strengthening culturally safe and humble perinatal care in ......• ensure that maternity care is...
TRANSCRIPT
Healthy Mothers, Healthy Babies ConferenceFriday January 21, 2020
Strengthening Culturally Safe and Humble Perinatal Care in BC: A Focus on Work Environments and Individual Reflection and Practice
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Acknowledgement
Unceded Territory
sḵwx ̱wú7mesh úxwumixw (Squamish)
xʷməθkʷəy̓əm (Musqueam)
sel̓íl̓witulh (Tsleil-Waututh)
Map by Deborah Reade
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Who We Are
Kayla SerratoSenior Policy Analyst, [email protected]
Delaram FarshadSenior Planner, [email protected]
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Learning Objectives
• Increase knowledge about what cultural safety and humility is, why it is important to better understand the unique contexts of Indigenous clients and how the health system and providers can work to addressing long-standing inequities
• Raise awareness of excellent work in BC that demonstrates culturally safe and humble perinatal environments and care
• Raise awareness and linkages to existing resources to support ongoing learning in relation to cultural safety and humility
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BC First Nations History
Since time immemorial Origin stories Economic systems Education and training Resource management Leadership structures Languages and cultures Health and Wellness
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Health and Wellness Interrupted
The vision of health and wellness comes from the ancestors and is relational
Colonization interrupted this worldview
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Imposition of Colonial Institutions & Systems
• Expropriation of land and territory • Cultural genocide and outlawing of economic and health systems• Denied access to justice • Segregation• Imposition of foreign governance• Undermining of individual, community, Nation identity • Imposition of patriarchal approaches • Undermining of self-determination
St Paul’s Indian Residential School, North Vancouver BC
Residential Schools Indian Hospitals
Coqualeetza Indian Hospital, Sardis BC
Children in ‘care’
Regina Leader-Post newspaper on Nov. 14, 1972
Justice System
Alouette Correctional Centre for Women, Maple Ridge BC
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“We are at a pivotal moment in our collective history, one where we have a unique opportunity to mature as a society. We are now entering a post-colonial era. This country is founded and built on a very solid foundation of Indigenous people. We will no longer be invisible in our own land.”
-Hereditary Chief Ian Campbell, Squamish Nation
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First Nations Perspective on Health & Wellness
Wellness belongs to every human being and their reflection of this perspective will be unique
The FNHA through its services or partnership works to support BC First Nations on their wellness journey
Acknowledging that personal health and wellness is impacted by the world around them
Royal Commission on Aboriginal People
1996
Transformative Change Accord:
First Nations Health Plan
2006
Truth andReconciliation Commission:
Calls to Action
2015
Declarations ofCommitment:
Cultural Safety & Humility
2015-Today
An Agenda for Change
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Cultural Safety and Humility
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Cultural safety is an outcome based on respectful engagement that recognizes and strives to address power imbalances inherent in the healthcare system. It results in an environment free of racism and discrimination, where people feel safe when receiving health care.
Cultural humility is a process of self-reflection to understand personal and systemic conditioned biases, and to develop and maintain respectful processes and relationships based on mutual trust. Cultural humility involves humbly acknowledging oneself as a life-long learner when it comes to understanding another’s experience.
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“It starts with me” Importance of leadership Power sharing
Health literacy is a two-way process Culture as healing Best of both worlds Understand impact of trauma
Relationship-based Person / family in context See each other as human beings Teamwork
Key Concepts of Cultural Safety and Humility
Creating a Climate for Change
• Creating a Climate for Change Resource Booklet• Partner Declarations of Cultural Safety and Humility• FNHA’s Policy Statement on Cultural Safety and Humility• Key Drivers and Ideas for Change• #itstartswithme Campaign• 10+ Cultural Safety and Cultural Humility Webinars• Website: http://www.fnha.ca/wellness/cultural-humility
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Declarations of Commitment
• Acknowledgement of the existence of racism• Acknowledgement of harm – past & present• Key terms & definitions
• Commitment to action• Create a climate for change
• Engage and enable stakeholders
• Implement and sustain change
• Report on progress
• Commitment to reciprocal accountability• A range of efforts underway by each signatory
organization
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With accountability to First Nations
Hardwiring Cultural Safety & Humility into health services in BC
Ministry of Health Ministry of Mental Health & Addictions First Nations Health Authority 5 Regional Health Authorities 1 Provincial Health Services Authority 20+Regulatory Bodies and Colleges Health system partners Health Canada/Public Health Agency of
Canada/Indigenous Services Canada Health System Associations Academic Institutions
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Nation Rebuilding & Self-Determination
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“While Indigenous children were being mistreated in residential schools by being told they were heathen, savages and pagans and inferior people -- that same message was being delivered in the public schools of this country.”
Justice Murray Sinclair
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Learning Pathway (Empathy to Ally)
Unlearning Learning Guilt/Shame Zone
Integration into Thinking
Learning into Action
Share with others (Champion)
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Relearning and Action
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Priorities for Action in Maternity Care
• Improve earlier access to quality prenatal care + the provider of choice
• Bring birth closer to home and into the hands of Indigenous women
• Improve coordination/communication across maternity care providers/organizations
• Increase the number of Indigenous maternity care providers and leaders
• Ensure that maternity care is wholistic and wellness focused
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A Systems Framework
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Considerations for Supportive Systems
• Education / Health Partnership• Intention to increase the number of Indigenous health students with
dedicated support• Indigenous faculty and curriculum• Elder and cultural lead supports• Dedicated Indigenous student seats & peer support• Practicum/shadowing in partnership with community
• Health Employer Vision • Intention to increase the number of Indigenous health service
providers and leaders • Indigenous recruitment and retention strategies• Culturally safe and humble work environments
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Considerations for Supportive Systems
• Workplace expectations and processes• Core competencies / performance reviews• Staff training and practice management supports• Self-reflective team huddles + reading groups• Operational policy• Patient experience + quality measures
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Considerations for Supportive Spaces
• Local territorial acknowledgement (verbally / physically)
• Inclusion of local First Nations language(s) (e.g. signage)
• Larger maternity rooms to accommodate family
• Dedicated space for ceremony / healing work
• Accessibility to wholistic care providers (e.g. doulas, navigators or liaisons, cultural healers, traditional healers)
• Accessibility to traditional foods and practices
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Considerations for Self-Reflective Practice
• Think about how your historical, cultural, social, cognitive, and personal experiences have impacted your world view and professional practice
• Reflect on your beliefs, attitudes and assumptions and where they come from and how they might impact others
• Think about how power imbalances occur in provider/client interactions and what you can do to support greater balance
• Think about how you can interact with others in a way that demonstrates respect and kindness
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Considerations for Client Centered Care
Value each individual, as a fellow human being
Honour an individual as an expert in their own health
Meet an individual wherever they are at
Focus on individual strengths, hopes and priorities
Support client self-determination / personal decision making Nuu-chah-nulth mother’s story approach (personal health descriptions,
lived experience, hopes and dreams, goals) Motivational interviewing / brief action planning
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Example Partner Resources and Linkages
Please note this represents a small number of resources that could be helpful.
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MMIWG Calls to Justice & TRC Calls to Action
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Community Driven & Informed Research
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National Aboriginal Council of Midwives
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https://indigenousmidwifery.ca/
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Doulas for Aboriginal Families Grant Program
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New Updates:• Two week turn around to process
applications
• Grants to support doula travel: To hospital, to communities where there are no doulas, to training
• Upcoming changes to doula requirements: Training or community reference letter, criminal record check and statement of practice
• Cultural safety video for non-Indigenous doulas coming
• ekw’í7tl doula collective training
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Jordan’s Principle FundingFacilitate access to services and supports for all First Nations children without delay or disruption.
To report a case of Jordan's Principle in BC or for more information, please contact:
Jordan's Principle Implementation778-951-0716sac.principedejordancb-bcjordansprinciple.isc@canada.ca
Or call the 24-hour line at 1-855-JP-CHILD or visit www.canada.ca/jordans-principle.
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Early Years Indigenous Cultural Safety Resource Guide
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FNHA / NCCIH Family Wellness Booklets
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National Collaborating Centre for Indigenous Health (NCCIH)[email protected]
First Nations Health Authority (FNHA)[email protected]
https://www.nccih.ca/27/Child,_Youth___Family_Health.nccih?id=439
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Wholistic Resources
36http://www.perinatalservicesbc.ca/health-professionals/professional-resources/health-promo/pregnancy-passport
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Prenatal / Breastfeeding Promotion
Best Start Indigenous Resources:
https://resources.beststart.org/product-category/resources/indigenous-prenatal-health/
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Video: The Creator’s Gift To Mothers Shibogama First Nations Council
https://www.youtube.com/watch?v=rkaxLGI5WBw
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Trauma Informed Principles – Reflective Questions
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Centre of Excellence for Women’s Health
Trauma Gender Substance Use Resources: http://bccewh.bc.ca/recent-work/traumagendersubstance-use-project-2/
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Discussion
• What has helped you in your personal learning and practice?
• What positive changes have you seen in providing more culturally safe maternity care? What supported these changes?
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