Provincial Aboriginal LHIN Network 2016-17 Annual Report
Cover page photo by Donna Lyons The Kettles The Kettles or 'concretions' that distinguish Kettle and Stony Point are of cultural and spiritual significance to the Anishinaabe. According to storytellers, who are also the oral historians of the First Nation, the Kettles are Thunderbird eggs. The Thunderbirds are powerful spirits that bring healing rains to the land and people; the point is said to be the nesting place for the Thunderbirds. For geologists the kettles are 'concretions', naturally occurring phenomena amongst sedimentary rocks that formed millions of years ago. There are many different sizes of kettles that range from miniscule to gigantic. In either case, the kettles are precious because of their rarity as there are few places in the world where kettles occur; however, there is no other place in the world that is home to the spherical concretions found in Kettle and Stony Point. Both the cultural and scientific explanations for the kettles are compatible because they speak volumes about environmental stewardship and the preservation of natural phenomena - Excerpt from Chippewas of the Kettle and Stony Point First Nation, History Arts Language and Culture website. 2
Table of Contents Moving Forward: Strengthening Relationships with Indigenous Communities and Organizations 4 PALN and LHIN CEOs Annual Meeting 4 Priority 1: Partnership Development with Indigenous Communities and Organizations 6 Priority 2: Primary Care 10 Priority 3: Advancing Indigenous Cultural Safety Training 14 Priority 4: Population Health 19 Indigenous Community Engagement and Planning 22 Moving Forward as Partners in Planning 22 References 23 Glossary 23 Members of the Provincial Aboriginal LHIN Network, 2016/17 Back row (L to R) Sarah May Garcia, ESC LHIN, Benedict Menachery, SE LHIN, Laura Kokicinski, NW LHIN, Suze Morrison, SW LHIN, Kate MacNeil, HNHB LHIN, Cynthia Stables, NE LHIN, Meaghan McCloy, CE LHIN, Larry Spence, NW LHIN Front row (L to R) Lindsay Blackwell, MOHLTC, Tanya Baniak, ESC LHIN, Tina Christman, NSM LHIN, Donna Lyons, Champlain LHIN, Carol Edward, C LHIN, Patrick Boily, MH LHIN, Ellen Blais, TC LHIN, France Tolhurst, WW LHIN 3
Moving Forward: Strengthening Relationships with Indigenous Communities and Organizations To better address Indigenous communities health needs, Local Health Integration Networks (LHINs) work alongside their local Indigenous 1 communities and organizations to make systematic health reforms. Improvements are needed, and the focus has been on: Strengthening relationships with Indigenous communities and organizations; engaging in dialogue to improve healthservice delivery and system change; and increasing culturally safe service delivery and care to enhance the quality of care for Indigenous people in Ontario. Regionally, this work is advanced with collaboration in each of the 14 LHINs. Provincially, system-wide changes are happening through collaboration across all LHINs. Each LHIN has a dedicated staff lead who facilitates dialogue with the Indigenous communities and organizations in the region. These LHIN Leads formed the Provincial Aboriginal LHIN Network (PALN), which is linked to the LHINs CEO table. PALN and LHIN CEOs Annual Meeting Beginning in 2011, the PALN and the LHIN CEOs have met annually to share information, wise and promising practices, and participate in local cultural activities and experiences. The meetings are a forum for discussion and dialogue on emerging issues and potential opportunities that exist at the systems level. With all 14 LHINs represented, the meetings also provide an opportunity to identify common priorities, and are the foundation for addressing Indigenous health planning across the province. This year, the meeting was hosted by the Erie St. Clair LHIN and held at the Chippewas of Stony and Kettle Point First Nation. Chief Tom Bressette welcomed the participants to their beautiful community. A key outcome of the meeting was the development of a two-year work plan to guide PALN activities. Chief Tom Bressette from Chippewas of Kettle and Stony Point First Nation 1. Aboriginal peoples of Canada are defined in the Constitution Act, 1982, Section 35 (2) as including the Indian, Inuit and Métis peoples of Canada. The terms Indigenous and Aboriginal are used interchangeably in this report depending on the preferences in each LHIN area. 4
Dr. Chris Mushquash, Associate Professor, Department of Psychology, Lakehead University - Speaker Common priorities were expanded to include the annual meeting s participant feedback, and the commitment in the Ministry of Health and Long-Term Care s (Ministry) Patients First: Action Plan for Health Care which is to continue the dialogue on how to strengthen Indigenous voices in system planning and health-service delivery. Jordan George, Stacey George, and Jeffery George, Chippewas of Kettle and Stoney Point First Nation This report will provide a snapshot of the progress made in 2016-17 on collaborative activities across the 14 LHINs related to Indigenous engagement and planning. Priorities include: Partnership Development with Indigenous Communities and Organizations; Primary Care; Advancing Indigenous Cultural Safety Training; and Population Health. 5
Priority 1: Partnership Development with Indigenous Communities and Organizations Patients First: Action Plan for Health Care outlines a commitment to work with First Nations, Métis Inuit and urban Indigenous partners to strengthen their voices in system planning and services, with respect to equitable access to services that meet their unique needs. Since their inception in 2008, the LHINs have worked in partnership with local Indigenous health committees to facilitate meaningful dialogue that leads to necessary changes in health service delivery and the health system. Collaboration within each LHIN health care system has advanced this work regionally, and collaboration across the LHINs continues to occur to advance system wide change across the province. Working with local Indigenous health committees remains a priority. As a result, PALN identified the need to further enhance and strengthen the relationships at the local level to support the continued engagement related to Patients First. This includes developing and implementing effective processes and strategies to strengthen communication and engagement with Indigenous communities and organizations. This will ensure that Indigenous voices are included at all stages of health system transformation in Ontario. Each LHIN region is unique. As a result, approaches to partnership, dialogue and health service planning with Indigenous communities and organizations varies. Grand Bend, Ontario 6
Here is a summary of progress in partnership development with Indigenous communities and organizations in each LHIN region: Erie St. Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton A three year Indigenous Health Strategic Plan was established by the Indigenous Health Planning Committee (IHPC). Priorities for 2016/2017 fiscal year which aligns with PALN priorities include: increasing cultural awareness, increasing direct primary care supports, improving patient navigation and supports, assessment of the palliative care needs, and increasing traditional healing supports within Indigenous communities. The Erie St. Clair LHIN and the board members have conducted individual meetings and sessions with local Indigenous leaders to discuss their localized needs and challenges. The LHIN has also been facilitating discussions and dialogue between HSP s and Indigenous communities to support the creation and maintenance of the direction relationships. The South West LHIN has developed an enhanced plan of action designed to strengthen accountability for the Patients First implementation with the goal of including Indigenous peoples at the forefront of this work. Recently their Indigenous Health Committee was restructured and a roadmap was developed for Indigenous inclusion and reconcili-action. The Indigenous web page has been updated to provide more information on Indigenous engagement. The Waterloo Wellington LHIN previously developed a strategy in partnership with the Indigenous community. Current efforts have been focused on the implementation of the strategy. The community is also involved in all planning activities in regard to the Patients First implementation. A new Indigenous health and wellness program has been funded in Wellington County and works in collaboration with a similar program in Waterloo Region. A partnership between the Hamilton Niagara Haldimand Brant LHIN, Six Nations of the Grand River, physicians and health service providers led to the development of an action plan that identified key priority areas for improving access to care for community members. These areas of focus include primary care, traditional medicine and home care. In addition to supporting the priorities in the action plan, the LHIN engaged and worked with health service providers to support the delivery of community driven and culturally based programs and services. The LHIN has also engaged actively to both inform communities and solicit feedback and recommendations in any significant changes as a result of Patients First. A collaborative work plan was developed between the Central West and Mississauga Halton LHINs which aims to work more effectively with Indigenous communities in the two catchment areas, creating opportunities for collaboration and maximizing resources in an effort to advance Indigenous health and well-being. Attendance at various Indigenous community meetings and events occurred and active involvement with the Peel Aboriginal Network (PAN) and the Métis Nation of Ontario Credit River Métis Council (MNO-CRMC) took place. 7
Toronto Central Central Central East South East Champlain In partnership with the Toronto Public Health and the Toronto Central LHIN, the Toronto Indigenous Health Advisory Committee (TIHAC), launched the first ever Toronto Indigenous Health Strategy in 2016. The report was released at a community feast, and presented to the LHIN board members. The LHIN has begun implementation of the recommendations to reduce health inequities for Indigenous People by implementing the recommendations in the report beginning in The LHIN has launched a co-design project for two-spirited and will continue in 2017-18. The Central LHIN has developed its annual community engagement plan which focuses on strengthening relationships with First Nation and urban/rural communities and organizations. The LHIN has Indigenous representation on its Citizens Health Advisory Panel. The Central East LHIN has developed an Indigenous Partnership Strategy, which resulted in the establishment of two Indigenous Health Advisory Circles that meet on a bimonthly basis. The effectiveness of this engagement strategy is measured bimonthly and on an annual basis through attendance information and member reports. Central East LHIN staff regularly engage with Indigenous health service providers, communities, and leaders on an in-person basis and in their home communities. This health care planning partnership will advise additional investments in Indigenous health care initiatives moving forward. The South East LHIN s Napanee Area Community Health Centre opened its new site, which included a dedicated sacred space for its Indigenous Health Program. The LHIN also met with the Mohawks of the Bay of Quinte to discuss the needs of their community. That discussion focused on the need for enhanced engagement with the community in light of the organizational transition within their community and the LHIN. Work began more broadly on the development of a region-wide engagement initiative, with initial talks held with the Indigenous Health Council based out of the Kingston Community Health Centre. The ultimate goal of these meetings will be to develop an Indigenous engagement protocol to support the LHIN in working with the First Nations, Inuit and Metis communities moving forward. A strategy session was held with the Indigenous Health Circle Forum (Circle) to identify ways to further strengthen the relationship between the Circle and the LHIN. The discussion was positive and focused on the need for parallel processes for Indigenous engagement. It also centred on the recommendations outlined in the report called Now Now Now: Mental Wellness for Indigenous Youth to increase the understanding of culturally based care, why a new Indigenous-led approach to service delivery is needed and how mainstream organizations can lend their support. LHIN support on a culture as treatment approach has been enthusiastic and integral to moving forward. The Circle s web page has recently been updated to provide a broader range of information on Indigenous initiatives. 8
North Simcoe Muskoka A strategy is in place which guides the North Simcoe Muskoka LHIN on engagement with Aboriginal communities and organizations. The strategy outlines the ways in which the LHIN connects with the Aboriginal Health Circle (AHC) and Indigenous community leaders in the area. A visioning day was held with the AHC. In addition the LHIN partnered with the AHC to host the Annual LHIN Care Connection Health Forum which was a huge success. The LHIN has recently updated the Indigenous, Métis webpage to provide more information on initiatives. North East The North East LHIN launched the Aboriginal Health Reconciliation Action Plan in 2016. The Plan encompasses four main strategic directions: Opportunities (East), Relationships (South), Knowledge and Understanding (West), and Evaluation (North). Established in 2009 the Local Aboriginal Health Committee (LAHC), advises the NE LHIN board members about priorities, community engagement, integration/ coordination/realignment opportunities and health care investments. The LAHC oversees the implementation of the Plan. The Plan is also aligned with the NE LHIN Mental Health and Addictions Action Plan. Two community engagement sessions, a special meeting of the LAHC and an online survey were held in February 2016 to gather input and respond to the MOHLTC Patients First. North West A communications, engagement and work plan strategy for 2017-2018 with Indigenous stakeholders is in development and includes the priorities identified under Patient s First. There will be a strong focus on inclusion of Indigenous partners in population health planning at the Sub-region and regional level. The North West LHIN has actively worked with the Aboriginal Health Services Advisory committee, First Nation stakeholders and provincial/federal government partners to jointly identify and plan initiatives that will improve access to health care services across the region. 9
Priority 2: Primary Care Undertake meaningful involvement of Indigenous communities and organizations in the development of and/or implementation of LHIN sub-regions The Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario discussion paper released in December 2015 focused on effective integration of services and greater equity through sub-regions as well as timely access to, and better integration of primary care. Services that address needs of Indigenous people across Ontario were a key focus and included a plan for meaningful engagement to address the unique health care needs and identify changes that were needed to health care delivery. Ontarians provided feedback to the discussion paper including Indigenous partners, which would inform the next steps of the Patients First: Action Plan for Health Care. Drum belonging to Jordan, Stacey and Jeffrey George In 2016, the legislation was passed to amend the Local Health System Integration Act, 2006 (LHSIA) and the Home and Community Care and Community Services Act, 1994 (HCCSA, among other statutes. In 2016, all LHINs have established subregions to plan performance improvement and service integration at the community level. To support this, the PALN work plan included a deliverable on engagement with Indigenous communities and organizations on the development of sub-regions in each LHIN area. 10
A summary of the sub-region dialogue with Indigenous communities and organizations includes the following: Erie St. Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central A total of six sub-region consultations sessions were conducted with local Indigenous communities/organizations to provide recommendations for the geographical sub-region boundaries. Regular progress and updates regarding the creation of the sub-region boundaries were provided to the IHPC. Prior to the sub-region discussions seven Patient s First consultation sessions were conducted with local Indigenous communities/organizations to inform them of the aim and focus of Patient s First proposal. The LHIN CEO and board members met with local Chiefs to update them on the boundaries and the transition. Meetings will continue in 2017-18 with all Indigenous communities and organizations. The LHIN has engaged the Indigenous Health Committee (IHC) on sub-regional planning every 8 weeks since March 2016, and in February 2017, the Committee made recommendation to the LHIN board members on a transitional Indigenous Collaborative Leads model to increase the accountability and continuity of Indigenous voice in decision making at the sub-regional Integration tables and leadership tables for an 8-month period of time commencing September 2017. By the end of the transitional collaborative leads model, a formal Indigenous integration strategy will be in place as one of the outcomes of a process of engagement and consultation with every Indigenous community, as well as formal recommendations from the IHC. Consultations were held with the Indigenous community on Patients First and the best way to meet the needs of the community for primary care including traditional healing. The specific needs of each sub-regions is addressed through the Indigenous Health and Wellness programs in Waterloo Region and Wellington County. Meetings were held with Indigenous partners to develop a plan for appropriate and equitable inclusion in sub-region planning. Subsequent engagement sessions were held with all Indigenous partners. Feedback from the partners included the need to plan across all sub-regions to strengthen the voice of Indigenous communities. Indigenous partners have committed to quarterly sub-region planning meetings and will identify core expectations for Indigenous people s health to consider in planning and decision making across all sub-regions. Regular quarterly planning meetings took place with our local Indigenous Elder, as well as engagement with our Indigenous community organizations. Identification of Indigenous specific priority health needs led to the development of a business case (Indigenous Holistic Wellness Project) and Terms of Reference were drafted for our upcoming Indigenous Advisory Health Circle. Informal discussions providing an overview of Patients First legislation and vision took place at our meetings with the Peel Aboriginal Network and the Métis Nation of Ontario-Credit River Métis Council. The Toronto Indigenous Health Advisory Committee was consulted by the Toronto Central LHIN on the development of sub-region boundaries. As well, Indigenous partners across the LHIN and Indigenous representatives on the Citizen s Panel have participated in sub-region consultations and planning. Feedback included the need accurate and appropriately-sourced data on health status and socio-demographic information of Indigenous people to inform equitable planning and service delivery. 11
Central Central East South East Champlain North Simcoe Muskoka North East North West Meetings were held with Indigenous leaders to discuss sub-regions and considerations for future planning. The Central East LHIN is in the process of developing a strategy for sub-region engagement and planning. In the past, Indigenous communities have expressed that they did not have the infrastructure capacity to participate within the seven Health Links Communities planning tables. To address this challenge, the LHIN has provided funding to support the provision of community specific mental health and addiction outreach services in each of the four First Nations and in the urban areas. One of the expectations of these new positions is that they will provide the capacity for each Community to engage with the LHIN at the sub-region planning tables. An Indigenous engagement strategy will be an integral part of the sub-region structure as the LHIN moves forward with establishing these tables. In addition, sub-region profiles have provided data that will permit a focused Indigenous engagement strategy throughout the LHIN. A round of sub-regional talks is being planned for 2017-18 which will include outreach to the Indigenous community to gather their feedback on how best to partner together. Quarterly meetings are also being planned between the Mohawks of the Bay of Quinte and the South East LHIN. In addition, the LHIN began seeking an Indigenous community member to sit on our Patients and Family Advisory Committee. The Champlain LHIN held a series of engagement sessions in five key areas of the region and a focused session with the Indigenous Health Circle Forum (Circle). Indigenous representation from the Circle member organizations occurred throughout all engagement activities. The Circle has committed to conduct planning in partnership with the LHIN to focus on further on addressing Indigenous health needs in sub-region planning in 2017-18. Engagement sessions were held with Indigenous communities to gather feedback on Patients First to inform the development of the five sub-regions. The North East LHIN plans to build and expand collaboration with Indigenous communities and organizations to gain an understanding of the LHINs Sub-Regions, and other initiatives such as Health Links, Rural Health Hubs to identify specific approaches for Indigenous communities and organizations. As well, the LHIN worked closely with the MOHLTC Primary Care Branch and the Association of Ontario Health Centres (AOHC) to conduct engagement sessions with various First Nation representatives in North Bay, North Cochrane and James Bay Coast related to the expansion of Indigenous Interdisciplinary Primary Health Care Teams. LHIN sub-regions have been in place informally for the past six years (previously known as Integrated District Networks) under the Health Services Blueprint model in the North West LHIN. Planning is currently underway to formalize communities of practice at the Sub-region level with a focus on the priorities listed under the LHIN mandate. Engagement with Indigenous communities and stakeholders will be fostered through relationship building and inclusion in population health planning at the Sub-region level. 12
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Priority 3: Advancing Indigenous Cultural Safety Training Evidence informed Indigenous cultural safety training can have an immediate impact on improving relationships between Indigenous people and their health care providers. The training addresses the need for increased Indigenous cultural safety within the system by bringing to light service provider bias, and the legacies of colonization that continue to affect service accessibility and health outcomes for Indigenous people. This can improve the patient/client experience, enable more equitable access to services, and contribute to a more culturally safe system of care. All LHINs support advancing Indigenous cultural safety (ICS) and/or Indigenous cultural competency training (ICC) within their LHIN. This work is considered foundational to the work of all LHINs and continues to be a priority of the PALN. This year, the Ministry funded foundational online core health/mental health ICS training for service providers working within LHINs funding health service provider organizations. The LHINs are uniquely positioned to influence a higher level of awareness and participation to provide more culturally safe services to Indigenous people both in their own organizations and through their funded health service providers. Indigenous Leads in each LHIN facilitate training for the LHIN board members, senior leadership and staff. The lead also encourages health service providers to commit to ICS/ICC training for their staff. The LHIN regions are unique and differ in their approaches to ICS/ICC training, and are at varying stages of planning and implementation. The Ontario ICS Program funded through the Ontario First Nations Health Action Plan aligns with provincial and regional equity goals and the need to prioritize the improvement of access to culturally safe health services and ultimately indigenous health outcomes. The main goals of the program are to facilitate and promote ICS training and uptake, employing evidence informed and coordinated training for all health care staff. The program works across the LHINs and all health/public health sectors to build collaborative partnerships geared to support organizational and systemic changes that will improve patient experiences. The foundational core ICS health and mental health online training modules were developed specifically for Ontario by Indigenous stakeholders in partnership with San yas ICS Program in British Columbia. 8,000 health care providers in Ontario have now taken the training. The Ontario ICS Program is administered by the Southwest Aboriginal Health Access Centre, originally funded by the SW LHIN and now employs a provincial team including a Director, Registrar and Practice Leads. In 2016/17 the Program worked collaboratively to have more than 4000 people registered for online training and partnered with BC to offer a free National ICS Learning Series, including six webinars with speakers from across Canada and beyond. Up to 2000 people registered for each webinar. The webinars can be viewed at www.icscollaborative.com 14
Here is a summary of each LHINs progress in advancing ICS or ICC training as of March 31, 2017. To provide the context on the reporting, please note the following: Since 2014, ICS training has been provided for LHIN board, management and staff. The training is reported on a cumulative basis; In 2016/17 the focus for training expanded more broadly across the LHINs for health service provider organizations (some LHINs offered training prior to this); In 2016/17, the Ministry of Health and Long Term Care provided funding for 3,951 online core health/mental health training seats offered through the Ontario ICS program. The seats were allocated across the LHINs based on a weighted criteria that considered each LHIN s percentage of total provincial population, percentage of total provincial Indigenous population, and percentage of total provincial LHIN-funded full time employees (FTEs). Funding was released in November and all seats were assigned to individuals by March 31; Some LHINs purchased additional seats in 2016/17 (LHIN and Ministry funded seats reported together); and Some LHINs have been providing training since 2014 or earlier which includes both the core health/mental health online training and other types of of training. Erie St. Clair The focus for the year was on compiling various learning tools and resources (presentations, patient videos, resource materials, and on line sessions) that can be tailored to specific audience/target group. 100% of LHIN staff and senior management and 60% of the board members have received Indigenous cultural awareness training consisting of in-person training sessions (in 2014/2015), lunch and learn sessions (three were conducted in 2016/2017) and the online core health/mental health ICS training. In the Fall of 2017, an in-person half day awareness training session will be provided to the staff and board members. As of March 31, 168 staff members from health service provider organizations were registered in the online core health/mental health ICS training. Of these, 139 successfully completed the training by the end of March. A total of 315 people have successfully completed the online core health/mental health ICS training since 2014. South West Training in the South West LHIN includes a combination of different modules in the ICS online training such as core health/mental health and post training such as Ally to Bystander and Unpacking the Colonial Relationship. 83% of senior management, 57% of staff and 50% of the board members have taken training. As of March 31, 824 staff members from health service provider organizations registered in the online core health/mental health ICS training. Of these, 740 successfully completed the training by the end of March. A total of 2,044 people have successfully completed the core health/mental health ICS training beginning 2013. Recently, there has been turnover in board members; however the board members have adopted a policy to make the training mandatory. 15
Waterloo Wellington Hamilton Niagara Haldimand Brant Waterloo Wellington LHIN is in year three of a five year training plan. 70% of LHIN staff and 71% of senior management have taken ICS training. Plans are underway to provide training to the LHIN board members in the fall due to turnover. As of March 31, 163 staff members from health service provider organizations registered in the online core health/mental health ICS training. Of these, 140 successfully completed the training by the end of March. A total of 175 people have successfully completed the online core health/mental health ICS training since 2014. An additional 150 staff members took face to face one day training that the LHIN offered in each of the sub-regions. 96% of LHIN staff, 75% of senior management and 75% of the board members have completed the online core health/mental health ICS training. Other staff have participated in the ICS Collaborative Learning Series webinars and board members participated in training facilitated by De dwa da dehs nye>s Aboriginal Health Access Centre. Recently appointed board members are currently enrolled in the online core health/mental health ICS training to be completed in 2017. As of March 31, 465 staff members from health service provider organizations registered in the online core health/mental health ICS training. Of these, 387 successfully completed the training by the end of March. A total of 553 people successfully completed the core health/mental health ICS training beginning 2015. Central West 50% of LHIN staff and senior management and 22% of LHIN board members have received the online core health/mental health ICS training. In 2017/18, the LHIN has made ICS training a priority for all senior management, board members and home and community care staff. Additional training was provided by a local Indigenous Elder. As of March 31, 143 staff members from health service provider organizations registered in the online core health/mental health ICS training. Of these, 119 successfully completed the training by the end of March. A total of 145 people successfully completed the online core health/mental health ICS training since 2014. Mississauga Halton 59% of LHIN staff have completed the Indigenous Cultural Safety (ICS) online training and in March 2016, senior management members participated in Indigenous Cultural Competency training facilitated in person by our local Indigenous Elder. As of March 31, 214 staff members from health service provider organizations registered in the online core health/mental health ICS training. Of these, 197 in 19 LHIN funded organizations successfully completed the training by the end of March. A total of 222 people successfully completed the online core health/mental health ICS training since 2014. There is an existing waitlist for 2017-18. 16
Toronto Central Plans are underway to offer the online core health/mental health ICS training to the LHIN board members, and expand the training throughout the LHIN. Training in the Toronto Central LHIN region includes a combination of training provided by the Ontario Federation of Indigenous Friendship Centres and online ICS training. 77% of LHIN board members and 50% of LHIN staff have completed training. As of March 31, 574 staff members from health service provider organizations registered in the online core health/mental health ICS training. Of these, 449 successfully completed the training by the end of March. A total of 636 people successfully completed the online core health/mental health ICS training since 2014 and over 3,000 staff from 103 organizations have participated in face to face training offered through the Ontario Federation of Indigenous Friendship Centres. Central 100% of LHIN staff, senior management and board members have completed both ICC and ICS training. Training in the Central LHIN includes a combination of training provided in collaboration with the Ontario Federation of Indigenous Friendship Centres and online ICS training. As of March 31, 279 staff members from health service provider organizations registered in the online core health/mental health ICS training. Of these, 241 successfully completed the training by the end of March. A total of 243 people successfully completed the online core health/mental health ICS training since 2014. Central East 100% of LHIN staff, senior management, and board members have either completed or are currently registered in the online core health/mental health ICS training. As of March 31, 324 staff members from health service provider organizations registered in the online core health/mental health ICS training. Of these, 264 successfully completed the training by the end of March. A total of 363 people successfully completed the online core health/mental health ICS training since 2014. All LHIN funded health service providers are required to demonstrate their compliance with offering services in an Indigenous culturally safe context. South East 60% of LHIN board members, 80% of LHIN staff and 50% of senior management have completed ICS training. As of March 31, 150 staff members from health service provider organizations registered in the online core health/mental health ICS training. Of these, 136 successfully completed the training by the end of March. A total of 220 people successfully completed the online core health/mental health ICS training since 2014. Champlain Training in the Champlain LHIN includes a combination of face to face training, online ICS training and ICS Collaborative Learning Series webinars and other educational activities. 98% of LHIN staff, 100% senior management, 90% of LHIN board members completed training. 17
North Simcoe Muskoka As of March 31, 597 staff members from health service provider organizations registered in the online core health/mental health ICS training. Of these, 525 successfully completed the training by the end of March. This includes staff from 60 organizations and 10 health links. A total of 773 people successfully completed the online core health/mental health ICS training since 2014. All LHIN funded health service provider organizations are required to report to the LHIN on any Indigenous cultural training they have taken. Training in the North Simcoe Muskoka LHIN includes a combination of training provided by the Barrie Area Native Advisory Circle and online core health/mental health ICS training. To-date, 50% of the LHIN board members, 100% of senior management and 94% of LHIN staff have completed training. As of March 31, 191 staff members from health service provider organizations registered in the online core health/mental health ICS training. Of these, 173 successfully completed the training by the end of March. This included Health Link Steering Committees and hospital mental health and addiction leads. A total of 190 people successfully completed the online core health/mental health ICS training since 2014. North East 98% of LHIN staff and senior management and 100% of board members received cultural safety training. In June 2016, N Mninoeyaa Aboriginal Health Access Centre in Cutler offered board members and senior management a session to help increase their understanding of Aboriginal people, their language, culture, and history. In September 2016, LHIN board members and staff attended a one day cultural safety training session at the Anishinabe Spiritual Centre. As of March 31, 396 staff members from health service provider organizations registered in the online core health/mental health ICS training. Of these, 348 successfully completed the training by the end of March. A total of 510 people successfully completed the online core health/mental health ICS training since 2014. The LHIN is currently planning in-person cultural competency training targeting front-line staff working in the Schedule 1 hospitals targeting high user units specifically ER, Mental Health and Addictions and Maternal/Child North West 100% of LHIN staff and 98% senior management and board members staff have completed ICS training. A plan is being developed to expand this training to all staff in 2017/18. As of March 31, 150 staff members from 20 health service provider organizations registered in the online core health/mental health ICS training. Of these, 128 successfully completed the training. A total of 197 people successfully completed the online core health/mental health ICS training since 2014. 18
Priority 4: Population Health Patients First: Action Plan for Health Care calls for stronger linkages between health and population health. The intent is for LHINs and public health units to work more closely to align their work, and ensure that population and public health priorities inform health planning, funding and delivery. Anticipated performance improvements are that Health service delivery better reflects population needs; Public health and health service delivery will be better integrated to address the health needs of populations and individuals; Social determinants of health and health equity are incorporated into health care planning; and Stronger linkages between disease prevention, health promotion and care are made. Despite advancements in Indigenous health, Indigenous people face the greatest health disparities in Canada. Equity is important to Indigenous people because Indigenous health is exemplified by systematic disparities in health outcomes, exposure to the determinants of health, health system responsiveness and representation in the workforce. (Champlain Indigenous Health Circle Forum, 2017) One of the impacts of colonization and aggressive assimilation policies of the government has led to discrimination and racism of Indigenous peoples which further contribute to Indigenous health inequities. In Canada these impacts have only been experienced by the Indigenous people and no other at risk group. (Champlain Indigenous Health Circle Forum, 2017) This calls for a stronger and more focused approach with multiple partners to address the health inequities faced by Indigenous people. The goal of PALN is to further work on initiatives to address gaps in health services for Indigenous people. 19
Here is a summary of the health equity initiatives undertaken by each LHIN: Erie St. Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Planning has begun on a list of indicators and assessment criteria for the Indigenous Health Strategic plan. A review of the public health program and services standards was completed and future meetings are planned devoted towards aligning health equity efforts locally. Health equity reports are a requirement of all LHIN funded health service providers and work has begun to align the reports with QIP Health Equity elements with Health Quality Ontario. The South West LHIN has conducted a Health Equity Impact Assessment on the transition and detailed a matrix to manage, monitor and amplify areas across the LHIN with respect to Indigenous Health in order to improve direct patient care; enhance Indigenous engagement and inclusion and address opportunities to create improvement in Indigenous health as the system transforms. A gap analysis on health services for the Indigenous community has been conducted. Work has begun to address the gaps in services. An Indigenous Health and Wellness program established in Wellington County (Guelph) to complement the existing program in Waterloo Region. The LHIN is also working in partnership with the Public Health Units in order to support each other in addressing the determinants of health which are very important to improve the health status of the Indigenous residents. Other partnerships include the Regional Police department, justice system and housing providers in both Waterloo Region and Wellington County. A health equity working group has developed a work plan to guide work throughout 2017-18. This consists of the development of a health equity action plan, a plan to educate and promote health equity across LHIN staff and health service providers to increase knowledge of and commitment to health equity, and to incorporate a health equity lens into sub-region planning. The Central West LHIN in collaboration with Colour of Change - Colour of Poverty (COC-COP) completed a pilot project on health equity data collection with early adopter health service providers. The data will be used to improve access for populations that should otherwise be utilizing the services. The LHIN has developed and vetted the LHIN s Health Equity Charter with local and provincial stakeholders. The charter outlines 8 areas of shared responsibility that will require the integration of health equity strategies, actions and improvements that fall within the LHIN s mandate. The Charter is intended to be utilized as a living document for equity planning, that considers the evolution of the the LHIN s landscape and needs of our diverse residents, serving as a guide and inspiration to improve equitable access and care to our residents. The Mississauga Halton LHIN has been an early adopter of the 8 core socio-demographic data collection questions which includes questions on racial or ethnic status. As part of our Health Equity Data Collection Project Focus Implementation Sites, health service providers in the Mississauga Halton LHIN championed best practice and participated in a community of practice. Our health equity work to date has established a strong foundation to build on and support sub-regional planning with health service providers and stakeholders. This positions our LHINs well to support advancement of the provincial Patients First agenda at the local level. 20
Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West The Toronto Central LHIN has established a population health and health equity leadership table and strategy table. Three advisers from TIHAC are participating. Data collection includes data compiled by Well Living House, Centre for Urban Health Solutions, Our Health Counts, the mental health and addictions data set, and the trans and two spirited data set to inform the health equity policy and measurement. The Central LHIN has a requirement for health service providers to submit a health equity report every two years. The report is used to inform and support the effective planning of resources across Central LHIN. As one of the LHINs with the most diverse populations in Ontario, Central LHIN embeds a health equity lens in local health system planning. Other priority population groups include Indigenous and French speaking residents/francophone communities. The Central East LHIN has begun the process to establish criteria for a baseline assessment of health equity status. The Health Equity Impact Assessment (HEIA) tool will inform the assessment and will align with the sub-regions framework. Further consultation will occur with the Indigenous communities and Advisory Circle members to obtain advice and determine the applicability to their communities. The South East LHIN has committed to provide funding for an Indigenous Nurse Practitioner in partnership with the Mohawks of the Bay of Quinte for the 2017-18 fiscal year. The LHIN also began working with community partners such as the South East Regional Cancer Program, to support raising awareness of available health care services for the Indigenous community to build trust and encourage increased usage. In addition, a palliative care engagement session was held to inform the Indigenous community on the provincial palliative care plan and to determine how to work together on a regional palliative care plan. The Champlain LHIN in partnership with the Indigenous Health Circle Forum (Circle) hosted an Indigenous Health Equity and Wellness think tank session. A draft IND-Equity Framework was developed which will inform future planning and will help guide the Circle and the LHIN to address gaps in health services for Indigenous people. Data collection efforts are underway and requests for data have been sent to the Simcoe Muskoka District Health Unit to provide population health data with the intent to establish a baseline. The LHIN in partnership with the Aboriginal Health Circle works with health service providers to collect voluntary self-identification data on the Indigenous population. The Indigenous lead participates on the provincial health equity table. The North East LHIN conducted a survey of Aboriginal health practices across north eastern Ontario to aid in the implementation of the Aboriginal Health Care Action plan. The survey was distributed to 300 individuals and a response rate of 28% was achieved, of which 35% were Aboriginal and 65% non-aboriginal. A discussion on a baseline assessment is underway with the intent to map out a NE LHIN health equity strategy. Identification of health priorities for the Indigenous population was informed through an extensive community engagement process carried out in 2016/17. An analysis of data provided information on health care utilization of Indigenous people versus the general LHIN population. Plans are underway to develop a health equity strategy in 2017/18. 21
Indigenous Community Engagement and Planning Through provincial legislation, the LHINs have a mandate to plan the delivery of health services for the population they serve, including Indigenous people. By building mutually respectful relationships and through direct engagement with regional Indigenous communities and leadership, LHINs have been able to develop regional Indigenous health strategies, which often incorporate a holistic view of health and wellness based on Indigenous worldviews. Locally, each LHIN continues to build and strengthen relationships with regional Indigenous communities and organizations. Most LHINs have developed Indigenous advisory structures to provide guidance and recommendations for appropriate and respectful engagement with inclusion of Indigenous people, communities and organizations. These advisory circles, networks and / or committees provide a connection between the health care system and Indigenous Kettles at Chippewas of Kettle and Stony Point First Nation communities so that key strategies, plans, and services can be identified and designed. PALN will continue to work with Indigenous communities and organizations at the local level. The goal is to ensure that Indigenous people are fully informed and involved as the LHINs plan and implement sub-regions and other initiatives stemming from Patients First. As LHINs develop relationships to support a more integrated approach to planning and engagement, new partnerships have provided more opportunities to adapt and enhance existing services or supports to be more culturally appropriate. Moving Forward as Partners in Planning Next Steps: The LHINs will continue to collaborate and strategize on critical needs, including the four areas of focus: o Partnership Development with Indigenous communities and organizations; o Primary Care; o Advancing Aboriginal Cultural Safety Training; and o Population Health The LHINs will meet in November 2017 to review the PALN work plan. This is important to: o Ensure it reflects any updates related to Patients First and other priorities for the second year of the two-year work plan; and o Begin planning discussions for the 2019-20 work plan. 22
References Champlain Indigenous Health Circle Forum. (2017). Developing an INDigenous Equity Framework for Improving Health Outcomes for Indigenous People in the Champlain LHIN Region: A Discussion Paper. Ottawa. Glossary Aboriginal Health Circle (AHC) - North Simcoe Muskoka LHIN Aboriginal Health Services Advisory Committee - North West LHIN Indigenous Health Advisory Circles - Central East LHIN Indigenous Health Circle Forum (Circle) - Champlain LHIN Indigenous Health Committee - South West LHIN Indigenous Health Council - South East LHIN Indigenous Health Planning Committee (IHPC) - Erie St. Clair LHIN Local Aboriginal Health Committee (LAHC) - North East LHIN Local Health Integration Network (LHIN) Ministry of Health and Long-Term Care s (Ministry) Peel Aboriginal Network (PAN) - Mississauga Halton LHIN Provincial Aboriginal LHIN Network (PALN) Toronto Indigenous Health Advisory Committee (TIHAC) - Toronto Central LHIN 23
o Begin planning discussions for the 2019-20 work plan. 24