Honouring Ours Strengths – Conclusions

Moving Forward

Honouring Our Strengths outlines a vision for a comprehensive continuum of services and supports to guide community, regional, and national responses to substance use issues among First Nations people in Canada. This vision recognizes that a strengthened system of care is the shared responsibility of various jurisdictions (community, province, federal), as well as a wide range of care providers including family and community members, community service providers, primary care and other medical staff, and off-reserve service providers. Within this vision, the emphasis is on ensuring that people, families, and communities have access to a range of effective, culturally- relevant care options at any point in their healing journey. Culture, family, and community are seen as the foundation of this approach; along with the important role that First Nations-specific social determinants of health play in revitalizing communities and reducing the extent of substance use issues. This approach also recognizes the connection between mental health and addiction issues, and that an integrated approach to programming at a system level is required to best meet the needs of clients and communities.

Renewal presents a significant opportunity for partners at all levels to initiate discussion on the vision for change, as well as how to support and facilitate this change. These discussions must acknowledge the important roles not only of community, provincial, federal, and territorial governments but also of regional and national organizations. They must also acknowledge the important role individuals, families and communities have in supporting each other and implementing a strengthened, systems-based approach to care. Realization of this vision will require ongoing commitment, collaboration, and sustained partnerships. Commitment and collaboration will, in turn, depend upon effective leadership throughout the system.

The NNADAP Renewal Leadership Team was formed in 2010 to exercise leadership in guiding the implementation of Honouring Our Strengths. In support of this goal, the Leadership Team will work with various networks and jurisdictions to facilitate open dialogue on renewal; advocate for additional resources; establish linkages and help to inform related efforts; and oversee a range of implementation activities to support a system-wide, strengthened approach to service delivery and planning. Membership of the team includes broad, cross-Canada representation from areas such as prevention, treatment, culture, youth, policy, health, nursing, public health, and research. Similar to the First Nations Addictions Advisory Panel, the Leadership Team is supported by national renewal partners—AFN, NNAPF, and Health Canada. As guided by the Leadership Team, the national partners in renewal have a responsibility to work creatively within available mechanisms to: raise awareness and gather information on areas of need within the system; work strategically with a wide range of partners to enhance this system; advocate for the resources required to make the vision of the framework a reality; and track and communicate progress on implementation to partners.

While it is recognized that full implementation of all aspects of the system that the framework describes will depend on increased resources, there are existing opportunities to positively influence change; optimize the use of existing resources; and leverage partnerships to better meet the needs of First Nations. For instance, with direction from the regional needs assessments and support from the National Anti-Drug Strategy investment, many communities and regions have already begun strengthening their services and supports in response to community needs.

The strength of the renewal process to date has been its connection to a wide range of regional and national First Nation health and wellness networks. These networks have provided guidance to the renewal process, shaped the vision for the framework, and supported engagement with First Nations communities. Key networks include, but are not limited to: the AFN First Nations Health Technicians Network; the NNAPF Board of Directors and their regional networks; Regional Addiction Partnership Committees, including advisory groups, co-management committees, and tripartite organizations; the Youth Solvent Addiction Committee; and Health Canada First Nations and Inuit Health regional offices and regional addiction/wellness consultants. These networks will continue to be essential in their ongoing sup- port and leadership of the process. This may include using the framework as a tool at both regional and national lev- els to initiate conversations with major healthcare providers, other service providers, and jurisdictional partners to enhance collaboration and build partnerships in order to ensure the needs of First Nations people are being met.

While the Leadership Teams, regional networks, and national networks all play an important role in facilitating implementation, it is important to note that solutions for renewal must come from First Nations people, who own the vision of the framework. They must guide its implementation. Many First Nations people, service providers, Elders, youth, and cultural practitioners have already demonstrated that change is possible through their selfless acts and continued efforts to promote wellness within communities and among their people. Renewal provides an opportunity to build upon these efforts and begin changing systems. Such change often begins with a small group of people who create collective ownership for change and which then transforms into communities of solutions.

In accordance with the belief that change is everyone’s responsibility, implementation of the framework must empower individuals, communities, and organizations to see their role and capacity in influencing this renewed approach to care. This will involve the development of tools or guides to support uptake of the renewal vision, including its use as a best-practice framework to guide the design, delivery, and coordination of addictions and mental health services at community and regional levels. It will also involve establishing ongoing feedback and engagement mechanisms facilitated through networks, the Leadership Team, and the renewal national partners—AFN, NNAPF and Health Canada.

While Honouring Our Strengths provides a comprehensive vision for the renewal of First Nations substance use- related services, it is recognized that the framework must be viewed as a living document, which can be adapted or revised based on the evolving Indigenous and mainstream evidence-base, as well as the changing needs and realities of First Nations people. Over time, this will require integrating programs for tobacco abuse, problem gambling, and other addictive behaviours. It will also involve efforts to expand and evolve a fully integrated mental wellness 24 continuum of services and supports, which will require additional resources and significant engagement with First Nations communities and leadership.

The opportunities that exist to strengthen the system of care are great. Many First Nations cultural teachings indicate that the Creator gave everyone tomorrow to make a difference, and with this promise of tomorrow comes responsibility. It follows then that everyone involved in the vision of this framework has a decision to make. How everyone chooses to manage the responsibility for “tomorrow” is dependent upon our answer to the question: “what difference will we collectively make?” Our shared vision for the future cannot be created with or bound by limitations, such as the lack of funding or barriers that may be encountered in facilitating change. The collective vision of the change we seek must be fuelled by courage to include all possibilities beyond our imagination. Courage is a vital characteristic of leadership, and is necessary to ensure we are ready when the timing is right: to be strategic in taking risks, to create new pathways, and to continuously seek answers to the unknown. In fact, it is in that which is yet unknown where we will find the answers that are there waiting for us. The vast numbers of youth which make up the First Nations population rely upon those in front of them on this path to the future to ensure the footprints we leave every day will lead them to their freedom from the harms of drugs, alcohol and the ongoing legacy of colonization. Every moment and every effort counts. We must “honour our strengths” with the belief that change is possible through our collective efforts.

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Endnotes

  1. First Nations Information Governance Centre (FNIGC). (2011). Preliminary Report of the Regional Health Survey: Phase 2 Results—Adult, Youth, Child. Ottawa, ON: FNIGC. Please note that at the time this report was produced preliminary findings from the Regional Health Survey (RHS) were available. These findings were used wherever possible. Where the data was incomplete, data from the 2002/3 regional health survey was used. For the most current RHS data, please consult the First Nations Information Governance Centre at: http://www.fnigc.ca/.
  2. The number of NNADAP and NYSAP centres and community programs are as of February 2011. Please note that these numbers are subject to change. Contact Health Canada for the most current numbers.
  3. Statistics Canada. (2008). Aboriginal Peoples in Canada in 2006: Inuit, Métis and First Nations, 2006 Census. Catalogue no. 97-588-XIE.
  4. First Nations Information Governance Centre (FNIGC). (2011). Preliminary Report of the Regional Health Survey: Phase 2 Results—Adult, Youth, Child. Ottawa, ON: FNIGC.
  5. First Nations of Quebec and Labrador Health and Social Services Commission (FNQLHSSC). (2008). Alcohol, drugs and inhalants—Profile of substance users and use patterns among Quebec First Nations. Wendake, QC: FNQLHSSC.
  6. McCain, M. N. & Mustard, J. F. (1999). Early years study: Reversing the real brain drain. Ontario: Publications Ontario.
  7. Ibid.
  8. Statistics Canada. (2008). Aboriginal Peoples in Canada in 2006: Inuit, Métis and First Nations, 2006 Census. Catalogue no. 97-588-XIE.
  9. First Nations Information Governance Committee. (2007). First Nations Regional Longitudinal Health Survey 2002/03. Ottawa: Assembly of First Nations/First Nations Information Governance Committee.
  10. First Nations Information Governance Centre (FNIGC). (2011). Preliminary Report of the Regional Health Survey: Phase 2 Results—Adult, Youth, Child. Ottawa, ON: FNIGC.
  11. First Nations Information Governance Committee. (2007). First Nations Regional Longitudinal Health Survey 2002/03. Ottawa: Assembly of First Nations/First Nations Information Governance Committee.
  12. Canadian Centre on Substance Abuse. (2008). Substance abuse in Canada: Youth in Focus. Ottawa: Ottawa, ON: Canadian Centre on Substance Abuse.
  13. Ibid.
  14. Adlaf, EM, Begin, P., and Sawka, E. (Eds). (2005). Canadian Addiction Survey (CAS): A national survey of Canadians use of alcohol and other drugs: Prevalence of use and related harms. Detailed report. Ottawa: Canadian Centre on Substance Use.
  15. First Nations Information Governance Committee. (2007). First Nations Regional Longitudinal Health Survey 2002/03. Ottawa: Assembly of First Nations/First Nations Information Governance Committee.
  16. Boyer, Y. (2006). Discussion Paper Series in Aboriginal Health: Legal Issues. No. 4.First Nations, Métis, and Inuit Women’s Health. Saskatchewan: Native Law Centre, University of Saskatchewan.
  17. First Nations Information Governance Committee. (2007). First Nations Regional Longitudinal Health Survey 2002/03. Ottawa: Assembly of First Nations/First Nations Information Governance Committee.
  18. Public Health Agency of Canada. (2006). The Human Face of Mental Health and Mental Illness in Canada 2006. Ottawa, Ont.: Minister of Public Works and Government Services.
  19. Health Canada. (2007). Non-Insured Health Benefits Annual Report: 2005–2006. Ottawa: Author.
  20. First Nations Information Governance Centre (FNIGC). (2011). Preliminary Report of the Regional Health Survey: Phase 2 Results—Adult, Youth, Child. Ottawa, ON: FNIGC.
  21. Statistics Canada. (2010). Health Indicators Maps. Catalogue no. 82-583-XIE, Vol. 2010, No.1.
  22. First Nations Information Governance Centre (FNIGC). (2011). Preliminary Report of the Regional Health Survey: Phase 2 Results—Adult, Youth, Child. Ottawa, ON: FNIGC.
  23. Environics Research Group. (2004). Baseline study among First Nations on-reserve and Inuit in the north. Ottawa: First Nations and Inuit Health Branch, Health Canada.
  24. According to the Mental Wellness Advisory Committee Strategic Action Plan, Mental wellness is defined as “a lifelong journey to achieve wellness and balance of body, mind and spirit. Mental wellness includes self-esteem, personal dignity, cultural identity and connectedness in the presence of a harmonious physical, emotional, mental and spiritual wellness. Mental wellness must be defined in terms of the values and beliefs of Inuit and First Nations people”; Mental Wellness Advisory Committee. (2007). First Nations and Inuit Mental Wellness Strategic Action Plan. Ottawa; Mental Wellness Advisory Committee.

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Appendix A:

First Nations Addictions Advisory Panel

The First Nations Addictions Advisory Panel (FNAAP) was a time-limited body of community, regional and national mental health and addiction representatives tasked with developing Honouring Our Strengths: A Renewed Framework to Address Substance Use Issues among First Nations People in Canada. The Panel included members of the AFN’s Public Health Advisory Committee, and was supplemented by addictions researchers, health professionals, Elders and First Nations community representatives. In addition to developing the Framework, the Panel also provided support to regions to complete their regional needs assessments.

>> Co-Chairs

Carol Hopkins (co-chair) — National Native Addictions Partnership Foundation

Winona Polson-Lahache (co-chair) — Assembly of First Nations

>> Advisory Panel

Jim Dumont — Elder

Dr. Malcolm King — Canadian Institutes of Health Research, Institute of Aboriginal Peoples’ Health/ University of Alberta

Dr. Kim Barker — Assembly of First Nations

Dr. Peter Menzies — Centre for Addiction and Mental Health

Shannelle Alexander — Kitselas First Nation, NNADAP Community-Based Program

Dr. Laurence J. Kirmayer — McGill University

Dr. Colleen Anne Dell — Canadian Centre on Substance Abuse/University of Saskatchewan

Chris Mushquash — Dalhousie University

Rose Pittis — Dilico, Ojibway Health Services

Dr. Richard MacLachlan — Dalhousie University

Dr. Brian Rush — Centre for Addiction and Mental Health/University of Toronto

Dr. Rod McCormick — University of British Columbia

Dr. Christiane Poulin — First Nations and Inuit Health— Atlantic Region

Dr. Lorne Clearsky — University of Calgary

>> Secretariat

Carol Hopkins (co-chair) — National Native Addictions Partnership Foundation

Winona Polson-Lahache (co-chair) — Assembly of First Nations

Marie Doyle—Health Canada

Darcy Stoneadge — Health Canada

Natalie Jock — Health Canada

Christine Wilson — Health Canada

Lynn Kennedy — Health Canada

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