Transcript Substance Use Treatment and Support for First Nations and

IMPROVING SUBSTANCE USE
TREATMENT AND SUPPORT FOR
FIRST NATIONS AND INUIT
WOMEN IN CANADA
Preventing Fetal Alcohol Spectrum Disorder
Context
This presentation captures discussions held in 2010, in a
“virtual community” which included participants from
three areas of Canada: 1) Manitoba and Saskatchewan,
2) Ontario, and 3) Yukon, NWT, Nunavut, northern
Quebec and Labrador.
We wanted to capture a sense of the rich diversity of the
experiences of Inuit and First Nations women living in
urban, rural, and remote settings.
Approach
Our approach was to bring together:
Research on promising or
“wise” practices in
women’s substance use
treatment and the
prevention of Fetal Alcohol
Spectrum Disorder
WITH
The wisdom of those who
are working on these
issues with First Nations
and Inuit women across
Canada
This presentation will cover:
1.
2.
3.
Barriers to treatment and prevention
Continuum of support
Recommendations
BARRIERS TO TREATMENT
AND PREVENTION
4 types of barriers
Barriers to Treatment and Prevention
There are significant barriers to treatment and
prevention for First Nations and Inuit girls and
women:
1.
2.
3.
4.
Personal and interpersonal barriers
Community or social barriers
Structural or program barriers
Systemic barriers
It’s Not Only About Alcohol
Exposure to
Violence
Poverty
Mother’s
use of
other drugs
Mother’s
nutrition
Policy on
Mothering
Mother’s
access to
prenatal
care
Racial
Discrimination
Mother’s
Alcohol
Use
Resilience
Mother’s
overall
health
Genetics
Mother’s
stress level
Context/Isolation
Age
Experience of Loss
Poole, N. (2003). Mother and Child Reunion: Preventing Fetal Alcohol Spectrum Disorder by Promoting Women's Health.
Vancouver, BC: BCCEWH
1. Personal and interpersonal barriers
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Fear of the implications for seeking treatment (child
apprehension, stigma, isolation in the community, separation
from family)
Experience of trauma and violence, including childhood abuse
and adult sexual assault
Stigma, shame and guilt
2. Community barriers
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Lack of confidentiality/privacy within small communities
Lack of awareness and education about women’s substance use
and FASD
In some communities, the overall level of substance use is so
high, it makes it difficult for women to see the need for help or
be supported to reduce/stop using
3. Program barriers
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Lack of tailored programming addressing culture, creating
safety, and addressing women-specific health impacts of
substance use
Lack of child care for women attending treatment, and lack of
linked treatment for mothers and children
Access issues such as availability of programs in or near one’s
community, transportation barriers
Program criteria barriers
Lack of community-based supports (pre and post treatment)
4. Systemic barriers
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Women pushed to go to treatment to regain custody of their
children, even though they are not ready, or substance is not
their key problem
Fragmentation of services, such as separating violence and
addictions treatment services
Lack of priority for funding of women-specific treatment
programs
Lack of continuity in support, health promotion and prevention
initiatives
Integration & reflection
1.
2.
What, if anything, would you add to list of
barriers?
What is most pressing for your
community/program/service at this time?
CONTINUUM OF SUPPORT
6 Levels of Support
1.
2.
3.
4.
5.
6.
Awareness building/stigma reduction
Discussion and brief intervention
Outreach and engagement
Specialized holistic support
Structured treatment
Ongoing support in the community and
community wide change
Continuum
of Care Model
First Nations and
Continuum
of for
Support
Inuit Women with Substance Use Concerns
Many examples of
promising work being
done in communities
across Canada were
identified.
These examples fall
within six levels of
needed treatment and
support that have been
found to be helpful to
FASD prevention
From Poole, N., Gelb, K., & Trainor, J. (March 2009). Substance Use Treatment and Support for First Nations and Inuit Women
at Risk of Having a Child Affected by FASD. Vancouver, BC: British Columbia Centre of Excellence for Women's Health.
1. Awareness Building & Stigma Reduction
Considerations
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It is important to balance stating the risks of drinking in
pregnancy on one hand, and showing that change is possible
(and help is available) on the other hand.
Because women who have substance use problems have been
portrayed as ‘bad mothers’ and especially for women with
histories of trauma, it is important to convey that they will be
welcomed and treated with respect when they come for
treatment and support.
Promising practices
Awareness building and stigma reduction
Creating broad based community development and inclusion
programs have shown promise in building awareness and
reducing stigma. In many communities, women have taken
leadership on changing community alcohol policy, educating via
community radio and other community wide strategies.
Practices in action
Building awareness and reducing stigma
Positive messaging as in the BC
Aboriginal Network on Disability
posters
2.Community-based workshops led
by Pauktuutit, that support discussion
of the issues, and the processing of
grief and loss in a social and
supportive way
3.Use of community radio Inuulitsivik Health Centre
4.Using Asset Mapping as a tool to
help communities identify their
strengths and develop a plan of
action
1.
2. Discussion & Brief Intervention
Considerations
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A wide range of service providers need to take a role in
discussing alcohol with women, not only addictions experts.
Drinking is stigmatized, it can be helpful to include alcohol use
in discussions of other health and social issues facing women.
Training for service providers in approaches that are based on
guiding, listening, and supporting readiness can be useful.
Training about FASD, the specific impact of alcohol on women’s
bodies, and women-centred treatment approaches may also
be needed.
Women may be afraid to speak of alcohol use, for fear of
losing custody of their children - discussion of how her
information will be shared or used is important.
Promising practices
Discussion of substance use
Increasingly service providers and researchers have demonstrated
that this “front end” approach to discussing substance use with
women, and engaging women in care – more than substance use
treatment itself – is central to assisting women with substance
use problems at risk of having a child affected by FASD.
(Health Canada, 2006, p.75)
Practices in action
Discussion of alcohol with women
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Use of the Medicine Wheel Difference Game to assist women in
identifying and planning the changes they would like to make
in their substance use and related life areas. (Elsipogtog First Nation
in New Brunswick )
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Pauktuutit’s work in delivering community based training for
both professionals and women, on a range of women’s health
issues including FASD prevention, teen pregnancy, tobacco
reduction, violence and sexual health.
Using motivational interviewing, an evidence-based
communication style to support change in a collaborative,
guiding way.
3. Outreach and Engagement
Considerations
Systems and services need to shift to welcome and engage women. 10
fundamental components of FASD prevention include that systems/services are:
1.
Respectful
2.
Relational
3.
Self-Determining
4.
Woman-Centered
5.
Harm Reduction Oriented
6.
Trauma Informed
7.
Health Promoting
8.
Culturally Safe
9.
Supportive of Mothering
10.
Uses a Disability Lens
www.canfasd.ca/networkActionTeams/womens-health-determinants.aspx
Promising practices
Outreach and Engagement
Adjusting our approaches to engaging women in care on the part
of service systems, rather than making it the responsibility of
women who are facing substance use and related health and
social problems to show up ready for help, has been shown to be
critical to an effective approach to preventing FASD.
Practices in action
Enhanced outreach
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In urban settings – Anishnawbe Health Centre’s Circle of Care
Program and programs like Sheway in Vancouver who use
welcoming engagement practices, create safety and do not
make decreasing or stopping substance use a condition of
service access
In rural and remote settings – Peer support and health
promotion for girls and women such as kitchen table gatherings
(Qu’Appelle Valley) and outreach work being done by
mentoring programs across Canada
Sheway
Project
Support to build networks
- both friendship and
ongoing service support
Healthy Babies,
networks
Pre and postnatal
Infant/Child
Medical Care and
Development
Drop
In
Nursing Services
Advocacy and
Out Reach
Support on Access,
Nutritional Support
Crisis Intervention
Custody and other
and Services
Legal issues
Advocacy
Support
Advocacy and
Support on Housing
& Parenting issues
Support/ Counselling
Connecting with
on Substance
other services
Use/Misuse issues
Support in reducing
Support on HIV,
exposure to violence
Hepatitis C and
and building supportive
STD issues
relationships
Reducing barriers to care
4. Specialized Holistic Support
Considerations
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Beyond providing outreach, there are many ways in
which we can make it easier for women with alcohol
and other substance use problems to come for
treatment – our community-based support can
have a holistic focus, can span ages, involve
community members, and be informed by what we
know about the impact of trauma.
Promising practices
Holistic support
The Women and Children’s Healing and Recovery Program (WCHRP)
in Yellowknife was created to assist women who have experienced
trauma, on their journey to wellness. Ten themes were identified for
holistic support:
1) gender-specific healing and
recovery
2) trauma-based healing and
recovery
3) longer-term, phased, flexible
and diverse options
4) partnership approach
5) strength-based “empowerment”
model
6) holistic approach
7) continuum of care
8) healing needs of children
9) family-focused and linked to
healing for men, children and
youth
10) community-based and culturally
sensitive
(Four Worlds Centre for Development Learning, July 2003)
Practices in action
Minwaashin model
The Minwaashin Lodge in Ottawa
works from a life cycle model with
programming for women, children
and family members of all ages.
The Lifecycle Service Model
illustrates a holistic, integrated and
culturally safe approach to violence
prevention, trauma recovery and
balanced well-being.
Developmentally appropriate
programming specific to each of
the four stages of the lifecycle is
interwoven with ceremony and
cultural teachings that promote
mental, physical, emotional and
spiritual well-being in individuals,
families, communities and Nations.
The vision of this service model
derived from Traditional
Knowledge is to restore women’s
agency and authority in family and
community life.
5. Structured Treatment
Considerations
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Most on-reserve treatment provision accessible to First Nations
women is delivered through outpatient counselling. It is
challenging for outpatient counsellors alone to provide the
level of support that has been found to be helpful for pregnant
women and mothers at highest risk.
Need to define and expand options for First Nations and Inuit
women living in the north
Need to broaden understanding of ‘treatment’ - as a process
rather than a place, that includes a range of holistic supports
Promising practices
Structured Treatment
Structured treatment can also include day, mobile, land-based
and residential treatment. Women need access to treatment on
the community level (and beyond) which:
o includes cultural components;
o addresses coexisting trauma/violence and mental health
concerns with addictions; and
o links the support of mothers with their children.
Practices in action
Principle-based treatment approach
Through their collaborative work, Dr. Colleen Anne Dell and a
large research team, have identified key principles to guide
treatment providers in supporting Aboriginal women healing from
illicit substance use: RE-CLAIM
R=
E=
C=
L=
A=
I=
M=
Recognition
Empathy
Communication & Care
Link to spirituality
Acceptance
Inspiration
Momentum
See a description of these attributes at http://www.addictionresearchchair.com/creatingknowledge/national/cihr-research-project/view-our-findings-through-posters/
Promising
practices in action
Many aspects of healing
from trauma can be
supported through community
based services, assisting
people with substance use
concerns
From Chansonneuve, D. (2005).
Reclaiming Connections:
Understanding Residential Trauma
Among Aboriginal People.
www.ahf.ca/pages/download/28_
101
Practices in action
Treatment for women with FASD
Research led by Dr. Deborah Rutman, University of Victoria has
identified promising, substance use treatment approaches for
women living with FASD. They include:
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Whole-person
Culturally sensitive and appropriate
Multi-systems, multi-disciplinary & collaborative
Shift in timeframes; focus on readiness
Aftercare and/or follow up support
Celebration of small steps and accomplishments
Importance of HOPE
For more info see http://socialwork.uvic.ca/research/projects.htm
6. Ongoing Support in the Community
Considerations
Awareness, leadership and action are critically needed:
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Multi-audience education is needed to build awareness
of, and respect for, the treatment and support needs of
First Nations and Inuit women who are at risk of having a
child affected by FASD.
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There was a sense that it is time for leadership and action
to improve access to and quality of treatment for women
(that as the Zapatista women have identified in their work for dignity,
“ya basta” / that’s enough)
Integration & reflection
1.
2.
Where does your service/program/role fit
on the continuum of support?
Considering this same continuum, what is
working well in your community? What, if
anything, might be done differently?
RECOMMENDATIONS
Recommendations
Recommendations were made in 5 areas:
1. Increasing capacity and coordination of those on the
community level who are in a position to discuss alcohol with
women and help women find the optimal combination of
support to make possible their healing, growth and recovery
2. Improving access to treatment and related supports for
women, through for example, expansion of treatment and
support options on the community level, careful linkage with
treatment outside the community.
Recommendations
3.
4.
5.
Supporting mothers with substance use problems in their
abilities to retain custody of their children, and to heal, grow
and recover within community-based treatment programs
that have childcare and children’s treatment programming
Integrating support on violence and trauma with treatment
on substance use, so that women are able to make the
connections among these experiences, and are not
retraumatized in the course of treatment
Building awareness of, and respect for, the treatment and
support needs of First Nations and Inuit women who are at
risk of having a child affected by FASD
Integration & reflection
After reviewing these recommendations, what if
anything, might be the next step for your
community/program/service etc.?
Conclusion
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
This Moving Forward project is an
example of leadership with the goal of
improving treatment.
We hope to continue to work with
leaders who are working to improve
treatment through NNADAP programs
and through Inuit mental health
strategies in the north.
Writings by Aboriginal
women are capturing the
ever-growing leadership of
First Nations and Inuit
women in Canada on
treatment and related issues.
For more information…
Contact:
The written report on this virtual community’s work may
be downloaded from
www.coalescing-vc.org