ASCIRT Gathering: Knowledge development & transfer of suicide prevention, intervention and post-vention practices in BC First Nations communities

Transcription

1 November 18, 19, 2008 ASCIRT Gathering: Knowledge development & transfer of suicide prevention, intervention and post-vention practices in BC First Nations communities First Nations Health Council

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3 Table of Contents Recommendations:... 1 Introduction:... 1 Background:... 2 The ASCIRT approach:... 3 Team Descriptions:... 4 Challenges: Workshops: RespectED Workshop: Grief and Loss Workshop: Self Care Session: Coordinators Debriefing: Activity: APPENDICES: APPENDIX A Agenda P a g e

4 Recommendations: 1) Aboriginal Suicide Critical Incidence Response Team (ASCIRT) Coordinators to gather for two days every year. The first day will be dedicated to the Coordinators knowledge sharing and the second day will focus on professional development. 2) To change the name ASCIRT. Currently the name does not represent the reality of the work that is actually being done. The Coordinators of the teams will address this collectively and come up with a name that represents the work being done in First Nations Communities. 3) That in order to enhance sustainability, ASCIRT advocate for core funding and create collaboration with FNIH and that FNHC advocate for core funding for the federally funded teams. Current funding includes two teams funded by the Province, five teams by FNIH and, in some cases, in partnerships with Health Authorities. As of March 31, 2010 the First Nations & Inuit Health (FNIH) National Aboriginal Youth Suicide Prevention Strategy (NAYSPS) five year initiative funding will come to an end. Introduction: On November 18 & 19, 2008, the First Nations Health Council facilitated the first gathering of the Aboriginal Suicide Critical Incident Response Team (ASCIRT) Coordinators, Elders and two team members. The gathering was in response to the ASCIRT team Coordinators desire to share their knowledge, their challenges and best practices of their team s current approaches to suicide prevention, intervention and post-vention. The two day ASCIRT gathering consisted of: Team building activities Self care activities Workshops - grief and loss workshop, Red Cross RespectED training Coordinators meeting 1 P a g e

5 Background: In British Columbia, the suicide rates among First Nations communities are disproportionately high. The root causes of suicide for Aboriginal youth are many and include factors that are beyond their control (NAYSPS framework, 2008). The National Aboriginal Youth Suicide Prevention Strategy recognized that the impacts include an erosion of conditions that promote security of identity, colonization and rapid cultural change, trans-generational grief associated with Residential Schools, the child welfare system, and being a member of a marginalized and economically disadvantaged group (NAYSPS framework 2008). The Royal Commission on Aboriginal Peoples produced a report about suicide entitled Choosing Life in The document outlined various risk factors for suicide in Aboriginal communities: 1. Psychobiological factors pre-existing mental illness, cognitive style, anxiety disorders; 2. Life history of situational factors early childhood trauma, current dysfunctional family situations, child abuse, conflict with authority, absence of spiritual commitment. 3. Socio-economic factors- unemployment, poverty; 4. Culture stress loss of confidence in understanding life (norms, values, and beliefs that were taught to them within their original cultures) Chandler and Lalonde s 1998 report indicated that the Aboriginal youth suicide rates in BC were 4-5 times the rate of non-native youth: yet a decade later, the same tragic suicide rates remain. The report also revealed that Aboriginal communities have lower suicide rates when the community increases selfgovernment and power over the decisions in respect to education, language and culture of their own people; in fact, in some communities the suicide rate is nil (Chandler and Lalonde 1998). Chandler, M.J., and C. Lalonde. (1998). Cultural Continuity as a Hedge against Suicide in Canada s First Nations. Transcultural Psychiatry. Health Canada. (2008). National Aboriginal Youth Suicide Prevention Strategy Framework. Royal Commission on Aboriginal Peoples RCAP. (1995). Choosing Life: Special Report on Suicide Among Aboriginal People. Ottawa: Royal Commission on Aboriginal Peoples. 2 P a g e

6 The ASCIRT approach: Some First Nations and Aboriginal communities in British Columbia have adopted the Aboriginal Critical Incidence Response Team (ASCIRT) approach to suicide prevention and response. Although the initial name for this type of approach is ASCIRT each team has a unique name. It was brought up in Kelowna that an umbrella term other than ASCIRT should be used in the future because the work the teams are doing is focused on building community capacity, mobilization, education and support. For the purposes of this document, however, the term ASCIRT will be used. The goal of having a response team is not to replace what already exists, but to increase knowledge, awareness, capacity, and support a community in crisis. The main objective is to have a community based response team that will enhance primary suicide prevention efforts, and the existing community capacity to respond to community crises. The approach involves a cluster of communities or nations coming together and choosing members to participate in forming an incident response team. The members from each community obtain Band Council Resolutions (BCR) that stipulates the members are allowed up to 20 days during the year to be a part of the incident response team, while still maintaining their salary and job within their own community. The members from each community are then trained in mental health, the delivery of primary suicide prevention strategies, and critical incidence response to both suicide attempts and other crises within the community. The team involves many different types of responders such as clinical, knowledge keepers, traditional healers, and youth support to name a few. The community-based ASCIRT team is trained to respond to crisis within a culturally based protocol. The teams are also a part of a circle of outside clinicians and responders that can work in cooperation with the traditional methods to provide a holistic path to healing. The following descriptions of the teams will clarify how each cluster of communities has chosen to adapt their team from this approach. 3 P a g e

7 Team Descriptions: Inter Tribal Health Authority (ITHA - Nanaimo) - Kwa-Kwela-Xulti tu mustimuxw Kwa-Kwela-Xulti tu mustimuxw s is the Aboriginal Suicide & Critical Incident Response Team coordinated through ITHA. It is a team of trained First Nations community practitioners in the field of suicide education, prevention, community mobilization and crisis response. The team Coordinator provides training in suicide education, prevention and community mobilization to Chief and Council, Elders, community professionals, community members and youth. Kwa-Kwela-Xulti tu mustimuxw s vision is one of the communities being empowered to make a difference in the lives of their members. In addition, Kwa-Kwela-Xulti tu mustimuxw is also able to respond to a variety of community crises requiring emergency psychosocial services. Given the familiarity of the team members with the various communities culture and protocols they are able to respond quickly in assisting local practitioners as they move towards stabilizing the community following a tragedy. First Nations Action and Support Team (FAST) (Gitxsan) Embracing life through suicide awareness and community empowerment. The Gitxsan and the surrounding nation communities have been devastated with increasing numbers of attempted and completed suicides in recent years. Suicide affects us all and devastates family and community. In 2006, Gitxsan Health Society met with First Nations & Inuit Health Branch to discuss the possibilities of developing and implementing a crisis response team. This collaborative effort is currently comprised of 15 communities within the Nations of the Northwest corner of BC. Gitxsan Nation Kispiox, Glen Vowell, Gitanmaax, Gitsegukla, Gitwanga, Gitanyow Wet suwet en Nation Hagwilget and Moricetown Nisga a Nation New Alyansh, Gitwinsilw, Laxgaltsap and Gingolx Tsimshain Nation Kitsumkalum, Kitselas, Kitkatla The FAST program assists in the development, implementing, and establishing a trained team comprised of a member(s) from each of the 15 communities listed above who will commit to educating and empowering communities to mobilize in the time of a community crisis, specifically but not limited to suicide and suicide related issues.this approached is meant to complement existing services and present a coordinated effort to address community crises with an emphasis on holistic healing. 4 P a g e

8 Cowichan Spirit of Kweyulus Mustimuhw (Duncan) - Spirit of people of tomorrow The Cowichan people are a proud people and have come too far to allow the spirit of suicide to take our honor and our lives. We have survived the harshest of circumstances and together have beaten those circumstances, and we will continue to honor our ancestors and traditions by tackling the spirit of suicide as we have tackled many challenges, together as one with our ways of knowing. If we are dealing with the spirit of suicide we must develop suicide prevention and intervention programs that build on our spiritual strengths and teachings that come through our culture and language. These programs will include youth, adults and Elders, thus building our strength to work as one! Right now our team works with Cowichan Tribes, Halalt, Malahat and Lyachson and we have been contacted by other Nations for help on many health issues. Team members are continually trained in cultural and western models in the different areas of mental health such as: suicide prevention/intervention, anger management, lateral violence, and stress management, and importantly, how to bridge the two teachings together. Team members are truly building the spirit of people of tomorrow and empowering communities to take responsibility for their healing. Okanagan Nation Crisis Response Team (West Bank) The Okangan Crisis Response Team consists of front line workers who are able to help in community crises. They also deliver educational workshops. The team is built on the principal of Okanagan people helping one another. It respects and honors the gifts of the people who are already responding to the community by making themselves available to support others in times of crises. White Buffalo Team (Kamloops) The Aboriginal Suicide and Critical Incident Response Team are comprised of several community members who work as service professionals within the Kamloops region. We are honoured to have local community Elders and youth participate with and alongside the team. The team has completed training and is operational, providing presentations to youth groups, organizations and communities on many social issues identified by the host community or group. This development of sustainable relationships also assists the team when helping communities mobilize for a critical situation. We have/are responding to communities in crisis. 5 P a g e

9 The ASCIRT team is available to all First Nations groups on and off reserve, Inuit, and Metis. Organizations able to access the ASCIRT team include: band offices; friendship centers; Métis organizations; child and family service agencies; health centers; education centers and employment services. The team serves the following communities: Adams Lake Neskonlith Whispering Pines Bonaparte North Thompson Shuswap Nation Tribal Council Kamloops Skeetchestn Interior Metis Child & Family Services Little Shuswap Spallumcheen Two Rivers Metis Society Salmon Arm Metis Association Valemont Metis Association Interior Indian Friendship Society Secwepemc Child & Family Services White Buffalo Spallumcheen Child & Family Services Sexqulpqim Health Q wemtsin; Shuswap Family Resource and Referral Center Thompson Rivers University School District#73 Secwemc Cutural Eeducation Services Aboriginal Employment Services. The ASCIRT team is funded by the Ministry of Children and Family Development. The regional area that ASCIRT covers is the Shuswap zone as was defined by the Aboriginal Peoples Family Accord. The White Buffalo ASCIRT is currently deciding on a team name and logo and will be making the final decision in January 2009 at a team meeting. L.I.F.E TEAM (Merritt) Living is for everyone The service area for the LIFE team is from Lillooet-Shalath, Lytton-Canyon and Merritt- Nicola including the communities of Merritt, Nicola Valley, Lytton, Spuzzum, Ashcroft, Esquimalt, Seton Lake, Pavilion and Shalath. The focus of this group is suicide prevention. Its purpose is to strengthen Aboriginal communities by providing workshops and community based training that might lead to further training in matters such as drug and alcohol counselling, family violence, or address any other issues which might lead a person to feel desperate and consider suicide. Funding for this team comes from the Ministry of Children and Family Development for child and youth mental health projects, but suicide prevention is for all community members. 6 P a g e

10 Team Updates: The following updates were produced in Kelowna on flipcharts by the individual teams and they form the core information shared with each other. InterTribal Health Authority: ITHA was the 1 st ASCIRT team Serves 29 First Nations communities on Vancouver Island Name of ASCIRT means to save, to help people in need ASCIRT team to provide services to ITHA nations on Suicide prevention Ray McGuire, the previous clinical supervisor for the team, envisioned that all 29 First Nations would sign Band Council Resolutions that outlined 20 days per person per year could be spent on prevention and response as a part of the ACIRT team. The vision was when a crisis happened in one community, the ASCIRT team would respond, aside from the member who comes from the community where the crisis happened 24 people were signed up; however, by January 2008 only 8 people were active participants on the team. By the second year the Coordinator at the time and her husband were responding to all the crises that the team was called for After an independent evaluation of the team, it was decided that the ASCIRT approach was not working as intended and the communities of ITHA would be broken down into regions, North, Central and South So far, 2 communities have completed the 6 month training process that would teach how to train, respond and deliver prevention messages People did not have the time to deliver the training within their communities as volunteers and do their actual jobs. It was decided by ITHA to hire people to conduct the workshops. Current funding allows the hiring of 2 facilitators Now the goal is to support community based teams. Essentially it is a birth of a new process and implementation is changing from the original model The volunteers of the team are able to talk about family values through the tribal journeys that have taken place for years The Canoe Journey Life Journey was introduced a life skills workbook for First Nations communities, used along with their tribal journey, also used as a resource for Boys and Girls groups Currently, clinical support for the team is provided by Susan Butler The youth have connection to their past, their culture, their traditions, to Elders to other youth, to communities they visited, teachings our ways are strong and we are all family. 7 P a g e

11 FAST (Gitxsan) Four Nations Action and Support Team In August of 2007, due to the alarming rates of suicide within that year our team was formed: 8 suicides in 2006/2007 fiscal year within the Gitxsan area The team had 2 trainings, but quickly found out that they needed manuals and more (facilitation) comprehensive training to be able to follow such as program. There is overwhelming support from communities and stakeholders for the team For the first time 4 Nations came together for a common purpose and this included 15 communities There are 1-2 people volunteered from each community to be on the team, and they are committed to work with the team for 2 years October November 2008 there were 4 completed suicides in Nisga a territory, and the FAST team was mobilized. They identified families at risk and conducted debriefing sessions with the families. The family members responded that they felt better after the debriefing and the families became advocates for others in the same situations The Coordinator spends lots of time marketing the FAST team in communities, through newsletters, meetings, the media and word of mouth It has been difficult for members to complete the workshops within their communities. To date, one community has done a community workshop for high school students Cowichan Spirit of Kweyulus Mustimuhw (Cowichan): Spirit of the people of tomorrow Just started 2009 and we are working on all 7 of our reserves. ASCIRT started as a result of 2 shootings and one young person dying Teaching young people living in traditional and non-traditional worlds that they can help each other and their peers There is a need for intensive and extensive training to be current People who can t continue with program are still a resource Working with Ray McGuire to develop team in Cowichan Looking at our culture, using the Elders to develop a Wisdom team consists of Elders, and staff members Our people are ready to start healing Team members are taking a different angle of working with people of tomorrow. Working together with the young people, looking at their parents so they understand their young people and the young people will understand their parents and grandparents 8 P a g e

12 Balance spirit is balanced you learn to look after yourself and respect yourself and you won t hurt yourself or others When visiting 29 communities Elders and adults spoke about not having the culture, purchased 3 canoes for Canoe Journey and Life Journey (life skills program for Elders and youth working together), out of 35 Elders only 3 had been on a canoe journey When you pull a community together you learn how to work together and the community becomes stronger You can talk about suicide or you can talk about life We need a brand, a way for others to identify Okanagan Nation Crisis Response Team: The Coordinator provides the clinical support for the team members ONA team addresses violence due to the high volume of drugs and trafficking ONA took the idea of a team of volunteers from different communities from ASCIRT but came up with their own model that would work within their region. The Coordinator assessed individual team member s skill level and provided training and curriculum. Also, reassesses the team all the time to be sure that everyone is prepared to respond The Coordinator developed a policy and protocol manual for the team it includes protocol for accessing the team and for the team to go into the communities The team consists of knowledge keepers, counsellors, women, men, and youth Providing training to all skills levels was difficult, however team building was able to provide support There are 4-3day booster trainings a year that team members participate in, as well as a 1 day booster on vicarious trauma and lateral violence. The Coordinator also trained the band councils in the later of the trainings There is a minimum 2 year commitment, and so far 17 people are on the team from the 8 communities the ONA team serves Most of the support work is at funerals of violent deaths, murder trials, and shootings There is a program called R Native Voice that is run in each of the 8 communities and is funded by MCFD. The Coordinator used this program to deliver 2 extra modules on suicide and depression and developed the curriculum for these 2 extra sessions. As a part of their facilitators training and prevention work, they teach the 2 session The team has been fortunate that there has only been 1 crisis where they could not plan ahead, otherwise the Coordinator as time to assess who will respond to a crisis, and how the response will take place 9 P a g e

13 It is important to recognize that people at the front line level have a hard time distinguishing crisis from chaos, so the Coordinator developed a curriculum to do some pre-work with the band councils and front line work ONA approach includes pre work, work, and post-work, since it takes about 1 year for a traumatized community to be ready to do post work White Buffalo (MCDF funded) Kamloops: There has been a new coordinator since the beginning of October 2008 MCFD funds the team through core funding, and pays for travel and food The team covers Kamloops, Enderby, Salmon Arm, Clearwater, Adams Lake, and Spallumcheen Some communities said no to the idea of the ASCIRT team Started Critical Incident training Have used Elders and youth to promote the team in meetings The team is unable to service entire reserves, because of boundaries. LIFE (MCFD funded) Merrit: Since August 2007, MCFD funds the team through core funding It has taken about 6 months to contact RCMP, chiefs, school districts, nurses, as well as recruit team members Tried to follow the ITHA team concept Ray McGuire trained the team 6 days of training and team building, and 2 days of critical incidence response training, 2 days of ASSIST About half the team has a social work background while the other half don t MCFD reimburses the travel and food costs, while the time is borrowed from the volunteers jobs A 2 day suicide prevention and intervention training has been provided to the team The team responds to off-reserve, on-reserve, First Nations, Metis and Non-First Nations The team has input to what they do and don t do The mandate is that the team has to be called into a community. As well, the team needs to know the protocol for entering each community The team has capacity but needs proper funding to support their capacity. The team has been operational since June A team member passed away while on duty in Lytton and the entire team responded to their team member s family and community. The team will be responding to another murder trial in another community soon 10 P a g e

14 The team is doing a 4 th follow up to a 4 yr old who witnessed his father killing his mother The team works with victim services and families Upcoming Team: Sto:lo was invited to this gathering because they have submitted a proposal to begin the process of building a team. In the spring of 2008 Sto:lo held a stakeholders meeting and there was overwhelming support from community members and service providers. In attending this conference Sto:lo gained valuable insight into successes and challenges as presented by each of the teams. Challenges: During a plenary session, the teams collectively expressed challenges facing them. The response to incidents is often more costly and timely than planned. Year to year funding is stressful and makes it hard to plan ahead. It s difficult for the volunteers to travel and be away from their families. Team members are usually employed making it difficult to coordinate the response. Employers often want the team members to schedule time ahead but crisis aren t something one can schedule around ahead of time. Not all communities have bought into the ASCIRT approach. Meeting different community needs, with a diverse working group. It has been difficult to complete workshops within the communities as well as responding to crises. Not enough time to get into all communities so the team has to prioritize which communities to target based on the greatest need. In some teams, there is a lack of clinical support making team liability a concern. Working with hospitals/rcmp to collect data can be a challenge. Encouraging all team members to incorporate self care as a priority. It takes more than 6 months to educate and market the ASCIRT teams. Recruitment and retention the team members. 11 P a g e

15 Workshops: RespectED Workshop: Walking the Prevention Circle & Creating Safe Environments for Children and Youth. The RespectED workshop was presented by the Red Cross. The team members participated in this workshop. The target audience is First Nations/Aboriginal communities or people involved with such communities. The objectives of the workshop were: To present an overview of the three day Walking the Prevention Circle Training, Train the Trainer model, and Creating Safe Environments for Children and Youth process. To define the different types of abuse and neglect, their indicators and their effects on children and youth. To place child/youth maltreatment with the historical context of residential schools. To understand how to respond to disclosures of abuse and neglect, and to understand the required legal reporting process. To examine ways to proactively prevent abuse and neglect from occurring on individual, organizational and community levels. This workshop typically is held over a 3 day period but due to time restraints a shorter version was created. The Red Cross shared basic safety and process information to the participants. Grief and Loss Workshop: Objective: To pilot a few chapters from an Aboriginal Grief and Loss Manual Description: T55Caelano introduce the group to Aboriginal and Non-aboriginal ways of grieving in order to obtain their feedback about the efficacy of the manual. The manual is to help non-professional Aboriginal people initiate and provide support for other Aboriginal people who are experiencing grief and loss. Workshop: The Coordinators and Elders attended this workshop facilitated by Rod McCormick, however, the Coordinators wanted to use this time to exchange contact information and have a round table discussion of key concerns. The time was used for sharing local experiences of grief and loss. 12 P a g e

16 Self Care Session: As a way of acknowledging the work and commitment each ASCIRT team member has contributed to their Communities, Tuesday evening was set aside for self care activities. The Okanagan Nation Alliance organized this activity and it included such services as: Massage Pedicure/manicure Reflexology Tarot card reading Facial Chair Massage Rekki Coordinators Debriefing: Wednesday afternoon the Coordinators of the ASCIRT teams and the Elders spent the time networking and sharing their best practices. The closed door session was facilitated by Ron Hamilton. The feedback received from the Coordinators was that they wished they had more time to share and they wanted to have some fun built into their day. Activity: Wednesday afternoon was spent with the ASCIRT support team members participating in a scavenger hunt which was organized by the Okanagan Nation Alliance. The group was divided into teams and was given tasks to complete in a certain amount of time. The teams drove around Kelowna doing various activities that supported team building, trust, giving back to the community, and environment aspects. The participant response to this activity was positive and appreciated. 13 P a g e

17 APPENDIX A ASCIRT Gathering November 18 & 19, 2008 Cover Resort, West Bank, BC 4205 Gellatly Road Westbank, BC V4T 2K2 AGENDA Wednesday November 17, :00-9:00 am Breakfast is served 9:00-9:30 am Registration 9:30-9:45 am Opening Prayer Ron Hamilton 9:45-10:45 am Introductions and a brief description of your team and communities you represent 10:45-11:00am Nutritional Break 11:00-12:00 Continuation of Introductions 12:00-1:00pm Lunch is served 1:00-2:30pm Coordinators and Elders in Grief and Loss Workshop with Hilda Greene 1:00-2:30pm Red Cross Respect Ed Workshop All other Team members 4:30-4:45 Debriefing and Closing Circle Ron Hamilton 2:30-2:45 Nutritional Break 5:00-8:00pm Dinner on your own ( credit at the restaurant) 6:00-8:00pm Self-care appointments 14 P a g e

18 Thursday November 18, :00 am to 9:00 am Breakfast 9:00-9:30 am Opening Prayer Ron Hamilton check in 9:30-12:00 Continuation of Grief and Loss Workshop 9:30-12:00 Continuation of Respect Ed Workshop 10:45-11:00 am Nutrition Break 12:00-1:00pm Lunch is served 1:00 3:00pm Closed door session for Coordinators 1:00-3:00pm Team building - for all other participants, Health Canada & Ministry of Health Speak 3:00-4:30pm Closing Circle 15 P a g e

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