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, . 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. The site team has involved a number of different health services staff in becoming better acquainted with the data collection component of ACCESS Open Minds. At the Elsipogtog site, as with all sites across the network, participation in research does not change or affect the services provided. Collection of this data is an ongoing process, and though the site team believes that the assessments are extremely important, client care is first and foremost the focus of our staff.

The Elsipogtog team hopes that the information collected with the youth of Elsipogtog will help them, other service providers, and community leaders to make informed decisions about program design and service implementation going forward. Importantly, our site upholds the OCAP principles of data ownership for ; this study is not being conducted “on us, but conducted by us, for us,” says Clair. Elsipogtog First Nation, Clinical approaches (2) New Brunswick The informal approach... it works!

Encouraging youth to seek help for their mental health needs starts with making services, and service-providers, approachable. “Youth didn’t want to talk to us because we ‘looked all business,’ so now we dress more casually.”

One goal of a more informal practice is to be seen as “a good friend youth can turn to,” and one thing friends do is keep an eye on each other. By orienting their support towards youth and their day-to-day needs, ACCESS OM Elsipogtog is able to build meaningful relationships with at-risk youth. This approach means support workers might accompany young people to get the birth certificates and SIN cards needed to find work; it also means a large portion of youth seen by the service are self-referred, seeking help on their own because they feel safe and comfortable.

The team is also a little less formal in its approach to educating youth on mental health self-care and life skills. A weekly event dubbed “De-Stress Night” pairs a fun activity with a learning topic, such as mindfulness exercises alongside a budgeting lesson. Another example is a spa night for young women that included worksheets on negative self-talk. “We’re able to address anxiety and distress by giving young people a hand-up instead of handout,” says Clair. “We can’t solve their problems for them, but we can equip them to help themselves, and that leaves them with a sense of accomplishment.”

One consequence of ACCESS OM Elsipogtog’s community-based mental health care program is increased freedom to address barriers to care. Early Identification and Rapid Access are two of the project's main objectives, and the team in Elsipogtog is able to address them well. Allowing youth and community members to access support workers directly via informal means such as Facebook and text messaging allows support workers to connect with distressed youth quickly. This social presence also allows workers to monitor the state of mind of youth to whom they are already connected. “The cry for help has changed with the use of social media,” says ACCESS OM Clinician, Theolyn Martin. “Youth express themselves on social media far easier... why, because our social skills and interactions are breaking down in society.”

Care is close to home

The ACCESS OM Elsipogtog team is proud to be almost entirely made up of local community members. Team members have roots in Elsipogtog itself, which helps make the team’s informal approach to care successful. The road to trust is just that much shorter.

Being a part of the community means it’s easy for community members to refer friends and loved ones for support, because it’s less like interacting with an institution and more like turning to a friend for advice. It also doesn’t hurt that the informal referral process allows people to refer via a forwarded Facebook message.

ACCESS OM Elsipogtog works closely with the Elsipogtog Restorative Justice Program. Youth can be referred to the ACCESS OM team for counselling and community service as a mandated means of avoiding a criminal record. What’s more, local youth are asking to be referred to ACCESS OM. Elsipogtog First Nation, ACCESS Youth Space New Brunswick

The ACCESS OM Elsipogtog office is located in the Community Youth Centre, in the middle of the community, close to the gymnasium and hockey arena. Before ACCESS OM, youth seeking mental health or psychological services would have to go to the local health centre or to off-reserve services. This new location makes a significant difference, since the Youth Centre offers a stigma-free and discrete location where a young person might be participating in a fun activity or seeking mental health support.

Being housed at the Youth Centre allows the ACCESS OM Elsipogtog team to be more embedded in the community itself. With a dedicated focus on outreach, the community’s youth appear to be more comfortable interacting with mental health support workers in the context of the Youth Centre. SAFE SPACE

Safe Space operates out of the youth centre along with ACCESS Open Minds. They offer daily activities for youth aged 6-18, and have 4 full-time staff who develop close bonds with the youth. In the summer months, Safe Space staff run a day camp in which each age group has one full week of fun activities, such as trips to the water park, or tubing down the Miramichi River. Each camp group also has a cultural activity hosted at Kouchiboquac National Park, where they hear ancestral stories and learn their Mi'kmaq seven sacred teachings from Elsipogtog Elder, Marilyn Ingram.

ACCESS OM staff participate in many of these activities, but also run similar weekly activities in smaller groups for youth aged 11-18 who may suffer from social anxiety of bullying and are uneasy with large groups. ACCESS staff also focus on providing safe social activities for youth aged 19-30, an age group that — prior to ACCESS — had no dedicated services in the community.

ACCESS OM also collaborates with NAYSPS (National Aboriginal Youth Suicide Prevention Strategy) and Mawiw Council Inc. to host cultural activities such as Hand Drum making, Traditional Medicine Teachings and traditional craft making. Our staff also attend sweatlodge ceremonies in the community with youth who request it. Elsipogtog First Nation, Impacts so far New Brunswick The team in Elsipogtog First Nation is implementing the ACCESS OM framework in the unique context of their community, and youth are already benefitting. With plenty of room to expand and increase services, ACCESS OM Elsipogtog is blazing a trail for youth mental health care and building a community of support.

Continuity of care Before the ACCESS OM transformation, older youth in the community (i.e. ages 18-25) were a group that often went unserved. “There was a big need,” says Nancy Milliea, Site Lead for ACCESS OM Elsipogtog. “Now we have four ACCESS OM workers whose job it is to help these older kids.” These new and dedicated staff are able to provide counselling and referrals to appropriate services for youth who might be facing problems at home, or experiencing anxiety or depression. Aimed at attracting youth In Elsipogtog, like in many First Nations communities, programs like ACCESS OM come and go quickly. A program starts and if its targets are not achieved in a short period of time, the program is closed. This has caused distrust in programs for youth in Elsipogtog. “Why would I open up to someone who’s gonna be gone in 2 months? They never stay,” says Kayla Peters, an Elsipogtog youth. This reluctance made the initial months of ACCESS a bit of a struggle, but the team persevered, and proved to the community’s youth that ACCESS will not abandon them. Offering services for youth informed by youth themselves has brought over 700 youth through our doors for either an intervention, a referral to another service, or a chat on a bad day — and a number of these youth have gone on to become full-time clients. We have also conducted over 1,300 brief crisis interventions.

Among the youth involved in the programs, 57 are participating in the ACCESS OM research and evaluation component of the project. The ACCESS OM Elsipogtog team has a 50% participation rate — a number of youth have noted that sometimes the assessment process will “bring them down” if they're feeling good, but still the youth are participating and note its importance.

The ACCESS OM NB Elsipogtog team is now happy to be considered a pillar in the community. All services in Elsipogtog are aware of our program and what we do. We have partnerships with:

Elsipogtog Alchohol & Drug Prevention Kent County ISD program Elsipogtog Restorative Justice Program Bonar Law Memorial High School Elsipogtog Probation Eleanor Graham Middle School Elsipogtog Restorative Justice Program Rexton Elementary School Elsipogtog RCMP Detachment City Hospital Elsipogtog Maternal Child Care S.A.G.E Solutions Counselling Services Elsipogtog Nutrition Program Elsipogtog Crisis Center Elsipogtog Federal School National Aboriginal Youth Suicide Prevention Strategy (NAYSPS) Elsipogtog Child and Family Services Jordan's Principle Program Elsipogtog Family Resource Center Mawiw Council Inc. Elsipogtog First Nation, Next steps New Brunswick Data collection is ongoing

Data collection is scheduled to wrap up in September 2020, and the project results will be published in 2021. To date, 57 youth in Elsipogtog have particiated in data collection.

Community-driven care

A small staff team and limited funding means that the ACCESS OM Elsipogtog team spends the bulk of their time meeting and assisting a group of young people that they see on a regular basis. One of their strengths is building trusting relationships with youth in the community, building bridges with young people who might already need support, or who might benefit from additional support in the future. The site team also hopes that in the future, they are able to spend time expanding their work towards giving topic-focused workshops.

Despite the difficulties of maintaining enthusiasm in a multi-year research and evaluation project, there is a definitive sense of optimism among the ACCESS OM Elsipogtog team. This optimism is not just for the project, but for the youth of the community, as well. “We have lots of plans,” says Clair, “but we don’t have all the resources to implement them all yet. Our community wants in, though. People are talking about ACCESS Open Minds and spreading the word.” A bigger space to call home In the coming year, the site will be adding an extension to the Youth Space that will include one large, open-concept room for activities that will also serve as a “lounge” area for older youth who would like to “just have a place to call our own,” as Kyla Clair puts it. This area will have comfortable seating and a pool table, as requested by the youth. The space will also have a small private office designated for client/peer worker sessions. ACCESS OM workers will continue to meet youth where they are most comfortable, wherever that might be in the community, with the hope that someday all youth will consider this space their safe space.

The ACCESS OM Elsipogtog Youth Council will be working with local artists to create a mural that speaks to the culture of the community’s youth and their environment. We will also be designing a “Calming Corner,” which will consist of plush, soft furniture and drapery to allow youth to slip into when they are feeling overstimulated or are experiencing anxiety. This space is based on a treatment program, the “60-second fix,” created by Dr. Reggie Melrose; the team has ben employing this approach with many of our youth. Once our extension is open, our Peer Support Workers will be working mainly evening shifts to ensure the space is always open and available to our youth. CHANGING THE STATUS QUO

The site team in Elsipogtog First Nation is implementing the ACCESS Open Minds framework in a unique and community-specific way. As ACCESS OM NB Research Assistant Lacey Clair puts it, "Being a part of this national project allows us to see that although each community is different, we all share the common goal of helping our youth towards a better future across Canada."

"The numbers may not all be in and calculated yet, but we can clearly see that the less formal, more flexible approach to mental health care is working in Elsipogtog! Distrust of mainstream systems runs high in our community, which stops people from accessing the services they need. ACCESS OM NB Elsipogtog gave these help-seekers a different option, and their trust in us allowed them to trust in the local services we recommend."

This transformation is something that Elsipogtog continues to contribute towrads in the pan-Canadian ACCESS OM research and evaluation project, helping to build a robust framework for supporting youth wellness in any context across Canada. FOR MORE INFORMATION: www.accessopenminds.ca

ACCESS Open Minds @Access Open Minds Elsipogtog First Nation NB Elsipogtog

250 Big Cove Road Elsipogtog First Nation, NB Like and follow our page, E4W 2S1 and feel free to inbox us Phone: 506-523-6412 Fax: 506-523-8382