The following are the highlights of two meetings of the Champlain Local Health Integration Network (LHIN) Board of Directors held in Ottawa at the Wabano Centre for Aboriginal Health on November 22, 2017 and Champlain LHIN corporate office on December 13, 2017.
Champlain LHIN Board Chair Jean-Pierre Boisclair opened the meeting and acknowledged it was taking place on traditional Algonquin land. With the mental wellness team at Wabano Centre for Aboriginal Health, Mr. Boisclair introduced Louella Tobias, Oshkaabewis (Traditional Knowledge Keeper). This role, funded by the LHIN, focuses on culture as the foundation of service delivery for Indigenous youth and families.
Ms. Tobias is from Delaware Nation. A mother of three, and grandmother of seven, she has been following her traditions for over half her life. Ms. Tobias learned about traditional healing and medicines such as sweat lodges, cedar baths and pipe ceremonies from Grandmothers in Sudbury, Ontario. She now shares this traditional knowledge, along with her contemporary social work expertise, with the Indigenous children and youth she sees at Wabano who are facing mental health and addictions issues.
“A lot of youth that come are very young and they have lost their identity,” Ms. Tobias said. “We look after them and we teach them through our medicine...We teach them how to walk in this time with the gifts that they have.”
The Champlain LHIN partners with the Indigenous Health Circle Forum (Circle) to plan for Indigenous health services in the region.
Allison Fisher (Wabano Centre for Aboriginal Health Executive Director, and Circle Co-Chair) and Donna Lyons (Champlain LHIN Indigenous Engagement Specialist) presented an update on the priorities of the Circle, current investments and critical next steps.
Ottawa is home to the second largest Indigenous population of all Ontario cities, and includes First Nations, Inuit, and Métis. Indigenous people experience high rates of chronic conditions including diabetes, hypertension, and cardiovascular disease.
In addition, many Indigenous youth experience mental health issues and have higher rates of depression, anxiety and substance abuse than non-Indigenous individuals. Furthermore, one in two First Nations children is living in poverty. “The needs are high, but the resources are low,” advised Ms. Fisher. “We are playing catch-up.”
Ms. Fisher and Ms. Lyons described the work undertaken by the Circle and the LHIN to address four key priorities:
Mental Health and Addictions
In 2012, the Circle, with funding from the LHIN, developed a report called My Life, My Wellbeing, which examined the mental health experiences of Indigenous youth in the city of Ottawa. Indigenous youth reported that the racism and disrespect they experience have created barriers to accessing mainstream services. Culturally-based, appropriate care is critical, the report concluded.
This year, in follow-up to the report, the Circle prepared the report Now Now Now: Mental Wellness for Indigenous Youth in the Champlain Region. This report presents guidelines and a new approach to culturally-based care, whereby Indigenous culture, traditional practices and teachings are critical therapeutic interventions. “Culture is primary care,” Ms. Fisher said, adding that non-Indigenous agencies also have roles and responsibilities to ensure that Indigenous children and youth have access to culturally-based care.
The Champlain LHIN has provided funding for the Now, Now, Now Conference taking place in March 2018, when the report will be shared publicly. The LHIN also funded three positions at Wabano: a mental health and addictions counsellor, Oshkaabewis (Traditional Knowledge Keeper), and a role dedicated to providing outreach services for people with opioid addictions.
Indigenous Cultural Safety Training
Indigenous cultural safety (ICS) training helps health service providers reflect on their biases and the stereotypes, and how these biases and stereotypes affect Indigenous people. Over the past three years, the Champlain LHIN has facilitated this training in the region for its health service providers. For instance, over 400 online ICS training spaces have been purchased, and an ICS training program has been developed to provide face-to-face training.
In addition, a cultural safety obligation has been included in the Champlain LHIN’s service accountability agreements with its health service providers. Preliminary analysis shows that through this obligation, 95 LHIN-funded organizations have provided training sessions to more than 4,000 staff members and volunteers. What’s more, the LHIN has committed to ensure that its staff, management and Board members participate in this training by March 2018.
Chronic Disease (Diabetes)
Diabetes is one of the fastest growing diseases among the Indigenous population in Canada. Rates of type 2 diabetes are three to five times higher among Indigenous people, and children are acquiring diabetes at a younger age. A needs assessment in Renfrew County, outlined in a report called Identifying Wise Practices in Diabetes Management revealed that wait times, lack of benefits and transportation are barriers to accessing services, and that a culturally relevant care model is required. In response, the Champlain LHIN funded a diabetes navigator position for the Renfrew area who will work closely with the Algonquins of Pikwàkanagàn First Nation and the Renfrew and District Aboriginal Friendship Centre.
“Why is the health of Indigenous population so much worse than the rest of the population? The simple answer is inequity,” Ms. Fisher stated. In 2016, the Circle hosted a Health Equity Think Tank, which led to the development of an “Ind-Equity Framework”. The dimensions of the framework include ICS training, Indigenous culturally-based care, commitment to system transformation and reporting on equity. A preliminary review of the framework will happen at the Now Now Now Conference in March 2018. Moving forward, the framework will be used to address system gaps in strategic planning, service provision and impact assessments.
Mr. Boisclair thanked Ms. Fisher and her team at Wabano for hosting the meeting, and arranging a tour for the Board. The tour included a visit to the agency’s educational and commemorative exhibit on Indian Residential Schools.
The Champlain LHIN has invested new funding to meet the growing needs of individuals with opioid addictions. Rod Olfert (Champlain LHIN Senior Integration Specialist) presented to the Board on these investments. He explained that the opioid crisis has impacted every aspect of the health care system. Visits to the emergency room due to opioids, and opioid-related deaths, have increased in the Champlain region. Overdoses have also risen in the community. Furthermore, drugs tainted with fentanyl and carfentanyl have been found in the region, resulting in a growing risk of overdose.
In 2017-18, the Champlain LHIN has invested an additional $1.7 million in ongoing funding to health service providers across the region for new opioid-related programs. This funding will expand and better coordinate services, making it easier and quicker for people to get a range of service options that fit their unique treatment needs.
The new services will be integrated into existing programs along the continuum of care, including prevention, early intervention, stabilization, treatment and harm reduction. For example, new community-based treatment counselling services will complement existing withdrawal management beds (sometimes referred to as ‘detox’) and residential addiction treatment spaces.
“We are trying to save lives,” Mr. Olfert emphasized. Moreover, through screening, assessment, motivational counselling, goal-setting, skill-building, and treatment planning, the new and expanded services will assist in addressing underlying issues, such as mental-health or other life challenges.
This funding complements efforts that are already underway. For example, thanks to public-health units and local pharmacists, the number of naloxone kits distributed in Champlain is significantly higher than any other region in Ontario.
LHIN Board Chair Jean-Pierre Boisclair noted that it will be important for the Board to review the results of the new opioid investments to understand the impacts of the new and expanded programs.
News release: Champlain LHIN Expands Opioid Addiction Treatment Services
The Regional Planning Table for Trans, Two-Spirit, Intersex and Gender Diverse Communities is comprised of community members, health and social service providers and the Champlain LHIN. Its goal is to develop and implement strategies to ensure gender-affirming services are a part of everyday care.
Planning table members Simone Thibault (Centretown Community Health Centre Executive Director) and community members Patricia Vincent and Kaeden Seburn presented to the LHIN Board on the health needs and gaps faced by members of trans, two-spirit, intersex and gender-diverse communities.
Ms. Thibault said there has been a dramatic increase in demand for health services for these communities. The demand has placed pressures on health professionals to provide care that is timely, competent, culturally appropriate and gender affirming.
Mx. Seburn and Ms. Vincent began by sharing their experiences. Mx. Seburn, the youngest member of the planning table and trans health advocate, uses the pronouns they/them/he. They explained that accessing services has not been very positive. “Health service providers are well-intentioned, but lack knowledge,” they said. For example, they described a situation where their physician’s unfamiliarity with the OHIP approval process left them to complete the paperwork for a surgical procedure.
As the parent of a child who is transgender, Ms. Vincent’s instinct was to visit her family doctor for support. However, although willing, the doctor lacked the specific knowledge about available resources, and as a result, was unable to provide the supports and referrals to appropriate services the family needed.
“I was looking for help, my son was looking for help, and there was very little available,” Ms. Vincent said, adding that when they finally received services, they were not always confident that they were getting competent care - but there was nowhere else to go.
The planning table conducted a local environmental scan of existing services for trans, two-spirit, intersex and gender diverse communities. It revealed:
- Four agencies and seven practitioners provide some targeted services
- Wait lists for targeted services range from one week to six months
- 58 per cent of agencies that do not have targeted services regularly see clients from these communities
- Of those providing targeted services: 50 per cent of agencies and 17 per cent of practitioners offer service in both French and English
- There are no agencies that provide specialized services for Indigenous, racially diverse and/or disabled people from these communities
- Almost all service providers would like opportunities to increase their cultural competency in working with members of these communities.
The planning table prepared a report to the LHIN. It describes gaps in pathways to care and pathways through care for trans, two-spirit, intersex and gender diverse communities. For example, service providers lack basic codes of practice and conduct, and there are not enough targeted services and resources to meet the demand. In addition, socio-economic barriers such as geography, finances and age prevent individuals from accessing care.
Once individuals access care, they may face a negative or harmful experience. Many providers lack cultural competency related to hormone replacement therapy, use stereotypes and lack awareness about intersecting identities.
The Champlain LHIN is supportive of the nine recommendations included in the report. “These recommendations align with the Champlain LHIN’s strategic priority to provide culturally appropriate care,” said James Fahey, LHIN Director of Health System Planning.
This year, the Champlain LHIN has provided funding to maintain the operations of a Trans Health Clinic at Centretown Community Health Centre. Funding has also been provided to Family Services Ottawa for a system planner. This individual will work with the regional planning table to prioritize and develop implementation plans to improve system navigation, cultural competency, targeted services and pathways to care.
Champlain LHIN Board Chair Jean-Pierre Boisclair thanked the group members for sharing their experiences and leadership. “This is the beginning of the conversation,” he explained. “You have shared great ideas and the Board looks forward to an update on the progress toward realizing this vision.”
Dr. Jack Kitts, The Ottawa Hospital CEO, presented a plan to the LHIN Board related to the hospital’s budget challenges this fiscal year. Katherine Cotton, The Ottawa Hospital Board Chair, was also in attendance. The plan outlined strategies to balance the hospital’s budget in 2017-18, including administrative efficiencies and new revenue-generating opportunities amounting to $14 million. Dr. Kitts proposed other strategies that would save an additional $4 million; however, implementing those specific changes would negatively affect patient care.
Board members carefully considered the hospital’s plan, approving the administrative efficiencies and revenue-generating opportunities. However, they felt strongly that any cuts to services would result in hardship and risk for patients, and therefore would not be in the public’s interest. Such cuts would also place a burden on other parts of the health system such as primary care, other hospitals, community services and home care.
In addition, the Board considered that The Ottawa Hospital has maintained balanced budgets in the past, and that patient demand has increased significantly. In fact, the hospital has needed to open new, unfunded beds to care for the rising number of patients visiting the emergency room or being admitted.
After much discussion, LHIN Board members made a decision to provide $4 million in additional one-time funding to The Ottawa Hospital. As an agency overseeing health care in a coordinated and integrated system, the LHIN has a responsibility to direct funding in a manner most beneficial to the population.
The decision ensures that current levels of services (now running above budget) will be maintained for people across Champlain requiring acute-care services at The Ottawa Hospital, including highly specialized care that is not provided elsewhere in the region.
The additional one-time funds for the hospital will come from the LHIN’s direct services budget. During the past six months, the Champlain LHIN has invested heavily in home care, and reduced home-care wait lists. Even so, there is still significant demand for home care. Unfortunately, the LHIN is unable to ramp up home-care services as quickly as it would like, due to a province-wide shortage of personal support workers. LHINs are working with the Ministry of Health and Long-Term Care and other partners to resolve this important human resources challenge.
The LHIN Board expressed its appreciation for the diligence and timeliness of the actions of The Ottawa Hospital Board, CEO and management related to budgetary challenges. In turn, the LHIN Board requested that officials from The Ottawa Hospital support regional, transformative change to improve the transition of hospital patients to other levels of care in the health system, which would help alleviate acute-care pressures.
The Royal is presently using a version of a Hospital Information System (HIS) that was deployed over a decade ago. It requires updating to better serve the needs of its patients and clinicians. The Royal reviewed a number of options and found that that the optimal solution would be to join an existing HIS cluster with two other mental health hospitals in the province: Ontario Shores Centre for Mental Health Sciences (Whitby) and Waypoint Centre for Mental Health (Penetanguishene).
This option will benefit The Royal and its patients, as it enables better and more efficient care in a shorter time frame than other options, explained Cal Crocker (The Royal Executive Vice President and Chief Financial Officer). The Royal will benefit from work already done, and will leverage tools and practices operational in the provincial mental health cluster.
The LHIN reviewed the proposed plan and found that it is a cost-effective choice that does not pose financial risk. Mr. Crocker advised that capital and operating costs have been identified and approved by The Royal's Board of Directors. Lastly, this option is well aligned with provincial strategies for HIS renewal and electronic health records.
The Champlain LHIN Board of Directors supported the voluntary integration of the HIS between The Royal, and Ontario Shores Centre for Mental Health Sciences and Waypoint Centre for Mental Health.