Community Development Approach

in the

First Nations and Inuit Health Branch: Building Health Capacity in Communities

August 2011

2

Overview • Rationale for new approach

• What is community development?

• Principles of Indigenous Community Development

Importance of Cultural Competence

• New Community Continuum model for discussion

• Approach and direction:

CDCB National Advisory Committee

CDCB Framework / Lens

Facilitate continuous learning opportunities for FNIHB employees

Support innovative community-based planning, partnerships and sharing of lessons learned

Capacity Building in First Nations and Inuit Communities

Partnerships for Community Well-being

Joint work with AAND

• References

3

Rationale for the approach

• Community development a priority of the Health Canada Executive Committee workplan.

• Deputy Ministers of Health Canada (HC) and Aboriginal Affairs and Northern Development (AAND) have prioritized community development and community capacity building.

Community development was focus of the HC-AAND Collaboration Forum on December 1-2, 2010.

• HC has committed both to self-government and tripartite health approaches highlighting the importance of building a strong First Nations and Inuit health management cadre with skills to effectively engage communities, develop and implement strategic plans, and negotiate partnerships.

4

What is Community Development? • An approach to support better outcomes in First Nations and Inuit health, by

empowering First Nations and Inuit communities to manage their own services, building on their own strengths including culture

• A lens to apply to FNIH/B policy, programs and decision-making:

What can FNIH/B do to support First Nations and Inuit community capacity, management and development?

How can FNIHB effectively increase First Nations and Inuit community decision-making for their own health?

• Deputy Minister Glenda Yeates:

We need to think [the policy or the program] all the way through to what it does on the ground – if it doesn’t work on the ground in community, then it’s not a good policy.

• Associate Deputy Minister Anne-Marie Robinson:

The answers are in community, and FNIHB’s role is to support them to articulate their answers and take action.

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Principles of

Indigenous Community Development

Lessons Learned Principles for Government Action

The most successful and sustainable

initiatives in communities are community-

centred: community-based, community-

paced, and community-led. This includes

examples of communities that have

resolved crisis or challenge.

Facilitate community initiative and

ownership, and reduce prescriptive

policy and programs.

Facilitate community capacity in

decision-making, facilitation and

strategic planning.

Culture (traditional and cultural activities,

indigenous intelligence) is an important, and

perhaps the most important protective factor

in community. Culture acts as a buffer

against crisis. Cultural discontinuity is a risk

factor, particularly in mental health.

Culture is an essential determinant

of health in First Nations and Inuit

communities, and an eligible

expense in health programs.

It is the responsibility of FNIHB and

of FNIH/B employees to be

culturally competent.

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Lessons Learned Principles for Government Action

Formal and informal community leadership is

a protective factor against crisis, and an

essential factor for success.

Support short- and medium- term

leadership development and

emerging leaders in communities.

First Nations and Inuit define health as holistic

(physical, emotional, mental and spiritual), and

activities that have impact across the circle of

health will have more impact than those which

focus on only one. Factors contributing to

health and wellness, and healthy communities,

are larger than any one department or partner.

Successful communities have innovative

relationships with neighbouring communities,

NGOs and additional funders.

Leverage commonalities and

partnerships between programs,

and reduce silos within FNIHB.

Leverage commonalities and

partnerships, and reduce silos

and reporting burden with other

departments including AAND.

Facilitate relationships between

First Nations and Inuit and the

NGO and private sectors.

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Indigenous Community Development

Two unique aspects:

1. Community Development as a process to undo historical policies

The policy of residential schools experience in effect was to reduce First

Nations and Inuit community strength and culture

Rapid cultural change along with residential schools and other harmful

policies are known to have eroded traditional First Nations and Inuit

societies, negatively impacting cultural practices, family structures and

parenting skills, community support networks – leading to inter-generational

trauma and very high rates of mental illness and physical illness

High rates of mental and physical health issues including trauma in a

community can be a barrier to individual growth and healing, and also to

community development, social inclusion and a shared vision for the future

FNIHB has a role to play to support First Nations and Inuit community

(re)development including building capacity of individuals.

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2. Cultural competence is a necessary prerequisite

Knowledge

• History of colonization and government relationship to First Nations and Inuit, impact of residential schools; cultural, social and spiritual determinants of health; traditional healing practices in the area you live

• Community development, empowerment, reciprocity and relationships, how to approach indigenous community to build partnership

• Inequities in health

Self-awareness

• Describe what cultural competence is to you, how and why communication is key, demonstrate ability to build therapeutic relationship

• Know your own response to this topic, and explore your beliefs and actions

Demonstrable skill in building relationship

• Demonstrate collaborative relationship with First Nations and Inuit/M and non-Aboriginal practitioners, and between mainstream and traditional health practitioners.

• Share health information and strategies to improve

• Demonstrate ways to acknowledge and value indigenous knowledge

• Demonstrate authentic inclusive relationship

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FNIHB Community Development Continuum

• Just as “health” is more than the absence of disease, community development is more than the absence of crisis or issues. Successful First Nations and Inuit communities provide a sense of belonging and support, opportunities for growth for individuals and families, and the hard and soft infra-structure to build wellness.

• The Continuum is a draft graphical approach to spark discussion about how FNIHB supports community wellness and development, based on

Mainstream CD theory and research (capacity, SDoH, social capital, resilience)

Indigenous CD theory and research (culture, impacts of colonization, healing and self-determination)

Real life stories from communities who have successfully negotiated through crisis to stability

• This is NOT intended and should not be used as a diagnostic or evaluation of a community.

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PARALYSIS

COPING REBUILDING

COLLABORATING

FNIHB CD Continuum

Acting on what we know

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PARALYSIS Programs/services ineffective or

unavailable

Lack of collaboration between

programs

Financial management issues

Little to no community consensus

Conflict & lateral violence

Substance abuse

Risk of suicidiality & clusters

Few individuals healing

COPING Financial mgmt coping

Programs/services reactionary

High turnover of staff

Gatherings possible but

consensus difficult

Little trust in each other or leaders

Starting to work together

Risk of suicidiality and clusters

Individuals starting to heal

REBUILDING Programs starting prevention

Programs starting to work together

Stable financial mgmt

Stable staff

Building trust in each other & leaders

Defining own vision and goals

Individuals/families healing

Community addressing violence

Youth, women, Elders have voice

COLLABORATING Implement, evaluate & adapt strategic plan

Innovative programming with SDoH

Accessing resources beyond FNIHB/AAND

Excellent mgmt, accredited

Separate politics and civil service

Collaboration with external partners

Collaboration across sectors Supporting, mentoring other communities

Potential national leader in areas of strength

Stabilizing mental, primary and public health

Descriptors of each quadrant: Financial/mgmt, community planning, health

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PARALYSIS

COPING REBUILDING

COLLABORATING Tipping Point: Active culture

Just enough formal

or informal leaders

External supports for

those leaders

Mental health and

healing supports

CRISIS INTO

OPPORTUNITY

Progression: ↑ Number of people with capacity

Awareness & supports for personal health practices

Youth, women, Elders involved

Progression: Community

agreement and

action on a

priority

Progression: Valuing

connections

outside

community

Theory of Community Change

&

Lessons from Communities

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PARALYSIS

COPING REBUILDING

COLLABORATING

Healing from IRS & colonization

Integration

Social Inclusion

Community sense of agency

Hope and Vision

IRS & colonization trauma

Fragmentation

Isolation

Sense of disempowerment

Loss of hope and future

Additional Descriptors and

Change Process

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PARALYSIS

COPING REBUILDING

COLLABORATING

GoC Roles to Support

Support culture

Support healing for

individuals and leaders

Supports and networks for

emerging leaders

Awareness of IRS impacts

Facilitate safety

Support culture

Support healing for

individuals and community

Development opportunities

for leaders

Management development:

team-building, facilitation,

group decision-making

Support culture

Development opportunities in

programmatic knowledge

Continuing development for

leaders

Management development in

strategic planning, etc

“Get out of the way”

Support capacity development in

negotiation, mentoring others

Support knowledge dissemination

of successful practices

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Approach and Direction

• Goal: Healthy First Nations and Inuit communities

• CDCB National Advisory Committee

Provide input and recommendations on implementing the approach, and provide input into CDCB Framework/Lens, with membership:

• AFN, ITK, First Nations Health Managers Association,

• FNIHB regions, Office of Nursing Services, Office of Community Medicine, Non-Insured Health Benefits, Primary Health Care and Public Health Directorate, Strategic Policy Planning and Analysis Directorate, Business Planning and Management Directorate, Community Programs Directorate),

• AAND, Public Health Agency of Canada, Public Safety

• FNIHB CD Framework / Lens

Develop framework by April 2012 as a tool/lens to implement a CDCB approach, to be submitted to departmental senior leadership

• Facilitate continuous learning opportunities for FNIHB employees

Support employees to understand culturally competent CDCB, how it can inform their work

Host learning and sharing event for FNIH/B staff working with communities and Contribution Agreements

Form CDCB community of practice network on GC-Pedia

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• Support innovative community-based planning, partnerships and sharing of lessons learned

Aboriginal Learning Initiative in BC (Ahp-cii-uk) to increase engagement and economic development for youth

Social Capital in Swampy Cree, MB, to increase social connectedness

Community planning project in Kitigan zibe, QC, to document process and tools

Support knowledge transfer and networking of First Nations Health Managers through the national FNHM Association

Partnership with province of Ontario and AAND to support communities in distress

• Capacity Building in First Nations and Inuit Communities

Collaborate across programs within FNIH to leverage resources to build capacity in management and leadership

• management competencies based on the FNHM Competency Framework

• Leadership expertise based on Wharerātā Declaration

Collaborate across programs within FNIH to leverage resources to build community capacity in health content knowledge and expertise

Consider effective ways to support: • culturally competent learning opportunities in leadership: decision-making, facilitation, strategic

planning

• culturally competent learning opportunities in health specific skills and expertise

Reduce administrative and reporting burden and silos within FNIH and in collaboration with AAND

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• Partnerships for Community Well-being

Document successful practices in First Nations and Inuit communities that have innovative partnerships with NGOs and private corporations

Facilitate innovative partnerships with NGOs, private corporations

Facilitate capacity of partners to enter into culturally competent relationships with First Nations and Inuit

Develop FNIH approach to facilitate partnerships that contribute to First Nations and Inuit community health

Continue to work with interested partners: IPAC, Conference Board of Canada, etc.

• Joint work with AAND

Senior Officials of HC and AAND continue to meet regularly to coordinate and collaborate on CD and Capacity Building

Potential for joint work in supporting capacity development in community

Harmonize AAND and FNIHB funding frameworks, where appropriate:

• Joint audit expectations or policy

• Potential joint authority

• Potential joint intervention policy

• Potential for joint community plans

Potential joint work with additional federal departments including Public Safety

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For more information

• Rose Sones, Branch Lead on CDCB, FNIHB

Rose.sones@hc-sc.gc.ca

(613) 954-7757

• CDCB GC-Pedia wiki (in development)

http://www.gcpedia.gc.ca/wiki/First_Nations_%26_Inuit_Comm

unity_Development

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