Transcript Coordinated Action for Holistic Early Childhood Care and

Quality of Life
of Aboriginal Young Children
Jessica Ball, M.P.H., Ph.D.
Early Childhood Development
Intercultural Partnerships
School of Child and Youth Care
University of Victoria
Demographic tsunami
The success of Canada depends in large
part of the success of the Aboriginal
population.
2006 Census:
• 3.8% of Canada
• Increased 45% in 10 yrs. (6 Xs faster than nonAboriginal pop)
• 48% Aboriginal pop under 25 yrs. (31% nonAboriginal)
• By 2026, 36% of children and youth in
Saskatchewan will be Aboriginal
• By 2017, Canada’s 150th Birthday, 50% of
Aboriginal children will be growing up in a lonemother headed household, unless we intervene to
turn the tide.
Time to act*
Canada’s performance in early childhood care and
development (ECCD), particularly for the most
vulnerable, has been lacklustre.
As a group, Aboriginal children are the most vulnerable.
More similarities among Aboriginal compared to nonAboriginal, but also important distinctions between Inuit,
Metis, First Nations on- and off-reserves.
Histories
Epidemiology
Governance
Jurisdictional issues
Needs
Circumstances
Opportunities
One size will not fit all!
*National Council of Welfare Reports: First Nations, Metis and Inuit Children and Youth:
Time to Act (Fall, 2007).
“The variance between where we are today
and our desired health outcomes is far
greater for First Nations, Metis, and Inuit
children” *
Aboriginal children:
•
SIDS leading cause of infant death (2.5 X nat’l average)
•
Injuries major cause of premature death of children on
reserve (5 Xs nat’l average)
•
50% of children on reserve overweight or obese
•
91% affected by dental decay (7.8 teeth by 6 yrs)
•
Tuberculosis epidemic in northern Aboriginal
communities (4 Xs nat’l average)
•
Respiratory disease in Inuit children highest in world
•
FASD may affect 1 in 5 Inuit and First Nations children
•
Hearing loss, speech/language delays far greater
•
Early school leaving, juvenile detention & incarceration,
suicide highest among Aboriginal youth
Kellie Leitch: Reaching for the top: A report by the Advisor on healthy
children and youth. Health Canada (2008).
Quality of life is a composite.
Social determinants of well-being.
Social
support
Genetics
Early
learning
opportunities
Affection/
Nurturance
Family
Income
Child Health &
Development
Health
services
Nutrition
Health
behaviours
Physical
environments
Biological
endowments
Key Contributors to Aboriginal
children’s QoL
•
•
•
•
•
Poverty
Housing
Support for Family Life
Access to needed services
Community-appropriate models of
support
 Largest contributions to Aboriginal
children’s health & development and
opportunities for success.
Ecologies of Experience
Poverty is the single greatest contributor to poor quality of
life.
Overcrowded & substandard housing (1 in 4 homes need
repairs)
Low food security
Desolation & domestic violence
Canadian Incidence Study of Reported Child Abuse &
Neglect (Trocme et al. 2006): neglect, more than
abuse, figures prominently in child welfare interventions
Neglect can reflect lack of money & means to meet child
needs: secure & nutritious supply of food, warm
clothing, safe housing, medical services, stable income,
transportation)
Chronic complex challenges: Canada is moving at a
glacier pace to address key issues, such as water
contamination in water, crowding, lack of heat &
ventilation, employment opportunities, recreation
infrastructure, and overall social inclusion.
Can. Prenatal Nutrition Program (CPNP) monitors &
supplements nutrition, FASD prevention, tobacco
cessation.
Aboriginal families are the most
important site for improving QoL of
Aboriginal children
• QoL for children is centred at home, in
families.
• Colonial interventions have diminished
parenting capacity and disrupted familybased care of Aboriginal children.
• 40% of children in care are Aboriginal.
• Revolving door foster care
• Removals from communities continue in
the same numbers as at the height of the
Indian Residential Schools era.
Strengthening Aboriginal Families
 Family centred approaches
 Parents as children’s ‘Most Valuable Players’
 Start in elementary school (e.g., Roots of Empathy)
 Middle school – postpone parenthood
 Communication skills
 Healthy lifestyles, cooking
 Parenting
 Prenatal care
 Social support
 Fathers involvement: 50% uninvolved
 high rate of non-registration of paternity
 “Greatest untapped resource” (Grand Chief Ed John)
 Teen parents: 1 in 10 births, 7 X higher than nonAboriginal teens (same as Nepal & Somalia)
 Other countries invest in national programs to meet needs
of teen parents in areas of parenting support, health,
education, employment
Quality child care improves several
components of Quality of Life
Safe, stimulating places for children
Socialization & emotional security
Social support for child and caregiver
Early learning, incl. skills related to safety in & out of
doors
Response to acute health needs
Prevention (injury, dental hygiene, malnutrition,
stress & anger management)
Early identification and referral
Management of chronic disease (medications,
assistive technologies, supported child care for
children w special needs)
Currently about 18% of needed spaces….
Add respite care, including evening & overnight care,
close to home
Aboriginal Head Start
Most successful national initiative
supporting Aboriginal children & families.
6 mandated program components:
1.
2.
3.
4.
5.
6.
Aboriginal culture & language
Parental involvement
Nutrition
Education & school readiness
Health promotion
Social support
Child Youth Advisor* recommends increase to 25% AHS coverage
(estimates range from 12-15% on reserve and 7.6-10% off
reserve, as well as in Inuit communities)
Customized in each community, yet guided by national mandate
and tools to evaluate progress on program goals
*Kellie Leitch (2008): Reaching for the Top: A Report by the Advisor on Healthy Children
and Youth. Health Canada.
Mobile clinical & ancillary services
outreach team
Gov’t of Canada fragments provision of
services to address high needs of
Aboriginal children with chronic disease,
developmental delays & disabilities
 Many children removed from home &
community for medical foster care &
medical institutions
 Close to home initiatives
 Inter-sectoral delivery of ancillary
services including, OT, PT, SLP as well
as diagnostic assessment, paraprofessional training to parents &
community-based practitioners
Jordan’s “child first” Principle
Support for Aboriginal children’s QoL is
complex jurisdictional issues lead to
disputes about payment for services.
Jordan’s Principle: in a dispute over who
should pay for Status Indian child’s
services, federal gov’t will pay for
services to child first, with cost recovery
through health transfer payment
adjustments if dispute resolution
indicates that province should pay
Many pathways
“Finding our way to supporting wellness among diverse
communities of children and families requires many
pathways. No one approach, no one program model,
will reach or work for everyone.”
Meadow Lake Tribal Council Administrator
Local innovation & resourcefulness can combine the ‘right’
number & variety of people, professions, services that a
community wants & needs to achieve their own ECCD
goals
“Place-based research” (M. Brant-Castellano)
Compare remote, rural & urban demonstration projects
Research on integration & coordination
successes in 3 different settings in B.C.
Community
Members
Emergency
Services
School
Heritage
Language Nest
GP/
MD
Community
Kitchen
Child Care
Centre
Health
Promotion
Centre
Child &
Family
Development
Services
After School
Care Centre
Health
Services
Centre
Occupational
Therapist
Community
Health Rep.
Physical
Therapist
Public Health
Nurse
SpeechLanguage
Pathologist
Dental
Hygienist
Specialist Diagnostic Services
ECCD as Hook & Hub
Immunization, hearing, vision,
and dental checkups
Infant Development Worker and
pre-natal and post-natal support
Adult Support for Tobacco Reduction
Counseling for Substance Abuse
Family support
services
Adoption Court
assistance
Child protection
Foster care
Health
7%
14 2/
Education
Nutrition
& 2School
%
%
7
4 /7
1Readiness
14 2/
ECCD
Safety
7%
14 2/
Literacy
%
& 7Pre14 2/
Literacy
Parenting play
groups
Pre-literacy groups
Speech & language
support
Occupational
therapy
Socialization for
school readiness
%
7 % 1Cultural
4 2/7
14 2/
Socialization
Teachings
Elders
Fluent mother tongue
Traditional foods, crafts, & lifestyles
Festivals & community events
Jessica Ball, 2004
Get it together!
Streamline ….. Coordinate
• One stop shopping for funding, reporting,
service delivery to families
• Inter-sectoral coordination
• Integrated services
• Hubs (generally community-based in
Friendship Centres, community centres
rather than school-based)
• Culturally based
• Intergenerational
• Weaving together Indigenous & nonIndigenous knowledge
Key recommendations of AFN First Nations Early Learning
and Child Care Plan (2005)
Principles
Made in Canada solutions
Community self-determination
…not a “best practice” model designed by
national office
• Where to start
• Who to target
• What approach
• What to integrate
• Who to hire
• What indicators of effectiveness
Consultative & flexible
Recognize successes
Principles advocated by Romanow Commission Building on
values: The future of health care in Canada (2002)
F/P/T Level Support
Training
Aboriginal practitioners in community health, early childhood care
and development, early intervention
Family support
Training non-Aboriginal practitioners to work effectively with
Aboriginal families & communities
Tools & training for monitoring and evaluating efforts to improve
children’s QoL
National data bases to monitor developmental trajectors & identify
opportunities to influence key determinants of QoL
First Nations Regional Longitudinal Health Survey (AFN)
nation-wide health survey
Aboriginal Children’s Survey (Statistics Canada/HRSDC) nationwide development survey
Research to develop evidence-based practice:
Centres of Excellence for Children’s Well-being:
Dedicated programs of research & knowledge mobilization
within each of these focused on Aboriginal young children
“We will raise a generation of First
Nations, Inuit and Metis children and
youth who do not have to recover from
their childhoods. It starts now, with all our
strength, courage, wisdom and
commitment.”*
Many policies, partners, professions and parents
need to come together to recognize the
outstanding needs and potential of Aboriginal
young children and to improve their quality of life
for today and for the future wellbeing of
Canadians as a whole.
*
Declaration of Many Hands, One Dream: New Perspectives on
the Health of First Nations, Inuit and Metis Children and Youth
(Blackstock, Bruyere, & Moreau, 2005)
From Dreams to Reality at
Lil’wat Nation
Mount Currie, B.C.
140 km NW of Vancouver, near Whistler
Supporting children’s health &
development where they are . .
On their traditional territories . . .
In their community . . .
Pqusnalhcw multi-service community centre
Opened May, 1999
In the families they have . . .
Working together & learning across
professional disciplines & services
With cultural pride & social support
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•
•
Indigenous languages
Cultural learning
Family involvement
Celebrating children
Communities focused on children’s Quality of Life