Building Bridges for Indigenous Children’s Health: Community Needs Assessment Through Talking Circle Methodology
Sherri Di Lallo,1 Keren Schoenberger,2 Laura Graham,2 Ashley Drobot,2 Mubashir Aslam Arain3
1Stollery Awasisak Indigenous Health, Alberta Health Services, Edmonton, Alberta, Canada; 2Health Systems Evaluation and Evidence, Alberta Health Services, Edmonton, Alberta, Canada; 3Health Systems Evaluation and Evidence, Alberta Health Services, Calgary, Alberta, Canada
Correspondence: Mubashir Aslam Arain
Health Systems Evaluation and Evidence, Alberta Health Services, 10301 Southport Lane SW, Calgary, Alberta, T2W 1S7, Canada
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Objective: The Stollery Children’s Hospital in Edmonton, Alberta, introduced the Stollery Awasisak team to provide targeted support to Indigenous families and their children. Talking Circles were conducted across northern communities from 2017 to 2019 to better understand how Indigenous people perceive the current state of healthcare services delivered by the Stollery Hospital.
Methods: The 2019 Talking Circles were held in six cities: Grande Prairie, Slave Lake, High Level, Fort McMurray, Edmonton, and Cold Lake, which were the biggest circles held to date with an attendance of 160 participants. Participants included members of Treaties 6 and 8, and Metis Nations of Alberta, as well as healthcare professionals in those regions.
Results: Talking Circles identified challenges Indigenous (First Nation, Inuit and Metis) pediatric patients and their families experienced from accessing care to transitioning home to exploring their positive experiences with the Stollery Hospital and other frontline collaborates. Through these circles guided by Elders in ceremonies, priorities and recommendations were made to help support pediatric patients and their families.
Conclusion: Multiple perspectives provided rich data on how best to adhere to the Truth Reconciliation of Canada 19th mandate and ensure equitable healthcare access to all Indigenous children. Together, leaders, healthcare providers, service providers and community members reflected on the lessons of the Medicine Wheel quadrants and the Seven Sacred Teachings, and brought forward four priorities; capacity building, continuity of care, culturally responsive care and increased communication.
Keywords: discharge planning, Indigenous Health, Talking Circles, cultural safety
In 2015, the Truth and Reconciliation Commission of Canada (TRC) released 94 “calls to action” that “redress the legacy of residential schools and advance the process of Canadian reconciliation”.1 The TRC documents the impacts of colonialism and cultural genocide on Canadian Indigenous people, including the 120-year history of the Canadian Indian residential school system, which an estimated 150,000 children attended.1 The stories were told by survivors who recounted their traumatic experiences, its impact on future generations, and the resulting effect of distrust among Indigenous people toward government institutions. The consequences are seen in the health outcomes of Indigenous people who live in isolated communities, where there is a lack of available health services and on-going care management within the provincial-federal system.2,3
Stollery Awasisak Health Program
Notably, the 19th “call to action” is to address the healthcare inequalities for Indigenous (First Nation, Inuit and Metis) peoples.1 In Alberta, there are three large tribes: Algonquian (Blackfoot, Cree and Saulteaux), the Dene (Beaver, Chipewyan, Slavey and Sarcee), and the Siouan (Stoney) tribes.4 Despite the implementation of mandatory Indigenous awareness training for all Alberta Health Services (AHS) staff, systematic barriers continue to affect Indigenous families and children. Indigenous families living in rural and remote communities face the arduous challenge of finding reliable transportation to the nearest children’s hospital (eg 220–982 kilometers away). Transportation is usually obtained through a driver or a bus service. Moreover, local pharmacies are in short supply and the cost of living is high in northern communities. Also, many northern First Nation and Metis people considered Cree or Dene as their first language, yet few hospitals offered interpretation services in these languages. As a result, the Stollery Children’s Hospital introduced the Stollery Awasisak team to provide targeted support to Indigenous families and their children. Awasisak is named after the Cree word “children.” The Awasisak Health Program is comprised of Indigenous staff who provide programs and resources to support families and facilitate educational training for AHS staff. The group offers support for navigating health systems, and assistance with discharge plans (eg accessing mental healthcare), providing a safe space, daily tea and bannock, and Indigenous ceremonies (eg smudging and drumming). The Stollery Awasisak Health Program is guided by the Medicine Wheel principles,5 the Seven Sacred Teachings,6 and Jordan’s Principle.7–9
The Talking Circles were evaluated from 2017–2019 to maintain the standards of data quality and methods used (see Appendix A to review Guiding Evaluation Principles and Appendix B to review Ownership, Control, Access, and Possession (OCAP) Principles), and to better understand how Indigenous people perceive the current state of healthcare services delivered by the Stollery Hospital in Edmonton, Alberta. Talking Circles were held in urban cities in Northern Alberta, close to Indigenous communities, to allow all participants to travel shorter distances to a culturally safe space. The 2019 Talking Circles were held in Grande Prairie, Slave Lake, High Level, Fort McMurray, Edmonton, and Cold Lake (Figure 1).
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