Transcript A Pilot Project for Mental Health Service Treatment

NAHO CONFERENCE 2009
A Pilot Project for Mental
Health Service Treatment
Provision for Residential
School Survivors
AUTHORS: Dr Bob Chaudhuri (1); Tom Terry(1); Robert
Thomas(2); Brian Walmark (2)
AFFLIATIATIONS (1): Northern Ontario School of Medicine (NOSM)
AFFLIATIATIONS (2): Keewaytinook Okimakanak (Northern Chiefs
Council)
Canada's Indigenous population is a vulnerable group in the
health care system, with specific mental health and healing
needs that are not widely being met.
Indigenous peoples face certain historical,
cultural-linguistic, socioeconomic, and
system barriers to access to mental health
care that government, health care
organizations, and social agencies must
work to overcome.
Current health indicators undermine Canadian
Indigenous health status, including mental
health.
To address some of these
inequities in health and
health care, some Indigenous
health organizations have
recently developed services
to mental health that include
traditional cultural approaches
to healing.
However, Indigenous health and
healing information and practices are
practically non-existent through the
mainstream health care system, which
is dominated by Western approaches.
An Indigenous paradigm of health has been
successfully employed by Indigenous peoples for
thousands of year prior to the arrival of Europeans
and colonialism.

This study seeks to create new and different
methods of treating First Nations people linking
traditional Indigenous healing practices and
western practices using a community mental
health care delivery system as well as
teleconferencing

It should be noted that teleconferencing is an
antiquated term . In reality we mean
videoconferencing (Internet Protocol IP)
The focus of this research is to investigate the successes and
challenges by this new delivery system, which offers both
Indigenous and Western forms of healing to clients in mental
health service agencies, and to get descriptive information from
their clients about success of such an approach.
The KO Indian Residential School
Survivors Program - IRSSP
• The mental health treatment services delivery model for a pilot
project (the KO Indian Residential School Survivors Program IRSSP) being jointly proposed by the Sioux Lookout First
Nations Health Authority (SLFNHA) NODIN Child and Family
Intervention Services and by Keewaytinook Okimakanak (KO),
the Northern Chiefs Council, a tribal council serving six first
nations in Ontario’s far north.
• This pilot project combines the resources of
Multiple First Nation partners and communities.
Unfortunately, the Legacy of Residential Schools
And Intergenerational trauma has had a large
Effects in NorthWestern Ontario among other
Places in Canada.
IRSSP
• The project will facilitate both counselling and
community supports for Indian Residential
School survivors in the KO First Nation
communities of Deer Lake, Fort Severn,
Keewaywin, North Spirit Lake, and Poplar Hill.
• Both traditional and western methods for
Mental Health treatment of “Post-Colonial” or
Residential School Trauma survivors will be
employed.
KO COMMUNITY MAP
IRSSP
• The overall purpose of the KO Indian
Residential School Survivors Program (IRSSP) is
to:
– 1. Provide appropriate and sufficient community-based
therapy.
– 2. Support services to promote healing from IRS trauma for
survivors and families within their home community.
– 3. KO is in charge of facilitating the funds for this program.
IRSSP
• Unfortunately, we have learned the hard way that conventional
models of mental health treatment services delivery for survivors
of Residential Schools from remote northern Ontario First
Nations have generally resulted in client recidivism.
• As well, high costs associated with the conventional models of
service delivery have meant that service delivery must be highly
structured to control costs. High travel costs mean reduced
access to client services.
• Examples of how the KO IRSSP video-enabled therapy and
traditional healing would address some of the existing service
delivery challenges are:
Comparison of Existing Model with proposed KO IRSSP Community-Based Model
Existing Service Delivery Challenges
-High cost of travel: financial; social/family;
personal/spiritual
KO Model to Address Challenges
-Less therapy-related travel with more communitybased services mean more effective use of resources
and greater access to services by more IRS survivors.
-Gaps in existing community based support 24/7
- KO Project provides connection and continuity
with client, treatment plan and therapist or
traditional healer.
-Existing ‘fee-for-service’ (FFS) model is too similar
to Residential Schools. Very challenging for clients
from remote settings, who need to be very selfmotivated and in an urban or road access
community for realistic chances of success.
- IRSS clients best served & have the greatest chance
of success in treatment when both therapy & aftercare activities are based in the client’s home
community, where the natural, most culturallyappropriate and most effective client supports exist.
Family, survivor peers and community context are
required for client success
- Non-conformity with accepted characteristics of
successful treatment for IRS Survivors (familybased, trans-generational)
-Therapy models / treatment planning will conform
to unique specialized requirements for successful
IRSS tx
Comparison of Existing Model with proposed KO IRSSP
Community-Based Model Continued
Existing Service Delivery Challenges
Continued
-Existing Local Mental Health Workers often lack
clinical experience, have little or no training,
provide little if any case management, maintain a
high caseload, respond primarily to crisis
needs/situations, do not maintain regular
schedule of client consults, and suffer from lack
of staff support.
KO Model to Address Challenges
Continued
- Local IRSSP Coordinators will be trained to a
minimum standard in basic counselling
(NODIN) and TGTM, will be supported to
complete required case management functions,
and will work with and provide support for
Survivors and families on long-term and intergenerational effects of residential school trauma
Comparison of Existing Model with proposed KO IRSSP
Community-Based Model Continued
Existing Service Delivery Challenges
Continued
-Failures in past with IRS Survivors are due to
lack of aftercare/follow-through on Plans
(resulting in high system and community/family
costs due to recidivism)
KO Model to Address Challenges
Continued
-KO IRSSP Local Coordinators will
coordinate/facilitate after-care and follow-up at
the community level to ensure access to and
utilization of local supports. Specialized social
supports available only in home community.
-Existing FFS model is appropriate for more
immediate acute social needs and not residential
school trauma
-KO IRSSP model specialized to address longterm individual, collective and intergenerational
aspects of trauma and treatment planning
- NODIN stressed – responding to acute
needs/crisis
- immediate acute needs met locally or
w/NODIN
- IRS trauma was collective. Treatment must have -KO IRSSP develops integrated treatment plans
collective component.
which may indicate unique and innovative
approaches to utilize local supports / family /
Committees
IRSSP
• Telemedicine-enabled therapy, traditional healing and support
services for Residential School Survivors from the KO First
Nations will be cooperatively developed and initially supervised
by a mental health professional (the IRSSP Pilot Coordinator) at
the KO Office in Balmertown.
• Regional coordination of program development, community
consultation and IRSS Committee development, assistance to
Chiefs & Councils in assigning support responsibilities to local
worker(s), program promotion, training, approvals and billing for
overall therapy and traditional healing services through NIHB,
worker support and advocacy, and coordination of evaluation
activities, will be the responsibility of the KO IRSSP Pilot
Coordinator.
IRSSP
• Local IRSSP Program responsibilities will include establishing a
local support network amongst survivors, local promotion of
IRSSP and supports, providing and/or facilitating referrals,
coordinating client services (both local via tele-medicine or other
and NODIN), client and group advocacy, facilitating and
encouraging client follow-through on treatment plans.
• Providing (or facilitating access to) emergency counselling if
needed between clinical sessions, and participating in evaluation
activities.
• These responsibilities will be fulfilled by existing local mental
health workers who will be tasked with additional responsibilities
under this IRSS Program.
IRSSP
• The mental health Single Agreement for Service Model will
provide the general template for collaborative treatment.
• Essential face-to-face consults with therapists normally accessed
by video-technology will occur early on in the treatment process
-- either up-front or after the first few therapy sessions – and will
occur in the client’s home community context via a community
visit by the therapist.
• As well, consults with traditional healers will include a face-toface consult early on in the treatment process (via a community
visit), and will then progress to regular video-enabled consults
for a majority of the treatment sessions.
IRSSP
• IRSSP therapy and traditional healing services may be accessed by IRS
survivors and their families in a number of ways:
•
1)
Direct contact with the IRSSP Local Coordinator by the
survivor or family member(s);
•
2)
Direct contact with KO Health Services or KOTM, which
informs the Pilot or the Local Coordinator;
•
3)
Direct contact with the KO IRSSP Pilot Coordinator, who will
contact the Local Coordinator;
•
4)
Contact at-a-distance with related crisis and support contact
lines, which will then contact the IRSSP.
• IRSSP therapist and traditional healing services will require “prior-approvals”
from NIHB. Prior-approval will be applied for once a referral is made to
IRSSP staff. When necessary, IRSSP staff will assist the IRS applicant in
completing the necessary forms to apply for ‘prior-approval’. The next slide
will define the necessary information required for ‘prior-approval’.
IRSSP
• The necessary information for “prior approval” in the
application includes:
• a) a letter from the Chief/Council recognizing the person as a
Traditional Healer/Elder, and that they welcome the Elder to
the community on such and such a date;
• b) name and address of the Elder/Healer;
• c) confirmation from the Elder/Healer that there is an
appointment with former IRS student(s) - dates and times
scheduled or that the person is attending a healing event;
• d) if there is a community healing event - date and agenda of
the event;
• e) name, address, phone #, date of birth and DIAND # (band
number) of the former IRS student plus names and dates of
birth of family members;
• f) if the person is a family member of a survivor, the actual
survivors personal information, ie. DOB, DIAND#, School
attended;
• g) travel dates, for accommodation - dates requested.
.
IRSSP Treatment Process
• When this information is received, travel
arrangements will be reviewed and the applicant
will receive an IRS prior approval number from the
NIHB office (which may take seven working days
to process).
• Once the video-session or community visit has
occurred, an invoice is submitted to NIHB
including the prior-approval number (IRS###), as
well as a statement identifying all expenses with
attached original receipts for accommodation,
transportation, and a written and signed
confirmation of attendance for each day of travel.
• Once treatment plans are approved by NIHB,
prior-approvals may apply to multiple consults as
part of the overall plan.
IRSSP KOTM best practices (1)
• Counselling environment, successful client engagement and
confidentiality issues during video therapy sessions and remote
sessions with a traditional healer will be addressed by applying
existing guidelines / protocols established by KO Tele-Medicine
(KOTM) over the last five years. KOTM serves 26 remote First
Nations communities in Ontario’s far north.
• These practises are articulated in the following KOTM
documents:
• Telecounseling Consultation Information Sheet – a client
information sheet which describes KOTM and Telecounselling,
as well as providing detailed information for clients on “What
Happens During a Telecounselling Appointment”, “What About
Privacy / confidentiality?”, “What are the Potential Risks?”, the
Benefits to Telecounselling, as well as what other options are
available.
IRSSP KOTM best practices (2)
• Protocol for Telepsychiatry Consults – a program delivery
tool for KOTM staff to ensure sensitive, confidential, effective
and proper consults, and covering topics such as background
noise, other persons in the clinic area, technical issues related to
equipment operation, as well as other service delivery aspects
required for successful consults such as Oaths of Confidentiality
for staff and necessary consent forms for clients.
• IT User Guide – providing technical instruction for use of
phone and video suite equipment
• Privacy and Confidentiality Policies section from the KOTM
Policy and Procedures Manual
• Protecting Your Personal Health Information – KOTM
client information brochure
Timeline and Evaluation
• The evaluation / assessment of video-enabled therapy and
traditional healing services through the KO IRSSP will be ongoing and result in a final report at the end of the Pilot period
(March 2010), and for each subsequent year of service delivery.
• Outside evaluators will work collaboratively with IRSSP staff to
determine the scope and focus of the assessment activities and
design an evaluation plan. Evaluative tools will be administered
at the end of most IRSSP activities, including all video-enabled
sessions and any formal support functions/events held in each
First Nation.
• As well, staff and Committee training will be evaluated by
participants for relevancy, appropriateness and usefulness.
• Quantitative analysis of statistics, together with projection of
costs for same level of service/activity if not video-enabled, will
provide some relative measure of cost effectiveness when
compared to existing models which support client travel away to
urban settings for therapy or healing services in isolation from
family and peer supports.
IRSSP Implementation Workplan
July 2009 – March 2010
• Summary Objectives/Activities to be completed:
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Program Design
Establish local IRS Support Communities
Community Consultations
Hiring – the appropriate coordinators
Confirming Traditional Healers
Training – include case management, confidentiality, basic
counselling, crisis intervention
Program Promotion
Service Delivery
Program Planning – Year 2
Program Evaluation/Assessment
Current KO Mental Health Clients
• KO Mental Health Office reports that the
present KO mental health client list (all 5 FNs)
totals 78 individuals
• 39 of which are direct IRS survivors
• 18 are inter-generational victims, and the
remaining
• 21 (primarily children) present other MH issues.
• Once in operation, the IRSSP will increase # on
list
Community Front Line Workers
Questions
• Thank you
• Acknowledgments to Krystal Kohar.