BEING LEAST INTRUSIVEApril Struthers M.Ed, R.C.C. & Lindsay Neufeld, MSW RSW

An orientation to practice in responding to situations of abuse and neglect of vulnerable First Nation adults

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‘Our Elders have for so many years had people push into their lives. We as health professionals think we have authority to do that. We need to remember it is a privilege and honor to be involved in Elders’ lives – we need to give honor and dignity.’

‘You can be accepted by Elders so you can do your job – make yourself present and you will know when they accept you.’

Dorothy HutchinsonHome and Community Care Director

Peter Valentine reserveGrand Rapids, Manitoba

Introduction

Emerged from 5 years of collaboration on the issue of Abuse and Neglect of older adults, across multiple dimensions

Practice implications of BC Adult Guardianship legislation for FN individuals and communities

What does it mean to be “least intrusive” What is our role and responsibility in facilitating culturally safe

encounters and environments

The use of CRN model in developing collaborative response to abuse & neglect in FN communities

Lots of interest in the model and approach

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Introduction

The development of working partnerships between Health Authorities (designated agencies) and FN health organizations in responding to situations of abuse & neglect of older adults in FN communities.

Building mutual capacity to respond to situations of abuse and neglect in culturally relevant and safe ways

Identification of ‘promising approaches’ utilized across Canada by service providers working in the area of abuse and neglect of adults

Few tools identified used to specifically address abuse and neglect of vulnerable adults. No assessments reflecting aboriginal point of view

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Being Least Intrusive: the working paper

Desire to articulate the foundational concepts underpinning a different orientation to practice in responding to situations of abuse and neglect of vulnerable FN individuals.

Being least intrusive

Re-conceptualizing Vulnerability and Capability to reflect the social, cultural and historical context in which vulnerability, risk emerge

Cultural Safety: a critical outcome of encounters

Integrating Mainstream and Indigenous knowledge and practice theory to develop a more holistic epistemological approach

Collaborative, meaning centered approach

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Being Least Intrusive: the working paper

Informed by direct and comprehensive feedback, frontline experience, dialogue and collaboration with FN partners and colleagues.

KDC Health and HCC partnership in Campbell River

4 Provincial dialogues with 20 First Nations communities (PGT /BCACRNS /HA)

2 regional video conferences with ITHA / WHRN

Introducing Re:ACT & FN Re:ACT materials to First Nations communities & health authority staff (VIHA)

WEAAD events / BCACRN outreach

Participation/Dialogue at First Nation Health Forums (KDC)

Direct review of BLI paper by clinicians, FN colleagues

Issues raised at VIHA Aboriginal Health Council

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A coalescing of ideas, collaborative work, and intentional partnerships

BCACRN was commissioned by FNIH and PHAC to do a scan of national tools and promising approaches, specific to adult abuse and neglect.

The ideas behind “Being least Intrusive” and the findings of the ‘Promising Approaches” scan came together rather unexpectedly

the ‘Flowchart of Intervention’ blended the findings, feedback and approach of both projects

Public Guardian and Trustee of BC commissioned work to develop a provincial template for an interagency protocol between provincial health authority and First Nation communities specifically addressing the issue of adult abuse and neglect.

It is being piloted and adapted to an existing partnership between VIHA and KDC Health (North Vancouver Island)

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Flowchart of Intervention

Outcome of BCACRN project commissioned by FNIH and PHAC: Maps where different tools and promising approaches could be used within an over process / flow of response

Outcome of Being Least Intrusive: Illustrates a front line response process internal to FN reserve communities (non-designated agency)

Defines a coordinated and intentional process of response. Encourages collaboration within communities as well when

communities and ‘outside’ agencies partner to respond together. Identifies community strengths, gaps in resources, Builds Capacity to respond more effectively (case/community)

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Key Question

What is my role in facilitating a culturally safe encounter and experience?

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When Concern Arises re Possible Abuse(Action internal to FN Community)

Indicators- FN

ReACT

Monitor

Nurse

Concernarises

Family

Referto ...

Team Mtg ordo nothing, -

CRN

No

No

Deeper/wider

assessing

Less or noconcern

Monitor

Yes

OtherSocialWkr

Yes

No

Yes

Approach based on AFN Balance Wheel and'hybrid' working

Support Plan includes holistic elements,cultural practices and other healing

Outsider is consulted with, 'invited in', or inBC must visit because of investigatingreports (least intrusive)

Cultural safety is an outcome - outsider andothers are / are becoming, more culturallysafe.

Note: Assessments may not be cultureneutral or culturally appropriate

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When Concern Arises re Possible Abuse(Action internal to FN Community)

Indicators- FN

ReACT

Monitor

Nurse

Concernarises

Family

Referto ...

Team Mtg ordo nothing, -

CRN

No

No

Deeper/wider

assessing

Less or noconcern

Monitor

Yes

OtherSocialWkr

Yes

No

Yes

Approach based on AFN Balance Wheel and'hybrid' working

Support Plan includes holistic elements,cultural practices and other healing

Outsider is consulted with, 'invited in', or inBC must visit because of investigatingreports (least intrusive)

Cultural safety is an outcome - outsider andothers are / are becoming, more culturallysafe.

Note: Assessments may not be cultureneutral or culturally appropriate

Being Least Intrusive: the tool

Developed to assist front line service providers (primarily non-aboriginal) in orientating themselves to respond to situations of abuse and neglect of vulnerable FN adults in a way that :

Is Culturally Safe

Facilitates a more holistic understanding of health and wellness

Honors cultural and spiritual diversity

Creates Space for collaboration and partnership, and the development of deeper understanding

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Being Least Intrusive: the tool

Challenges clinicians to

engage in critical practice

understand vulnerability, abuse and neglect in the social, historical and cultural context within which it emerged and is experienced

be reflexive and develop critical self-awareness of social location and power

be thoughtful, intentional, respectful in their engagement with clients, families and communities

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Being Least Intrusive: Core Concepts

Most Effective, Least Intrusive BC Adult Guardianship Legislation

Cultural Safety Jessica Ball, UVIC

Vulnerability and Capability (re-conceptualized): Vanguard Project, BC A&N Collaborative

Aboriginal Understanding of Health: Assembly of First Nations : Social Determinants of Health

Meaning Centered Practice: Clark

Social Work Theory: Anti-Oppressive Practice

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Being Least Intrusive: the tool

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Being Least Intrusive: the questions16

Orientation to Self:When: prior to engagement

4.Who am I (personal and professional role, socio-economic status, cultural affiliations, worldview, etc)?

• What is/are my understanding, attitude, assumptions about the issue of abuse, neglect and self-neglect of vulnerable adults? and of vulnerable First Nation adults?

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Being Least Intrusive: the questions17

Orientation to Self:

3.Will any of my values or biases impede my role/responsibility in creating a safe environment or safe encounter for the client/family with whom I am working?

5.Who am I in relationship to the client/family/community with whom I am working? (How do they see me? understand my role? What is the power differential?)

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Being Least Intrusive: the questions18

Orientation to ContextCommunity and CultureWhen: before casework begins.

5.What are the resources within the community (eg. social & health care services, eldercare services)?

7.Are there specific protocols of engagement (eg. cultural traditions, values) with/within this community that I need to be aware of and incorporate?

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Being Least Intrusive: the questions19

Orientation to ContextCommunity and Culture

4. Who can I partner with in this community – who is the most appropriate person (has a knowledge of and connection to the client/family, is in a position of trust, can act as a cultural guide and can assist in developing a culturally safe and appropriate support and assistance plan)?

6. What is the history of engagement, collaboration that my organization (eg. community health agency) has had with this specific community regarding service delivery?

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Being Least Intrusive: the questions2 0

Orientation to ContextSpecific SituationWhen: prior to engaging with client/family/community

5. What are the objective details of this situation? (What are the facts, overarching or specific concerns reported, who is involved)?

7. Who reported the concerns of abuse & neglect (e.g. family, client, community member, service provider) and what is their connection to the situation?

9. Will my involvement with client/family/community be welcome?

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Being Least Intrusive: the questions2 1

Orientation to Context:Gathering InformationWhen: over the course of multiple interactions with client/those involved

5.How does the client experience his/her own Physical, Mental, Emotional and Spiritual Health?

• What are the words they use to describe their current state of well-being and functioning across these dimensions?

• How do they make sense of the current situation?• Do they have any specific concerns about any aspects of

their health and well-being?• How do the client’s perspective, experience and meanings

differ from those of their family, caregivers and service providers?

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Being Least Intrusive: the questions2 2

Orientation to Context:Assessment3.What are the specific factors in the following holistic dimensions that contribute to the client’s vulnerability or act to protect against or mitigate client’s risk? • Physical well-being (physical functioning, health issues, activity

level)• Mental well-being (cognitive functioning, education, mental health)• Emotional well-being (self-esteem, sense of control over forces

affecting one’s everyday life, livelihood and health)• Spiritual well-being (cultural identity, engagement, integration -

past/present)• Relationships (connection and belonging to family, extended

family, community, land, environment/creation)• Social Well-being (income, security of shelter and food, language,

access to support and resources)

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Being Least Intrusive: the questions2 3

Orientation to Context:Assessment

4.How will I distinguish between my understanding/definition of health, well-being and risk from those of the client/family/community/culture with whom I work?

6.How will I distinguish between my values regarding standards of care, family relationships, physical surroundings and those of the client/family/community/culture with whom I work?

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Being Least Intrusive: the questions2 4

Orientation to Reflection Process:

3.Was I least intrusive/most effective in my intervention (e.g. was the client’s autonomy respected, was the client’s self-determination and right to live at risk balanced against the need for support and assistance)?

5.Was my involvement experienced by the client as culturally safe (was client’s cultural identity, values and preferences taken into account in the service encounter; was the client engaged in the encounter; was the client involved in developing a respectful and appropriate support and assistance plan, did the client welcome my involvement, was I invited back for further engagement)?

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Being Least Intrusive: the questions2 5

Orientation to Reflection Process:

4.What did I learn about myself (were my values and assumptions about the situation, client, culture, etc challenged?)

6.What is the feedback I have received from client, family, community, colleagues about the process?

8.How could my practice improve?

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Thank You

An Invitation Feedback is welcomed - it will shape our final tool version –

being formed through action research; to be distributed nationally

Focus Groups Fill in evaluation and feedback form

One of 9 tools being developed by NICE through the Federal Elder Abuse Initiative

Please visit us at the NICE table or contact one of us

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Thank You

April Struthers Email: witworks@dccnet.com Tel: 604 885 0651

Lindsay Neufeld Email: lindsay.neufeld@viha.caTel: 250 850 2172

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Reports Available

Promising Approaches for Addressing / Preventing Abuse of Older Adults in First Nations Communities

Being Least Intrusive: An Orientation to Practice

www.bccrns.ca/projects/index.php