of Record keeping has been identified as a top high potential to help and resolve any life experiences, and an awareness on users and providing support to them and their priority in ensuring appropriate quality, continuity problem. She has a good job. She’s on families. Priorities include access to appropriate of services and respect of users’ rights, with new different point of views with a high psychosocial evaluation within the framework of record keeping standards of practice. Consulta- time to help in time of needs. level of patience. the person of full age protection plan, with some tion on the “S5-placement policy” took place, — Narcisa Fernando, talking about Annie Langevin, — Rosemary Thomas temporary solutions occurring locally. Steps both toward an official policy and also to ensure Social Worker at Wihiichituwin in Val-d’Or Social Worker at the clinic in Mistissini are being taken towards innovative solutions for these exceptional measures are part of social after-hours emergency social services, as well interventions that empower users and families. as towards access to social services for hemodi- Continuity remains important in ensuring that alysis patients in Montreal, in collaboration with social services are well integrated within each lo- Wiichihiituwin. cal interdisciplinary team, that frontline services are connected to Youth Protection, and that users sent outside communities are receiving appropriate care when returning home. Policies, protocols and tools have been drafted, especial- ly regarding referrals between disciplines, and links with Youth Protection and suicidal crisis intervention. chisasibi

hospital Preparation for the inauguration of a new Shaputuan at the Chisasibi Regional Hospital

The Chisasibi Hospital has made great efforts to EMERGENCY MEASURES LABORATORY AUXILIARY SERVICES develop its regional mission, serving the whole It was a very busy year with the hospital par- After the recruitment of an Assistant Laboratory This year’s focus has been on the housekeep- population of Eeyou Istchee. The hospital has ticipating in three simulations: code orange Head, Maryse Gionet, Coordinator of Clinical ing team, who received MSSS hygiene salu- seen important changes in the past year, begin- (disaster or mass casualties), code red (fire), Services, finalized the regionalization of labo- brity training—an important step in meeting ning with the appointment of Philippe Lubino as and code green (hospital evacuation, which ratories under the leadership of the hospital to MSSS guidelines to improve management and Director of Hospital Services in April 2016. The was a community evacuation). The code orange maintain coherent, quality and efficient services ­prevention of infection risks. hospital has also welcomed six new permanent simulation involved a plane crash scenario with across the territory. She continued to work with doctors to the team, allowing for the Medical De- 18 casualties, testing the hospital’s ability to the MSSS on the province-wide Optilab project. WIICHIHIITUWIN CHISASIBI partment to structure specific doctors respon- triage and provide medical assistance to a large With the development of Telehealth services sible for specific departments or units. number of casualties at once. RADIOLOGY and the increase in visiting specialists in Chisa- Two medical imaging technologists are being sibi, the number of client arrivals at the hospital NURSING HEMODIALYSIS certified to autonomously perform obstetrical ul- increased by 23%. This trend should continue The nursing team worked hard throughout the The Hemodialysis Department received new trasounds without supervision of an obstetrician in the coming year, given the expansion of 70 year to update protocols, actively participat- hemodialysis machines like those at Montreal or a radiologist, allowing more pregnant women ­specialized services at the hospital. 71 ing in the review of emergency plans and staff General’s referral centre and the other satel- to be seen in Chisasibi, not flown to Val-d’Or. training for those plans. The simulations were lite unit in Mistissini. The department facilitates NISHIIYUU MIYUPIMAATISIIUN appreciated by nursing staff, given the collabo- training and harmonization of practices be- PHARMACY The management team recognizes the cultural ration with Chisasibi CMC and the identification tween all units. Chairing the Cree Renal Health The arrival of pharmacist Guillaume Kuate component of the hospital, respecting the of areas for improvement. Committee, the Director of Hospital Services Fotso and the new Head of Pharmacy, Anh sensibilities and beliefs of everyone. Cultural focused on a holistic approach towards renal Nguyen, has energized the hospital pharmacy. safety training has been integrated into the health with the goal of developing an integrated Despite numerous challenges, the dedicated nurses’ annual two-week training. Last summer, renal care program. team worked hard to improve services, with a Shaputuan was built on hospital premises in encouraging results showing towards year end. collaboration with the Nishiiyuu Miyupimaatisi- CHISASIBI REGIONAL HOSPITAL iun department and the Cree Nation of Chisa- Activities 2015-2016 2016-2017 Variation ARCHIVE sibi. Wheelchair accessible, it gave the patients Admissions 678 790 16.5% The archivists team enforced a regional-level an opportunity to reconnect with their roots, enjoy traditional food and not feel confined to Hospitalization days 5,480 6,568 19.9% ­vision of services through increased collabora- tion, sharing of experiences and practices, and the hospital. The Shaputuan is also intended Transfers to other health centres N/A 123 N/A a first annual meeting in Chisasibi in January, to be a safe place of intercultural collaboration; Deaths 10 7 -30.0% which led to a regional action plan. The plan indeed, the Maanuuhiikuu department helped Average stay in acute care (days) 8 6 21.3% highlights steps necessary for the second phase plan a cultural and history event for all staff. Bed occupation rate 64.0% 64.3% 0.4% of the Master Patient Index (MPI) under the Sage smudging rituals were also performed at Clinic consultations 18,461 16,274 -11.8% leadership of the archive team, as well as the the hospital upon patient request. Specialist consultations 2,478 2,506 1.1% standardization of user files. Locally, the team Observation hours 4,268 6,113 43.2% integrated a new archivist, Maude Beauséjour, Radiology technical units 136,881 162,093 18.4% increased opening hours, and redesigned the work area with space provided by manage- Laboratory tests 229,195 249,648 8.9% ment—increasing productivity and motivation. Dialysis treatments 2,617 2,443 -6.6% Pre-dialysis 198 210 6.1% specialiZed services telehealth Specialized services are the regional services APSS (PRIORITIZED ACCESS TO Telehealth continued its steady development. TeleDermatology has been used in all com- within the Miyupimaatisiiun Department which SPECIALIZED SERVICES) This year, admin supports have been hired and munities. This speciality has a lot of potential take care of the coordination, implementation The MSSS introduced at the end of 2016 the trained in the 6 communities where visiocon- as it is simple, easy and very efficient. During a and the delivery of specialized services, which APSS, which is a new way of organizing spe- ference is accessible (Waswanipi, Oujé-Bou- regular consultation with the client, with the cli- include Telehealth services. cialized services for the whole province of goumou, Mistissini, Nemaska, Wemindji and ent’s approval, the family physician just needs Quebec. The goal is to centralize requests, to Chisasbi). to take pictures of the skin and send them to Co-managed by the DMAS and the Director better define and harmonize their priority and to the MUHC dermatology department. All the of Chisasibi hospital, the vision of Specialized direct them to the correct specialist. While the A new telehealth speciality has started in process is confidential and secured as we use Services is to provide second and tertiary line overall implementation has been challenging Chisasibi: Internal medicine. On top of their MSSS approved software. The specialist’s services to the population more efficiently, across the province, our region has managed regular on-site visits, two internists, Drs Patrick ­report is received on average within two weeks. closer to their community and at the right mo- to introduce the new MSSS forms and to put in Willemot and Romina Pace, started to offer ment. In terms of structure, a new Coordinator place the resources to ensure their processing. consultations through telehealth which allows of Specialized Services will be hired. Additional The APSS started with a phase one of only 9 them to provide more services and more regu- 72 resources will also be provided to the commu- specialities. We will need to continue the hard lar follow-ups, and also makes their physical 73 nities as visiting specialists require space and work in the future as phases 2 and 3 will include visits more efficient (focusing on clients who human resources to support their visits. 17 new specialities. don’t meet the criteria for telehealth). Working closely with the MSSS, the DMAS managed to obtain new specialist positions dedicated to our region. Therefore, our family physicians will have a better support from the specialists, more visiting specialists will be on the territory, and more telehealth services will be developed. Overall this will lead to fewer patients having to travel for services outside the territory. Community Telehealth Officers (CTO) with Chisasibi Hospital Director Philippe Lubino. From left to right: Julianna Neeposh (Mistissini), Sheena Napash (Oujé-Bougoumou), Leona Shem, Crystal Mianscum (Waswanipi) Community Miyupimaatisiiun Centres (CMCs) are the community presence of the CBHSSJB, similar in many ways to CLSCs in other parts of Québec, although with a different structure and a distinctive Cree cultural element. Each CMC includes a walk-in clinic, as well as community health clinics serving different age groups: Awash (children 0-9), Uschiniichisuu (youth and younger adults aged 10-29), and Chishaayiyuu (mature adults aged 30 and above). CMCs also offer dentistry, pharmacy, mental health and social support, and home care and rehabilitation services including day programs at the local Multi-Service Day 75 Centre (MSDC). Each CMC has an Administration department which takes care of areas such as financial management and maintenance of buildings and 4 equipment. ᐃᐦᑖᐎᓐ communityᒥᔪᐱᒫᑎᓰᐎᑭᒥᒄᐦ miyupimaatisiiun centres “Our local health conference in January, an initiative of Clarence Snowboy’s, received feedback on services from the community, which we used in our budget planning projections. Involving the community really gave added meaning to our work,” says local director Jeannie Pelletier, who also points to two more initiatives building collaborations. “The Awash AMA program helped to integrate teams, and is a catalyst changing how workers connect, manage awash 0-91 995 q 0.7% conflicts, and manage responsibilities. And the Clinical Coordination chisasibi Jeannie Pelletier Uschiniichisuu 10-29 1,696  1.8% and Integration Committee will increase communication between Interim Local Director 4,693 Chisasibi CMC Chishaayiyuu 30+ 2,002  2.1% management and clinical teams. With the Nishiiyuu Department TOTAL2 4,693  1.4% leading this movement, we are seeing a cultural shift. Exciting and creative service delivery opportunities lie before us.”

medical EVACUATIONS The Chisasibi CMC’s upcoming move to a The Uschinichisuu unit’s major success came The Administration unit hired a Chishaayiyuu EMERGENCY - larger location will allow it to enhance services with the Uschiniichisuu Clinic’s launch, in Au- coordinator in May, giving the CMC a full team. scheduled - and share resources, as Awash, Uschiniichisuu gust 2016, and the hiring of a new clinic nurse. In February, though, the Local Director was current services3 and Chishaayiyuu will be under the same roof. A community worker was hired under the devel- assigned elsewhere, so the Awash coordinator doctors (pgm & clinic) 3,804 The new Clinical Coordination and Integration opment resources plan, as were two CHRs. The has become the interim Local Director. awash3 Committee, bringing together local manage- Chisasibi Elementary School sealants applica- nurse (pgm, incl. vacc.) 2,491 ment and medical teams, has set an initial tion program screened 217 grades 1-3 students Once the move to the old arena is complete, CHR (individual) 486 goal of increasing communication between for dental sealants, provided sealants to 85 the unit aims to fill all vacant CMC positions; 76 CHR (groups) 983 management and staff, in order to help the students, and referred 59 to the dental clinic. lack of office space is currently limiting the 77 Community worker 191 organization deliver patient-centered, evidence- The Uschiniichisuu nutritionist was involved in capacity to fulfill services and meet all the school nurse (incl. vacc.) 270 based services within a culture of continuous 57 activities and 240 interventions. community needs. Staff will also benefit from Uschiniichisuu3 ­improvement. better working conditions and a healthier work nurse (pgm & curative) 982 The Chishaayiyuu unit received a new coor- environment. CHR (individual) 1,644 The Awash unit welcomed 89 new babies this dinator in May and a mental health nurse was CHR (groups) 932 year, and four new nurses; it will also be hiring a hired in July. With more than 200 clients receiv- Community worker 784 social worker to fill a vacancy. Awash continues ing foot care, the CMC launched a foot care social worker - with the  Mashkûpimâtsît Awash (AMA) inte- clinic to be held every two months; in February, school social worker (ind.) 42 grated approach, including the very successful a home care nurse began providing foot care NNADAP worker 488 Waspishun Baby Wrap project. The team sup- to HCCP clients. Two nurses – including a team 3 Chishaayiyuu ports Monthly Activities Calendars for the CHRs leader – were hired for the Chronic Disease Masters of Our Own Health Conference, Chisasibi nurse (pgm) 6,860 and AMA Training in clinical and psychosocial Clinic, starting in April 2017. footcare nurse - intervention for Awash staff. It also assists the CHR (individual) 644 community organizer in developing commu- CHR (groups) 88 nity focus groups and sharing information with Community worker 2,540 other stakeholders. social worker - homecare (no. of clients) - MSDC (attendance) 453 MSDC (meals served) 2,926

1. The 0-4 age group (a) is underestimated since newborns are often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2010-2013 births (+ 2014 and 2015 estimates) and 2010-2014 MSSS deaths numbers. 2. Does not include 288 Inuit, Métis and/or non-aboriginals. 3. In Chisasibi, many clinical services are offered at the hospital. See page 70. “Our social services have really developed this past year,” says Rita Gilpin, local director of the Eastmain CMC. “Our nutritionist had been working with a lot of individuals, and still does individual counselling, but she has also worked with our Chishaayiyuu CHR to develop a program of community workshops on preparing healthy meals awash 0-91 195  4.6% eastmain and maintaining healthy lifestyles for families.” Rita Gilpin Uschiniichisuu 10-29 262 q 1.5% Local Director 803 Eastmain CMC Chishaayiyuu 30+ 346  4.3% TOTAL2 803  3.9%

medical EVACUATIONS The Eastmain CMC saw a number of important The Chishaayiyuu/Current Services unit has The Administration unit’s coordinator position EMERGENCY 41 hires in the past year, including professionals, filled all nursing positions; a new development has been vacant for two years, with the posi- scheduled 694 Chishaayiyuu/Current Services nurses, CHRs, a position for a diabetes clinical nurse posted tion’s responsibilities being carried out by the current services maintenance worker and a general aide worker. in March 2016 remains to be filled. Two part- other two coordinators in collaboration with doctors (pgm & clinic) 1,037 The move just over a year ago to stay open time doctors service the community’s medical the local director, and with assistance of the visiting specialists 115 during lunch hours has improved access to needs. The CMC’s extended hours have in- Material Resources Department in Chisasibi. other 0 services. creased access to services, and the Nutritionist One transit had renovations and new furniture nurse (walk-in clinic) 9.415 has been developing family-oriented programs purchased. The community is still experienc- 78 nurse (refills) 3.233 The Awash/Uschinniichisuu team contin- such as one in healthy cooking. ing a lack of housing units and transits, and 79 nurse (clinical lab tests) 985 ues to develop and encourage participation in ­equipment storage space is urgently needed. awash community programs. The Awash team, which Teleophthalmology screening continues; two nurse (pgm, incl. vacc.) 976 welcomed twenty new babies last year, ad- trained staff members screened 57 patients CHR (individual) 385 dresses healthy living for children, youth and this past year. One nurse has received training Eastmain CHRs Daisy Gilpin-Cheezo and Edna Mark-Stewart CHR (groups) - families through evening programming and in to support teleophthalmology, and the other Community worker 114 clinic teachings on health eating and lifestyles. permanent nurses will receive training in the social worker 99 The community workers and social worker have coming year. The HCCP recently hired a home Uschiniichisuu created a strong team to work with those seek- care nurse to support the program’s 18 clients; nurse (pgm ) 917 ing assistance with personal, family or social the MSDC has 14 ongoing clients, and a new CHR (individual) 198 issues. Despite a turnover in staff, the unit re- physiotherapist is arriving in spring 2017. CHR (groups) - mains committed to promoting healthy lifestyles Community worker 183 and healthy choices, and will continue its focus social worker 665 on building relationships with the ­community NNADAP worker - entities with which we share clientele. Chishaayiyuu nurse (pgm & curative) - footcare nurse 98 CHR (individual) 933 CHR (groups) - Community worker 118 social worker 488 homecare (no. of clients) - MSDC (attendance) 762

MSDC (meals served) 762 1. The 0-4 age group (a) is underestimated since newborns are often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2010-2013 births (+ 2014 and 2015 estimates) and 2010-2014 MSSS deaths numbers. 2. Does not include 30 Inuit, Métis and/or non-aboriginals. “This year we are starting to see plans made by the previous director, Yionna Wesley, grow and evolve,” says Taria Matoush, local director in Mistissini. “One big improvement for patients is that we are starting to implement specialized care, with specialists in ophthalmology, psychiatry, psychology, general surgery and other areas visiting to care for patients mistissini awash 0-91 709 q 2.9% here. In addition, we used to pull nurses from 3,763 Uschiniichisuu 10-29 1,355  2.7% Awash or Uschiniichisuu if Current Services or  Chishaayiyuu 30+ 1,699 1.1% Chishaayiiyuu were running low, but now we have 2  TOTAL 3,763 0.9% stabilized nursing services in all units.”

medical EVACUATIONS This past year Current Services operated he- The Uschiniichisuu unit has hired a mental The HCCP faced many challenges, includ- EMERGENCY 277 modialysis units six days a week, thus increas- health nurse and a community worker. Increas- ing complex chronic diseases and increasing scheduled 105 ing dialysis sessions by 30% over last year (in- ing requests for treatment programs also sug- demands for palliative care, which require on- current services cluding 13 emergency treatments). The walk-in gest a need for more prevention and awareness going multi-disciplinary collaborations across doctors (pgm & clinic) 7,531 clinic saw an 8.6% decrease in clients, largely initiatives on drug and alcohol use, but this entities. The MSDC hosted daily activities for ENT 66 because blood tests are no longer counted in is impossible with only one NNADAP worker. elderly and special needs participants. Un- other 369 this statistic; a pilot project added an evening The hiring of Uschiniichisuu and school social fortunately, no field trips were possible as no nurse (walk-in clinic) 15,326 and night shift to give better services, with an workers bolstered support to the social ser- adapted vehicle was available. The West Lake 80 nurse (refills) - average of eight patients being seen over these vices team, and collaboration with the school Hockey School visited the MSDC to skate with 81 nurse (clinical lab tests) 76,630 shifts. Many patients come for skin problems, and other entities enabled activities such as the participants at the Complex, and the Aanis- radiology 4,294 so in the coming year we will prioritize the Family Challenge. Regular clinical meetings and chaaukamikw Cree Cultural Heritage Institute hemodialysis 2,468 prevention of these. We also plan to extend the team meetings were established to encourage sent three employees to work with the elderly awash opening hours (8 am to 8 pm), while continuing multidisciplinary collaboration and ensure con- participants, who shared stories with them. nurse (pgm, incl. vacc.) 2,958 to offer quality services. tinuity and quality of care for clients. The team CHR (individual) 1,264 anticipates many exciting challenges in the new CHR (groups) - The Awash unit provides services in maternal year, including the Baby College and the Ac- Community worker 565 and child health. Its integrated services, offered cess program, and will be developing ways to social worker 998 through  Mashkûpimâtsît Awash, support reach out to youth. Chishaayiyuu new mothers and families, and last year Mistis- nurse (pgm & curative) 10,057 sini was blessed with 82 infants. The birthing This year the Chishaayiiyuu unit managed Matthew Coon Come welcomes walkers on Cancer Awareness Journey footcare nurse 722 project was reactivated and, in collaboration to increase services for its clientele with no CHR (individual) 2,428 with Nishiiyuu, a local committee was formed additional resources. It offered clinics in tele- CHR (groups) - to support it. Awash workers facilitated the sec- retinopathy and visits with specialists while Community worker 512 ond ᓂᐦᑖᐅᑎᓈᐅᔔᑖᐤ Nihtaautinaaushuu College continuing to provide quality care. social worker 458 in collaboration with Head Start, and a Special homecare (no. of clients) 761 Needs Support Group was formed to assist MSDC (attendance) 1,279 MSDC (meals served) 1,279 parents of children with special needs. Both groups promote health and preventive strate- gies, offering support and information on child Statistics for Uschiniichisuu are not available for this community development and parenting skills. this year.

1. The 0-4 age group (a) is underestimated since newborns are often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2010-2013 births (+ 2014 and 2015 estimates) and 2010-2014 MSSS deaths numbers. 2. Does not include 120 Inuit, Métis and/or non-aboriginals. The Nemaska CMC confronted major, unanticipated changes this past year when three of four managers left for various reasons in June. “So we need to establish some stability with permanent managers, because right now all our managers are interim,” says Linda Orr, the CMC’s interim local director. “Fortunately, we have been able to work together and establish some solid teamwork, making awash 0-91 153 q 7.3% nemaska sure that our services continue for the community.” Linda Orr Uschiniichisuu 10-29 277  3.7% Interim Local Director 801 Nemaska CMC Chishaayiyuu 30+ 371  1.9% TOTAL2 801  0.6%

medical EVACUATIONS Nemaska’s Awash/Uschinichisuu unit wel- The Chishaayiyuu/Current Services unit’s The HCCP’s client caseload is small and stable. EMERGENCY 61 comed 24 newborns this year. The Awash nurse nursing team has remained stable, with only For the third year, the team organized an over- scheduled 637 retired in July after many years, and a replace- one resignation; this vacant role has been night fishing trip to Smokey Hill in Waskagan- current services ment has been hired. Minimizing turnover of transformed into an “Assistant to the Immedi- ish. The MSDC receives 2-10 clients daily, and doctors (pgm & clinic) 1,438 staff for youth remains challenging but the ate Supervisor” position, which should be filled efforts are underway to increase attendance. visiting specialists 132 hiring of a replacement-hour school/Uschinich- soon. A community telehealth officer was hired other 401 isuu nurse should provide stability. Working in January, increasing video-conference con- Priorities include hiring a full-time physiothera- nurse (walk-in clinic) 8,427 with Public Health, our school nurse completely sultations with specialists and reducing patient pist. Nursing services are needed on the Old 82 nurse (refills) 2,422 updated the centralized immunization records, travel. Telehealth consultations will increase Nemaska traditional site during the annual gath- 83 nurse (clinical lab tests) 693 and the team aims to ensure all children are further in the coming year as services are de- ering in July; we were unable to provide them in awash following their vaccination schedules. The HR veloped regionally and locally. The nutritionist 2016 but are planning to send staff in 2017. nurse (pgm, incl. vacc.) 612 officer, serving as the interim coordinator of this returned from parental leave, and, with Awash The Administration unit’s coordinator was CHR (individual) 424 unit, has worked to reunify psycho-social files, CHRs, held workshops at the MSDC, daycare, CHR (groups) 136 named the CMC local director (interim) in June. provide clinical guidance to frontline staff, and school and community events. The community Five positions were filled this past year, and Community worker 284 implement a fully revised procedure for referrals is taking greater advantage of the CMC being social worker - several remain to fill. Other highlights this past to psycho-social and mental health services. open during lunch hours; currently the CMC year include a new housekeeping FT position Uschiniichisuu takes walk-in consultations 36 hours per week. nurse (pgm, incl. vacc.) 386 created through Development Funds and a CHR (individual) - Both Chishaayiyuu CHRs completed one- new vehicle to transport clients to and from the CHR (groups) - month intensive training with the diabetes airport and Chibougamau. Community worker - educators in February. We have a full-time and social worker - a part-time physician, with the part-time physi- NNADAP worker 90 cian providing regular continuing education Chishaayiyuu sessions to nurses and increasing consulta- nurse (pgm & curative) 269 tions with patients. A child psychiatrist made a National Nursing Week, Nemaska footcare nurse 344 first visit in December and will visit bi-annually. CHR (individual) 1,559 A mental health nurse joined in June as part of CHR (groups) 21 the Mental Health Pilot Project, and collabo- Community worker 354 social worker - rates with the psychologist (visiting monthly homecare (no. of clients) - for the past year) and the visiting psychiatrist MSDC (attendance) 212 and child psychiatrist. The CMC is without an ophthalmologist, is recruiting a physiotherapist, MSDC (meals served) 1,699 1. The 0-4 age group (a) is underestimated since newborns are often registered late in the JBNQA beneficiary list; and (b) has and is sharing an occupational therapist with been corrected using the MSSS 2010-2013 births (+ 2014 and 2015 estimates) and 2010-2014 MSSS deaths numbers. Oujé-Bougoumou. Limited housing remains an 2. Does not include 50 Inuit, Métis and/or non-aboriginals. issue, delaying the posting of positions. “We have had a lot of vacant positions because of a lack of office space and housing, but we have now secured lease agreements with the Oujé-Bougoumou Cree Nation and we’re able to fill positions,” says Louise Wapachee, local director (since May 2017) of the Oujé-Bougoumou CMC. “In addition, more and more our Awash/Uschiniichisuu and Chishaayiyuu/Current Services units are working together, oujÉ-bougoumou awash 0-91 188 q 7.8% maximizing benefits by sharing resources.” 845 Uschiniichisuu 10-29 316  5.0% Chishaayiyuu 30+ 341  0.8% TOTAL2 845  0.2%

medical EVACUATIONS The Awash/Uschiniichisuu unit provides sup- The Chishaayiyuu/Current Services unit has The Administration unit dealt with management EMERGENCY - port for pregnant women, children, youth, young benefited from having stable nursing staff, with and space challenges this past year. For most scheduled - families, clients with special needs, and clients two nurses always available to address the of the past fiscal year Janie Wapachee served current services with addictions. Interventions are provided needs of clients, perform refills, and support as interim local director of the Oujé-Bougoumou doctorS (pgm & clinic) 1,187 through prenatal and postpartum follow ups, laboratory work, Chishaayiyuu programs, and CMC while also maintaining her position as visiting specialists 49 home visits, and walk-ins at the CMC. Addi- urgent transfers by ambulance to Chibouga- coordinator of Awash/Uschiniichisuu; Louise other - tional support is provided through promotion mau. Since May 2016 the team has also had Wapachee was hired as the local director of the nurse (walk-in clinic) 7,247 and prevention group activities, which include an Assistant Immediate Superior, who also CMC starting April 10, 2017. The personnel plan 84 nurse (refills) 2,537 (among others) prenatal classes, regional breast- provides assistance when needed. A telehealth this year included new positions for a PPRO 85 nurse (clinical lab tests) 722 feeding week, a diabetes awareness campaign, technician started in September, and the unit (Nishiiyuu), a community worker, an “attendant Chishaayiyuu screening activities, community outreach, and a is in the process of hiring a community health in a northern establishment,” and an Awash nurse (pgm & curative) 336 swimming rehabilitation program for clients with nurse; after this nurse has been in place for clinical nurse. The unit experienced challenges footcare nurse 76 special needs. This year the unit hired a new several months, we will be able to re-evaluate if in filling much-needed positions because of the CHR (individual) - Awash nurse and a school/Uschiniichisuu nurse. this position is needed in current services. lack of CMC office spaces and of housing for CHR (groups) 0 the new positions. However, eight additional Community worker 156 Community partnerships are essential to the As usual, our professionals, including the nutri- housing units and secure office space has been social worker 0 success of many programs, including the tionist, dental hygienist, psychoeducator, phys- acquired on a two-year lease of two CBHSSJB- homecare (no. of clients) - Eenou Awash Piimaatsiiwin College, which was iotherapist, CHRs, nurses & part-time occupa- owned trailers to be relocated from Mistissini to MSDC (attendance) 453 introduced for the first time in the community. tional therapist, are involved in conducting many Oujé-Bougoumou. The new fiscal year will also MSDC (meals served) 870 This program, which helps parents enhance activities during the year, such as the “Drop the see the CMC assume responsibility for the First their parenting skills, had seven successful Pop” challenge, Diabetes Month, a booth at Responders team, formerly under the auspices Statistics for Awash and Uschiniichisuu are not available for this graduates. Other programs engaging with our Annual General Assembly, and school & multi- community this year. of the Oujé-Bougoumou Cree Nation. community partners include Suicide Preven- service day centre (MSDC) cooking classes. tion Month, Special Needs Camps, Angel Tree (a Christmas activity for children), IAMP (Iiyuu The MSDC team provides activities three days Ahtaawin Miyupimaatisiiun Planning), Mental a week but is planning to increase this to five Health First Aid and AIDS HIV Awareness. days. The Home & Community Care Program (HCCP) clientele is stable.

1. The 0-4 age group (a) is underestimated since newborns are often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2010-2013 births (+ 2014 and 2015 estimates) and 2010-2014 MSSS deaths numbers. 2. Does not include 90 Inuit, Métis and/or non-aboriginals. “We’re stuck in a building that is not big enough and is used to its fullest, so we’re trying our darnedest to provide the best services we can with what we have, but we need to improve a lot,” says Bert Blackned, local director in Waskaganish. “For instance, we don’t have mental health services, because we don’t have the office space to provide them. So we’re working to bring in awash 0-91 533 0.0% waskaganish some trailers to address this problem and enable us to Bert Blackned Uschiniichisuu 10-29 874  1.1% Local Director Waskaganish 2,398 maximize our services.” CMC Chishaayiyuu 30+ 991  1.4% TOTAL2 2,398  1.0%

medical EVACUATIONS This past year Waskaganish’s Awash/Uschi- as people are seeking help. A community orga- Priorities include securing adequate housing EMERGENCY 121 niichisuu unit welcomed 69 new babies; the nizer was hired in January 2017, a great addi- and office space to accommodate the posi- scheduled 2,316 team of Awash nurses, CHRs and community tion to the team. We also hope to add an Awash tions on the current organogram, and then current services workers strives to provide the best care to nurse and much-needed additional community filling mental health and midwifery positions. doctorS (pgm & clinic) 3,394 pregnant women and families. workers, and look forward to increased office It is especially important to hire a pharmacy visiting specialists 410 space and more housing units. technician (or two). All staff will undergo train- other 249 This past school year, the replacement school ing in CPR, Basic First Aid and PDSB. The nurse (walk-in clinic) 15,598 nurse and Uschiniichisuu CHR created the first The Chishaayiyuu/Current Services unit is a multi-disciplinary team will institute problem- 86 nurse (refills) 4,818 list of students identified with allergies, con- multi-disciplinary team aiming to provide the solving techniques into their daily practice, 87 nurse (clinical lab tests) 1,612 ducted training on how to use an epi-pen, and best possible health care to Waskaganish and and will continue to meet quarterly with the dental hygienist 1,421 shared critical information with teachers. Also, to foster miyupimaatisiiun. ­management team. awash for the first time, an optometrist saw elementary The nursing team was once again in transition, nurse (pgm & curative) 2,691 students at the school. The Administration unit includes Finance, CHR (individual) 1,433 and due to a lack of housing some positions Material Resources, Human Resources and CHR (groups) 51 The team maintains a strong relationship with cannot be filled. The team completed neces- Information Technology. This year, employees Community worker - Child and Family Services to provide group ac- sary tasks by using PDSAs, but has inadequate working in food service took training in “Food social worker - tivities, including parenting classes and baby- staffing to carry out many prevention activi- Safety and Hygiene for Food Handler,” while Uschiniichisuu bundle workshops for pregnant women. ties. The CMC has been unable to secure a managers took the “Food Service Administra- nurse (pgm) - pharmacy technician, so the nursing team tor Course.” Priorities involve attracting recall The CMC has been involved in diagnosing CHR (individual) - spent an average of 60 hours/week dispensing workers and ensuring training for our per- Fetal Alcohol Spectrum Disorder (FASD) among CHR (groups) - ­medications in the pharmacy. manent and recall employees. We must also younger children, with support and assistance Community worker - address the shortage of housing; the new units from the local school and the Regional Special The HCCP and MSDC staff are stabilizing and social worker - being built will help us to deliver the health care NNADAP worker 451 Needs Services. Attending to high risk preg- programs are meeting client needs. Profes- services our ­community needs. Chishaayiyuu nancies, individuals and families demands sional Services experienced many staff mater- nurse (curative) - additional nurses and community workers, es- nity and sick leaves, but the team ensured that footcare nurse 498 pecially to address unhealthy lifestyles choices. necessary services were provided. The physio- CHR (individual) 1,111 The NNADAP worker has experienced a big therapist’s and nutritionist’s programs were well CHR (groups) - increase in his caseloads providing counsel- received by the community. Community worker 1,788 ling and supporting individuals wanting to quit social worker - alcohol and drugs, which is a positive indication homecare (no. of clients) 3,957 MSDC (attendance) 2,492 1. The 0-4 age group (a) is underestimated since newborns are MSDC (meals served) 2,455 often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2010-2013 births (+ 2014 and 2015 estimates) and 2010-2014 MSSS deaths numbers. 2. Does not include 25 Inuit, Métis and/or non-aboriginals. “We may have the only multi-service day centre catering to youth,” says local director Alan Moar. “We have two youth groups. One group has about ten youth experiencing social and behavioral problems at school—they come once a week for activities with our staff. In March our psychotherapist organized a treasure hunt in the community for them, which was a huge success, and now other communities have been awash 0-91 422 p 0.2% asking about it. The second group, youth with special needs, waswanipi Alan Moar Uschiniichisuu 10-29 753 p 1.8% have a range of activities with all our professionals. For Local Director 1,978 Waswanipi CMC Chishaayiyuu 30+ 803 p 1.0% example, the nutritionist organized cooking classes for them in TOTAL2 1,978  1.1% the winter months. This has been a highlight for us, and we’ll continue collaboration with the school for these groups.”

medical EVACUATIONS Solidifying the local management group, a pri- The Awash/Uschiniichisuu unit welcomed 49 In June the Administration unit received a new EMERGENCY 105 ority from last year, was achieved with the hir- new infants this year; the unit collaborates with coordinator, whose human resources experi- scheduled 1 ing of a Coordinator of Administration in June. Niishyiiuu to support programs and services, ence has helped with HR issues. However, the current services The CMC also filled development positions and such as providing Wapsooyan/Niishyuu Baby ability to fill all positions is limited by insufficient doctors (pgm & clinic) 2,585 worked closely with the Waswanipi First Na- Bundles. The school nurse has given students housing and transits. The team, in collaboration visiting specialists 206 tion to better the lives of community residents. vaccinations and STD prevention information with the regional office, provided services and other (footcare) 172 Since August the CMC has had a permanent sessions, and youth STD and pregnancy rates support for the Air Shuttle, offering transporta- nurse (walk-in clinic) 9,027 local doctor, and she plans to create and lead have decreased. A school social worker has tion the Chibougamau Hospital and the airport 88 nurse (refills) 5,856 a multi-disciplinary team to address chronic yet to be hired. A senior CHR provides orienta- for clients travelling to Val-d’Or and Montreal. 89 nurse (clinical lab tests) 1,944 diseases and diabetes. The liaison nurse and tions to other CHRs on various subjects, and awash chronic disease nurse positions have been front-line workers were given many training Priorities for the coming year include hiring all nurse (pgm & curative) 112 approved and three CHR positions will also be ­opportunities. new development positions. Six units are to CHR (individual) 840 filled; these new permanent positions will help be constructed in Waswanipi to meet housing CHR (groups) - clients with chronic diseases and diabetes. The The Current/Chishaayiyuu unit has a signifi- needs. A central CMC and MSDC appointment Community worker 429 CMC assisted in Waswanipi’s second annual cant turnover among nursing staff. However, centr is in the process of being established. social worker - health fair, the community organizer working two nurses now provide foot care service, and The CMC will support the physician in develop- school nurse (incl.vaccinations) 1,491 with Waswanipi First Nation staff to ensure a CHRs offer 3-5 days of tele-ophthalmology ing and maintaining a multi-disciplinary team to Uschiniichisuu successful event. services monthly. A tuberculosis case was di- address chronic diseases and diabetes. We will nurse (curative) 657 agnosed and monitored this past year, with the also continue to support the new Waswanipi- CHR (individual) 803 CMC working closely with Public Health to treat based Inland Women’s Shelter, Robin’s Nest. CHR (groups) - the patient. The MSDC continues to support Community worker 317 traditional teachings and now provides services school social worker - and programs to special needs clients and NNADAP worker - school students at risk. The HCCP continues to community worker (addictions) 183 build, with two homecare workers hired; more Chishaayiyuu clients are expected to receive HCCP services nurse (pgm ) - in the near future. The pharmacy is facing chal- footcare nurse - lenges and needs support to ensure secure CHR (individual) - services for the community. CHR (groups) 1,737 Community worker 650 social worker - homecare (no. of clients) 513 1. The 0-4 age group (a) is underestimated since newborns are MSDC (attendance) 1,383 often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2010-2013 births (+ 2014 and MSDC (meals served) 5,209 2015 estimates) and 2010-2014 MSSS deaths numbers. 2. Does not include 30 Inuit, Métis and/or non-aboriginals. “Last July we had a water shortage crisis that lasted over a month, and it really brought together the whole community,” says Mary Shashaweskum, interim local director of Wemindji’s Willie Matches Memorial Miyupimaatisiiun Centre. “We worked closely with other entities and the band to keep functioning. And it connected well with the Emergency Planning training we wemindji awash 0-91 304 q 5.6% received in January.” 1,539 Uschiniichisuu 10-29 500  2.7% Chishaayiyuu 30+ 735  1.7% TOTAL2 1,539  0.5%

medical EVACUATIONS Wemindji Willie Matches Memorial CMC The Chishaayiyuu/Current Services has The final report regarding radon devices in- EMERGENCY 110 Wemindji’s Awash unit continues to thrive undergone changes with the posting of new stalled in May was reviewed with Public Health scheduled 1,067 under the  Mashkûpimâtsît Awash (AMA) development positions. The HCCP nurse was in November. Several locations had higher than current services program, piloted by the Wemindji CMC in 2008, reassigned to help assess and suggest improve- recommended radon levels, so remedial mea- doctors (pgm & clinic) 1,908 and this year the community welcomed 30 new ments to our administrative and clinical services. sures are planned for summer 2017. visiting specialists 205 babies. We also received encouraging results We continue to take advantage of staff train- other 0 of the AMA evaluation from the CHB, showing ing opportunities: nurses attended the annual The unit at 13 Porcupine Road was renovated nurse (walk-in clinic) 5,686 that services are reaching most families in We- two-week training in Montreal, the local Awash as a transit. We are receiving seven new hous- 90 nurse (refills) 3,489 mindji. The program’s impact is reflected in the trainer gave refresher training on CPR and ing units and aim to have them operational this 91 nurse (clinical lab tests) 1,641 increased number of fathers attending appoint- CMDSA, four new nurses had CMDSA train- year, as they will enable us to post all vacant awash ments with their children and partners. While ing in Val-d’Or, a community worker received and development positions. nurse (pgm & curative) 1,345 some components need improving, with AMA PCFI training, and two CWs attended the Basic CHR (individual) 861 we are building services that support healthy Trauma Informed Approaches training in Chisa- CHR (groups) 6 children and families. sibi and Mistissini. In addition, we trained two Community worker 66 CHRs in ­teleophthalmology, and the MSDC and social worker 0 The Uschiniichisuu unit collaborates with com- HCCP workers in moving clients safely. Uschiniichisuu munity partners and other allied professionals nurse (curative & PGM) 0 to promote healthy living and prevent illness. Turnover in the nursing staff required us to CHR (individual) 3,643 Priorities for this year are to maintain relation- hire nurses from the recall list and agencies. CHR (groups) 70 ships with partners and to continue planning for A ­community telehealth officer was hired in Wemindji CHRs: LaurieAnn Georgekish, Elizabeth Shashaweskum, Community worker 88 the implementation of the Youth Clinic. The team November 2016. Geneva Shashaweskum, Julianna Kakabat and Carol Sashaweskum social worker 272 will continue working with the school to ensure NNADAP worker 0 specific student concerns are addressed. Other The Administrative Unit has been without a community worker (addictions) 0 areas of interest include reinforcing the skills of Coordinator since Mary Shashaweskum was Chishaayiyuu parents with preschool children and addressing reassigned as interim local director in July nurse (pgm & curative) 934 drug and alcohol use in sexually active youths. 2015. She continues to oversee the department footcare nurse 0 Our NNADAP worker hosted the 20th Annual with the assistance of colleagues. CHR (individual) 230 Cree Addictions Awareness Conference from CHR (groups) 5 A water shortage crisis in summer 2016 lasted September 19-22, 2017 in collaboration with Community worker 318 over a month, closing the clinic’s non-essential social worker 0 other regional NNADAP workers. services. In January, the Current/Chishayiyuu homecare (no. of clients) 324 coordinator and the local director attended a MSDC (attendance) 21,281 1. The 0-4 age group (a) is underestimated since newborns are session on Emergency Planning to better pre- MSDC (meals served) 21,281 often registered late in the JBNQA beneficiary list; and (b) has been corrected using the MSSS 2010-2013 births (+ 2014 and pare in case of an emergency in the community. 2015 estimates) and 2010-2014 MSSS deaths numbers. 2. Does not include 55 Inuit, Métis and/or non-aboriginals. “The renovation of a four-plex unit, completed in February, brought it up to standard and gives us more housing to support our professionals,” says Charlotte Kawapit Pepabano, interim local director of the Whapmagoostui CMC. “Two units are housing our new social worker and the school nurse, and the other two units are for our doctor and visiting physicians and whapmagoostui awash 0-91 190  2.2% student doctors.” 990 Uschiniichisuu 10-29 394  1.5% Chishaayiyuu 30+ 406  1.0% TOTAL2 990  1.4%

Statistics are not available for this community this year. Whapmagoostui CMC is searching for a new The Current Services/Chishaayiyuu unit The IT team is upgrading the network speed, permanent local director since the departure consists of physicians, nurses, physiothera- installing new cabling that will enable the CMC of John George in summer 2016. Josephine pists, occupational therapists, CHRs, commu- to merge with the phone system used by the Sheshamush served as the interim local direc- nity workers and social workers. The medical rest of the CBHSSJB. Whapmagoostui remains tor from last summer until March 2017, with staff provides medical care and collaborates in the only community without a fibre optic con- Charlotte Kawapit Pepabano, interim coordina- administrating preventive, diagnostic and thera- nection, which would improve telehealth and tor of the Administration unit, acting as interim peutic care. The community and social workers visio-conference connections. local director from the end of Ms. Shesha- offer individual, family and or marital counsel- 92 mush’s period until May 15, 2017, when Patricia ling where supportive assistance is required to 93 George began as the new interim local director. maintain healthy relationships and to improve the quality of life for families. The CHRs offer The Awash/Uschiniichisuu unit received a additional support to patients, especially those new interim coordinator, Angelique Laberge, in with diabetes. They also provided public aware- February 2017, as the coordinator has been on ness and disease prevention programs through sick leave since April 2016. The team consists media – mainly radio – and school visits, and of community workers, nurses, a social worker, distributed bush kits, gluco-meters, and pam- an NNADAP worker, a human resources officer, phlets containing essential information about and a community organizer, in addition to visit- certain illnesses. A nurse-sharing pilot project Whapmagoostui artist Natasia Mukash created this image for Awash ing general and specialist physicians and other last year saw two nurses share one position in programs; it will be used for maternal and child health materials. professionals. A new social worker joined the Current Services and the HCCP program. team in January. The community workers evalu- ate the cases of physical, emotional and mental The Administration unit received a new interim abuses, provide counselling services, and if coordinator, Charlotte Kawapit Pepabano, in necessary recommend further psychological September. The unit has been working to ad- or psychiatric services. The NNADAP educates dress the housing shortage, and has signed an the public on substance abuse and its dangers, agreement with the Co-op Hotel to house pro- and is involved in the care and support for fessionals. In addition, a four-plex apartment those seeking assistance for their addictions. was renovated to accommodate employees. While the community will receive a new CMC building, a temporary solution to the problem of insufficient office space must be found. To this end, four trailer units are being converted into 1. The 0-4 age group (a) is underestimated since newborns are often registered late in the JBNQA beneficiary list; and (b) has additional office space. been corrected using the MSSS 2010-2013 births (+ 2014 and 2015 estimates) and 2010-2014 MSSS deaths numbers. 2. Does not include 65 Inuit, Métis and/or non-aboriginals. The Administrative Resources Group provides essential regional support functions to the organization: Human Resources, Finance, Information Technology, Material Resources and Wiichihiituwin (formerly Cree Patient Services). Wiichihiituwin manages transportation, accommodation, meals and medical appointments for clients who must leave their home community for services not available in the Territory. The department was added to the Administrative Services Group as part of the 2016 restructuring, in an effort to rebalance the size of major departments and tie Wiichihiituwin 95 more closely to other related units: Cree Non-Insured Health Benefits (CNIHB) and the Northern 5 Operations Centre (NOC), which coordinates air transport. ᐋ ᐅᐦᒋ ᐱᒥᐱᔨᐦᑖᑭᓂᐎᒡ administrativeᐋᐱᑎᓰᐎᓐ resources CBHSSJB organigram

board of directors Human Resources CBHSSJB booth at the National Job Fair, Place Bonaventure, Montreal, October 13-14, 2016 executive direction This compilation of reports and data of the The Virtuo GPRH Project Phase 2 is in progress, ­Administrative Services Group is the product and consists mainly of finetuning HR processes of the efforts of the whole team throughout the and deploying the application to the manag- year. The information in this chapter is an ac- ers. Communications will be sent to managers curate synthesis of the accomplishments of the regarding deployment and training. teams and contains validated performance indi- cators. I extend my sincere thanks to all the em- Human Resources management recognizes ployees for their engagement. Their hard work is that the creation of a strong and stable work- nishiiyuu pimuhteheu miyupimaatisiiun administrative essential to the fulfilment of our mandate. force plays an important strategic role in the miyupimaatisiiun resources Liliane Groleau, Interim Assistant Executive Director development of the CBHSSJB and its capacity to offer quality care. These values are at the STAFFING core of its mission now and in the future. The staffing unit redoubled its efforts and restructured in order to meet demand. A senior OCCUPATIONAL HEALTH AND SAFETY 96 human resources 97 Staffing Advisor and two team leaders were In 2016, the Occupational Health and Safety unit put in place an annual prevention plan to financial brought in to improve efficiency. Of the current resources 2,244 employees, the unit recruited 460 new support managers in the creation of a safe envi- people, an increase of 36% in hiring compared ronment for their teams. Two communities were information to last year. There are still 360 vacancies to fill; inspected by the new Prevention Officer, and technology recommendations for improvement were imple- resources however, many new positions can only be filled as and when office space, housing and budget mented. The inspection and improvement of material become available. the remaining communities will be complete by resources summer 2017. Great attention is paid to helping HR is pursuing a strategy of workforce stabili- employees on leave due to occupational injury wiichihiituwin zation: over 150 temporary positions are being return to work. A toolkit was created to help (formerly cree patient services) made permanent. This process will have a posi- managers and employees deal with medical, tive effect on employee retention and recruit- chisasibi maternity and CSST related situations. ment and will help teams to improve the quality, va l- d’o r continuity and accessibility of services. chibougamau montreal New development funds from the Ministry of Health and Social Services of Québec (MSSS) will help the organization directly improve services. All new positions authorized by the Ministry last year are now being staffed. As of March 31, 2017, more than $3.5 million was added to the operational budget thanks to these development positions. This process is ongoing, and through it existing teams are ­being consolidated. Financial Resources

HUMAN RESOURCES DEVELOPMENT COMPENSATION AND BENEFITS AND The Financial Resources team led by Denis The HRD team supported over 200 training LABOUR RELATIONS Tremblay has continued to improve thanks to activities for a total cost of $1.2 million. 500 Human Resources created a Compensa- the hiring of very experienced new people. employees and managers were trained, and a tion and Benefits unit, staffed by Advisor for The department’s methods of financial report- training plan aligned with the CBHSSJB stra- Compensation and Benefits, Solange Char- ing and data analysis are now more efficient tegic orientations was approved for 2017-2018. lebois, and Employee and Labour Relations and faster. At the end of the fiscal year a new In addition, a unit dedicated to organizational ­Coordinator, Sandra Bolduc. software was installed that will streamline the development was created. A workplan for this process of budgeting and year-round financial unit is currently being developed. The Labour Relations Unit advises managers tracking. and employees on collective agreements and CREE SUCCESSION PLAN meets regularly with both the nurses’ union FIQ The Department put in place new procedures The Cree Succession Plan, approved and put in and the CSN, the union to which the majority for tracking the financial aspect of projects place in fall 2015, enables JBNQA Beneficiary of non-management employees belong. The undertaken by the Material Resources Depart- 98 employees who show management potential local matters negotiations begin in the coming ment. These new procedures will also be used 99 to bridge educational and skills gaps in order months. Of the 54 ongoing CSN grievances, in other sectors of the organization, such as IT to qualify for management positions. Thanks to nine were withdrawn and one settled. There are and new housing unit construction. two outstanding FIQ grievances. the Plan and a partnership with McGill Uni- In line with its goal of reducing the use of paper versity, the CBHSSJB is helping employees cheques, Accounts Payable increased the reach personal goals while developing the next proportion of payments made through elec- generation of Cree leaders. 22 employees are tronic transfer by 5%, for a total of 38% of all pursuing an undergraduate certificate and 15 ­payments. employees are studying for a graduate certif- icate—a total of 37 employees. Three cohorts Other notable accomplishments for the past will graduate in the Fall of 2019, and more year include: ­employees will be invited to apply in fall 2017. ●● The hiring of an Administrative Process Specialist providing user training and ­assistance with the Material Resources STATUS OF HUMAN RESOURCES, 2016-2017 portion of Virtuo.

% ●● Ongoing community visits to facilitate 2015-2016 2016-2017 variation ­department ordering processes and reor- Full-time managers 77 83 7.8% ganization of stock reserves. Part-time managers 0 0 0% ●● Conversion of the majority of Virtuo users Managers in employment stability 1 1 0% to electronic requisitions for inventory and Full-time regular employees 979 954 -2.6% special order products. Part-time regular employees 66 72 9.0% ●● Continued efforts to maximize the ten- Employees in job security 0 0 0% dering process and also augment group ­purchasing savings. Occasional employees (number of hours) 440,650 400,490 -9.1% Occasional employees (full-time equivalent) 240 220 -8.3% Information technology Resources

The IT Department welcomed new Coordina- The Network Operations Centre now provides ONGOING AND NEW PROJECTS OBJECTIVES tor Francois Bérubé and other additions to IT with “real-time” information and early warn- Whapmagoostui network improvements The IT department will continue improving technical and administrative positions. With ings when components have failed or are about ­(Phases 2 and 3): service quality by further streamlining and Mr. Bérubé’s diligence and customer service to fail, monitoring both physical infrastructure ●● Bell Megalink services between Chisasibi standardizing processes and practices, while oriented leadership, services have steadily and applications. and Whapmagoostui; continuing to work closely with all CBHSSJB improved in both timeliness and quality. The ●● Replacement of telephone system with departments to better support them in the funding agreement between the MSSS and ACCOMPLISHMENTS VoIP integrated to CBHSSJB network; ­quality improvement objectives and goals CBHSSJB is ready for signature by the Cree ●● Replacement of all 250 Windows XP PCs; ­outlined in the Strategic Regional Plan. ●● Quality of services implementation for Tele- Nation Government/CBHSSJB and the MSSS. ●● Upgrade of all Windows 2003 servers to Health, Radiology, Laboratory, and VoIP; Notwithstanding, the MSSS has reimbursed 2012; $1.7M for expenses incurred for IT projects ●● Implementation of WiFi to provide wireless ●● Replacement of 400 hardware SecureID from 2013-2015, bringing the total reimbursed communications indoors and out; tokens (jetons) with software versions; amount to approximately $4M from 2012-2015. ●● new office space infrastructure installation 100 The Executive Direction has committed to sup- ●● Implementation of centralized security and move. 101 porting IT projects for the coming fiscal year monitoring station in Chisasibi; pending agreement completion. ●● VoIP (telephony) integration North and South; Oujé-Bougoumou: ●● Infrastructure replacement; ●● Wemindji network and telephony OPERATIONS ­replacement; ●● New office space infrastructure installation The IT Helpdesk experienced a sharp increase and move. ●● Mistissini public health infrastructure in service requests and incidents during the ­installation and move; Chisasibi: 3rd and 4th quarters of the 2017 fiscal year. At ●● Telephony infrastructure replacement; times, the number of concurrent calls over- ●● Chisasibi Youth Protection infrastructure whelmed the telephone lines in service and installation and move; ●● Redundant computer room installation and temporary measures had to be implemented ●● Montreal HR, HRD, Public Health, Espresso move; pending a permanent solution planned for later Hotel infrastructure installation and move; ●● Administration and CMC move. in the year. Additionally, user growth due to ●● Whapmagoostui infrastructure replacement; Waskaganish: HR’s accelerated recruitment efforts increased ●● Montreal & Mistissini WiFi pilot; the number of users and devices, propor- ●● New office space infrastructure installation ●● Nemaska & Oujé-Bougoumou cellular tionately contributing to increases in services and move; ­signal booster installation; requests, incidents, and IT operating costs. ●● Women Shelter infrastructure installation; ●● IT Asset Management system; ●● Fiber optic connection. ●● IT Network Operations Centre system; Waswanipi: Robin’s Nest (Women Shelter) ●● Centralized management of application ­infrastructure installation. licensing and maintenance; ●● Spearheading formation of representative Eastmain: fiber optic connection. 5,097 workgroups to participate in MSSS and total requests 2,564 inter-regional meetings and efforts. Mistissini: Youth Detention Facility total ­infrastructure consulting (design), installation. incidents Material Resources

The Material Resources Department’s objec- In Waskaganish, planning for additional space The MRD took over biomedical services, hiring Seven communities are scheduled to receive tive is to create the best possible environment required by the CMC to dispense service took a biomedical engineering specialist. A special- training: for clinical and administrative departments in place, and a study on installing A/C units at the ized clinical medical equipment working group ●● Waskaganish CMC, May 30-31, 2017 order to dispense services to our Eeyou/Eenou CMC was outsourced. A women’s shelter in was put in place to ensure purchases meet ●● Nemaska CMC, June 6-7, 2017 clients. The department maintains 47 clinical Waswanapi was built by the Cree Nation Gov- organization needs. The Project Management and administrative buildings and 443 housing ernment for the CBHSSJB and, in Wemindji, Office was started, and an engineer hired to ●● Mistissini CMC (Hemodialysis department), units, with the addition of the construction of 13 Porcupine was renovated and training on support the Capital project team. A position July, 2017 women’s shelters in Waswanipi, Waskaganish Radon Remediation Methods took place. In was created to assume the responsibilities of ●● Ouje-Bougoumou CMC, August 29-30, and the Youth Custody Centre in Mistissini. Whapmagoostui, 14 Whapmakw fourplex was the RORC (person responsible for ensuring 2017 renovated. contracts are compliant with Treasury Board ●● Waswanipi CMC, September 5-6, 2017 Accomplishments in Chisasibi include: Secretary regulations). Cree Building Services ●● Eastmain CMC, October 3-4, 2017 ●● Renovation of living unit F2-8; In Montreal, three departments were moved to Technicians were hired. the new location at 1055 René-Lévesque: HR, ●● Wemindji CMC, October 11-12, 2017 ●● Creation of a Wiichihiituwin lounge at the Public Health and Wiichihiituwin. And region- 102 airport; OBJECTIVES 103 ally, 40% of buildings were audited for major ●● Continued renovation and maintenance of ●● Relocation of local youth protection from renovation requirements, bringing the total to our assets; 500 Wiishkichaansh to 12 Maamuu; 70% including last year. ●● Support and advice to local directors on ●● Completed installation of new hospital building and vehicle maintenance; generator; For non-medical equipment, 11 vehicles in- cluding ambulances and adapted buses were ●● Continued partnership with the Capital ●● Cold porches on Matthew Sam Road; replaced, as was Human Resources furniture. Projects Team in determining CBHSSJB ●● Ceiling in storeroom. Wiitchituwin, Public Health and Pimeutheu de- needs for buildings and housing units; partments were also replaced. Medical equip- Mistissini saw the relocation of Public Health, ●● Extension of project management office ment was replaced through in the amount of general administration and Pimuhteheu de- services to the clinical area. $995,582.24. partment to a new building built by the CNM; the renovation of 392 Mistissini Blvd, 11 living Quebec Ministry standard training for health Wiichihiituwin lounge at Chisasibi Airport units (Phase 1) and renovation and corrected and hygiene was provided for two communi- drainage problem of 13 Blazzo; and the refur- ties: Chisasibi and Whapmagoostui. Chisasibi bishment of ventilation and security systems ­Hospital employees were the priority (13 train- at the reception centre. In Eastmain, there ees, September 5-6, 2016), followed by Chisa- were renovations to 149 and 164 Shabow and sibi CMC and Regional Building employees (8 14 Netaochekin, and the sale of the old clinic trainees, November 29-30, 2016), and Whap- to the community was finalised. 12 and 14 magoostui CMC employees (2 employees, Whapew were renovated in Nemaska. 204A&B March 28-29, 2017), for a total of 23 employees. and 206 A&B Opemiska, and the server room at the Healing Centre were renovated in Oujé- Bougoumou, and the condensation problem was corrected as well. wiichihiituwin

In the fall a contest was held to find a new A 40-page information brochure was produced name for Cree Patient Services and Wiichihiitu- for clients and escorts, providing guidance and win, which means ‘helping one another’, came information on how to access Wiichihiituwin into effect in December. Air charter services support and liaison services. were expanded, with a new inland charter service launched in July, which flies five times In all four points of services, there is an in- per week between Chibougamau Airport, and crease in arrivals of patients and escorts: Val-d’Or and Montreal. The coastal charter Montreal increased by 16%, Val-d’Or by 14%, service flies six times a week between Robert Chisasibi by 16%, and Chibougamau by 18%. Kanatewat Airport (Chisasibi), and Val-d’Or and 9,181 escorts have been authorized for a Montreal. total of 22,283 patient arrivals. In total, 62,819 ­regional transportations were coordinated by Clients and escorts travelling to Montreal stay this ­department. 104 at the newly-renovated Espresso Hotel. Two 105 floors of the hotel are set aside for Wiichihi- ituwin clients, and priority parking spaces are reserved for their vehicles. New offices for Wiichihiituwin dispatchers and other community workers were built to facilitate services. Clients also have exclusive access to a community kitchen, a spiritual room, an activity room and a new laundry room. Existing boarding homes became private lodging. 107 6 ᐋ ᒥᓯᓈᓱᑦ

ᑳfinancial ᐃᔅᐱᔨᑦ statements ᔔᔮᓐ Deloitte LLP La Tour Deloitte 1190 Avenue des Canadiens-de-Montréal Suite 500 Montréal, Quebec H3B 0M7 Canada Tel.: 514-393-7115 Fax: 514-390-4111 www.deloitte.ca Report of the Independent Auditor on the Summary Financial Statements

To the members of the Board of Directors of the Cree Board of Health and Social Services of James Bay

The accompanying summary financial statements of the Board of Directors of the Cree Board of Health and Social Services of James Bay, which comprise the statement of financial position as at March 31, 2017 and statements of operations, accumulated surplus (deficit), change in the net financial assets (net debt) and cash flows for the year then ended and related notes, are derived from the audited financial statements of the Cree Board of Health and Social Services of James Bay (CBHSSJB) for the year ended March 31, 2017. We expressed an unmodified audit opinion on those financial statements in our report dated June 14, 2017. Neither these financial statements nor the summary financial statements reflect the effect of events subsequent to the date of our report on these financial statements.

The summary financial statements do not contain all the disclosures required by Canadian Public Sector Accounting Standards. Reading the summary financial statements, therefore, is not a substitute for reading the audited financial statements of the CBHSSJB.

Management’s responsibility for the summary financial statements Management is responsible for the preparation of a summary of the audited financial statements on the basis described in Appendix 1 of circular relating to the annual management report (03.01.61.19) published by the Ministère de la Santé et des Services sociaux du Québec (MSSS).

Auditor’s responsibility Our responsibility is to express an opinion on the summary financial statements based on our procedures, which were 109 conducted in accordance with Canadian Auditing Standard (CAS) 810, Engagements to Report on Summary Financial Statements.

Opinion In our opinion, the summary financial statements derived from the audited financial statements of the CBHSSJB for the year ended March 31, 2017 are a fair summary of those financial statements, on the basis of the criteria described in Appendix 1 of the circular relating to the annual management report (03.01.61.19) published by the MSSS. However, the summary financial statements are misstated to the equivalent extent as the audited financial statements of the CBHSSJB for the year ended March 31, 2017.

The misstatement of the audited financial statements is described in our qualified opinion in our report dated June 14, 2017. Our qualified opinion is based on the fact that an amount receivable from the Ministère de la Santé et des Services sociaux du Québec (MSSS) in the amount of $111,317,520 as at March 31, 2017 related to specific allocations for the Non-Insured Health Benefits Program could not be confirmed with the MSSS as at the date that the financial statements were issued. However, the MSSS asked the Establishment not to delete the amount receivable. Consequently, we were unable to determine whether adjustments could have been made to the amounts of MSSS grant revenue, surplus for the fiscal year and cash flows related to operating activities for the years ended March 31, 2017 and March 31, 2016, financial assets and net financial assets (net debt) as at March 31, 2017 and March 31, 2016, as well as the accumulated surplus as at April 1, 2016 and 2015 and March 31, 2017 and 2016. Consequently we expressed a modified audit opinion on the financial statements for the year ended March 31, 2016, because of the possible impact of this limitation of scope.

Our qualified audit opinion states that, except for the effects of the described matter, the audited financial statements present fairly, in all material respects, the financial position of the CBHSSJB as at March 31, 2017 and the results of its operations, the change in its net debt, its remeasurement gains and losses and its cash flows for the year then ended in accordance with Canadian Public Sector Accounting Standards.

[original signed]1

June 30, 2017

1 CPA auditor, CA, public accountancy permit no. All0078 cbhssjb cbhssjb statement of operations | 31 march 2017 31 march 2017 statement of operations | Name of Institution Code Page / Idn. Name of Institution Code Page / Idn. C.B.H.S.S.J.B. 1625-8899 200-00 / 1625-8899 358-00 /

All funds year ended March 31, 2017 - AUDITED General fund year ended March 31, 2017 - AUDITED STATEMENT OFOPERATIONS STATEMENT OF OPERATIONS

Budget Operations Capital assets Current Year Prior Yr. Total Budget Main activities Incidental Total (C2+C3) Prior year Current Current Year Total C2+C3 Activities Year (Note 1) 1 2 3 4 5 (R.of P358 C4) REVENUE 1 2 3 4 5 REVENUE MSSS Grants (P362) 1 137,352,000 219,905,641 219,905,641 206,313,395

Government of CanadaGrants 2 6,468,624 6,468,624 6,040,534 MSSS grants (FI:P408) 1 137,352,000 219,905,641 9,747,742 229,653,383 217,623,338 (C2:P290/C3:P291) Government of Canada grants 2 6,468,624 6,468,624 6,040,534 (FI:P294) User contributions (P301) 3 697,771 XXXX 697,771 521,946 User contributions 3 697,771 XXXX 697,771 521,946 Sales of services and collections 4 410,854 XXXX 410,854 133,777 (P320) Sale ofservices and collections 4 410,854 XXXX 410,854 133,777 Donations (C2:P290/C3:P291) 5 72,493 Donations (FI:P294) 5 72,493 Investment revenue (P302) 6 Investment revenue (FI:P302) 6 Business revenue 7 Business revenue 7 (C2:P661/C3:P351) Gain on disposal (FI:P302) 8 23,033 23,033 Gain on disposal (P302) 8 9 XXXX XXXX XXXX XXXX XXXX 9 XXXX XXXX XXXX XXXX XXXX 10 XXXX XXXX XXXX XXXX XXXX 10 XXXX XXXX XXXX XXXX XXXX Other revenue (FI:P302) 11 655,056 655,056 1,906,998 Other revenue (P302) 11 332,425 322,631 655,056 1,906,998 TOTAL (L.01to L.11) 12 137,352,000 228,137,946 9,770,775 237,908,721 226,299,086 TOTAL (L.01to L.11) 12 137,352,000 221,346,691 6,791,255 228,137,946 214,989,143

EXPENDITURES EXPENDITURES

Salaries, benefits and payroll taxes 13 90,336,000 116,118,841 XXXX 116,118,841 100,191,381 Salaries, benefits and allowances 13 90,336,000 111,155,534 4,963,307 116,118,841 100,191,381 110 (C2:P320/C3:P351) 111 Medications 14 10,204,598 XXXX 10,204,598 Medications (P750) 14 10,204,598 XXXX 10,204,598 Blood products 15 71,963 XXXX 71,963 Blood products 15 71,963 XXXX 71,963 Medical and surgical supplies 16 3,182,850 4,288,053 XXXX 4,288,053 2,361,824 Medical and surgical supplies 16 3,182,850 4,288,053 XXXX 4,288,053 2,361,824 Foodstuffs 17 703,886 691,726 XXXX 691,726 726,548 (P755) Honoraria paid to non-­institutional 18 XXXX Foodstuffs 17 703,886 691,726 XXXX 691,726 726,548 Inresources Honoraria paid to non -­institutional 18 XXXX Carrying charges (FI:P325) 19 350,000 811,996 4,251,422 5,063,418 5,902,901 resources (P650) Maintenance and repairs, including 20 2,292,105 2,808,432 2,808,432 2,502,363 Carrying charges (P325) 19 350,000 811,996 XXXX 811,996 435,797 non-­capital costs related to capital assets Maintenance and repairs (P325) 20 2,292,105 2,808,432 2,808,432 2,502,363 Bad debts 21 XXXX Bad debts (C2:P301) 21 Rent 22 1,030,500 6,690,494 XXXX 6,690,494 5,327,099 Rent 22 1,030,500 6,670,039 20,455 6,690,494 5,327,099 Capital asset depreciation 23 XXXX 6,269,307 6,269 , 307 6,141,082 (FI:P422) Transfer expenses (P325) 23 Loss on disposal of capital assets 24 XXXX Other expenditures (P325) 24 39,456,659 82,768,285 1,807,493 84,575,778 97,375,922 (FI:P420, 421) TOTAL (L.13to L.24) 25 137,352,000 219,470,626 6,791,255 226,261,881 208,920,934 Transfer expenses 25 XXXX 26 XXXX XXXX XXXX XXXX XXXX SURPLUS (DEFICIT) FOR THE YEAR 26 0 1,876,065 0 1,876,065 6,068,209 Other expenditures (FI:P325) 27 39,456,659 84,575,778 84,575,778 97,375,922 (L.12 -­ L.25) TOTAL (L.13to L.27) 28 137,352,000 226,261,881 10,520,729 236,782,610 220,529,120

SURPLUS (DEFICIT) FOR THE YEAR 29 0 1,876,065 (749,954) 1,126,111 5,769,966 (L.12 -­ L.28)

Note 1: Column 3 applies to public institutions only

AS-471 - Annual Financial Report Template LPRG-2017.1.0 Revised: 2015-2016 AS-471 - Annual Financial Report Template LPRG-2017.1.0 Revised: 2016-2017

Validation stamp: 2017-06-14 08:55:33 Report V 1.0 Validation stamp: 2017-06-14 08:55:33 Report V 1.0 cbhssjb cbhssjb

statement of accumulated surplusCode (deficit) | 31 march 2017Page / Idn. statement of financial position | 31 march 2017 Name of Institution Code Page / Idn. 1625-8899 202-00 / Name of Institution

C.B.H.S.S.J.B. 1625-8899 204-00 / All funds year ended March 31, 2017 - AUDITED STATEMENT OF ACCUMULATED SURPLUS All funds year ended March 31, 2017 - AUDITED (DEFICIT) STATEMENT OF FINANCIAL POSITION

Operating Fund Capital Assets Current Year Prior Yr. Total. FUND General Capital assets Current Year Total Prior Yr. Total. Current Year Fund Total (C1+C2) Current Year (C1+C2) 1 2 3 4 FINANCIAL ASSETS 1 2 3 4 Notes ACCUMULATED SURPLUS (DEFICIT), 1 39,370,208 4,412,655 43,782,863 38,012,897 Cash on hand ( overdraft) 1 3,282,730 3,282,730 7,859,204 BEGINNING OF YEAR,ALREADY ESTABLISHED Short-­term investments 2 Accounting changes with 2 Receivables -­ MSSS (FE:P362, FI:P408) 3 131,823,837 1,170,689 132,994,526 120,399,735 prior year restatement (specify) Other receivables (FE:P360, FI: P400) 4 4,594,883 4,594,883 2,558,395 Accounting changes without prior year 3 XXXX Cash advances to public institutions 5 XXXX restatement (specify) Interfund receivables (debts) 6 7,239,283 (7,239,283) 0 ACCUMULATED SURPLUS (DEFICIT), BEGINNING4 39,370,208 4,412,655 43,782,863 38,012,897 Grant receivable (received in advance) -­ accounting reform 7 5,770,765 (19,679,534) (13,908,769) (14,041,789) ADJUSTED (L.01 to L.03) (FE:P362, FI:P408)

SURPLUS (DÉFICIT) FOR THE YEAR 5 1,876 065 (749,954) 1,126,111 5,769,966 Portfolio investments 8 Other changes: Deferred debt issuance costs 9 XXXX

Inter-­institution transfers (specify) 6 10 XXXX XXXX XXXX XXXX

11 XXXX XXXX XXXX XXXX Interfund transfers (specify) 7 (3,222,193) 3,222,193 12 Other items applicable to private establishments 8 XXXX Other items (FE: P360, FI: P400) 12 2,333,022 1,870,857 4,203,879 4,804,634 under agreement (specify) TOTAL FINANCIAL ASSETS (L.01 to L.12) 13 155,044,520 (23,877,271) 131,167,249 121,580,179 XXXX XXXX XXXX XXXX LIABILITIES TOTAL OTHER CHANGES (L.06 to L.09) 10 (3,222.193) 3,222,193 Short-­term debts (FE: P365, FI: P403) 14 83,007,969 3,647,640 86,655,609 70,664,585

112 Accounts payable -­ MSSS (FE: P362, FI: P408) 15 113 ACCUMULATED SURPLUS (DEFICIT) END OF 11 38,024,080 6,884,894 44,908,974 43,782,863 YEAR (L.04+ L.05 + L.10) Other accounts payable andaccruals (FE: P361, FI: 16 20,119,251 20,119,251 25,179,516 P401) Consisting of the following: Cash advances -­ decentralized envelopes 17 XXXX External restrictions 12 XXXX XXXX Accrued interest payable (FE: P361, FI: P401) 18 88,405 1,170,689 1,259,094 1,257,872 Internal restrictions 13 XXXX XXXX 4,927,151 4,661,673 Deferred revenue (FE: P290 and 291, FI: P294) 19 8,126,930 8,126,930 9,026,160 Unallocated balance (L.11 -­ L.12 -­ L.13) 14 XXXX XXXX 39,981,823 39,121,190 20 XXXX XXXX XXXX XXXX TOTAL (L.12 to L.14) 15 XXXX XXXX 44,908,974 43,782,863 Long-­term debts (FI: P403) 21 XXXX 103,823,790 103,823,790 105,495,185 Liability for contaminated sites (FI: P401) 22 XXXX Liability foremployee future benefits (FE: P363) 23 7,725,764 XXXX 7,725,764 6,634,614 24 XXXX XXXX XXXX XXXX Other items (FE: P361, FI: P401) 25 675,865 1,870,857 2,546,722 2,964,894 TOTAL LIABILITIES (L.14 -­ L.25) 26 119,744,184 110,512,976 230,257,160 221,222,826

NET FINANCIAL ASSETS (NET DEBT)(L.13 -­ L.26) 27 35,300,336 (134,390,247) (99,089,911) (99,642,647)

NON-­FINANCIAL ASSETS

Capital assets (FI: P423) 28 XXXX 141,275,141 141,275,141 141,387,004 Supply inventory (FE: P360) 29 1,431,429 XXXX 1,431,429 1,271,114 Prepaid expenses (FE: P360, FI: P400) 30 1,292,315 1,292,315 767,392 TOTAL NON -­FINANCIAL ASSETS (L.28 to L.30) 31 2,723,744 141,275,141 143,998,885 143,425,510

SHARE CAPITAL AND CONTRIBUTED SURPLUS 32 XXXX ACCUMULATED SURPLUS (DEFICIT) (L.27 + L.31 -­ L.32) 33 38,024,080 6,884,894 44,908,974 43,782,863 Contractual obligations (pages 635-­00 -­ 635-­03) and PPP (638-­01 and 638 -­02) Contingencies (pages 636-­01 and 636 -­02) Column 2: Public institutions only Line 06: Column 3: Amount must be equal to zero Line 32: applicableto private institutions only

AS-471 - Annual Financial Report Template LPRG-2017.1.0 Revised: 2015-2016

Validation stamp: 2017-06-14 08:55:33 Report V 1.0

AS-471 - Annual Financial Report Template LPRG-2017.1.0 Revised: 2013-2014

Validation stamp: 2017-06-14 08:55:33 Report V 1.0 cbhssjb cbhssjb statement of variance of net financial assets/debts | 31 march 2017 cash flow statement | 31 march 2017 Name of Institution Code Page / Idn. Name of Institution Code Page / Idn. C.B.H.S.S.J.B. 1625-8899 208-00 / C.B.H.S.S.J.B. 1625-8899 206-00 /

All funds year ended March 31, 2017 - AUDITED All funds year ended March 31, 2017 - AUDITED STATEMENT OFVARIANCE OF NET FINANCIAL ASSETS (NET DEBT) CASH FLOW STATEMENT

Budget General f und Capital assets Total -­ Current Total -­ Prior yr. Current Year Prior year fund Year 1 2 Notes (C2+C3) OPERATING ACTIVITIES 1 2 3 4 5 Surplus (deficit) for the year 1 1,126,111 5,769,966 NET FINANCIAL ASSETS (NET 1 37,331,702 (136,974,349) (99,642,647) (105,761,901) DEBT) BEGINNING ALREADY ESTABLISHED Accounting changes with 2 prior year restatement ITEMS NOT AFFECTING CASH FLOW:

Accounting changes without 3 XXXX Provisions tied to portfolio investments and loan guarantees 2 prior year restatement Supply inventory and p repaid expenses 3 (685,238) (71,141) NET FINANCIAL ASSETS ( NET DEBT), 4 37,331,702 (136,974,349) (99,642,647) (105,761,901) BEGINNING, ADJUSTED (L.01 to L.03) Loss (gain) on disposal of capital assets 4 (23,033) Loss (gain) on disposition of portfolio investments 5 SURPLUS (DEFICIT) FOR THE YEAR 5 1,876,065 (749,954) 1,126,111 5,769,966 Amortization ofdeferred revenue related to capital assets: (P.200, L.29) -­ Government of Canada 6 VARIANCE DUE TO CAPITAL ASSETS: -­ Other 7 Acquisitions (FI:P421) 6 XXXX (6,184,411) (6,184,411) (5,720,653) Capital asset depreciation 8 6,269 307 6,141,082 Annual depreciation (FI:P422) 7 XXXX 6,269,307 6,269,307 6,141,082 Capital loss 9 Gain/loss on disposal of assets(FI:P208) 8 XXXX (23,033) (23 , 033) Amortization of debt issue costs and management 10 Proceeds of disposition (FI:P208) 9 XXXX 50,000 50,000 Amortization of bond premium or discount 11 Bad debts (FI:P420, 421-­00) 10 XXXX MSSS grants 12 (5,496 320) 540,999 Capital asset adjustments 11 XXXX Other (specify P297) 13 114 12 XXXX XXXX XXXX XXXX XXXX 115 13 XXXX XXXX XXXX XXXX XXXX TOTAL ITEMS NOT AFFECTING CASH FLOW (L.02 to L.13) 14 64,716 6,610,940 TOTAL VARIANCE DUE TO 14 XXXX 111,863 111,863 420,429 Changes in financial assets and liabilities related to operation 15 (19,262,050) (42,990,022) CAPITAL ASSETS (L.06 to L.13) CASH FLOW RELATED TO OPERATING ACTIVITIES (L.01 + L.14 + L.15) 16 (18,071,223) (30,609,116) VARIANCE DUE TO SUPPLY

INVENTORY AND PREPAID EXPENSES: Acquisition ofsupply inventory 15 (8,792,701) XXXX (8,792,701) (1,271,114) CAPITAL ASSET INVESTMENT ACTIVITIES

Acquisition of prepaid expenses 16 (1,304,515) (1,304,515) (767,392) Cash outflow related to capital asset purchases 17 (6,238,180) (4,755,956) Use of supply inventory 17 8,632,386 XXXX 8,632,386 1,226,976 Proceeds of disposition ofcapital assets 18 50,000 Use of prepaid expenses 18 779,592 779,592 740,389 CASH FLOW RELATED TO CAPITAL ASSET INVESTMENT ACTIVITIES 19 (6,188,180) (4,755,956) TOTAL VARIANCE DUE TO 19 (685,238) (685,238) (71,141) (L.17 + L.18) SUPPLY INVENTORY AND PREPAID EXPENSES (L.15 to L.18)

INVESTMENT ACTIVITIES Other variance in accumulated surplus (3,222,193) 3,222,193 0 ( deficit) 20 Variance of short-­term investments 20

Portfolio investments 21 INCREASE (DECREASE) IN 21 (2,031,366) 2,584,102 552,736 6,119,254 Proceeds of disposition of portfolio investments 22 NET FINANCIAL ASSETS (NET DEBT) (L.05 + L.14 + L.19 + L.20) Portfolio investments 23 CASH FLOW RELATED TO INVESTMENT ACTIVITIES (L.20 to L.23) 24 NET FINANCIAL ASSETS ( NET DEBT ), 22 35,300,336 (134,390,247) (99,089,911) (99,642,647) END OF YEAR (L.04 + L.21)

AS-471 - Annual Financial Report Template LPRG-2017.1.0 Revised: 2015-2016

Validation stamp: 2017-06-14 08:55:33 Report V 1.0

AS-471 – Annual Financial Report Template LPRG-2017.1.0 Revised: 2015-2016

Validation stamp: 2017-06-14 08:55:33 Report V 1.0 cbhssjb cbhssjb

cashName of Institutionflow statement (cont’d) | 31 marchCode 2017 Page / Idn. cash flow statement (cont’d) | 31 march 2017 C.G.H.S.S.J.B. Name of Institution Code Page / Idn. 1625-8899 208-1 / C.B.H.S.S.J.B. 1625-8899 208-2 /

All funds year ended March 31, 2017 - AUDITED All funds year ended March 31, 2017 - AUDITED CASH FLOW STATEMENT (cont’d) CASH FLOW STATEMENT (suite)

Current Year Prior year Current Year Prior year 1 2 Notes 1 2 Notes FINANCING ACTIVITIES VARIANCE OF FINANCIAL ASSETS and LIABILITIES RELATED TO OPERATION:

Long-­term debts -­ Debts incurred 1 1,284,517 Receivables -­ MSSS 1 (13,477,928) (47,056,918) Long-­term debts -­ Debts repaid 2 (5,311,920) Other receivables 2 (2,036,488) 440,363 Capitalization of discount and premiumon debt instruments 3 Cash advances to public institutions 3 Variance of short-­term debts -­ general fund 4 16,007,969 37,000,000 Grant receivable -­ accounting reform -­ employee future benefits 4 Short-­term debts incurred-­ capital asset fund 5 3,674,960 Deferred debt issuance costs 5 Short-­term debts repaid -­ capital asset fund 6 (340,936) Other assets 6 600,755 (4,536,340) Variance from government sinking fund 7 Accounts payable -­ MSSS 7 Other (specify P297) 8 (50,483) Other accounts payable and accruals 8 (4,485,993) 6,568,366 CASH FLOW RELATED TO FINANCING ACTIVITIES (L.01 to L.08) 9 19,682,929 32,581,178 Cash advances – decentralized envelopes 9 Accrued interest payable 10 1,222 187,923

Deferred revenue 11 (536,596) (1,751,567) INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS 10 (4,576,474) (2,783,894) (P.208-­00, L.16 + L.19 + L.24 +-­ P.208 01, L.09) Liability for contaminated sites 12 Liability for employee future benefits 13 1,091,150 193,257 Other liability items 14 (418,172) 2,964,894 CASH AND CASH EQUIVALENTS, BEGINNING OF YEAR 11 7,859,204 10,643,098 TOTAL VARIANCE OF FINANCIAL ASSETS AND LIABILITIES REL ATED TO 15 (19,262,050) (42,990,022) OPERATION (L.01 to L.14)

116 CASH AND CASH EQUIVALENTS, END OF YEAR(L.10 + L.11) 12 3,282,730 7,859,204 117 OTHER INFORMATION:

CASH AND CASH EQUIVALENTS, END OF YEAR,INCLUDING: Capital asset acquisitions included in accounts payable as at March 31 16 910,928 964,697 Proceeds of disposition of capital assets included in receivables as at March 31 17 Cash on hand 13 3,282,730 7,859,204 Other items not affecting cash and cash equivalents (specify P297) 18 Short-­term investments 14

TOTAL (L.13 + L.14) 15 3,282,730 7,859,204 Interest:

Creditor interest (revenue) 19 Interest received (revenue) 20 Interest receivable (expenses) 21 5,063,418 5,902,901 Interest spent ( expenses) 22 772,762 5,714,980

AS-471 – Annual Financial Report Template LPRG-2017.1.0 Revised: 2015-2016 AS-471 – Annual Financial Report Template LPRG-2017.1.0 Revised: 2016-2017 Validation stamp: 2017-06-14 08:55:33 Report V 1.0 Validation stamp: 2017-06-14 08:55:33 Report V 1.0

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