Expanding and Building our Partnerships to Improve Access Health Canada ~ Health Services Integration Fund (HSIF) Project Portrait of the Situation for English-speaking First Nations: Accessing Health and Social Services in English in the Province of Québec Final Research Report October 21, 2013 Portrait of the Situation for English-speaking First Nations: Accessing Health and Social Services in English in the Province of Québec Final Research Report By: Amy Chamberlin, M.A. Submitted to: Onkwata’karitáhtshera and Coalition of English-speaking First Nations Communities in Québec (CESFNCQ) October 21, 2013 Cover design: Doug Lahache, KSCS Communications Layout: Marie David, KSCS Communications CESFNCQ October 2013 HSIF Steering Committee Members 2 Back Row (left to right): Jimmy Peter Einish, Joyce Bonspiel-Nelson, David McLaren Missing: Monique Raymond Front Row (left to right): Robin Decontie, Donna Metallic, Rheena Diabo, Eleanor Pollock CESFNCQ October 2013 Contents 1. INTRODUCTION..................................................................................................................5 1.1 Foreword.............................................................................................................................5 1.2 Mandate and purpose of the research...................................................................................5 1.3 Health Canada: mitigating gaps in health............................................................................6 1.4 Scope and limitations..........................................................................................................6 1.5 Data collection ...................................................................................................................7 2. METHODOLOGY..................................................................................................................9 2.1 Goal and objectives ............................................................................................................ 9 2.2 Research approach.............................................................................................................. .9 2.3 Activities..............................................................................................................................9 2.4 Methods..............................................................................................................................10 3. BACKGROUND.....................................................................................................................11 3.1 Aboriginal health legislation and policy environment.......................................................... 11 3.2 Government responsibilities................................................................................................ 12 3.3 Québec’s Network .............................................................................................................. 13 3 3.4 Access Programs..................................................................................................................15 3.5 Québec’s Health Services and Social Services Act................................................................. 16 3.6 First Nations’ Rights............................................................................................................ 17 4. COMMUNITY PROFILES ....................................................................................................19 4.1 First Nations communities in Québec................................................................................19 4.2 Coalition communities .......................................................................................................19 5. FINDINGS..............................................................................................................................23 5.1 Overview.............................................................................................................................23 5.2 Exposing issues and challenges.............................................................................................23 5.3 Strategies and solutions .......................................................................................................34 6. CONCLUSION............................................................................................................... ....... 39 7. RECOMMENDATIONS........................................................................................................ 41 APPENDIXES.................................................................................................................. 43 4 CESFNCQ October 2013 CESFNCQ October CESFNCQ October 2013 1. INTRODUCTION 1.1 Foreword the health and well-being of Aboriginal population.[2] As such, access to, and making decisions about, health and social services is critical in order to begin addressing the many pressing health The project “Expanding and Building our Partnerships to and social concerns prevalent in First Nations communities. Improve Access” is a three-year project that started in 2012 with funding from Health Canada’s Health Services Integration Fund In working towards solutions to mitigate the ‘disproportionate (HSIF). The project is sponsored by Onkwata’karitáhtshera; an burden of illness’ carried by Aboriginal Peoples, the Coalition agency that oversees health and social services in Kahnawake (a of English-speaking First Nations of Québec oversaw a one-year Mohawk community on the south shore of Montréal). research project. The overarching objectives of the project were to: The goal of the project was to establish a coalition among English-speaking First Nations Communities in Québec i) Create a portrait of the specific issues and challenges (CESFNCQ) in order to expose and improve access to health facing First Nations when accessing health and and social services in federal and provincial systems. The social services in English; and Coalition is comprised of four nations – Naskapi, Mi’gmaq, Mohawk, and Algonquin, from eight First Nations communi- ii) Identify strategies that English-speaking First ties: Kawawachikamach, Gesgapegiag, Listuguj, Kanesatake, Nations communities have in place, or would Kahnawake Eagle Village First Nation / Kipawa, Kitigan Zibi, recommend, on how to improve access to those 5 and Timiskaming. The communities are located in different services. geographical areas (remote, rural and urban). While each First Nation community has its own distinct needs, In April of 2012, the English-speaking First Nations com- the Coalition enables First Nations to work together, and to munities began working together to address access issues. The come before the government with one strong voice.[3] The Coalition, made up of directors and key individuals from First research is part of an ongoing effort to improve English-speak- Nations health and social services organizations, identified ing First Nations access to health and social services from pro- that there is a lack of existing health, social and related services vincial and federal systems. Participants’ comments are included accessible for First Nations in the English language: as such, throughout the report to capture their perspectives—challenges, English-speaking First Nations do not have the same level of positive experiences, and proposed solutions —with respect to access to services as that of the mainstream Québec population. accessing health and social services. In Québec, English-speaking First Nations communities face many challenges when attempting to access services from the federal and provincial systems. There are obstacles because of language, and for First Nations there are access issues resulting 1.2 Mandate and purpose of the from historical and social injustices. Generally speaking, under- research lying issues such as poverty, coupled with the intergenerational effects of colonization and residential schools, continues to affect the health and wellness of Aboriginal peoples.[1] Further- The mandate for the research was to document a portrait more, numerous studies and reports have raised concerns about of the situation for English-speaking First Nations the health concerns facing Aboriginal People. For example, John people when accessing health and social services in Eng- O’Neil et al. assert that: “Aboriginal Peoples bear a dispropor- lish from federal and provincial systems. The Coalition tionate burden of illness in Canada”; the authors argue that oversaw the direction of the research, and Organizational community well-being is fundamentally linked with ‘self- governance’ in terms of both the administration of services and 2 O’Neil, John, et al. “Community Healing and Aboriginal Self-Government.” Aboriginal Self-Government in Canada. 2nd ed. Ed. John Hylton. Saskatoon: Purich, 1999: 139–142. Print. 1 Health Council of Canada. Empathy, dignity and respect: Creating cultural 3 Coalition of English-speaking First Nations Communities in Québec safety for Aboriginal people in urban health care. Toronto: Health Council of (CESFNCQ). “HSIF Project Launch.” Québec City, 28 Jan. 2013. Research Canada, 2012: 4. PDF file. Meeting. CESFNCQ October 2013 Development Services (ODS) provided management 1.4 Scope and limitations support for the project.[4] The purpose of the research was to expose and identify: In November of 2012, the Coalition engaged a research con- sultant to design and to conduct the research. The intent of the • Access issues and challenges facing English-speaking