five -year evaluation of the h’ulh-etun health society ... society 2010-2020 health plan final...

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Five -Year Evaluation of the H’ulh-etun Health Society 2010-2020 Health Plan

Final Report

“My people, My healing, My culture, My home.”

March 24, 2015 Gerotech Research Associates Principle: Dr. Elaine Gallagher

[email protected]

H’ulh-etun Health Society Evaluation

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Acknowledgements

I wish to thank the Executive Director, Board and Staff of the H’ulh-etun Health Society for their generous time and effort contributing to this report and the community members for sharing their stories and opinions. Wendy Montgomery, an Associate of Gerotech Research, contributed extensively to the data collection and writing of the report. I wish to also thank Thomas Hleck for suggesting the theme for this report – My People, My Healing, My Culture, My Home.


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Table of Contents

EXECUTIVE SUMMARY…………………………………………………………………………….…….5

1.0 Introduction……………………………………..…………………………………..………..…...7

1.1 Purpose of this Report……………………………………..…..……………………....…..7 1.2 The H’ulh-etun Health Society………………………………..………………….………..7 1.3 Vision, Mission, Philosophy and Organizational Chart ……………………..…………8 1.4 About the Community………………………………………………………………….…..10 1.5 Funding……………………………………………………………………………………..11

2.0 Five-Year Evaluation…………………….………….…………..…..…………….…..……...12

2.1 Methods Used ………………………………………………………….…..…….………12

2.2 The Participants in the Evaluation…………………………………………….…………13

3.0 Evaluation Findings…………………….………….…………..….………………….….…….15

3.1 Health of Community Members…………………………….………….……….…..…….15 3.2 Health Governance and Infrastructure Support……………………….……….………...18

3.3 Implementation of Targeted Programs …………………………..………..….…………18 3.3.1 Flexible Transfer Funds………………………………………………….……..…19 3.3.1.1 Community Programs – Children and Youth Program …………..19

3.3.1.2 Community Programs–Mental Health and Addictions Program...20 i. Mental Health Crisis Management……………………….…..…….20 ii Solvent Abuse Program………………………………………..……21 iii Brighter Futures………………………………………….……….…21 iv. Native Alcohol and Drug Abuse Program…………………….…22 3.3.1.3 Community Programs - Chronic Disease and Injury Prevetion..23 3.3.1.4 Health Protection-Communicable Disease Control Program.….24 3.3.1.5 Environmental Health and Research Program ….….…………..24

3.3.1.6 Primary Health Care Program…………………….……….…….…24 3.3.2 Set Funding ……………………………………………..………………………...26

3.3.2.1 Health Protection–Environmental Health and Research Program …………………………….………………….……………26

3.3.2.2 Primary Health Care Program Funding………………………......26

i. First Nations and Inuit Home And Community Care ….…..…...26 ii. Children’s Oral Health Initiative……………………….…….…....28 3.3.2.3 Non-Insured Health Benefits Program …………………….…….29 3.3 Achievement of 2010-2020 Goals and Objectives……………………….……………29 ` Goal 1: To Provide Holistic and Culturally Appropriate Care………….…..…..….....29 Goal 2: To provide integrated delivery of community, youth and family

health services and programming………………………………………….…...32 Goal 3: To improve access to specialized medical and other programs

and services…………………………………………………………………….….36 Goal 4: To provide education and information on public health concerns

prevention of injury, suicide and environmentally-related illness …………...37 Goal 5 : To increase capacity and skills of HHS employees……….…………….…...39


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Goal 6: To increase the number of community members that obtain the necessary skills and training to work in health and health-related

professions.…………………………………………………………..….…….….40

Goal 7: To enhance HHS governance, organizational and operational capacity…..41

4.0 Summary Of Strengths And Opportunities For Growth…………………..…………45

5.0 Discussion Of The Disengagement Of Penelakut……………………………………46

6.0 Strengths And Recommendations………………………………………………………...47

APPENDICES Appendix 1a: HHS Health Evaluation 2015: Staff Survey Appendix 1b: Community Member Information and Satisfaction Survey 2015 Appendix 1c: H’ulh-etun Health Society Board Discussion Questions Appendix 1d: HHS Partners Interview Guide and Recording Sheet Appendix 1e: List of Key Questions for Staff Focus Group Appendix 2: Summary of Amendments to HHS Transfer Agreement Appendix 3: Summary of HHS Programs by Site from Community-Based Reporting Template


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Executive Summary The purpose of this evaluation of the H’ulh-etun Health Society (HHS) was to assess the progress they have made since 2010 in accomplishing the goals outlined in the ten-year (2010 to 2020) H’ulh-etun Health Society Health Plan. The evaluation is a requirement of the Health Funding Consolidated Contribution Agreement (Flexible Transfer) with Health Canada and the First Nations Health Authority (FNHA). Methods used for the evaluation included an extensive document review, focus groups and an on-line questionnaire for staff members, a focus group with the Board of Directors, an interview with the Executive Director and six community partners, a survey for H’ulh-etun community members, personal interviews with 34 community members and open forums held at Halalt and Penelakut sites. The Society recruited a new Executive Director in August, 2014, and under her leadership a new Vision, Mission, Philosophy and Organizational Framework have been adopted. Role descriptions for team leaders and staff are being developed and the Society is undergoing a complete review of policies and procedures in keeping with their desire to achieve full accreditation. The staff and Board strongly supported the new directions and believe this will result in better health care for community members.

STRENGTHS OF H’ULH-ETUN HEALTH SOCIETY (HHS)

Comprehensive Programming: The Society has continued to provide and expand upon a solid base of programs and services encompassing the lifespan, in spite of a rapid turnover in leadership.

Moving Forward: The Vision, Mission, Philosophy, and Organizational structure provide a solid roadmap to move forward in carrying out the Society’s goals and objectives.

Meeting the Needs: Programs are adapted to meet the ongoing needs of the community.

Cultural Relevance: Many programs and services are adapted to the culture and traditions of the Nations being served.

Strong Leadership: The Executive Director has engaged Board and Staff members in strengthening the Society’s organizational foundation and programs.

Qualified and Satisfied Staffing: There is a high level of job satisfaction among staff and their training is geared towards addressing community needs.

Improving Quality and Safety: The Accreditation process is underway affording additional opportunities for enhancing quality and safety.

Effective Resource Management: Resources have been effectively allocated within funding guidelines to maximize community benefit.

RECOMMENDATIONS

Increase Wellness: Continue expansion of programs and services to address outstanding health concerns in the community such as mental or spiritual health imbalance, drugs and alcohol misuse, nutritional needs, diabetes, dental problems and elder care. More


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emphasis on prevention and health promotion should be incorporated as well as an increase in Home Care services.

Prevent Falls and Injury: Implement a falls-prevention program for Elders, identified as a client need that aligns with the goals of accreditation.

Integrate Cultural Traditions: Further integrate cultural traditions and food in HHS’s programs and services.

Improve Access to Programs and Services: Undertake a comprehensive study of transportation issues and solutions to address barriers to community wellness. Ie. Hire a patient travel driver.

Encourage Fitness: Improve opportunities for fitness among community members who are experiencing financial or health barriers, are employed during the day, are elderly or are in need of child-minding. Boot camp could be offered twice a week and programs for youth enhanced.

Enhance Employment Opportunities: Undertake initiatives to facilitate community members’ opportunities to seek employment in health-related fields.

Improve Communication and Conflict Resolution: Strategies are needed to improve relationships and develop conflict resolution skills among the Health Centres and between HHS and Chiefs and Councilors. Strategies are also needed to better engage community members and enhance their relationships with HHS staff.

Ensure Consistency and Integrity of Programs: Find a way to resolve the dramatic reduction in services reported by residents of Tussie Road. Examine further the inconsistencies in service delivery across the Health Centres.

Promote New Partnerships: Explore new partnership opportunities with other First Nations. Develop clear guidelines for engagement and disengagement.

Provide Emergency Contact: Explore feasibility of an after-hours contact person to respond to critical needs of community members during evenings, nights and on weekends.

Dental Program: Negotiate with FNHA to provide funding to renovate and purchase another chair that should include a full dental program five days per week. For example, hire a dental therapist three days per week, a dentist one day per week and a dental hygienist one day per week – to fully utilize the up-to-date dental office that is currently sitting empty most of the week.

Impact of Catalyst Paper Mill: Undertake a study of the impact of effluent emissions on the health of Halalt First Nations people.


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1.0 INTRODUCTION 1.1 PURPOSE OF THIS REPORT

The primary purpose of this evaluation is to assess the progress that H’ulh-etun Health Society (HHS) has made since 2010 in accomplishing the goals outlined in their ten-year (2010 to 2020) H’ulh-etun Health Society Health Plan. The evaluation is a requirement of the Health Funding Consolidated Contribution Agreement (Flexible Transfer) with Health Canada and the First Nations Health Authority (FNHA). The evaluation was also designed to provide the Society with information useful as a planning tool in identifying opportunities for growth as they move forward. The theme for the report – “My people, My healing, My culture, My home” – was inspired by a wish expressed by a former Executive Director. When asked what he hoped the evaluation would accomplish, he said he hoped it would promote the feeling of the community and the staff that HHS is a place that uniquely served their people, helped with their healing, related to their culture and where they felt at home. Hopefully the findings of this report will contribute to this goal.

1.2 THE H’ULH-ETUN HEALTH SOCIETY Opened in 1994, the H’ulh-etun Health Society assumed responsibility for their transfer negotiations in 1995. The initial agreement included Chemainus, Penelakut and Lyackson. Halalt and Malahat joined subsequently and in October 2001, a revised community health plan was prepared to include all five communities. In March 2008 Chemainus First Nation separated from HHS and assumed control of their health transfer funding. The current member Nations of the H’ulh-etun Health Society include Lyackson, Malahat, and Halalt. Penelakut was a member until October, 2014 when they disengaged and is therefore included in this review period. We have tried to include their programs and services throughout the report but as many new services have been recently introduced by HHS and Penelakut is operating with no transfer funds yet and a reduction in staffing, this was somewhat difficult. The head office of HHS is located in the Halalt traditional territory with an additional health unit in Malahat and one in Penelakut.

H’ulh-etun is currently governed by a Board of Directors whose members are appointed by the Chief and Council of each member community. The board meets once a month to provide strategic direction to the Executive Director. Until they disengaged, Penelakut also had a representative serving on the Board. The 2015 H'ulh-etun Board comprises three directors. Current Board members are Chief James Thomas (Halalt), Jennifer Jones (Lyackson) and Russel Harry (Malahat). Previous Board members during the evaluation period included Tyler George (Halalt), Rebecca Jerman (Penelakut), Chief Randy Daniels (Malahat), Chief Earl Jack (Penelakut) and Ken Thomas (Penelakut). The Executive Director (ED) is appointed by the Board of Directors and reports directly to them. The ED is responsible for overseeing the day-to-day operations and management of the HHS, meeting regularly with the Board and ensuring community involvement in the planning and


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development of health programs and services. Under the direction of the Board, the ED is responsible for ensuring that the HHS and staff have the necessary resources to carry out the health plan and oversees its implementation. The ED is also involved in applications for funding and managing special HHS projects. A total of eight people have filled the ED position in less than six years, often serving only a few months. They were:

Cynthia Rayner - January 2007- February 2010

Brenda Potter (interim) – February 2010 – May 2010

Karen Flannery – May 2010 – August – 2010

Tyler George (interim) – August 2010 – April 2011

Hal Schmidt – April 2011 – November 2011

Mary Knowles – December 2011 – December – 2013

Thomas Hleck (interim) - December 2013 – August 2014

Edith-Loring-Kuhanga – August, 2014 - present Hired in August, 2014, the current ED - Edith Loring-Kuhanga, Nox Gyes - is from the Wolf Clan of the Gitxsan Nation, BC. In August 2007, she was given the head Matriarch’s name within her house, Nox Gyes, recognizing the role that she carries in her family and across Canada. She has a Bachelor of Education Degree and a Masters in Education Leadership. For the past 30 years, she has worked extensively in the education and health fields. Since joining the Society Edith has overseen a large number of initiatives. She has worked collegially with staff and the Board to develop a new mission, vision and organizational framework. She assisted and advised the Board on the disengagement process, worked with the lawyer on the final disengagement agreement, updated the Board’s By-Laws, Governance Policies and consulted with Elders on the proper spelling of the Society’s name. She is in the process of developing or updating all HHS policy manuals and guidelines. This work is partially related to the Society’s desire to achieve full accreditation status with Accreditation Canada. It also reflects a substantial need to address the unfinished business that accumulated due to the high turnover of ED’s over the past seven years.

1.3 Vision, Mission, Philosophy and Organizational Chart1

The Vision of HHS is: H’ulh-etun Health Society’s Vision for our member Nations is Nuts’umaut Shqwaluwun (working together as one from the heart) to maintain autonomy over our health programs and services for present and future generations. The Mission is: Our Mission is to provide holistic health services by weaving traditional and modern health practices to empower and support healthy lifestyles.

The Philosophy/Values/Snuw’uyulh is: We believe:

1 The new Vision, Mission, Philosophy and Org Chart were approved by the Board of Directors in March,

2015. They were jointly created by the Board, Staff and ED.


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That everyone at H’ulh-etun Health Society (the Board of Directors, employees, volunteers and contractors) has a responsibility to quality care and client safety

In blending the traditional Coast Salish teachings and medicines with modern health principles and practices

That our language and culture are the core foundation for healing and wellness in our communities

That our Elders are our connection to our past and our connection to our future

That our programs and services must reflect the needs of our community members and cultural practices

In promoting and supporting the emotional, physical, mental and cultural/spiritual well-being of our community members

That all of our community members must be treated with respect, dignity and honesty

That our community members must be provided with all pertinent information in order to make informed decisions about their health care and well-being

That we have a responsibility to maintain client records and respect confidentiality

That our staff are our most important resource and should be valued, respected and supported in a safe, healthy work environment

That it is important to gather data, and conduct research and evaluation in order to keep up to date on current best practices in health and wellness

That laughter is a form of good medicine

That the Board of Directors and employees strive to have healthy bodies, minds and spirits in order to be good role models for our communities

That all employees must be qualified and have a responsibility to continuously update their qualifications

That establishing and maintaining teams within the organization can increase communication to better serve our community members

That we must build and maintain cooperative and respectful relationships with member nations and other Aboriginal organizations so that we can effectively address the broader social determinants of health for our community members

That the accreditation process and designation will help us maintain a high standard of quality care and client safety for our community members.

Organizational Structure: The 2015 organizational chart reflects HHS’s new vision of streaming the Health Centre activities under four teams with a Team Leader assigned to each team. This replaces an older model that showed all programs reporting directly to the ED. The team leaders report to and are supported by the Executive Director. HHS is accountable to the three Nations that they serve. The organizational chart is based on the medicine wheel with four components - four teams - and is holistic.


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H’ULH-ETUN HEALTH SOCIETY ORGANIZATIONAL CHART

1.4 ABOUT THE COMMUNITY The four HHS Nations are members of the Coast Salish People. In 2013 they numbered about 56,590 with 28,406 registered to Coast Salish bands in BC and 28,284 registered to Coast Salish Tribes in Washington State. It is believed that this grouping of nations is unique in having a patrilineal, not matrilineal culture. They consist of numerous nations with many different cultures and languages. Harvesting, preserving and consuming seafood – particularly salmon - was traditionally a cornerstone of the cultural, economic, social and nutritional fabric of many of these


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Nations. Sadly, due to contamination of local waterways, these activities have been significantly curtailed. Population statistics for the four HHS partners indicate an overall 1% decrease in the total population since 2009 with an 11% increase in the number of members living off reserve. The number of members living on reserve declined 11% over the five-year period. Lack of housing, employment, services and transportation were cited as reasons for the decline on reserves.

Community Registered On

Reserve 20141 2009 Total2

Registered Off Reserve 2014

Total 2009

Total Registered Members 2014

Total Registered Members 2009

Male Female Male Female

Lyackson 10 6 41 76 94 157 186 198

Malahat 72 52 151 76 70 111 270 262

Halalt 48 40 107 51 53 105 192 212

Penelakut 266 252 542 174 173 316 865 858

746 838 767 689 1513 1530

1. fnp-ppn.aandc.gc.ca (December, 2014) 2. 2010 Transfer Agreement

HHS also serves a number of people who are either not registered as having status and live on the reserves or are living on the reserves but registered to other Nations. Members from neighbouring reserves also take advantage of services such as dentistry and fitness programs. The Board of Directors Chair suggested these could account for up to 30% of the total clientele using the HHS services.

This means that a large number of people are receiving services but aren’t included in the population totals above and for whom HHS does not receive funding. According to the ED “It is difficult to turn them away when they live on our reserves and we are the closest health services to them.” This funding disparity should be addressed by FNHA.

1.5 FUNDING

Funding is primarily derived from the Health Services Transfer administered through the First Nations Health Authority (FNHA). The 2010-2020 agreement provided for $13,175,297 to be distributed in incremental installments. Amendments to the total budget were made in each year. These are detailed in Appendix 2.

Total 2010 FNHA Transfer Funds and Amendments as of 2014

2010-11 2011-12 2012-13 2013-14 2014-15 TOTAL FOR

CONTRACT

2010 Health Services Transfer

$1,561,232

$1,332,034

$1,332,034

$1,278,571

$1,278,571

$13,175,297

Last Amended


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Jul 1, 2014 $1,689,807 $1,781,526 $1,868,750 $1,911,408 $2,016,966 $17,411,427

Additional special purpose funds and contactors have been secured but as they are not part of the FNHA Transfer they are only briefly mentioned in this report.

2.0 FIVE-YEAR EVALUATION The primary purpose of this evaluation was to assess the progress that H’ulh-etun Health Society (HHS) has made since 2010 in accomplishing the goals outlined in their ten-year (2010 to 2020) H’ulh-etun Health Society Health Plan. The evaluation is a both a requirement of the Health Funding Consolidated Contribution Agreement (Flexible Transfer) with the First Nations Health Authority (FNHA) and an opportunity to identify emerging issues and needs useful for future panning.

Specific objectives of the evaluation were outlined by HHS as:

1) Assess the implementation and effectiveness of the health programs and services in the Contribution Agreement

2) Assess the extent to which HHS implemented its 2010-2020 Community Health Plan as intended

3) Determine if expected outcomes are being achieved

4) Identify unanticipated outcomes

5) Identify areas requiring additional funding or possibly new business models to meet health services needs of our Member Nations

6) Review alignment of governance structure, strategic health priorities, program objectives and administrative/operational capacity to support delivery of safe, high quality health services

7) Review effectiveness of HHS internal communication strategies with the Board, administration and its three sites

8) Create a final written report (hard copy and electronic version) with recommendations to update how the HHS can move forward to meet its strategic health priorities by 2020.

2.1 METHODS USED

The evaluation took place between January 19 and March 31, 2015. Methods included a review of the original transfer agreement and amendments, Board and staff meeting minutes, three available annual reports (missing 2011-12 and 2014-15), audit reports, Community-based Reporting Templates, newsletters and other related documents. We also reviewed evaluation reports from 2002 and 2009 and used the results for comparisons with this evaluation where possible in the evaluation process.

In order to examine impacts and outcomes of the Society a mixed methods approach was used that included both qualitative and quantitative methods. Qualitative methods included personal interviews, focus groups and community discussion forums. Ethical principles were applied. Each informant was advised of their right to refuse, the purpose of the evaluation and that the information they provided would be reported anonymously. Quantitative methods employed on-line/print surveys. The survey questionnaires and focus group guides are attached as Appendices 1a through 1e.


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We analyzed all quantitative and qualitative data and examined it according to the seven goals outlined in the 2010-2020 Plan. The seven goals are: 1. Provide more holistic and culturally appropriate health services and programming 2. Provide integrated delivery of community, youth and family health services and programming 3. Improve access to specialized medical and other health and well-being programs and services

offered through all HHS Health Centres. 4. Provide education and information on public health concerns, prevention of injury, suicide and

environmental-related illness 5. Ensure all employees and contractors have the skills and capacity to perform assigned duties 6. Encourage individual members to obtain the necessary skills and training to work in health and

health-related professions 7. Enhance the overall governance of the H’ulh-etun Health Society.

2.2 PARTICIPANTS IN THE EVALUATION

Staff members from all four nations participated in two ways. Eighteen members completed an on-line or print survey. Five reported being from the Cowichan nation, three from other nations and 10 responded “other” or did not complete the question. Eight were between 26 and 45 years of age and seven were between 45 and 65 years old. Their length of employment ranged between a few months and ten years with an average of 3.4 years. Of these, ten were employed full-time and three were working part-time. Five people did not complete this section due to a clerical error in printing the forms.

We also held two focus groups with staff at the Halalt Health Centre with a total of 12 participants, one with four Malahat staff members and one with six Penelakut staff in attendance. We conducted a focus group with the three members of the Board and an interview with the Executive Director. Six external professional people who have engaged with HHS participated in individual interviews. They included a physician, an Aboriginal liaison nurse, a band administrator, a dentist and two child protection workers.

Community members had three opportunities to contribute to this evaluation. We conducted an on-line/print survey that was completed by 93 community members. Their characteristics are presented in the table below. They should be considered a convenience sample as they were not chosen at random and so do not necessarily reflect the views of the whole community.

Community Survey Informants

Characteristic Number Percent

Nation : Halalt 27 29%

Malahat 12 13%

Lyackson 5 5%

Penelakut 15 16%

Other 15 16%

Gender: Female 56 60%

Male 36 40%

On/off Reserve: On Reserve 73 79%


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Off Reserve 12 13%

On other reserve 7 8%

Age Range: 13-18 Years 7 7.4%

18-25 Years 7 7.4%

26-45 Years 36 36.2%

46-65 Years 39 39.4$

66 and Up 10 9.6%

Marital Status: Married 53 59%

Separated/Div. 10 11%

Single 23 26%

Widowed 4 4%

Employment: Work full-time 22 25%

Work part-time 19 22%

On disability 14 16%

Seeking employment 12 14%

Retired/on pension 8 9%

Income: Under $500 14 17.5%

$500-1000 22 27.5%

$1000-1500 19 23.8%

$1500-2000 11 13.8%

$2000-2500 4 5.0%

Over $2500 10 12.5%

We also carried out in-depth interviews with 34 community members. Contacts were identified by self-referral, staff referral and referrals by family and friends. A gift card was given to each participant to thank them. Of these, seven were from the Malahat Nation, six from Lyackson, seven from Halalt, and 14 from Penelakut. The interviews lasted from 30 minutes to two hours and took place in homes, coffee shops and the Health Centres. Each participant was thanked with a grocery gift card. Methods also included a community dinner and discussion forum with about 150 members attending at Halalt and 50 at Penelakut. A feast was graciously provided at both events along with door prizes for those in attendance. Cultural speakers and Elders guided the event. Crafts were provided for the children in attendance. The photo below displays the creative art the children produced at Halalt. A complete door-to-door survey of all community members was not feasible in the time frame and budget provided for this evaluation. Community member input was promoted by sending out the survey to each member with their HHS newsletter, posting the link to the on-line survey on the HHS web site, placing copies of the survey on the reception desk at the Halalt and Malahat health offices along with a small poster and distributing survey forms to everyone who attended the community dinner for those who had not yet completed the form. Penelakut members are underrepresented as they asked that the forms only be provided at the dinner and only 25 of their members completed the survey at that time. Thus overall, the community survey findings cannot


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be generalized to the whole population. However the use of multiple informant groups provided an opportunity to combine their information to enhance the validity of the findings.

3.0 EVALUATION FINDINGS

3.1 HEALTH OF COMMUNITY MEMBERS The community survey instructed people to rate their current health status. The graph below compares their responses with those reported in the 2002 Evaluation. The combined percentage reporting excellent or good health status has increased. How would you rate your overall health?

Staff members and community members were asked to identify the most important health concerns in the community. The community named addictions and mental health more frequently.

Health Concern Frequency named by Staff Frequency named by Community

Diabetes/arthritis/chronic disease 15 15

Mental health/spiritual/addictions 12 46

Nutrition/fitness/obesity 7 15

Child and youth health 2 2

Dental needs 2 7

0%

20%

40%

60%

1994 2000 2002 2015

Excellent Good Fair Poor

Children’s art at the

Halalt community

dinner


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Needs of Elders 2 7

Forty-two percent (39) of community members reported having chronic or long-term health problems. When asked if their health had changed over the past five years, 20% (18) of community members reported it was better, 60% (55) reported it was the same and 18% (16) claimed it was worse. Thirty-nine percent (32) of members reported that they had experienced addiction issues such as gambling, drugs or alcohol. Nearly 67% (54) community members reported that they had experienced mental or spiritual health imbalances.

Community Responses

Are you or have you experienced mental or spiritual health imbalances (e.g., depression, grief

and loss, giving/receiving abuse, anxiety, Residential School effects, etc.)

Response Chart Percentage Count

Yes 66.7% 54 No 33.3% 27

Total Responses 81

People were asked what barriers would prevent them from seeking help for addictions or mental health issues. In the one-on-on one interviews, the most common reasons people gave were were worries about confidentiality, discomfort asking for help, wanting to handle things on their own and uncertainty about what programs and services are available. “When the people at the Health Centre are your family or neighbours, its hard to call for appointments or go there for counselling and feel your confidentiality is being respected. I’d rather try and work it out on my own”

Community Responses

If you wanted to reach out for addictions or Mental Health services, what barriers might prevent you from seeking support?


Uncomfortable asking for help 34.6% 27 Worried about confidentiality 44.9% 35 Without transportation or child minding 11.5% 9 Not sure the HHS programs/services are right for me

19.2% 15

Not sure what programs are available 25.6% 20 Trying to handle it on my own first 28.2% 22 Other. Please describe: 12.8% 10 Total Responses 78

We asked community members if they use tobacco. The percentage who reported that they did, either frequently or sometimes, is shown below. When compared with figures reported in the 2002 Evaluation Report, there was a significant decline, particularly among youth.

Do you use tobacco?

1994 2002 2015

All Community Members 50% 56% 38%


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Youth (15-24) 42% 65% 21%

The survey instructed people to rate their level of physical activity. Nineteen percent (17) said they work out three or more times a week, 26% (23) said once per week, 10% (9) said occasionally and 49% (40) said not at all. The table below compares these results with those reported in the 2002 evaluation. The figures suggest that fitness levels may have declined since 2002. This does suggest that more attention needs to be paid to addressing the barriers that members of all ages encounter in becoming physically active. These are discussed more fully below. How often do you exercise?

The survey asked what barriers people have that keep them from becoming more physically active. They responded: cost (18), time (15), transportation (11) and health issues (8). Nearly all of the 34 members interviewed spoke of transportation as a barrier to accessing health programs and services and most said they would definitely attend more if transportation was provided. One community member also reported that there were times that the Society’s transportation to programs would not show up. “A few times in the winter, we would be waiting around in the cold for the ride and no one showed up.” Residents of Malahat indicated that activity programs for their youth and for Elders were minimal and that their young people need strong role models as youth leaders. People suggested ways of overcoming these barriers including: further subsidize costs and provide child-minding and reliable transportation. With well-equipped gymnasiums at Halalt and at the school in Penelakut, more on-reserve physical activities could be planned. Low-cost activities such as walking groups could also be implemented, perhaps in the gym when not in use by sports groups or other events. They also suggested more evening programs for those who are working during the day. As previously shown, many of the community members are living in poverty conditions. This is a major factor when considering not only recreation but also access to transportation, medicines, clothing, and other basic necessities.

0%

20%

40%

60%

1994 2000 2002 2015

3 or more times per week At least once per week

Occassionally or seasonally Don't exercise


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An independent summary of impacts from the Catalyst Paper Mill, located on the Halalt First Nation Territory, was published in 2012.2 The report concluded that the mill seriously contaminated the waters of the Chemainus estuary and Stuart Channel causing cultural, intellectual and lasting health impacts. However, no comprehensive research has been done to document the health outcomes that may be associated with consumption of contaminated seafood and breathing of polluted air. We strongly recommend that such a study be undertaken. According to the ED there are higher than expected rates of cancer in this area, which may or may not be related to this issue. Individual and focus group participants commented on other improvements observed in community members’ health status. Dental clinicians have seen major improvements in dental hygiene and dental repair work. The physician has observed a major reduction in alcohol and drug use among pregnant girls and women, thus reducing the risk of Fetal Alcohol Syndrome in newborns. Individual members spoke of having undergone major healing and life changes through their engagement with the HHS counselors.

Combined with the aforementioned reductions in smoking and increased self-rated health, the health status of the community appears to have undergone some significant improvements. The low levels of fitness and high incidence of emotional difficulties do still need to be addressed.

3.2 HEALTH GOVERNANCE AND INFRASTRUCTURE SUPPORT

Funding for health governance and infrastructure support was allocated by FNHA for the first 5 years as shown below. The figures reported here and in the remainder of the report are based on the latest amended transfer budget dated July 1, 2014.

2010-11 2011-12 2012-13 2013-14 2014-15 TOTAL Of TRANSFER

Health Planning and Management

$569,034 $603,723 $618,816 $644,334 $679,997 $3,115,904

Accreditation NA NA $51,084 $47,902 $47,902 $146,888

Capital Facilities/Operations and Maintenance

$123,886

$132,753

&130,793

$134,063

$141,537

$663,032

This pocket of transfer funds was used to support the administration and planning costs of the Society. In addition to ongoing maintenance costs, in 2015, the funds were also used to offer Levels 1, 2 and 3 of the Building Service Worker training program. The funds also support costs of becoming accredited. In the fall of 2013, H’ulh-etun Health Society received an Accreditation Primer Award from Accreditation Canada. An Accreditation Team Leaders Committee has been formed. The staff is working on Emergency Preparedness and they are setting up an Occupational Health and Safety Committee. HHS is also setting up an Elders’ Advisory Circle and is developing Cultural Protocols. They are working on an Ethical Framework, HR policy and procedures manual, and financial, administration and operational policies.

2 Independent Summary of the Impacts from Selected Effluent Emissions from the Catalyst Paper Mill,

Crofton, B.C. on Halalt First Nation’s Community Members and their Natural Resources. Volume 1:Final

Report, April 2012.


19

3.3 IMPLEMENTATION OF TARGETED PROGRAMS

Programs have been added and discontinued over the five-year period covered by this evaluation and some programs are offered at different sites with different names. One summary of the programs and services offered at each Health Centre is provided in Appendix 3, from information compiled from the Community-based Reporting Templates (CBRT) submitted to the First Nations Health Authority. No reports were available for 2010-2011 and several Nations’ reports were missing for the ensuing years.

Overall, community members expressed support for the programs and services offered by HHS over the past year. The following graph shows that the majority reported that they were satisfied or somewhat satisfied with HHS’s services. How satisfied are you with the services provided by HHS?

In the following, we have attempted to cluster the programs according to the categories outlined in the amended transfer agreement. Many services, such as nursing and Good Food Boxes, overlap several program funding clusters. Budget figures do not reflect the transfer out of the Penelakut portion of funds nor the changes in their staff and programs following their disengagement in October, 2014. Funds from the transfer agreement are labeled “Flexible” or “Set“. Set funds must be used for the program category assigned while flexible funds may be transferred to other programs if necessary. Flexible funds can be used to augment the programs under Set funds. The aforementioned Health Governance and Infrastructure Support funds were included in the “flexible funds” category. In addition to the programs included here, a review of HHS newsletters found numerous informative and educational articles on a wide range of health-related topics including diabetes, influenza, safety, nutrition HIV and smoking. Many issues included healthy recipes as well. Approximately 60-70% of those interviewed said they read and appreciate the newsletter. HHS


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also provided a number of talks and workshops on health-related topics, particularly during their Wellness Days (women’s, men’s and family Wellness Days), which are very popular events.

3.3.1 FLEXIBLE TRANSFER FUNDS

3.3.1.1 Community Programs – Children And Youth Program Cluster

2010-11 2011-12 2012-13 2013-14 2014-15 TOTAL Of

TRANSFER

Canada Pre-natal Nutrition Program

$25,643 $26,412 $27,072 $27,072 $29,296 $135,495

Good Food Box A box of nutritious food is provided once a month for those with chronic diseases, diabetics, pregnant mothers, new moms and Elders. Currently they deliver to 16 Halalt members,19 Malahat members and 5 Lyackson members. Penelakut Health Unit also has a Good Food Box program delivering approximately 50 boxes per month. The Food Box program is also funded in part through funds from Canada’s Prenatal Nutrition Program (CPNP) and through ADI. This program also offered prenatal, nutritional and parenting education and support. Parent and Tot programs are offered as well.

3.3.1.2 Community Programs – Mental Health and Addictions Program

i. Mental Health Crisis Management 2010-11 2011-12 2012-13 2013-14 2014-15 TOTAL Of

TRANSFER

Mental Health Crises Management

$38,739 $39,901 $40,899 $41,921 $44,258 $205,718

Registered Clinical Counsellor A Registered Clinical Counsellor is available at the Halalt Health Unit Mondays and Wednesdays from 8:30 a.m. to 4:30 p.m. each week. She is at the Malahat Health Unit Tuesdays from 1:00 – 4:30 p.m. Prior to the withdrawal of Penelakut she was available there one day a week. She offers counselling for individuals, couples and families who have experienced:

Childhood or adult physical or sexualized abuse

Abuse or assaults in residential schools

Harassment and stalking

Trauma related to events such as fires, motor vehicle accidents, or other incidents

Grief related to death, dying or other issues

Illness and disabilities

Suicidal thoughts or attempts and self-harming

Harmful use of alcohol or drugs

Relationship issues, separation and divorce

Issues with child protection services


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Work-related stress. In addition the counsellor supports those going through residential school settlement, provides referrals to residential services, counsels perpetrators of violence or abuse and gives workshops and presentations to staff and the community. Penelakut offered counselling services each day of the week. Counselors average 25-50 clients per week. In 2013-2014 HHS developed a suicide prevention protocol to ensure safety and well being of children and youth. Staff training was provided. This was triggered by a suicide in Penelakut that year. At present, the Health Coordinator is continuing to provide mental health services in addition to his administrative duties. He explained that the counselling needs are very great there and while he was nearing exhaustion, he could not refuse people his services. They are in the process of recruiting a new counsellor. They do continue to provide residential school counseling through the Indian Residential School Program. Penelakut reported in their CBRT that in in all five years of this report, until their disengagement, they offered Counselling, Suicide Prevention and Intervention, Substance Abuse and Addictions Counseling and Crises Intervention. (See Appendix 2.)

ii. Solvent Abuse Program 2010-11 2011-12 2012-13 2013-14 2014-15 TOTAL Of

TRANSFER

Solvent Abuse Program

$14,756 $15,199 $15,579 $15,968 $16,858 $78,378

These funds are combined with Mental Health Crisis Management funds to pay for Mental Health Clinicians.

iii Brighter Futures


Brighter Futures Program

$142,264 $146,532 $150,195 $153,950 $162,533 $755,474

Child and Youth Counsellor As of November 24, 2015, a Counsellor provides mental health addictions and trauma services for children and youth. She specializes in art therapy for children and incorporates tradition and culture into her programing. She is available Tuesdays and Fridays from 9:00 a.m. to 3:00 p.m. at the Malahat Centre and on Mondays, Wednesdays and Thursdays at the Halalt Centre from 8:30 a.m. to 4:20 p.m. Growing Together This program, started in November, 2014, is responsible for providing quality, educational and cultural programs for children and youth. The after school program supports the health, physical


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educational and social development of children and youth. It provides a supportive environment that allows children and youth to gain experience, develop skills and take on new challenges. Nobody’s Perfect Nobody’s Perfect is a parenting program for single parents. Information and support are provided to them to assist with their challenging role. A Triple P Parenting program was also offered in 2013. Youth Recreation Program A range of recreational, sports, educational and cultural programs are offered for youth between ages of 12 to 19 years of age. Activities include arts and crafts, recreation, sports, music and dancing, adventure programs and camping. After school programs are offered for youth with mentoring and tutoring services offered. Computers have been put in place for student use. This current program commenced on November 18, 2015. Further examples include a fitness program called 24/7 offered in 2012-2013 from 3:00 to 6:00 p.m. at Chemainus Secondary School. Between 15-45 participants attended, with family members often joining the youth for activities. Seven youth received youth coach training along with five adults. In 2011-2012 and 2012-2013 Lyackson held a Youth Summer Camp for 3 days and 2 nights on Valdez Island. The youth learned about language, traditional plants, fishing and other survival and cultural topics. In 2013-14, the H’ulh-etun Health Society, in partnership with Kwumet Lelum Child and Family Service, hosted a 6-week lacrosse camp. Canoe Journey – Life Journey In 2012-13 a program was established as a year-round opportunity to discuss and strengthen life skills using the canoe journey as a metaphor for the journey through life. HHS intends to offer this program again in 2015, with the inclusion of building a canoe. Malahat participated in the Tribal Journeys two years ago. Breakfast Program As of November 2014, a nutritious breakfast, including a hot item, is served for school children daily Monday through Friday at the Halalt and Malahat Health Units. Attendance varies from a couple of children to nearly 20. The Halalt chef consulted with a nutritionist prior to the program in order to ensure nutritionally-balanced menu planning. As well as breakfast, children are provided a snack for after school and breakfast and snacks are also provided for the daycare in Halalt.

iv. National Native Alcohol and Drug Abuse Program 2010-11 2011-12 2012-13 2013-14 2014-15 TOTAL Of

TRANSFER

Native Alcohol and Drug Abuse Program

$134,824 $134,824 $146,144 $146,144 $154,292 $716,228

Community Wellness Worker A full-time counselling and referral service for community members with alcohol and/or drug issues began October 6, 2014. Prior to that time it was a contract position, also serving Penelakut


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and offering a Men’s Group there as well. Services for HHS are now offered Mondays, Tuesdays and Wednesdays at the Halalt Health Unit from 8:30 a.m. to 4:30 p.m. and Thursdays and Fridays at the Malahat Health Unit from 10:00 a.m. – 3:30 p.m. Services include:

Counselling for community members requesting services

Counselling for people referred by MCFD and probation to address their use of violence and abuse

Responding to referrals from other service providers and making referrals as appropriate

Making referrals to residential treatment centers

Participating in training activities National Addictions Awareness Week (NAAW) The Penelakut Health Centre hosted NAAW festivities in 2013-14. A meal, prayers and teachings event was held with a candlelight vigil for those they had lost to addictions. They created an impressive coloured booklet to celebrate participants’ artwork and writings. In November 2014, a wide range of activities was offered for the entire National Addictions Awareness Week in Halalt and Malahat. They kicked off National Addiction Awareness Week( NAAW) with a staff breakfast to explain a bit about NAAW and how it ties into what they are doing at HHS. They also had an Elders lunch, art therapy session with Karen George, and a sobriety walk in both Halalt and Malahat communities where drummers sang songs as they walked in the communities. Also, they had a community dinner and heard stories from community members who shared with the audience about their struggles with addictions, a youth dance group performed and a candle light vigil was held to remember and honour the members who have left us.

3.3.1.3 Community Programs - Chronic Disease and Injury Prevention


Aboriginal Diabetes Initiative

$31,000 $31,000 $31,000 $31,000 $32,728 $156,728

An Aboriginal Diabetes Initiative Program was offered in 2010-11. Teaching topics included foot care, exercise and diet, nutrition, label reading and Diabetic bingo. Teleopthamology clinics were held at Halalt and Penelakut. Chronic Lunch A lunch program for people with chronic health issues is served once a month at the Malahat Health Unit. Elders Lunch A healthy lunch for Elders is provided twice a month at the Halalt and Malahat Health Units. They offer hair cutting, foot care and workshops on health-related topics of interest to the Elders. A similar lunch was offered at Penelakut and continues today but without speakers in attendance. In January 2015, Meals on Wheels were sent home for the Elders in Halalt who have mobility issues in getting to the luncheon.


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Good Food Box The Good Food Boxes are given to those with chronic diseases. A portion of their cost is from this funding pocket. Food for the Soul A nutritious lunch is served each Wednesday for the community at the Halalt Health Unit and was introduced in Malahat in January, 2014. Nurses attend and offer discussion on topics such as mold in the home, Traditional medicines, Diabetes, whooping cough, hand washing and many other health-related topics. Food Skills for Aboriginal Families This was a hands-on program that made eating, shopping and cooking both healthy and fun. This was a six-session program supported by the Canadian Diabetes Association.

3.3.1.4 Health Protection-Communicable Disease Control Program 2010-11 2011-12 2012-13 2013-14 2014-15 TOTAL Of

TRANSFER

HIV/AIDS Strategy $1,859 $1,859 $1,859 $1,859 $1,859 $9,295

Communicable disease control is a major service offered by nurses. Developed by the BC Centre for Disease Control, the program includes childhood immunizations, school health, annual flu vaccine clinics, disease outbreak contact tracing, vaccine control and TB skin testing. In 2010-11 the H’ulh-etun Health Society reported almost 100% coverage of vaccine coverage for Hepatitis A vaccine, administering over 500 vaccines. They achieved 92% uptake of childhood immunizations for the 0-5 age group. Also 96% of Grade 6 students on Penelakut Island received their required shots. Vaccine fridges were provided for all of the Health Units providing immunization services. However, vast amounts of vaccines have been damaged because of power failures. Back-up power sources have been installed but these have proven inefficient as they do not kick in fast enough and are inadequate for lengthy power failures. Repairs are estimated to cost in the thousands. Additional funds are required from FNHA to address this critical problem.

3.3.1.5 Environmental Health And Research Program Cluster 2010-11 2011-12 2012-13 2013-14 2014-15 TOTAL Of

TRANSFER

Drinking Water Safety Program

$14,120 $11,130 $23,375 $14,663 $19,481 $82,769

Water is tested weekly on the Halalt reserve as Malahat First Nation and Penelakut Tribe both receive their funds directly. Contamination was detected in 2010 at Halalt resulting in the need for use of bottled water for drinking for a period of three weeks. Test results since then have consistently showed no coliform or E Coli bacteria and chlorine levels have been satisfactory.


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3.3.1.6 Primary Health Care Program Cluster 2010-11 2011-12 2012-13 2013-14 2014-15 TOTAL Of

TRANSFER

Community Primary Health Care

$349,963 $360,462 $369,474 $378,710 $399,823 $1,858,432

Dentist Although Health Canada or the First Nations Health Authority provides no funding for the dental program, the HHS feels strongly that dental health is critical to the overall health and well-being of the community members. An extremely small amount is provided for COHI. The dental program is funded from the Health Governance and Infrastructure funding that HHS utilizes to operate its administration and governance. A dentist provides services once a week on Fridays at the Halalt Centre. He provides fillings, extractions, root canals and referrals. Service is by appointment. This program is partially funded out of transfer dollars. The dentist told interviewers that even though dental hygiene is still a substantial concern in the community, it has been getting better. He believes the dissemination of dental health information and the dental hygienist together have been making a positive difference. UBC Dental Alumni and Rotary Club International work with the Health Society. In 2012 they conducted three days of dentistry at the Halalt Centre. Dental Hygienist The dental hygienist provides services monthly on Tuesdays at the Halalt Centre. Oral exams, cleaning and teaching about good dental hygiene are provided. Medical Care Currently Island Health has a sessional contract with HHS for the doctors. Until 2011, funds were provided from transfer dollars to supplement doctors’ fees. They provide services at each Health Centre. Dr. Williams was at Penelakut Health Office from 2009 to 2014 and Halalt from 2011 to 2014, at which time he retired. Dr. Cutfeet replaced Dr. Williams at the Halalt Centre Wednesdays from 2:00 – 4:00 pm but is now also being replaced. Dr. Eberhard is at the Malahat Health Unit Wednesdays from 1:00 – 4:00 pm. No appointment is needed. Dr. Graham Blackburn goes to Penelakut once per month as he specializes in prenatal and post-natal. This was set up by HHS and he continues today. Eye Screening Program The H’ulh-etun Health Society has partnered with Inter Tribal Health Authority to deliver teleopthamology services to screen for vision problems among Elders and people with Diabetes. Women’s, Men’s and Family Wellness Mammogram Days are hosted once a year for member Nations at a rented hall in Chemainus. Transportation, a meal and crafts augment the day to encourage attendance along with a $5 Tim Horton’s gift card. In 2012-13 a separate screening clinic was held in Penelakut.


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A wellness day for women was held in 2012-13 to honor women and provide health information. Several pamper services were included. A challenge was noted for those from Penelakut due to weather and ferry scheduling complications. There is also a women’s group at Malahat but members from the community reported that the main activity provided is shopping trips into the nearby town. Men’s carving groups (Men’s Group) are held weekly on Tuesdays at the Malahat Centre and Wednesdays at the Halalt Centre. The Wellness Worker also went to Penelakut once per week to offer the program which continues today. They all carve, cook and discuss issues such as domestic violence, assault, and drug and alcohol abuse. Family Wellness days are held in August, to assist in preparing children for returning to school. Haircuts, vision and hearing screening, sun and water safety, lice, immunizations, hand washing and other health-related services are provided. Fitness A variety of fitness classes have been held over the five years of this review. For example, a long-standing program titled Aquafit takes place once per week and provides rides to allow members to attend the Cowichan Aquatic Centre. Members can then use the pool to swim, attend the Aquafit class, or work out in the weight room. Bootcamp has been held Tuesdays and Thursdays from 7:00 to 8:00 p.m. at the Halalt Gym. Child minding and snacks are provided. It is designed for anyone who wishes to improve their fitness with exercises ranging from beginners to advanced levels.

3.3.2 SET FUNDING 3.3.2.1 Health Protection – Environmental Health and Research Program

2010-11 2011-12 2012-13 2013-14 2014-15 TOTAL Of

TRANSFER

First Nations and Environmental Contaminants

$25,000 $00 $00 $00 $00 $25,000

In 2010 the health services conducted inspection of food, water treatment facilities, solid and liquid waste disposal, daycares, housing and community facilities. The ocean and air quality were examined specifically in 2011-2012 for selective emissions from the Catalyst paper mill in Crofton. At the conclusion of their 2012 report, the consultants acknowledge that due to significant contamination of the Stuart Channel area, cultural, intellectual, and health impacts have taken a heavy toll on the Halalt community. They note that this impact will affect generations to come, altering fishing, nutrition and a long-standing means of livelihood for this Nation. They also point out that little is known about the long term effects of the community’s consumption of contaminated fish between 1960 and 1990, during which time no restrictions were in place. They were unable to establish the extent of air pollution and recommended further study be conducted on air quality and its impact on health.


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3.3.2.2 Primary Health Care Program Funding

I. First Nations and Inuit Home and Community Care 2010-11 2011-12 2012-13 2013-14 2014-15 TOTAL Of

TRANSFER

First Nations Home and Community Care – Phase 3

$206,549 $215,561 $218,065 $223,517 $235,977 $1,099,669

Nursing Services Home Care Nursing service is delivered by RN’s, LPNs, and in addition, at Penelakut, Registered Care Aides. Four nurses cover the Halalt office five days a week and three of those serve at the Malahat office three days a week. Their services are based on ongoing assessments of needs. Services may include wound care, foot care, pain management, and palliative assessments and services. Nursing services have been significantly reduced on Penelakut following their disengagement. There were 4 RNs going to Penelakut on various days which was equivalent to 2.0 FTE nurses. Now there is 0.8 RN who is contracted by Inter-tribal Health Authority (ITHA) for Penelakut. She spends three days in Penelakut and one day on Tussie Road. HHS worked with Cowichan Tribes in writing a proposal to Island Health and the Ministry of Health for a Nurse Practitioner. The NP was to serve Halalt, Malahat, Lyackson, Penelakut and Cowichan Tribes. The proposal was successful and as a result, the NP started on March 9, 2015. HHS has her two days per week (Mondays in Malahat and Wednesdays in Halalt), Penelakut Tribes on Tuesday and Cowichan Tribes two days per week (Thursday and Fridays). Assistance is provided for supplying loans of specialized medical equipment through the Red Cross Loan cupboard and the Community Living Association. Longer-term purchases are obtained through the national NIHB Medical Supplies and Equipment program. Inter-Tribal Health Authority handles the NIHB program for HHS member Nations. The application process for NIHB funded equipment was described by the staff as cumbersome, with long delays in getting approval. The staff recommended a significant local fund be established to handle patients’ urgent needs for medical equipment. Since there are many items that are not funded through NIHB (now called First Nations Health Benefits (FNHB), HHS established a fund in October 2014 to address some of these urgent medical needs. It has already been evident from this program that a number of community member’s health has improved significantly just by being able to get their prescriptions, eye drops and dental work completed. Pre-natal/Post-Natal Program In 2012-13 the Halalt CHC/CHR attended five days of training for becoming a doula. A doula provides non-clinical physical, emotional and informational support and care to a woman and partner before, during and following childbirth.


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Also an Aboriginal Midwifery class was held in November 2013. Nurses provide pre and post-natal screening and check-ups, newborn assessments, support for breastfeeding and education. No groups are held at present as the numbers of pregnancies are small. While basic first aid is not in the nurse’s job description, such service is often rendered in the Health Centre. If the staff cannot provide services, VIHA will provide wound care and palliative services. Hospital discharge care is arranged in cooperation with the Aboriginal Liaison Nurse at the Cowichan hospital. In an interview she reported that she was often heavily booked and did not have time to get to know the families served by HHS as much as she would like to. She also identified a need for an after-hours contact person to help with unexpected hospital discharges or other urgent needs of community members in evenings and on weekends. Home Support Services Of the 4 RNs that were employed by HHS, two were Home and Community Care nurses. Because Penelakut had a difficult time accessing Island Health’s Home and Community Care Program, HHS made a decision to allocate the majority of home care funding and services to Penelakut from 2011 to 2014, up to when they disengaged. As a result, the clients in Halalt and Malahat were referred to Island Health Home and Community Care program and support services. After the disengagement, HHS re-allocated its home care program and services to its remaining three member Nations. They are currently working with Island Health in assuming some of the homecare responsibilities with new and existing community members who were accessing those services from them. Home support is offered as needed and includes personal service such as bathing, transferring, meal preparation, medication reminders, and assistance with blood glucose monitoring. The Nanaimo Association provides in-home respite service for Community Living as arranged by home care nursing. In 2012-2013 a fully modern bathing room was set up in the Penelakut Health Centre for clients. The heated floors and seated shower were designed for patient comfort. The staff reported that this service was underutilized. A similar one is located at the Halalt site which is currently being upgraded Two full-time Personal Care Aides were employed at Penelakut (2010-2011) serving seven clients each. There was also one homemaker who served 4 clients. Staff reported that there are currently 20 clients receiving Home Care. Malahat employed one homemaker that year. Community members who were interviewed did comment that there was a need for more homecare services and the interviewer had the impression that they were not fully aware of what kinds of home care were available to them. Foot Care Foot care is offered in conjunction with community events such as the Elders lunch program and every six weeks. It is offered for members of Lyackson, Halalt and Tussie Road. Healthy meals and nurse visits are often combined with this service. This was contracted out but HHS has


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purchased all of the equipment, materials and supplies to offer its own program at the Halalt Health Office. The LPN started providing the services in March 2015.

ii. Children’s Oral Health Initiative 2010-11 2011-12 2012-13 2013-14 2014-15 TOTAL Of

TRANSFER

Children’s Oral Health Initiative

NA NA $7,225 $12,458 $13,152 $32,835

Children’s Oral Health Initiative (COHI) The Children’s Oral Health Initiative (COHI) is a service provided to reserve First Nations children to help them establish and maintain healthy teeth and gums. COHI provides dental services to children from birth to age seven, and provides information to their parents/caregivers and expectant parents which help their children build and maintain healthy smiles right from the start. The program services about 95 children.

3.2.2.3 Non-Insured Health Benefits Program Cluster Medical Transportation 2010-11 2011-12 2012-13 2013-14 2014-15 TOTAL Of

TRANSFER

Medical Transportation

$37,170 $37,170 $37,170 $37,170 $37,273 $185,953

Families from each Nation are provided with transportation costs to surgeries, specialist medical appointments and other treatments as required in Victoria, Nanaimo and Vancouver. Travel use for 2010-2015 is presented below. (Penelakut managed their own travel funds so are not included.) This funding does not cover local appointments with doctors, dentists, healthcare professionals or medical testing or imaging appointments. Because patient travel is limited and isn’t available for community members to attend medical appointments in the area, they often miss their appointments. As a result, they are considered as “non-compliant”.

H'ulh-etun Health Society

Patient Travel Summary 2010-2011 to 2014-2015

Apr - Jun Jul - Sep Oct - Dec Jan - Mar

2010-2011 13 15 11 16 55

2011-2012 overlap 32 42 29 103

2012-2013 17 6 7 6 36

2013-2014 5 17 5 9 36

2014-2015 overlap 21 12 12 45

Total 275

3.4 ACHIEVEMENT OF 2010-2020 GOALS AND OBJECTIVES


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This section of the report will summarize the impacts and outcomes of the HHS programs and services offered between 2010 and 2015. The findings are reported according to the goals outlined in the 2010-2020 Strategic Plan and are analyzed in terms of strengths and opportunities for growth.

GOAL 1: TO PROVIDE HOLISTIC AND CULTURALLY APPROPRIATE CARE

Culturally appropriate care is that which respects and acknowledges historical influences such as colonialism and residential schools as well as language, values and strengths of community members. Holistic care recognizes the mind, body and spiritual aspects of a person’s wellbeing. We examined the documents, survey data, focus group data and interview results for evidence that the care being delivered was holistic and culturally appropriate and competent. Our overall findings indicate that considerable efforts were being made to accomplish this. Community members were asked to what extent they use traditional healing. The results were compared with the 2002 evaluation. It appears that there has been a reduction since the 2002 survey results.

Do you use traditional healing?

The staff was asked the extent to which they integrate cultural practices in their care delivery.

Staff Responses

To what extent do you integrate holistic and culturally appropriate health services and

programming into your work? (e.g., traditional food preparation, using traditional names)


Not at all 6.2% 1 A little 93.8% 15 A lot 0.0% 0 Not sure 0.0% 0

Total Responses 16

Staff members were also asked to what extent they provide information and discuss culturally relevant treatment options with their community members.

0%

50%

100%

1994 2002 2015

All Community Youth (15-24)


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Staff Responses

Do you provide information and discuss various treatment options with clients, including

traditional healing alternatives and holistic care?


Yes 43.8% 7 No 12.5% 2 Sometimes 37.5% 6 Not applicable 6.2% 1

Total Responses 16

One staff member commented, “After every session we have a talking circle, giving participants a chance to share. I would like to include more holistic and culturally appropriate services. We have so many resources we can use within our communities.” Another noted “I am currently engaging with Elders so they can support a more culturally sensitive approach to health care.”

Strengths The new HHS Vision, Mission and Philosophy place strong emphasis on cultural teachings and traditions. The Board members claimed that there has been a major shift towards bringing traditions and culture into HHS since the hiring of the new ED. They specifically mentioned “Elders in Residence” which is engaging Elders to advise on traditional ways and teach the Native language. Two Elders come in once per week. One Elder primarily works with the Community Wellness Worker and the other teaches the local language to the staff and interested community members. The Band has a Preferential Employment Opportunities Policy that outlines several options for reaching a goal of having all staff positions filled by First Nations people. There do not appear to be any policies for assisting non-Native staff members to increase their cultural competence. The backgrounds of the staff and the types of programs offered contribute to Goal One in the 2010-2020 Plan. The current Executive Director has a strong First Nations cultural heritage. She has a history of planning for health services that incorporate the best of Western and Traditional healing modalities. One LPN is a member of the Lyackson First Nation. A Community Health Nurse is from the Salt River First Nation in Fort Smith, N.W.T. The physicians, dentists and nurses appear to offer primarily Western medicine. The counseling staff includes a Registered Clinical Counselor (on contract) who provides services for survivors of residential schools and their descendants. A community wellness worker has been employed to work with community members who have alcohol and/or drug issues. He is a Cree from Opaskwayak Cree Nation. He came to H’ulh-etun Health Society (HHS) as the NNADAP Worker with over 20 years of working with First Nation’s communities and First Nations non-profit organizations. The child and youth counselor, hired in November 2014, is from Cowichan Tribes. She has specialized training in working with children and their families, in particular art therapy. The counseling program is described as having “Traditional Aboriginal concepts of health which


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are deeply embedded in a holistic approach focusing on the health and wellness of the body, mind, heart and spirit. Today, recovery involves many different paths integrating both Western and Traditional approaches to health and wellness.” A number of group programs focus on cultural issues. These include the Growing Together program for children and youth, Ladies Sewing Class and Men’s Carving Groups. The youth recreation program incorporates crafts, language, canoeing and other cultural traditions.

Opportunities Community members at the Halalt dinner were asked how well the Health Centre was using traditional healing in the services they provide. One hundred percent (44) rated this as poor. When asked for examples of why they chose this rating, several members explained that it was mainly because they wished to have greater knowledge of and access to traditional herbs and medicines. Those interviewed suggested adding opportunities for drumming, weaving, knitting, carving, canoe and paddle-making, and sweat lodges for people of all ages for both men and women. They expressed concern that the youth are losing interest in culture and tradition. A number of the staff participated in a Native Plants and Medicine course two years ago but it was not completed. Nurses in the staff focus group explained that it would be beyond their scope of practice to recommend these and that there were some risks associated with their use. This issue requires further thought and discussion. It was noted that many of the traditions belong to specific families and thus do not fit into a program per se but are passed on verbally to next generations. This needs to be respected. Further discussion with Elders and other band members should be undertaken to formulate a plan for addressing this issue. An Elders Advisory Circle was established in March 2015 with Elders from all three member Nations. Their purpose is to provide direction and guidance to the staff on incorporating language and culture into all health programs and services that HHS offers. Current nutrition programs do not reflect a strong emphasis on traditional food or preparation methods. There were exceptions. For example, for our community dinner at Halalt, the cooks prepared a bounty of fresh crabs and shrimp caught by band members. The Executive Director expressed a desire to integrate the traditional elk and deer hunt and local seafood into the HHS, distributing meat to community members. She also expressed a desire to hire a part time nutritionist and to engage the community more in canning and other traditional food preparation activities. Plans are underway to grow healthy food in a large, currently unused greenhouse on site. A large community garden was started on Penelakut and a similar idea has been suggested for Halalt and Malahat. Penelakut has done canning of fish, cherries and peaches for the Elders.

GOAL 2: TO PROVIDE INTEGRATED DELIVERY OF COMMUNITY, YOUTH AND FAMILY HEALTH SERVICES AND PROGRAMMING

The document review outlined a wide range of programs and services being offered by HHS. All of the programs being funded in the transfer agreement are being carried out. These were outlined in Section 2.0 of this report. Several new services and programs have recently been introduced.


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Community members in the survey were asked what programs or services they believed were most valuable for their community.

What HHS services do you think are most valuable?

Rank Service Number of Times Mentioned

1 Dentist/hygienist 19 2 Community Meals b/l/dinners Elders/chronic health /

diabetes 15

3 Nurse 12 4 Doctor 11 4 Counselling/mental health/mental illness support/

addictions counselling 11

4 Men’s or women’s group 11 5 Good Food Box (7), Healthy Eating, cooking and

Nutrition programs (3) 10

6 Exercise/Fitness/boot camp 8 7 Podiatry/foot care 6 7 Parent/tot mother’s group, parenting group 6 7 Prenatal, postnatal 6 8 Transportation for appointments 5 8 Youth programs 5

Staff members were asked to what extent HHS was addressing the health concerns of the community.

Staff Responses

To what extent are health concerns being addressed by HHS? Response Chart Percentage Count

Not at all 5.9% 1 A little 29.4% 5 A lot 52.9% 9 Not sure 11.8% 2

Total Responses 17

Staff members were also asked if the HHS programs and services had improved between 2014 and now.

Staff Responses

In your opinion, did the HHS programs and services improve between 2014 and now?


A lot 41.2% 7 Slightly 29.4% 5 Stayed the same 5.9% 1 Worse than before 0.0% 0 Don't know or no response 23.5% 4

Total Responses 17


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Community members replied to this question as well. As shown, both groups indicated that there have been improvements, particularly in the past year.

In your opinion, did the HHS programs and services improve:

A lot Slightly Stayed the same

Worse than before

Total Responses

Between 2010 and 2013?

18 (25.4%) 21 (29.6%) 28 (39.4%) 4 (5.6%) 71

Between 2014 and now? 17 (27.4%) 24 (38.7%) 16 (25.8%) 5 (8.1%) 62

Strengths Community members expressed sincere gratitude for the services provided by the Society. In particular they appreciated the doctors, nurses and counselors. At the community dinner in Halalt, we asked community members how they would rate the services provided by HHS. Twenty-five percent (14) rated the services as excellent, 60% (33) said they were average and 15% (8) rated them as poor. One participant noted. “I do the swimming, I get my teeth cleaned and I bring my grandchildren there. It’s important that the community use all the programs that are out there.” Another commented, “Our breakfast program is phenomenal. They served 60 kids breakfasts this week and 40 kids after school.” However, another community member who was interviewed said it was hard for many to get all their kids to the breakfast so early. She suggested that yogurt and a healthy snack bar be handed out at the bus stop for those who can’t attend as she claimed a number of children are still going to school hungry. Those attending the Halalt community dinner were asked how well the Health Centre provides for the needs of people across the lifespan. Twenty-six percent rated this as excellent, 63% said it was satisfactory and 14% gave this an unsatisfactory rating. Comments reflected strong support for youth-related programs but lack of programs for pre-natal/post-natal programs and those serving Elders. Those attending the Penelakut dinner expressed a need for programs supporting youth, particularly in terms of exercise and during the transition into adulthood. Since September, 2014, a child and youth counselor was hired and Growing Together was implemented - a homework and craft club for kids after school. Youth and recreation coordinators were employed and a hot breakfast program was started for school children and those in day care. A “girl power” dance was successfully held in Penelakut and Malahat staff members hope to offer a slumber party for their girls with Elders in attendance.

Opportunities Informants identified several needs for new or expanded programs and services. Staff members were asked, “Are there programs or services not offered by HHS that you feel should be included?” The following is a summary of their responses:

Chronic disease self-management groups, Elders programs

Pre-natal/mom’s groups


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Dietician

Mentoring/role model programs for youth and sexual health

Acupuncture, massage

Disability case management

More cultural programs One staff member wrote, “Given research showing that First Nations people are at increased risk for Vitamin D deficiency, which is associated with numerous health problems, I would love to see a Vitamin D project that includes education of community members, and provision of Vitamin D supplementation through NIHB-funded doctor's prescriptions.” Community members who were interviewed were asked how best to reach out to those who need help for addictions, violence or abuse. People suggested more support groups, more information in newsletters, more group gatherings and more attention to the issue by all staff members, even when they are not on duty. Another noted that many things have been tried but “you can’t force people to get help”. New funds have been approved for a youth program supporting puberty. However, in every group, low self-esteem - particularly among girls – and abuse and suicide risk among youth were identified as serious concerns. The newly hired Child and Youth Counselor serves all three Nations and has a large and growing caseload. She reported that an additional Counselor would allow HHS to meet this growing need for support for the children and youth of these Nations. Malahat and Penelakut community members thought that a better range of activities for youth should be offered. They believed that this lack was contributing to boredom and increased drug and alcohol use among the young people. Programs for Elders appear to be limited. Currently, home care services, an Elders lunch –with speakers - and foot care focus on this population. Meals on Wheels started in January 2015 in Halalt. A bathing room is being prepared for use at the Halalt Health Centre. Workshops on elder abuse have been held for staff but they said they found this is a difficult issue for many Elders to discuss. “This is a complicated issue and often reflects a cycle of abuse. Some Elders were abused in residential schools and by abusive parents and in turn abused their family members. Now that they are old and frail, some family members are abusive to them.” This issue warrants further attention. The need for a falls prevention program was identified and is one of the requirements for accreditation. A lack of programs tailored to meet Elder’s needs for physical activity was also identified. The staff expressed a desire to have more flexibility in accessing funds for equipment such as bed poles, oxygen, bath chairs, crutches etc. MSP and FNHA provide many items but this can all take time and the needs may be urgent. Currently, ITHA administers the First Nations Health Program on behalf of HHS’ member Nations which is extremely inadequate. It is strongly recommended that HHS take over the management of its own FNHB program from ITHA. As an interim measure and to assist some of the issues, HHS has established a small contingency fund but it is thought to be inadequate.


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There was variation in how staff and community members thought health promotion for Elders should be addressed. Some supported the idea of a comprehensive wellness program for the Elders that would encompass their physical, social, medical and safety needs. There is a plan in place to increase their involvement in food canning and distribution as well as partaking in the bounty of deer and elk hunts. Others suggested a more informal approach through increasing their opportunities for social engagement and activities. A more thorough consultation with Elders would assist in identifying what changes would best address their needs. HHS has a strong dental program at present, making it unique in a climate where many First Nations struggle to have dental needs met. This program is currently not funded. Instead it is supported with funds from Health Planning and Management and other administration programs. HHS has a full dental room with complete equipment and X-ray but only utilize it a maximum of six days per month because of the limited funds. HHS is interested in working with FNHA to get another chair so that a dentist could be hired full time. HHS is open to working with FNHA to refer clients to their centre for dental work if they were able to access the funds from FNHA to hire a dentist and dental assistant full time and a part time hygienist. In this way, the dental room could be fully utilized and operational. As one staff member noted “Our teeth are a window to self-esteem, diet and speech.” Community members talked about the need for emergency dental services as the dentist is only in once a week. Plans are underway for including expanded foot care acupuncture, massage, reflexology and Reiki. A room has been set up at Halalt for these and will be operational once practitioners are identified. The staff at Penelakut reported that plans are also underway for construction of a sweat lodge next to the Health Centre. They would also like to see a smoke house built. Home Care is currently delivering palliative care however, staff reported that it is not fully acknowledged or funded by the current transfer agreement. This type of care in-home is complex requiring extensive teamwork, pain management, family support and specialized equipment such as oxygen. It is recommended that a palliative care management strategy be developed and additional funding be sought to implement this fully. Several community members thought there was room for improvement in other services. The meals were described as repetitious and they said the food boxes contained over ripe fruit that was unappealing. “When food is delivered drivers honk their horns rather than dropping the box at the door. That is very disrespectful, especially to the Elders.” Residents of Malahat said that they believed the youth at Halalt were being better served and had better role models. The Staff at Malahat expressed a strong desire for a FASD worker. “We have one in Duncan but we never see them.” They also would like a designated diabetes worker, due to very high rates on their reserve. GOAL 3: TO IMPROVE ACCESS TO SPECIALIZD MEDICAL AND OTHER PROGRAMS AND

SERVICES

Strengths

Funding for transportation is included in the FNHA contribution agreement. This travel is restricted to appointments with specialists in Vancouver or Victoria. Several community members


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said they found the application process quite cumbersome. However, staff members said that having the forms signed by the physician was the only way of ensuring the funds were used appropriately.

Staff Responses

How would you rate the access for community members to specialized medical and other health

and well-being programs and services offered through all HHS Health Centres?

Excellent 17.6% 3 Good 64.7% 11 Fair 17.6% 3 Poor 0.0% 0 No Response 0.0% 0

Total Responses 17

HHS also has an informal practice of transport to local appointments and events. The Halalt/Lyackson site has five vehicles, Malahat has two and Penelakut has four. The four Nations are spread apart geographically and many community members do not have transportation to attend events and appointments in neighbouring reserves or communities. The Penelakut community members particularly evidenced this. Several new vans have been purchased, however, the needs have increased and clients have come to expect rides on short notice. Often it is front line staff members who leave their jobs to accommodate these needs. One of the vehicles in Halalt is a SUV but a more practical vehicle would be a van to transport more people and families.

Opportunities The staff at all locations, and community members in their survey, interviews and community forum expressed dissatisfaction with current driving and transportation arrangements. The 2010-2020 recommendations for new vans were adopted but no drivers have been hired as suggested. Staff in the focus groups strongly recommended hiring one or more drivers, along with a scheduling clerk. Other suggestions included requiring advance notice for all trips, scheduling transport to specific locations on certain days, hiring a driver to make a circular route to common destinations every day, and purchasing more vehicles, particularly at the Malahat office. A number of members suggested returning the stipend for family drivers that used to be available. It is recommended that a transportation committee be struck to further document this issue and come up with a transportation plan that meets the needs of the staff, organization and community members. Transportation is particularly problematic for people on Penelakut. Staff members claimed that: “A half hour appointment can take up to four hours. We are not classified as a semi-isolated community so we get no extra funding. People can’t afford the bulk ferry passes so it winds up costing them more per trip.” Staff members suggested hiring a full-time driver there. The idea of purchasing a boat for pedestrian travel was also mentioned. These issues require further study and planning.


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It is recommended that HHS negotiate with FNHA to have more flexibility with the patient travel program to meet the needs of community members. The program should be open to all medical appointments in the local area regardless of whether or not it is a specialist appointment or not. GOAL 4: TO PROVIDE EDUCATION AND INFORMATION ON PUBLIC HEALTH CONCERNS,

PREVENTION OF INJURY, SUICIDE AND ENVIRONMENTALLY-RELATED ILLNESS

Staff members reported that a number of programs were cancelled in 2010, under leadership of a previous ED. Many of these were events such as Family Wellness Days and Men’s Warrior Wellness, where a social gathering was used to deliver education, information, support and screening to community members who may not be attending the Health Centre regularly. These have been re-instated as of 2014 and provide valuable opportunities for addressing many health issues in the community. A new program for child abuse prevention and intervention – Walking the Prevention Circle – was offered in March, 2015. This three-day training is offered by the Red Cross and will assist staff in identifying children at risk and ways to intervene early.

Strengths The staff reported that they have seen some progress in attracting community members seeking mental health and addictions counseling. However, they said that depression, suicide risk, alcohol and drug addiction and family violence continue to plague these communities. Additional counselors have been hired and it is hoped that use of these services will continue to improve. Issues of confidentiality have been openly addressed and policies and practices put in place to protect client privacy. However, community members confided that this was still an issue for them in accessing services. It was most problematic for those seeking counselling as some were related to staff that work at the centre and felt very uncomfortable making and attending appointments. While the content of their counselling would be kept confidential, the fact that they were seeing a counsellor would not. They recommended more opportunities to meet with counsellors off-site and to make appointments through a separate dedicated phone line.

Opportunities

There appears to be a need for better communication concerning health issues. When asked at the Halalt forum to what extent the staff provide education and information on public health concerns to community members, 81% (35) rated this as poor, 16% (7) rated it as satisfactory and only and 2% (1) said it was excellent. A Penelakut community member suggested sending newsletters twice a month but others said these were not well read. Some people did say they were using the HHS website and Facebook more so updating the web site often and using Facebook to get out information would also be of value. Others said they read the posters in the Health Centre so that can also be enhanced. Lyackson members reported that they were often unaware of programs being offered at the Health Centre, learning of these only by word of mouth or on Facebook. Some community members lack telephones making it difficult to schedule


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appointments. Several people suggested regular talking groups for people struggling with mental health issues such as anger or depression, rather than just sending out information. They did not want groups to be labeled as counseling or substance abuse though. “People won’t go to something called group therapy or AA.” A community member reported that he was sent home from hospital with a list of medicines to give to a family member, but that he received little explanation as to their use. Others may be experiencing confusion concerning medicine regimes. No incidences of drug overdoses or interactions were mentioned but it is well known that these are commonly seen in emergency departments, particularly among seniors. While nurses reported that they regularly advise community members about their medicines, and often consult with pharmacists, an idea was put forward to invite a pharmacist to come to the Health Centre regularly to hold free medication reviews. As earlier mentioned, a comprehensive falls-prevention program for Elders would be valuable. The SAIL (Seniors Active and Independent Living) program also includes assessment and intervention for prevention of fires as well as an in-home exercise program. This program would also work well in conjunction with an overall inventory of housing conditions as was recommended in the 2010-2020 Health Plan. That recommendation was for a full environmental health survey and provision of support to individual Nations for mitigating environmental hazards such as mold, fire hazards, faulty stairs or ramps, problems with plumbing and other hazards. A joint effort involving HHS, Housing Departments and the Bands could spearhead such an initiative.

GOAL 5: TO INCREASE CAPACITY AND SKILLS OF HHS EMPLOYEES

Strengths

HHS has facilitated a wide range of opportunities for staff to upgrade their knowledge and skills in the past five years. The following is a list of the various types of training that HHS provided to staff members:

FitNation Training SportMed Training

Fire extinguisher training Fire Drills

Food Safe Non Violent Communication

Lateral Violence Workshop Food Skills for Families

Confidentiality training Hul'qumi'num (language classes)

Supervisor training Leadership training

Advanced Foot Care WHMIS

CPR-C e-SDRT training

Lateral Violence What is wellness

Sharps/Blood Borne Pathogens First Aid Level C

Suicide ASIST E-SDRT

Fitness Master Theory FitNation Training

SportMed Training ASIRT

CDC courses Smoking cessation


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Trauma Informed Care STI Certification – one of our RNs took the training in 2014 and was certified

EBOLA 2 staff are currently enrolled in the Aboriginal Health and Community Administration Certificate Program at UBC

In addition to training provided by HHS, many staff members are pursuing independent opportunities to advance their knowledge and skills. When asked this question the following range of impressive responses was provided.

Attended the Canadian Domestic Violence Conference in Toronto,

Attended two conferences on leading edge counselling practices (in Ottawa and Toronto),

Attended conferences on responding to violence in Calgary and Yellowknife.”

Learned Expressive play therapy methods to help children who suffered a loss

FNHA-2014 Nursing Education Forum, CDC, Skills Checklist, Tuberculosis and Immunization 101

Enrolled in Masters in Education Leadership

Enrolled in Aboriginal Health and Community Administration at UBC which is divided 4 ways, HHS covers some expense, CSETS, Friendship center, and my Nation (Cowichan tribes).

Vancouver Art therapy institute to complete art therapy diploma.

Attended Expressive Play Therapy training to help children who suffered a loss

Overall (64%) of the staff who had training found it useful while 2 (12%) said it was somewhat useful. Nine (53%) reported that they felt they were fully qualified for their jobs while 7 (41%) reported feeling somewhat qualified.

Opportunities

The staff and the Executive Director identified some additional training that they thought would assist in becoming better prepared for respective roles. These include:

More training with suicide, grief and loss.

On-line addictions training

Time management and planning/Timerex software

Additional training to implement a fire and falls prevention program

Emergency preparedness and occupational health and safety

STI or contraception management

Policy writing, computer training, accounting, minute-taking

Leadership/managerial

Advanced fitness theory

Law

Renew Nobody’s Perfect

Foot care, wound care and Diabetic training


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When Penelakut Health Centre and staff were part of HHS, they had the support of a governing structure, policies, many professionals and administrative assistance and now they are being required to do all of this in addition to their usual roles. They expressed the view that they lack the experience, knowledge and financial resources to perform all of these roles and are undergoing considerable stress. It is strongly advised that the Health Coordinator or his successor be offered administrative training and that succession planning be undertaken as soon as possible.

GOAL 6: TO INCREASE THE NUMBER OF COMMUNITY MEMBERS THAT OBTAIN THE NECESSARY SKILLS AND TRAINING TO WORK IN HEALTH AND HEALTH-RELATED

PROFESSIONS.

Strengths Staff members were asked whether they encourage community members to obtain skills to work in health-related fields.

Staff Responses

Do you encourage individual community members to obtain skills and training to work in health

and health-related professions?


Yes 62.5% 10 No 6.2% 1 Sometimes 25.0% 4 Not applicable 6.2% 1

Total Responses 16

In 2014-2015 three levels of Building Service Worker training were provided to a group of nine men to enhance their capacity for employment in health and related fields. This was open to community members as well as the Health Center staff. Thus it provided opportunities for future employment in health-related fields. Other training programs have also been open to community participation. These include Food Safe, CPR and First Aid. One Malahat member was sponsored to enroll in health care aide training but chose not to work in this field following the course. Another staff member reported “I offered my participants to join me in the SportMed Running Training. Two attended the training session with me. These two members are now my co-leaders. Soccer is also huge in Halalt community so I try promote any coaching or referee training sessions that are available.”

Opportunities

The 2010-2020 Health Plan recommended distributing information to the community about health-related careers and engaging First Nations professionals to talk to the community about


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careers in health. Further action to support this goal would be appropriate. Board members suggested creating incentives for young people to enter health professions by offering a bursary. Other ideas included offering co-op placements for students in the Health Centre, hosting career days with a focus on health, and creating volunteer opportunities. Shadowing members of the health care team was also suggested along with fully sponsoring community members to enroll in programs such as health care aide programs.

GOAL 7: TO ENHANCE HHS GOVERNANCE, ORGANIZATIONAL AND OPERATIONAL CAPACITY

Strengths

Major efforts have been undertaken to enhance governance, organizational and operational capacity of HHS, particularly in the past six months. The three-member Board has undergone significant development in the short period of time. They described their role as moving from being a “hands-on” one to more of a “policy-focused” one, now that they have “confidence in the management’s ability to manage the day-to-day operations of the Health Centre.” The ED, with approval of the Board chair, generally sets the agendas of meetings. Updated comprehensive By-Laws, Board Manual and set of Board Governing Policies has been created to guide the Board and ED. These are consistent with the Vision and Mission. Finance and Policy Committees have been struck with a Board member as Chair and staff representation. Staff members were asked in their survey if they thought the new Organizational Chart, Mission, Values and Philosophy would improve the organization and their services to the community. (The Penelakut staff were not aware of the changes so reported “don’t know”.)

Staff Responses

Do you feel that the new Organizational Chart, Mission, Values and Philosophy will improve the

organization as a whole and improve programs and services to community members?


Yes 64.7% 11 No 0.0% 0

Don't Know 35.3% 6 No Response 0.0% 0

Total Responses 17

Some staff members in the focus groups claimed that they are still uncertain of what they are expected to do in their new roles. When asked if their roles were clearly defined, nine of all staff said yes and four said somewhat. When asked how satisfied they were with their current job, five members said they were very satisfied, eight said somewhat satisfied and three did not respond. The new organizational structure, mission, vision and policies will provide a strong basis for the Society to carry out its mission, goals and objectives. The accountability and support mechanisms are clear with maximum opportunities for developing leadership skills among the staff. It enhances teamwork and allows for clear communication pathways among and between staff, the Executive Director, the Board and the community at large.


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Staff members were also asked to what extent they thought the accreditation process would help in delivering quality care and client safety to the community. Their responses follow:

Staff Responses

To what degree do you feel that the Accreditation Process will help in delivering quality care and

client safety to community members?


A lot 58.8% 10 A little 11.8% 2 No difference 11.8% 2 Don't know 17.6% 3 No Response 0.0% 0

Total Responses 17

Communication between staff and Board members appears to have been significantly improved since the 2009 evaluation. The Board claimed that they have become more collegial with the staff through participation of all three members in three planning retreats since September, 2014. Staff members have appreciated working together with them and report that transparency has improved. Board minutes are being posted on the HHS web site, with the exception of in-camera meetings. Several staff members requested that Board meetings be open so they and others could attend. They said in the past many decisions were made that involved them but they had no opportunity for input. “This has led to rumors and paranoid feelings. The Board is trying to more a part of the Society now”.

OPPORTUNITIES

The Board suggested adding a non-member to the Board. They also recommended that a two-day Board development session be held every year. No specific topics were suggested. The Board also recommended that a mechanism be found to incorporate off-reserve members in the service plan of HHS. Many are now accessing the services informally but should be accounted for in the funding estimates. They also identified that a major opportunity lies ahead for engaging other neighbouring Nations in the Health Centre. There are several Bands that have expressed interest in partnering with HHS now that the organization is stabilizing and moving forward in a positive direction by weaving culture and modern health practices together in order to address the health needs and priorities of the member Nations. Funding for new initiatives continues to be a challenge. Current staff members expressed the wish that new programs not be added too quickly as they need time to adjust to their new roles and they claimed that space in the Health Centres is already at a premium. Additional space may be required in the near future, particularly if new programming is introduced. Staff members also believed communication could be improved with community members regarding services offered by HHS. In particular they commented that community members appear to be confused regarding the services provided by Home and Community Care. It is


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recommended that a clear brochure listing all services and programs be developed to assist community members in their understanding of the services offered. “Healing within the agency is taking place and now we have more work to do to gain the trust of the community”. Community members also reported feeling a lack of connection with the Health Centre as well as with the band administration. One member described in detail her belief that this had become “lateral violence” with those in power and positions of trust showing signs of elitism. “They need to be more visible and involved in the community”. Staff members also commented on internal communications between each other and between themselves and the ED. Cell phones were suggested for all staff. Tablets or laptops would also assist nurses with their charting needs. Another staff member wrote, “Malahat needs a lot of relationship building.” The staff was asked how they would rate the internal communications at HHS.

Staff Responses

How would you rate the internal communications at HHS?


Excellent 0.0% 0 Good 41.2% 7 Fair 52.9% 9 Poor 5.9% 1 No Response 0.0% 0

Total Responses 17

Efforts have been undertaken to improve internal communication at HHS. Since commencing her role as ED, the Director has held All Staff Meetings every two weeks to create a basis for open communication. They also brainstormed for ways to increase communication and many of the ideas the staff had been implemented. Now they meet once per week because the Team Leaders meet at least once every two weeks with their respective teams. Plans are underway as well for strengthening the communication between the Health Society and the Chiefs and Councils. The staff at one site felt they were almost in competition with their council in terms of certain health-related activities. Staff members commented that the Chief and Councilors may not be fully aware of the services that HHS provide, often sending people there for issues that should be directed to Housing or other programs. A staff member wrote, “Sometimes the division between the band offices and the health unit can be complicated because they are two different streams of funding - one is AANDC and the other is FNHA (Health Canada) and sometimes one does not know what the other is doing which can cause animosity and the community membership may feel the brunt of this communication barrier.” Staff members suggested that a clear list of HHS services be compiled, including a list of frequently needed items that are covered by non-insured benefits, and a list of items not covered. It was also suggested this be provided to the physicians who sometimes prescribe expensive


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items that are not covered under the benefits. An example given was an expensive bathtub for a patient. “This makes us look like the bad guys when we have to tell them its not covered.”

Staff Responses

How would you rate the communications between HHS and community members?


Excellent 5.9% 1 Good 58.8% 10 Fair 23.5% 4 Poor 11.8% 2

No Response 0.0% 0 Total Responses 17

We also asked staff members to rate the communication between HHS and their external

partners and agencies.

Staff Responses

How would you rate the communications between HHS and external partners/agencies?


Excellent 0.0% 0 Good 68.8% 11 Fair 31.2% 5 Poor 0.0% 0

No Response 0.0% 0 Total Responses 16

One staff member summed up his/her observations as follows. “I have only been here for a short time, but the sense I am getting is that H’ulh-etun staff has been through some turmoil over the last few years or so, and I think that staff need the opportunity to come together as a team, and be able to release, what they need to from past experience. Now the agency has brought aboard a great leader, but I think for the agency to move forward in a good, healthy way, some time for healing needs to happen.”

4.0 SUMMARY OF STRENGTHS AND OPPORTUNITIES FOR GROWTH While we did not have morbidity statistics and the participants may not represent all community members, there was evidence that the health of the population served by HHS has improved when compared with previous evaluation reports. Members reported reduced tobacco use, better self-rated health, better dental hygiene and repairs, reduced drug and alcohol use during pregnancy and marked personal benefits from counselling. Poverty continues to overshadow some of the observed health gains. One finding that stood out as needing particular attention was the low rate of people who exercise regularly. Transfer funds have been prudently used to provide a wide range of services and programs for the community. Overall, the services provided by HHS were highly valued by the community


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members and the staff believed they were meeting the needs of most of the population. Everyone believed the services had improved in the past year. Unmet needs were identified in terms of programming for youth and Elders. Some improvements in Mental Health services were suggested as well. The absence of a fully funded Palliative Care Program was noted. While Dental Services were highly rated, the opportunity for expansion of this program was identified. Integration of cultural traditions and practices was seen to have improved. A new Elders in Residence program was valued enabling language training and cultural education throughout the organization. The majority of staff members are from First Nations backgrounds. A number of suggestions were made as to how more culture could be introduced more fully into the Health Centre programs and services. Transportation for medical appointments in Victoria, Vancouver and Nanaimo has been provided but community members and staff found the application process time consuming and cumbersome. It was suggested that HHS assume responsibility for this in-house, along with applications for medical equipment and supplies. Transportation for other purposes continues to pose a barrier for members’ access to other needed appointments and services. This has resulted in poor follow-up for x-ray and lab tests and poor attendance at recreational activities or example. A larger passenger van was suggested along with hiring a driver and providing gas money to family members or volunteer drivers. Health promotion activities appear to be fairly effective. High rates of immunization were reported along with possible reduced suicide attempts. Community members were very grateful for the community dinners, breakfast and lunch programs and Wellness days. Improvements could be achieved with better information on Facebook, more regular newsletters and more group classes on prevention. The need for a falls-prevention program for Elders was identified. Medication reviews with a pharmacist on site were suggested for people with chronic illness. Overall the staff highly rated the training provided for them. Most staff believed they had the necessary skills to perform their duties. Additional ideas for training were identified. Some efforts have been undertaken to encourage community members to seek education and training for employment in health fields. Examples are maintenance worker training, first aide and food safe programs. Additional ideas for future efforts included in-school programs, bursaries, work-shadowing and health career days. The new Vision, Mission, Philosophy and Organization Chart were strongly supported by the Board of Directors and staff and were seen to be a valuable platform for moving forward. Following several years of rapid change in leadership, the new Executive Director was seen to be highly effective in establishing a solid and collegial platform for planning and delivering services. Communication between the Board and staff was thought to have improved greatly. But improved respect, trust and understanding were recommended for communications between the Centre and Chiefs and Councils, between the Centre and outside agencies and service providers, and between the Health Centre and the community. In particular, improved understanding of roles and eligibility requirements were suggested. Confidentiality was a continued concern for community members when scheduling and attending appointments at the Health Units.


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5.0 DISCUSSION OF THE DISENGAGEMENT OF PENELAKUT A number of issues related to Penelakut’s October, 2014 disengagement arose during the course of this evaluation. Many of the Penelakut community members, professionals who provide service there and staff from all sites expressed regret and even anger over the process and many feared that services were going to be adversely affected by this decision. A number of people said they wished they had stayed on to see the benefits that could be derived by an ED who believed in listening and problem-solving effectively.

The Board, ED, community members and staff were asked why they thought Penelakut had disengaged in October, 2014. Most believed this was primarily political, rooted in historical events as long as ten years ago. “The wounds were deep and long-lasting stemming from some difficult personnel decisions.” They also believed the decision was primarily made by the Band administration and did not reflect the views of many Band members.

One member noted that “No community-wide consultation was held and no official vote taken by community members.” Staff nurses claimed that in their final visits to former clients, many did not know of the decision and were very saddened. Generally it was thought that the Band leaders believed they were underserved by HHS and would receive better service if they aligned with another organization. Poor communication was also cited as a factor in the decision to disengage. “Information about upcoming meetings or events was often sent out on very short notice.” Others noted that dissatisfaction with a previous HHS Executive Director was also a key factor.

While guidelines for the process were in place, the view was expressed that these were not followed. There was evidence in the Board meeting minutes that the negotiations did not go smoothly.

A number of community members living on Tussie Road spoke openly at the community meeting and during interviews expressing their disappointment and ensuing difficulties in accessing programs and services under the new partnership agreement with ITHA. These members are geographically separated from the Penelakut Health Centre and must access many of their services by taking a ferry to that island. Future consideration should be given as to how these members can be better served. It is recommended that Penelakut Tribes consult more thoroughly with their members on Tussie Road to see if HHS could be contracted to deliver health programming and services to its members.

One interviewee noted “I feel strongly that FNHA and the First Nations Health Council should not have interfered with the disengagement process – they should have only been there to mediate to come to a resolution rather than assisting them in disengaging – they are also responsible for the outcome of the disengagement.”

6.0 STRENGTHS AND RECOMMENDATIONS This evaluation has identified a number of significant strengths and opportunities for development of the H’ulh-etun Health Society. These are summarized below.


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STRENGTHS OF H’ULH-ETUN HEALTH SOCIETY (HHS)

Comprehensive Programming: The Society has continued to provide and expand upon a solid base of programs and services encompassing the lifespan, in spite of a rapid turnover in leadership.

Moving Forward: The Vision, Mission, Philosophy, and Organizational structure provide a solid roadmap to move forward in carrying out the Society’s goals and objectives.

Meeting the Needs: Programs are adapted to meet the ongoing needs of the community.

Cultural Relevance: Most programs and services are adapted to the culture and traditions of the Nations being served.

Strong Leadership: The Executive Director has engaged Board and Staff members in strengthening the Society’s organizational foundation and programs.

Qualified and Satisfied Staffing: There is a high level of job satisfaction among staff and their training is geared towards addressing community needs.

Improving Quality and Safety: The Accreditation process is underway affording additional opportunities for enhancing quality and safety.

Effective Resource Management: Resources have been effectively allocated within funding guidelines to maximize community benefit.

In conclusion, the Society has experienced a turbulent five years with rapid turnover of leadership and the difficulties associated with disengagement of Penelakut. In spite of this, a strong set of programs and services has been offered and evidence of improvements in health of the members was found. Under new leadership, the Society is becoming strengthened with a new Vision, Mission, Philosophy and Organizational Structure. Issues of safety and quality are being addressed through their efforts to become fully accredited.

RECOMMENDATIONS Based on our assessment of the strengths and opportunities for growth, the following key priorities were selected for further action. Additional actionable issues are located throughout the report.

Increase Wellness: Continue expansion of programs and services to address outstanding health concerns in the community such as mental or spiritual health imbalance, drugs and alcohol misuse, nutritional needs, diabetes, dental problems and elder care.

Prevent Falls and Injury: Implement a falls-prevention program for Elders, identified as a client need that aligns with the goals of accreditation.

Integrate Cultural Traditions: Further integrate cultural traditions and food in HHS’s programs and services.

Improve Access to Programs and Services: Undertake a comprehensive study of transportation issues and solutions to address barriers to community wellness.

Encourage Fitness: Improve opportunities for fitness among community members who are experiencing financial or health barriers, are employed during the day, are elderly or are in need of child-minding.

Enhance Employment Opportunities: Undertake initiatives are to facilitate community member’s opportunities to seek employment in health-related fields.


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Improve Communication and Conflict Resolution: Strategies are needed to improve relationships and develop conflict resolution skills among the Health Centres and between HHS and Chiefs and Councilors. Strategies are also needed to better engage community members and enhance their relationships with HHS staff.

Ensure Consistency and Integrity of Programs: Find a way to resolve the dramatic reduction in services reported by residents of Tussie Road. Examine further the inconsistencies in service delivery across the two Health Centres.

Promote New Partnerships: Explore new partnership opportunities with other First Nations. Develop clear guidelines for engagement and disengagement.

Provide Emergency Contact: Explore feasibility of an after-hours contact person to respond to critical needs of community members during evenings, nights and on weekends.

Dental Program: Negotiate with FNHA to provide funding to purchase another chair, hire a dental therapist three days per week, a dentist one day per week and a dental hygienist one day per week – to fully utilize the up-to-date dental office that is currently sitting empty most of the week.

Impact of Catalyst Paper Mill: Undertake a study of the impact of effluent emissions on the health of Halalt First Nations people.

CONCLUSIONS This evaluation relied on multiple sources of information lending confidence to the reliability of our findings. In order to provide input of all community members, we recommend that future evaluations undertake door-to-door interviews, as there may be pockets of people who we were not able to reach in the methods used here. A computerized system of recoding program attendance would also generate better utilization data. The client database should also be fully used so as to enable an accurate list of numbers and Band affiliations of all users of HHS. Overall, we found H’ulh-Etun Health Society to be moving forward with a strong plan for building on past achievements and recognizing opportunities for improvement.


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APPENDICES

Appendix 1a: HHS Health Evaluation 2015: Staff Survey Appendix 1b: Client Information And Satisfaction Survey 2015 Appendix 1c: H’ulh-Etun Health Society Board Discussion Questions Appendix 1d: HHS Partners Interview Guide And Recording Sheet Appendix 1e: List Of Key Questions For Staff Focus Group Appendix 2: Summary Of Amendments To HHS Transfer Agreement Appendix 3: Summary Of HHS Programs By Site From Community-Based Reporting Template


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APPENDIX 1A: HHS HEALTH EVALUATION 2015: STAFF SURVEY We would like to take this opportunity to thank you for your participation in the H’ulh-etun Health Society (HHS) Five-year Evaluation. Your views and opinions are important to HHS and will contribute to the Health Society’s 2010-2020 Health Plan. Your answers will be kept confidential. Please complete this Survey by February 18, 2015. Thank you.

-------------------------------------------------------------- Please fill in the blanks or select the answer that most likely represents your views and make comments accordingly – there is an additional comments field at the end of this survey, please feel free to expand on any questions or add general comments.

1. Age Range: Under 18yrs. 19 - 25 yrs. 26 - 45 yrs. 46 - 65 yrs. 66 and up

2. If from a Nation, which one: Halalt Lyackson Malahat Penelakut Other

3. HHS Job Position title: ___________________________________________________ 4. This position is: Full-time Part-time Contract Casual Seasonal 5. Length of time in this position: ___ years ___ months ___ days (if less than 1 month)

6. Your overall satisfaction with your current job?

Very Satisfied Somewhat Satisfied Dissatisfied Very Dissatisfied

7. Is your position and role within HHS clearly defined? Yes No Somewhat Not sure

8. What staff training and development have you received over the last 5 years? A. For HHS? B. On your Own?

9. Did you find the training at HHS useful? Yes No Somewhat Comment:

10. Do you feel you are fully trained and qualified for your position? Yes No Somewhat

What additional training would assist you in your role at HHS

11. What HHS Programs and Services do you provide in your role? (please list all that apply)

12. To what extent do you integrate holistic and culturally appropriate health services and programming into your work? (e.g., traditional food preparation, using traditional names)

Not at all A little A lot Not sure Comment

13. Do you provide information and discuss various treatment options with clients, including traditional healing alternatives and holistic care? Yes No Sometimes Not applicable Comment:

14. To what extent do you provide education and information on public health concerns, injury

prevention, suicide and environmental-related illnesses? Not at all A little A lot Not sure

Comment:


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15. Do you encourage individual community members to obtain skills and training to work in health and health-related professions? Yes No Sometimes Not applicable Comment:

16. What do you think are the 3 most important health concerns in the community?

17. To what extent are these health concerns being addressed by HHS?

Not at all A little A lot Not sure Comment:

18. What HHS Programs or Services do you believe are the most useful for the community?

19. What HHS Programs or Services do you believe are the least useful for the community?

20. Are there programs or services not offered by HHS that you feel should be included? If yes, please describe:

21. In your opinion, did the HHS programs and services improve between:

2010 - 2013? A lot Slightly Stayed the same Worse than before Don’t know 2014 and now? A lot Slightly Stayed the same Worse than before Don’t know

22. How would you rate the access for community members to specialized medical and other health and well-being programs and services offered through all HHS Health Centres?


23. How would you rate the internal communications at HHS? Excellent Good Fair Poor

24. How would you rate the communications between HHS and community members?


25. Do you feel that the new Organizational Chart, Mission, Values and Philosophy will improve the organization as a whole and improve programs and services to community members? Yes No Don’t Know

26. To what degree do you feel that the Accreditation Process will help in delivering quality care and client safety to community members?

A lot No difference A little Don’t know

27. What recommendations do you have to improve quality care and safety to community members?

28. What goals would you like to see HHS establish for the next 5 years?

Additional Comments:

-------------------------------------------------------------- Huy tseep q'u Siem!


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APPENDIX 1B: CLIENT INFORMATION AND SATISFACTION SURVEY 2015 Please help us serve you better by taking a few minutes to tell us about yourself and your experiences of the programs and services that you have received or participated in at the H’ulh-etun Health Society over the last year. No names will be used in reporting the results and you may leave questions blank if you do not wish to answer. Completed surveys can be dropped off in a box at one of the Health Units, brought to one of the Community Dinners (Halalt on February 24th and Penelakut dinner on March 11, or completed online: (http://www.hulhetun.ca/). We encourage all family members (over the age of 12) to complete the survey – extra copies are available at the Health Units or online, or you may copy yourself. Everyone who completes a survey and attends a Dinner has a chance to win amazing door prizes!

--------------------------------------------------------------- Please fill in the blanks, select, or circle the answer that most likely represents your views and make comments accordingly - feel free to use the bottom of this survey for further comments. About You and Your Family

1. You are: Male Female Other 2. Age Range: 13 - 18 yrs. 19 - 25 yrs. 26 - 45 yrs. 46 - 65 yrs. 66 and up

3. Which Nation are you from? Halalt Lyackson Malahat Penelakut Other

4. Where do you live? On Reserve Off Reserve On Other Reserve

5. Marital Status: Married/Live together Divorced/Separated Widowed Single

6. Employment Status: Full-time Part-time Looking Not working or looking Student

Other (e.g., EI, WCB, etc.) Disability Pension Retired

7. Your estimated Monthly Income: Under 500 500-1000 1000-1500 1500-2000 2000-2500 Over 2500

8. If you are an adult, how many children do you have? ___ What are their ages? ________ Number of male children? ________ Number of female children? ________

9. How would you describe your overall health? Excellent Good Fair Poor

10. How has your health improved over the last 5 years? Better Same Worse Not Sure

11. Do you have chronic or long-term health problems? Yes No Don’t Know (such as asthma, diabetes, high blood pressure, arthritis)

12. How would you describe your level of physical activity? (select the most accurate statement) ___ I work out or exercise 3 or more times per week ___ I work out or exercise at least once per week. ___ I exercise occasionally, for instance with sports or as part of my job. ___ I am not physically active. ___ I am not physically active, but would like to exercise more regularly.

13. What barriers do you have to being more physically active? (e.g., I can’t afford to go to a gym, don’t

have a vehicle, too busy tending children or Elders, health issues; not enough time, etc.) 14. Do you use tobacco? Yes, regularly Sometimes No

http://www.hulhetun.ca/


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15. Do you use Traditional Healers and/or Cultural Practices for your overall health and wellness? Yes, regularly Sometimes No

16. Are you or have you experienced addiction issues (gambling, smoking, drugs, alcohol)?

Yes No

17. Are you or have you experienced mental or spiritual health imbalances (e.g., depression, grief and loss, giving/receiving abuse, anxiety, Residential School effects)? Yes No

18. If you wanted to reach out for addictions or Mental Health services, what barriers might prevent you

from seeking support? Please select all that apply. I am: __uncomfortable asking for help __worried about confidentiality __without transportation or child minding __not sure the HHS programs/services are right for me __not sure what programs/services are available __trying to handle it on my own first __ Other. Please describe: ______________________________

About H’ulh-etun Health Society (HHS)

19. What HHS programs or services do you believe are the most useful for your community? (please list all that apply)

20. What HHS programs or services do you believe are the least useful for your community?

(please list all that apply)

21. Are there programs or services not offered by HHS that you feel should be included? If yes, please describe:

22. In your opinion, did the HHS programs and services improve:

between 2010 - 2013? A lot Slightly Stayed the same Worse than before between 2014 and now? A lot Slightly Stayed the same Worse than before

23. Overall, how satisfied are you with the programs and services provided by HHS? Very Satisfied Somewhat Satisfied Dissatisfied Very Dissatisfied

24. Do you believe HHS programs or services have increased your knowledge and understanding of health issues or contributed to you living a healthier lifestyle?

Yes No Somewhat

25. What do you think are the 3 most important health concerns in your community? Would you be willing to have a personal (and confidential) interview to talk about your experiences with managing your health and use of the H’ulh-etun Health Society services? If so, please provide your name (or initials) and telephone number below. An interviewer will call you to set up a time and place that best suits you. Alternatively, feel free to send an email to Wendy at [email protected] to request an interview or if you have any questions or concerns. Those who agree to give additional time for an interview will be eligible for other amazing door prizes. We appreciate your cooperation, and your feedback will help to guide the future planning of HHS programs and services.

mailto:[email protected]


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APPENDIX 1C: H’ULH-ETUN HEALTH SOCIETY BOARD DISCUSSION QUESTIONS

The following questions are designed to open up topics for discussion. We will try to limit the discussion for each question so as to be sure we cover them all.

1. How long have each of you served on this Board?

2. A. What role does the Board play? Would you say it is hands-on, policy focused or hands-off? Place an X on the line below.

Hands-on Policy-focused Hands-off

B. Has this changed since 2010? Not at all ____ Somewhat ____ A great deal ____

3. Who drives the Board activity? Is it the Executive Director, the Board or a combination of both?

Executive Director Combination Board

4. How well do you think your organization provides care that is based on traditional cultural belief,

language and traditions?

Strong focus on tradition Based primarily on western medicine ___________________________________________________________________________________

5. A. What types of Board development have you engaged in? B. What other suggestions do you have for further opportunities for Board development?

6. Have you supported any community member to obtain necessary skills or training to work in health

and health-related professions? If so, explain:

7. Do you have any suggestions for improving the overall governance and operating of this organization? For example improvements in communication, Board structure, issues of confidentiality, staffing, other?

8. What challenges has the organization currently addressed and what challenges do you see the

organization may have in the future?

9. What has been done in the last five years to increase community members’ access to external

health and wellness services? 10. What has been done in the last five years to increase the capacity and skills of HHS employees?

11. Tell us in your opinion, why one of the communities disengaged from HHS?

12. What changes would you like to see in your organization to ensure stability and enhancement for

member Nations and staff?

13. What do you feel are the successes that your organization has had in the last 5 years


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APPENDIX 1D: HHS PARTNERS INTERVIEW GUIDE AND RECORDING SHEET First, thanks for your participation in the H’ulh-etun Health Society (HHS) Five-year Evaluation project. Your views and opinions are important to HHS and will contribute to how the Health Society is fulfilling the 2010-2020 Health Plan. Your names will not be used in reporting the results.

1. What professional industry do you belong to: __________________________________ 2. What is your specific job title: ______________________________________________ 3. Is your position: Full-time Part-time Contract Casual Seasonal 4. What is your role with the H’ulh-etun Health Society (if not self-explanatory by Q#2):

________________________________________________________________________ 5. Length of time involved (or partnering) with the Health Society? ___________________

6. Which of the H’ulh-etun communities do you provide services to?

Halalt Lyackson Malahat Penelakut All

7. What HHS Programs and Services do you provide in your role? (please list all that apply)

8. In your work with HHS, would you say that you offer, advise on and/or integrate holistic and culturally appropriate health care services and treatments to community members?

Not at all A little A lot Not sure Comments:

9. Do you have any suggestions on how HHS can enhance their goal of providing both western and Traditional approaches to healing?

10. What do you think are the 3 most important health concerns in the HHS communities?

11. To what extent do you believe these health concerns are being addressed by HHS?

Not at all A little A lot Not sure Comment:

12. How would you rate the accessibility for community members to participate in HHS health-related programs and services?

Excellent Good Fair Poor Has access improved over the last five years?

Yes Somewhat No Not sure 13. Overall, how would you describe your relationship with the HHS?

Excellent Good Fair Poor Comment:

14. How do you feel the communication is between your organization and HHS? Are there ways that communications could be improved?

15. Have you encountered any barriers or issues in your work with the HHS or its clients? If yes, please explain further:

16. What HHS programs or services do you think are the most useful for the communities?

17. What HHS programs or services do you think are the least useful for the communities?

18. Are there programs or services not offered by HHS that you feel should be included? If yes, please

describe: 19. Do you have any other suggestions for HHS on how to improve the health care services of its

members?


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APPENDIX 1E: LIST OF KEY QUESTIONS FOR STAFF FOCUS GROUP

1. Were there any gaps in the ways that HHS addressed the needs of people across the life

span? This includes pre-natal, newborn, children, teens, parents, people with chronic illness such as diabetes, arthritis, etc., people with mental health and addictions issues, Elders and the terminally ill. What else is needed for your community now in the years ahead?

2. What barriers have people faced in accessing services both on and off the reserve?

What could be done to improve this as you move forward?

3. How well have you been able to integrate cultural traditions into the programs and services that you provided with HHS?

Can you provide specific examples. Do you offer traditional healing modalities to your clients? Do you involve Elders giving guidance regarding cultural traditions?

Can you think of more ways to integrate culture?

4 Are there any ways that you think communications and trust at HHS could have been improved? Between ED and staff? Between Board and Staff? Between your Chief and Council and staff? Between the Health Centre and community members?

As you move forward, do you have any ideas for how this can be improved?

5 Are there any gaps in the ways that you have provided health promotion efforts in the past 5

years in terms of providing information and support for environmentally related illness, injury and suicide and other mental illnesses? Suggestions for improvement?

6 Tell us in your opinion, why your community disengaged from HHS? How are you dealing with the changes that have taken place since the disengagement?

7. Do you have any other recommendations that would assist HHS in improving its health care for

their communities? A. As an organization: B. In delivering health programs and services to community members:

Huy tseep q'u Siem!


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APPENDIX 2: SUMMARY OF AMENDMENTS TO HHS TRANSFER AGREEMENT


Oct 1, 2010 $1,647,458 $1,435,365 $1,435,365 $1,381,902 $1,381,902 $14,191,402

Jan 1, 2011 $1,696,897 $1,470,226 $1,470226 $1,416,214 $1,416,214 $14,550,847

Feb 1, 2011 $1,689,807 $1,472,247 $1,472,247 $1,416,214 $1,416,214 $14,547,799

Apr 1, 2011 $1,689,807 $1,717,792 $1,472,247 $1,416,214 $1,416,214 $14,793,344

July 1, 2011 $1,689,807 $1,728,922 $1,472,247 $1,416,214 $1,416,214 $14,804,474

Jan 1, 2012 $1,689,807 $1,781,526 $1,454,656 $1,454,656 $1,454,656 $15,165,180

Apr 1, 2012 $1,689,807 $1,781,526 $1,747,731 $1,454,656 $1,454,656 $15,401,656

Jul 1, 2012 $1,689,807 $1,781,526 $1,760,806 $1,454,656 $1,454,656 $15,414,731

Nov 1, 2012 $1,689,807 $1,781,526 $1,868,750 $1,498,972 $1,498,972 $15,832,887

Apr 1, 2013 $1,689,807 $1,781,526 $1,868,750 $1,911,408 $1,951,662 $17,090,683

Jul 1, 2014 $1,689,807 $1,781,526 $1,868,750 $1,911,408 $2,016,966 $17,411,427


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APPENDIX 3: SUMMARY OF HHS PROGRAMS BY SITE FROM COMMUNITY-BASED

REPORTING TEMPLATE

Name of HHS Program or Service

Halalt/Lyackson Malahat Penelakut

11-12 12-13 13-14 11-12 12-13

13-14

11-12 12-13 13-14

HEALTHY CHILD DEVELOPMENT

# Babies born 12 4 1 NA3 4 1 16 13

Children’s Oral (COHI) ✓ 22 ✓ 17 ✓ 86

Pre- and Post-Natal- Individual support ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Good Food Boxes (e.g., Pre- and Post-

Natal)

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Home visits & case management ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Maternal and child health screening ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Life skills ✓ ✓ ✓ ✓

Parenting Classes (e.g., Nobody’s Perfect; Healthy Children, Healthy Futures)

✓ ✓ ✓ ✓ ✓ ✓

FASD activities ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

MENTAL WELLNESS

Counselling ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

# Clients Suicide Prevention and Intervention

3 4 3 NA 1 4 NA NA 157

Substance Abuse and Addictions

Counseling

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Community celebrations and activities ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Crises Intervention ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

HEALTHY LIVING

# with Diabetes 10 15 7 10 NA 14

# Foot Care NA 15 39 0 NA 50

3 Not available


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Lunch Program (for those with chronic medical conditions)

✓ ✓

Food for the Soul ✓ ✓ ✓ ✓ ✓ ✓

Food boxes ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Other Cooking/Nutrition Courses (e.g., Food Skills for Families)

✓ ✓ ✓ ✓ ✓ ✓

Wellness Days (Men’s, Women’s, Family)

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Elders Lunch ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Women’s Groups/Outings (e.g., mammogram days)

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Women’s Activities (e.g., sewing, weaving)

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Men’s Groups/Retreats (including Men’s Carving group)

✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Traditional food preparation/cooking classes

✓ ✓ ✓ ✓ ✓

Community gardens ✓ ✓ ✓ ✓ ✓

Aquafit/Yoga/Boot camp ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

School based feeding program ✓ ✓ ✓ ✓

COMMUNICABLE DISEASE

MANAGEMENT

Education ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Vaccine doses administered 84 41 79 NA 21 36 29 NA 322

HOME AND COMMUNITY CARE

Home support4 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

4 VIHA collaborative agreement

five -year evaluation of the h’ulh-etun health society ... society 2010-2020 health plan final...

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