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ACCESS Open Minds Elsipogtog First Nation Transforming Youth Mental Health Care CANADIAN INNOVATION in ACTION

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ACCESS Open Minds Elsipogtog First Nation Transforming Youth Mental Health Care CANADIAN INNOVATION in ACTION Project Impact Report 2019 ACCESS Open Minds Elsipogtog First Nation Transforming Youth Mental Health Care CANADIAN INNOVATION IN ACTION ACCESS Open Minds is changing youth mental health care across Canada by transforming and improving services, generating new knowledge, and forging connections across the country. This report highlights key site activities, clinical approaches, and success stories from the ACCESS Open Minds team in Elsipogtog First Nation, New Brunswick. Today after one year of being in the ACCESS program, I'm in a better place of mind than I was before. If I didn't see the post {a Facebook post about an ACCESS activity night}, I don't believe I'd be here. I'm a better mother for my son, a better wife to my husband, and most of all I'm a better me. Kyla Clair, 24, ACCESS Client and Member of the ACCESS OM Elsipogtog Youth Council TABLE OF CONTENTS 01 About ACCESS Open Minds 02 Background and history 03 Project timeline 04 Clinical approaches 05 ACCESS Youth Space 06 Impacts so far 07 Next steps About ACCESS Open Minds Initiated in 2015, ACCESS Open Minds (ACCESS Esprits ouverts in French) is a pan-Canadian service transformation and research project, jointly funded by the Canadian Institutes of Health Research and the Graham Boeckh Foundation under CIHR's Strategy for Patient-Oriented Research. The ACCESS OM network is made up of over 300 individuals including youth, family members and carers, service providers, researchers, and policymakers from across Canada, all working together to transform youth mental health services. At the 14 ACCESS Open Minds service sites located across the country, youth and their families and carers are able to get rapid and barrier-free access to mental health support based on their own goals and needs, where and when they want it. By implementing a common research program and evaluation toolkit, all ACCESS Open Minds sites provide evidence-based care, and are generating evidence that will inform policymakers and ultimately improve mental health care across the country. Where are we? 14 diverse sites across Canada... Ulukhaktok, NT Edmonton, AB University of Alberta, AB Sturgeon Lake First Nation, SK Chatham-Kent, ON Puvirnituq, Nunavik, QC Cree Nation of Mistissini, Eeyou Istchee, QC Dorval-Lachine-LaSalle, QC Parc-Extension, QC RIPAJ-Montréal, QC Province of New Brunswick: Elsipogtog First Nation, Péninsule Acadienne, and P.E.E.R. SJ in Saint John Eskasoni First Nation, NS Project outcomes... we are: Creating a pan- Transforming services, Generating Involving youth and Canadian network making mental health new knowledge and families/carers care systems into learning evidence through health care systems research Core Values at ACCESS OM services How are services taking shape?.. Early Identification: targeted activities that support help-seeking as soon as possible Rapid Access: youth are offered a mental health assessment within 72 hours of seeking help Appropriate Care: if required youth are offered a referral to additional services within 30 days Continuity of Care: seamless services are provided to youth ages 11-25 Youth and Family Engagement: youth and their families/carers are considered partners in their own care and design of services at sites Elsipogtog First Nation, New Background Brunswick and history The health care workers in Elsipogtog First Nation note that they encounter clients with high rates of drug addiction and overdose, and their resources are often stretched thin when it comes to providing support and crisis intervention. At times, youth from the community reach adulthood and find themselves without a set goal or clear next step, which can make turning 18 a difficult time of transition. Previously, youth workers in the community had noted that they would benefit from training in the area of counselling youth who are experiencing difficulties – whether they are related to mental health or not. In partnering with the ACCESS Open Minds project, the health services team and the community of Elsipogtog First Nation aim to transform how they support the mental health of their youth and young adults. The ACCESS OM team is composed of several members including an ACCESS OM Clinician, Research Assistant, and youth support workers. This team has worked together to reach out to youth in a variety of ways, including using mobile technologies and social media, and by destigmatizing seeking mental health support by normalizing support services and situating them in activities that youth from the community enjoy. The team is also working to support the youth of Elsipogtog in accessing appropriate care as quickly as possible, when needed. An approach that works for the youth of Elsipogtog First Nation Lacey Clair, the ACCESS OM NB Research Assistant for Elsipogtog First Nation and former Peer Support Worker, notes that the method of delivering mainstream clinical mental health services doesn’t necessarily work for all youth in First Nation communities. Although there are many great mental health services offered in Elsipogtog, Clair notes that the existing stigma surrounding more mainstream or clinical approaches to mental health care tends to make youth avoid accessing services altogether. Many people from the community, including the local crisis workers, agree that in order to best serve the community’s youth, a more accessible, youth-friendly approach is necessary than what has been offered by mainstream services. This approach is a good fit with the ACCESS Open Minds framework – the local site team meets youth where they are, gives space to listen to their desires, and can support the other professional care providers to best meet the needs of Elsipogtog’s youth. Elsipogtog First Nation, Project timeline New Brunswick TRAM 2014 Transformational Research in Adolescent Mental Health (TRAM) grant competition is held Representatives from New Brunswick participate in TRAM process 2015 Getting started ACCESS Open Minds is announced as the successful TRAM network Members of the New Brunswick site 2016 team participate in the first ACCESS Provincial roll-out OM network meeting in Montréal, QC The New Brunswick ACCESS Open Minds/Esprits ouverts provincial secretariat works on identifying and engaging Partnering Communities where the ACCESS OM project will 2017 Boots on the ground take place Elsipogtog First Nation is identified as a Partnering Community, and the project begins on-site in June 2017 2018 Growing momentum Primary focus was to spread awareness of the program ACCESS OM Elsipogtog hosted its official Site Launch event on April 17, Presentations were given at all local 2018 schools, and youth were asked what services they wanted The program has grown to be considered a pillar of the community, and is running smoothly and Site team began creating successfully community partnerships Despite its late start in the pan- Canadian ACCESS OM initiative, the site team projects that the research 2019 target goal for 2020 will be reached Next steps... earlier The ACCESS OM Elsipogtog Youth Center will have an extension built to service the 18-30 year old age group, and to provide private one-on-one counselling space The research target goal is reached before the final year of the project! Elsipogtog First Nation, Clinical approaches New Brunswick Providing community-appropriate care One of the most important aspects of the ACCESS OM Elsipogtog team is that the team members understand the youth in their community and how they express themselves. For instance, young people often use the term "depression" as a word to describe a variety of types of distress (and not just what is meant by "clinical depression"). Understanding the way in which things are said, and even the words and the language used, is of utmost importance when fully understanding a young person in distress, and then making the decision as to how best to support them. At the Elsipogtog site, we see Cultural forms of treatment (e.g. Sweatlodge ceremony, Smudging, fasting, drumming, and all forms of prayer) as a clinical approach, and not as an “alternative” treatment. These practices “need to be recognized as a valid and effective form of treatment, the same as western approaches,” says Clair and ACCESS OM Clinician Theolyn Martin. Some youth prefer turning to their traditional roots for healings; it helps in developing a strong sense of self. Identity is something that many Indigenous youth struggle to find, as youth feel forced to straddle two worlds. This does not mean that all youth do not also prefer having the option of westernized forms of treatment, as well. “This is why we allow the youth to choose which services they prefer.” Furthermore, in Elsipogtog, the site team is workind hard to ensure that youth in need of more specialized care are connected to whatever help they need, including accompaniment should the young person wish. The provision of appropriate care goes both ways, though: as Clair points out, “We’re making sure we don’t refer people to psychiatrists who just need a friend.” ACCESS OM Peer Support Workers are able to accompany youth to services outside the community when needed and/or when that sort of support is requested. Lacey Clair explains: “We’re giving them what they need when they need it, but even if we don’t think they need [to see a psychiatrist/psychologist], if someone wants specialized services, we’ll refer them.” Providing an inappropriate service can be just as damaging as not providing a service at all.” Integrating research and evaluation into clinical practice A main component of the ACCESS Open Minds project is collecting information with youth and families/carers who receive services at the site. Some of the information being collected includes: demographic information (who is accessing services?) pathways to care (tracking trajectories of how youth access support) satisfaction of services symptoms and functioning of youth, both at one point in time and over the course of time Site team members use a combination of paper-based questionnaires and a web-based data collection platform to gather this information, which allows the clinical team members and research staff to better understand the needs of youth in their community.
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