Project Impact Report2019

ACCESS Open MindsElsipogtog First NationTransforming Youth Mental Health Care

CANADIAN INNOVATIONIN ACTION 

ACCESS Open Minds is changing youthmental health care across Canada bytransforming and improving services,

generating new knowledge, and forgingconnections across the country.

This report highlights key site activities,clinical approaches,

and success stories from the ACCESS Open Minds team in

Elsipogtog First Nation, New Brunswick.

Today after one year of being in theACCESS program, I'm in a better place ofmind than I was before. If I didn't see thepost {a  Facebook post about an  ACCESSactivity night}, I don't believe I'd be here. I'ma better mother for my son, a better wife tomy husband, and most of all I'm a betterme. 

Kyla Clair, 24, ACCESS Clientand Member of the ACCESSOM Elsipogtog Youth Council

TABLE OFCONTENTS

01 About ACCESS Open Minds

02 Background and history

030405

Clinical approaches

06Next steps07Impacts so far

Project timeline

ACCESS Youth Space

About ACCESS Open MindsInitiated in 2015,  ACCESS Open Minds (ACCESS Esprits ouverts in French) is a pan-Canadianservice transformation and research project, jointly funded by the Canadian Institutes of HealthResearch and the  Graham Boeckh Foundation under CIHR's  Strategy for Patient-OrientedResearch.

The ACCESS OM network is made up of over 300 individuals including youth, family members andcarers, service providers, researchers, and policymakers from across Canada, all working togetherto transform youth mental health services.

At the 14 ACCESS Open Minds service sites located across the country, youth and their familiesand carers are able to get rapid and barrier-free access to mental health support based on theirown goals and needs, where and when they want it. By implementing a common research programand evaluation toolkit, all ACCESS Open Minds sites provide evidence-based care, and aregenerating evidence  that will inform policymakers and ultimately improve mental health careacross the country. 

Where are we? 14 diverse sites across Canada...Ulukhaktok, NT

Edmonton, AB

University of Alberta, AB

Sturgeon Lake First Nation, SK

Chatham-Kent, ON

Puvirnituq, Nunavik, QC

Cree Nation of Mistissini,

Eeyou Istchee, QC

Dorval-Lachine-LaSalle, QC

Parc-Extension, QC

RIPAJ-Montréal, QC

Province of New Brunswick:

Elsipogtog First Nation,

Péninsule Acadienne,

and P.E.E.R. SJ in Saint John

Eskasoni First Nation, NS

Early Identification: targeted activitiesthat support help-seeking as soon aspossibleRapid Access: youth are offered a mentalhealth assessment within 72 hours ofseeking help Appropriate Care: if required youth areoffered a referral to additional serviceswithin 30 daysContinuity of Care: seamless servicesare provided to youth ages 11-25Youth and Family Engagement: youthand their families/carers are consideredpartners in their own care and design ofservices at sites  

How are services takingshape?..

Generatingnew knowledge and

evidence throughresearch

Creating a pan-Canadian network

Transforming services,making mental health

care systems into learninghealth care systems

Involving youth andfamilies/carers

Project outcomes... we are:

Core Values at ACCESS OM services

Background and history

Elsipogtog First Nation, NewBrunswick

The health care workers in Elsipogtog First Nation note that they encounter clients with high rates ofdrug addiction and overdose, and their resources are often stretched thin when it comes to providingsupport and crisis intervention. At times, youth from the community reach adulthood and findthemselves without a set goal or clear next step, which can make turning 18 a difficult time of transition.Previously, youth workers in the community had noted that they would benefit from training in the areaof counselling youth who are experiencing difficulties – whether they are related to mental health or not.

In partnering with the ACCESS Open Minds project, the health services team and the community ofElsipogtog First Nation aim to transform how they support the mental health of their youth and youngadults. The ACCESS OM team is composed of several members including an ACCESS OM Clinician,Research Assistant, and youth support workers. This team has worked together to reach out to youth in avariety of ways, including using mobile technologies and social media, and by destigmatizing seekingmental health support by normalizing support services and situating them in activities that youth fromthe community enjoy. The team is also working to support the youth of Elsipogtog in accessingappropriate care as quickly as possible, when needed.

Lacey Clair, the ACCESS OM NB Research Assistant for Elsipogtog First Nation and former Peer SupportWorker, notes that the method of delivering mainstream clinical mental health services doesn’tnecessarily work for all youth in First Nation communities. Although there are many great mental healthservices offered in Elsipogtog, Clair notes that the existing stigma surrounding more mainstreamor clinical approaches to mental health care tends to make youth avoid accessing services altogether.

Many people from the community, including the local crisis workers, agree that in order to best serve thecommunity’s youth, a more accessible, youth-friendly approach is necessary than what has been offeredby mainstream services. This approach is a good fit with the ACCESS Open Minds framework – the localsite team meets youth where they are, gives space to listen to their desires, and can support the otherprofessional care providers to best meet the needs of Elsipogtog’s youth. 

An approach that works for the youth of Elsipogtog First Nation

Project timeline

Transformational Research inAdolescent Mental Health (TRAM)grant competition is held

Representatives from NewBrunswick participate in TRAMprocess

ACCESS Open Minds is announced asthe successful TRAM network

Members of the New Brunswick siteteam participate in the first ACCESSOM network meeting in Montréal, QC

Elsipogtog First Nation,New Brunswick

2015

2016

The New Brunswick ACCESS OpenMinds/Esprits ouverts provincialsecretariat works on identifying andengaging Partnering Communitieswhere the ACCESS OM project willtake place

2017

TRAM

Getting started

Provincial roll-out

Boots on the ground

2014

Growing  momentum

Next steps...2019

2018

Elsipogtog First Nation is identified asa Partnering Community, and theproject begins on-site in June 2017

Primary focus was to spread awarenessof the program

Presentations were given at all localschools, and youth were asked whatservices they wanted

Site team began creatingcommunity partnerships

ACCESS OM Elsipogtog hosted itsofficial Site Launch event on April 17,2018

The program has grown to beconsidered a pillar of the community,and is running smoothly andsuccessfully

Despite its late start in the pan-Canadian ACCESS OM initiative, thesite team projects that the researchtarget goal for 2020 will be reachedearlier

The ACCESS OM Elsipogtog YouthCenter will have an extension built toservice the 18-30 year old age group,and to provide private one-on-onecounselling space

The research target goal is reachedbefore the final year of the project!

One of the most important aspects of the ACCESS OM Elsipogtog team is that the team members understand the

youth in their community and how they express themselves. For instance, young people often use the term

"depression" as a word to describe a variety of types of distress (and not just what is meant by "clinical depression").

Understanding the way in which things are said, and even the words and the language used, is of utmost importance

when fully understanding a young person in distress, and then making the decision as to how best to support them.

At the Elsipogtog site, we see Cultural forms of treatment (e.g. Sweatlodge ceremony, Smudging, fasting, drumming,

and all forms of prayer) as a clinical approach, and not as an “alternative” treatment. These practices “need to be

recognized as a valid and effective form of treatment, the same as western approaches,” says Clair and ACCESS

OM Clinician Theolyn Martin. Some youth prefer turning to their traditional roots for healings; it helps in developing a

strong sense of self. Identity is something that many Indigenous youth struggle to find, as youth feel forced to straddle

two worlds. This does not mean that all youth do not also prefer having the option of westernized forms of treatment,

as well. “This is why we allow the youth to choose which services they prefer.”

Furthermore, in Elsipogtog, the site team is workind hard to ensure that youth in need of more specialized care are

connected to whatever help they need, including accompaniment should the young person wish. The provision of

appropriate care goes both ways, though: as Clair points out,  “We’re making sure we don’t refer people to

psychiatrists who just need a friend.”

ACCESS OM Peer Support Workers are able to accompany youth to services outside the community when needed

and/or when that sort of support is requested. Lacey Clair explains:  “We’re giving them what they need when they

need it, but even if we don’t think they need [to see a psychiatrist/psychologist], if someone wants specialized

services, we’ll refer them.” Providing an inappropriate service can be just as damaging as not providing a service at all.”

Integrating research and evaluation into clinical practice

Providing community-appropriate care

A main component of the ACCESS Open Minds project is collecting information with youth andfamilies/carers who receive services at the site. Some of the information being collected includes:

demographic information (who is accessing services?)pathways to care (tracking trajectories of how youth access support)satisfaction of servicessymptoms and functioning of youth, both at one point in time and over the course of time

Site team members use a combination of paper-based questionnaires and a web-based data collection platform to gather thisinformation, which allows the clinical team members and research staff to better understand the needs of youth in theircommunity. The site team has involved a number of different health services staff in becoming better acquainted with the datacollection component of ACCESS Open Minds.  At the Elsipogtog site, as with all sites across the network, participation inresearch does not change or affect the services provided. Collection of this data is an ongoing process, and though the siteteam believes that the assessments are extremely important, client care is first and foremost the focus of our staff.

The Elsipogtog team hopes that the information collected with the youth of Elsipogtog will help them, other service providers,and community leaders to make informed decisions about program design and service implementation goingforward.  Importantly, our  site upholds the OCAP principles of data ownership for First Nations; this study is not beingconducted “on us, but conducted by us, for us,” says Clair.

Clinical approaches Elsipogtog First Nation,New Brunswick

Encouraging youth to seek help for their mental health needs starts with making services, and service-providers,

approachable. “Youth didn’t want to talk to us because we ‘looked all business,’ so now we dress more casually.”

One goal of a more informal practice is to be seen as “a good friend youth can turn to,” and one thing friends do is

keep an eye on each other. By orienting their support towards youth and their day-to-day needs, ACCESS OM

Elsipogtog is able to build meaningful relationships with at-risk youth. This approach means support workers might

accompany young people to get the birth certificates and SIN cards needed to find work; it also means a large

portion  of youth seen by the service are self-referred, seeking help on their own because they feel safe and

comfortable.

The team is also a little less formal in its approach to educating youth on mental health self-care and life skills. A

weekly event dubbed “De-Stress Night” pairs a fun activity with a learning topic, such as mindfulness exercises

alongside a budgeting lesson. Another example is a spa night for young women that included worksheets on negative

self-talk. “We’re able to address anxiety and distress by giving young people  a hand-up instead of handout,” says

Clair. “We can’t solve their problems for them, but we can equip them to help themselves, and that leaves them with

a sense of accomplishment.”

One consequence of ACCESS OM Elsipogtog’s community-based mental health care program is increased freedom

to address barriers to care. Early Identification and Rapid Access are two of the project's main objectives, and the

team in Elsipogtog is able to address them well. Allowing youth and community members to access support workers

directly via informal means such as Facebook and text messaging allows support workers to connect with distressed

youth quickly. This social presence also allows workers to monitor the state of mind of youth to whom they are

already connected. “The cry for help has changed with the use of social media,” says ACCESS OM Clinician, Theolyn

Martin. “Youth express themselves on social media far easier...  why, because our social skills and interactions are

breaking down in society.”

Care is close to home

The informal approach... it works!

The  ACCESS OM  Elsipogtog team  is proud to be  almost entirely made up of local community members. Team

members have roots in Elsipogtog itself, which helps make the team’s informal approach to care successful. The

road to trust is just that much shorter.

Being a part of the community means it’s easy for community members to refer friends and loved ones for support,

because it’s less like interacting with an institution and more like turning to a friend for advice. It also doesn’t hurt

that the informal referral process allows people to refer via a forwarded Facebook message.

ACCESS OM Elsipogtog works closely with the Elsipogtog Restorative Justice Program. Youth can be referred to

the ACCESS OM team for counselling and community service as a mandated means of avoiding a criminal record.

What’s more, local youth are asking to be referred to ACCESS OM.

Clinical approaches (2) Elsipogtog First Nation,New Brunswick

ACCESS Youth SpaceThe ACCESS OM Elsipogtog office is located in the Community Youth Centre, in the middle of thecommunity, close to the gymnasium and hockey arena. Before ACCESS OM, youth seeking mentalhealth or psychological services would have to go to the local health centre or to off-reserve services.This new location makes a significant difference, since the Youth Centre offers a stigma-free anddiscrete location where a young person might be participating in a fun activity or seeking mental healthsupport.

Being housed at the Youth Centre allows the ACCESS OM Elsipogtog team to be more embedded inthe community itself. With a dedicated focus on outreach, the community’s youth appear to be morecomfortable interacting with mental health support workers in the context of the Youth Centre.

Elsipogtog First Nation,New Brunswick

Safe Space operates out of the youthcentre along with ACCESS Open Minds.They offer daily activities for youth aged6-18, and have 4 full-time staff whodevelop close bonds with the youth. Inthe summer months, Safe Space staff runa day camp in which each age group hasone full week of fun activities, such astrips to the water park, or tubing downthe Miramichi River. Each camp groupalso has a cultural activity hosted atKouchiboquac National Park, where theyhear ancestral stories and learn theirMi'kmaq seven sacred teachings fromElsipogtog Elder, Marilyn Ingram.

SAFE SPACE

ACCESS OM staff participate in many of these activities, but also run similar weekly activities in smallergroups for youth aged 11-18 who may suffer from social anxiety of bullying and are uneasy with largegroups. ACCESS staff also focus on providing safe social activities for youth aged 19-30, an age groupthat — prior to ACCESS — had no dedicated services in the community.

ACCESS OM also collaborates with NAYSPS (National Aboriginal Youth Suicide Prevention Strategy)and Mawiw Council Inc. to host cultural activities such as Hand Drum making, Traditional MedicineTeachings and traditional craft making. Our staff also attend sweatlodge ceremonies in the communitywith youth who request it.

Continuity of care

The team in Elsipogtog First Nation isimplementing  the ACCESS OMframework in the unique context oftheir community, and youth arealready benefitting. With plenty ofroom to expand and increaseservices, ACCESS OM Elsipogtog isblazing a trail for youth mental healthcare and building a community ofsupport.

Before the ACCESS OM transformation, older youth in the community (i.e. ages 18-25) were a group that oftenwent unserved. “There was a big need,” says Nancy Milliea, Site Lead for ACCESS OM Elsipogtog. “Now we havefour ACCESS OM workers  whose job it is to help these older kids.” These new and dedicated staff are able toprovide counselling and referrals to appropriate services for youth who might be facing problems at home, orexperiencing anxiety or depression.

Aimed at attracting youthIn Elsipogtog, like in many First Nations communities, programs like ACCESS OM come and go quickly. A programstarts and if its targets are not achieved in a short period of time, the program is closed. This has caused distrust inprograms for youth in Elsipogtog. “Why would I open up to someone who’s gonna be gone in 2 months? They neverstay,” says Kayla Peters, an Elsipogtog youth. This reluctance made the initial months of ACCESS a bit of a struggle,but the team persevered, and proved to the community’s youth that ACCESS will not abandon them.  Offeringservices for youth informed by youth themselves has brought over 700 youth through our doors for either anintervention, a referral to another service, or  a chat on a bad day — and a number of these youth have gone onto become full-time clients. We have also conducted over 1,300 brief crisis interventions.

Among the youth involved in the programs, 57 are participating in the ACCESS OM research and evaluationcomponent of the project. The ACCESS OM Elsipogtog team has a 50% participation rate — a number of youthhave noted that sometimes the assessment process will “bring them down” if they're feeling good, but still theyouth are participating and note its importance. 

The ACCESS OM NB Elsipogtog team is now happy to be considered a pillar in the community. All services inElsipogtog are aware of our program and what we do. We have partnerships with:

Impacts so far Elsipogtog First Nation,New Brunswick

Elsipogtog Alchohol & Drug Prevention Elsipogtog Restorative Justice Program Elsipogtog Probation Elsipogtog Restorative Justice Program Elsipogtog RCMP Detachment Elsipogtog Maternal Child Care Elsipogtog Nutrition Program Elsipogtog Federal School Elsipogtog Child and Family Services Elsipogtog Family Resource Center

Kent County ISD program Bonar Law Memorial High School Eleanor Graham Middle School Rexton Elementary School Moncton City Hospital S.A.G.E Solutions Counselling Services Elsipogtog Crisis Center National Aboriginal Youth Suicide Prevention Strategy (NAYSPS) Jordan's Principle Program Mawiw Council Inc.

Data collection is scheduled to wrap up in September 2020, and

the project results will be published in 2021. To date, 57 youth in

Elsipogtog have particiated in data collection.

Data collection is ongoing

Next steps Elsipogtog First Nation,New Brunswick

A small staff team and limited funding means that the ACCESS OM Elsipogtog team spends the bulk of their time

meeting and assisting a group of young people that they see on a regular basis. One of their strengths is building

trusting relationships with youth in the community, building bridges with young people who might already need

support, or who might benefit from additional support in the future. The site team also hopes that in the future, they

are able to spend time expanding their work towards giving topic-focused workshops.

Despite the difficulties of maintaining enthusiasm in a multi-year research and evaluation project, there is a definitive

sense of optimism among the ACCESS OM Elsipogtog team. This optimism is not just for the project, but for the youth

of the community, as well. “We have lots of plans,” says Clair, “but we don’t have all the resources to implement them

all yet. Our community wants in, though. People are talking about ACCESS Open Minds and spreading the word.”

Community-driven care

In the coming year, the site will be adding an extension to

the Youth Space that will include one large, open-concept

room for activities that will also serve as a “lounge” area

for older youth who would like to “just have a place to call

our own,” as Kyla Clair puts it. This area will have

comfortable seating and a pool table, as requested by the

youth. The space will also have a small private office

designated for client/peer worker sessions. ACCESS OM

workers will continue to meet youth where they are most

comfortable, wherever that might be in the community,

with the hope that someday all youth will consider this

space their safe space.

A bigger space to call home

The ACCESS OM Elsipogtog Youth Council will be working with local artists to create a mural that speaks to the

culture of the community’s youth and their environment. We will also be designing a “Calming Corner,” which will

consist of plush, soft furniture and drapery to allow youth to slip into when they are feeling overstimulated or are

experiencing anxiety. This space is based on a treatment program, the “60-second fix,” created by Dr. Reggie Melrose;

the team has ben  employing this approach with many of our youth. Once our extension is open, our Peer Support

Workers will be working mainly evening shifts to ensure the space is always open and available to our youth.

CHANGING THE STATUS QUOThe site team in Elsipogtog First Nation is implementing the ACCESSOpen Minds framework in a unique and community-specific way.As  ACCESS OM NB Research Assistant Lacey Clair puts it, "Being apart of this national project allows us to see that although eachcommunity is different, we all share the common goal of helping ouryouth towards a better future across Canada."

"The numbers may not all be in and calculated yet, but we can clearlysee that the less formal, more flexible approach to mental health careis working in Elsipogtog! Distrust of mainstream systems runs high inour community, which stops people from accessing the services theyneed. ACCESS OM NB Elsipogtog gave these help-seekers a differentoption, and their trust in us allowed them to trust in the local serviceswe recommend."

This transformation is something that Elsipogtog continues tocontribute towrads in the pan-Canadian ACCESS OM research andevaluation project, helping to build a robust framework for supportingyouth wellness in any context across Canada.

FOR MOREINFORMATION:

ACCESS Open MindsElsipogtog First Nation

250 Big Cove RoadElsipogtog First Nation, NB

E4W 2S1

Phone: 506-523-6412 Fax: 506-523-8382

www.accessopenminds.ca

@Access Open MindsNB Elsipogtog

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