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Supporting Indigenous families in the Cree territory: lessons from the  Mashkûpímâtsît Awash initiative

  • Faisca Richer
  • Emilie Robert
  • Michèle Boileau-Falardeau
  • Anne-Lou McNeil Gauthier
Innovations in Policy and Practice

Abstract

Objective

We describe the adaptation of an early childcare and development program to the Indigenous context of the Cree territory in Québec. We also share lessons on the challenging implementation of home visits by Indigenous family support workers (FSWs), which is a critical component of the intervention.

Participants

 Mashkûpímâtsît Awash (AMA) aims to enhance the health and well-being of pregnant mothers, young children, and their families by providing intensive interdisciplinary care and follow-up. Indigenous female FSWs from the community are the key frontline workers and cornerstone of the program.

Setting

AMA is implemented as part of the multidisciplinary services provided by the Community Miyupimaatisiiun Centres (primary health care centres) in three pilot communities of Eeyou Istchee.

Intervention

AMA builds on family centredness and cultural safety, integration of services, and creation of family-friendly communities. It emphasizes the role of female local Indigenous FSWs in providing culturally safe outreach services in the form of home visits.

Outcomes

The main challenge was conducting home visits. FSWs’ view of the pertinence of home visits, as well as their personal stories, seemed to influence their motivation to conduct home visits. Their level of experience appeared to facilitate home visits. Encouraging creativity, fostering autonomy, ensuring a step-by-step implementation, and promoting communication were found to create a supporting environment to facilitate home visits.

Implications

Hiring local Indigenous workers is necessary to ensure that early childhood development programs are culturally safe. Success of such programs relies on team management, provision of culturally adapted training, and quality of the ongoing emotional support provided to the FSWs.

Keywords

Health services, Indigenous Maternal-child health services Community health workers Culturally competent care 

Résumé

Objectifs

Cet article vise à décrire l’implantation d’un programme de soutien au développement de la petite enfance dans trois communautés pilotes en Territoire cri au Québec.

Participants

 Mashkûpímâtsît Awash (AMA) est un programme visant à offrir un soutien intensif adapté aux besoins des femmes enceintes et de leurs enfants dans le but de promouvoir la santé et le mieux-être des familles cries. Les intervenantes locales sont indispensables à la sécurisation culturelle de ce suivi octroyé sous la forme de visites à domicile.

Résultats

De multiples défis furent observés dans le déploiement des visites à domicile par les intervenantes locales, incluant leur perception du manque de pertinence des visites, mais également leurs expériences tant personnelles que professionnelles en lien avec les difficultés vécues par les familles. Ainsi, le soutien concret offert aux intervenantes par le mentorat, ainsi que le respect de leur autonomie et créativité ont été observés comme des facteurs facilitant le déploiement de visites à domicile. De même, une communication ouverte et une approche graduelle dans l’implantation des changements furent identifiées comme supportant les intervenantes dans l’accomplissement de leurs tâches.

Implications

Les intervenantes locales sont essentielles à la sécurisation culturelle des services de soutien aux familles en milieu autochtone. Le succès de ces approches repose sur la qualité du soutien apporté à ces travailleuses, tant sur le plan du développement professionnel (qui doit être adapté aux besoins et au mode d’apprentissage des intervenantes) que sur le plan personnel, afin de leur offrir le soutien émotionnel dont elles ont besoin dans le soutien des familles de leur communauté.

Mots-clés

Services de santé Santé des autochtones Services de santé de la mère et de l’enfant Agents de santé communautaire Compétence culturelle 

Notes

Acknowledgements

The authors thank Anny Tremblay (Â Mashkûpímâtsît Awash Nurse Counsellor and Project Coordinator at the time of the evaluation) and Dominique Arama (Community Psychology consultant at the time of the evaluation) for their ongoing support and trust during the evaluation. They would also like to acknowledge the participation of the Evaluation Advisory Committee. They express their gratitude to the Awash teams of all three pilot communities for their willingness to participate in interviews and consultations, and to the families who accepted to share some of their experience as part of the program. The richness of their contribution is priceless. The authors would also like to acknowledge the constructive feedback provided by the reviewers.

Compliance with ethical standards

Conflict of interest

ER was paid as a consultant by the National Public Health Institute of Quebec (INSPQ) for the evaluation. MBF and FR were employees of the INSPQ, which provided technical and financial support to the Cree Board of Health and Social Services of James Bay (CBHSS) for AMA implementation. AMG declares no conflict of interest.

References

  1. Ball, J. (2008). Promoting equity and dignity for aboriginal children in Canada. IRPP Choices, 14(7).Google Scholar
  2. Beauregard, D., Comeau, L., & Poissant, J. (2010). Avis scientifique sur l’efficacité des interventions de type Services intégrés en périnatalité et pour la petite enfance en fonction de différentes clientèles. Québec, QC: Institut national de santé publique du Québec.Google Scholar
  3. Best Start Resource Centre. (2010). Founded in culture: strategies to promote early learning in First Nations children in Ontario. Best Start Resource Centre: Toronto, ON.Google Scholar
  4. Best Start Resource Centre. (2012). When compassion hurts: burnout, vicarious trauma and secondary trauma in prenatal and early childhood service providers. Best Start Resource Centre: Toronto, ON.Google Scholar
  5. Bouchard, C. (1989). Lutter contre la pauvreté ou ses effets? Les programmes d’intervention précoce. Santé mentale au Québec, 14(2), 138–149.CrossRefPubMedGoogle Scholar
  6. Durie, M. (2003). Editorial: Providing health services to indigenous peoples: a combination of conventional services and indigenous programmes is needed. BMJ, 327(7412), 408–409.  https://doi.org/10.1136/bmj.327.7412.408.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Gauthier, J., Haggerty, J., Lamarche, P., Lévesque, J.-F., Morin, D., Pineault, R., et al. (2009). Entre adaptabilité et fragilité : Les conditions d'accès aux services de santé des communautés rurales et éloignées. Québec, QC: Institut national de santé publique du Québec.Google Scholar
  8. Gendron, S., Dupuis, G., Moreau, J., Lachance-Fiola, J., & Dupuis, F. (2013). Évaluation du programme de soutien aux jeunes parents (PSJP) des Services intégrés en périnatalité et pour la petite enfance à l’intention des familles vivant en contexte de vulnérabilité. Montréal, QC: Faculté des sciences infirmières, Université de Montréal.Google Scholar
  9. Goodleaf, S., & Gabriel, W. (2009). The frontline of revitalization: influences impacting aboriginal helpers. First Peoples Child & Family Review, 4(2), 18–29.Google Scholar
  10. Irvine, K. (2009). Supporting aboriginal parents: teachings for the future. National Collaborating Centre for Aboriginal Health: Prince George, BC.Google Scholar
  11. Lewin, S., Lavis, J. N., Oxman, A. D., Bastias, B., Chopra, M., Flottorp, S., et al. (2008). Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews. Lancet, 372(9642), 928–939.  https://doi.org/10.1016/S0140-6736(08)61403-8.CrossRefPubMedGoogle Scholar
  12. Loppie-Reading, C., & Wien, F. (2009). Health inequalities and social determinants of aboriginal peoples’ health. National Collaborating Centre for Aboriginal Health: Prince George, BC.Google Scholar
  13. McCulla, K. (2004). A comparative review of Community Health Representatives’ scope of practice in international indigenous communities. Kahnawake, QC: National Indian and Inuit Community Health Representatives Organisation (NIICHRO.Google Scholar
  14. Mildon, R., & Polimeni, M. (2012). Parenting in the early years: effectiveness of parenting support programs for indigenous families. Australian Institute of Health and Welfare: Canberra.Google Scholar
  15. Ministère de la Santé et des Services sociaux. (2004). Les services intégrés en périnatalité et pour la petite enfance à l’intention des familles vivant en contexte de vulnérabilité - Cadre de référence. Québec, QC: Gouvernement du Québec.Google Scholar
  16. Minore, B., Boone, M., Katt, M., Kinch, P., & Birch, S. (2001). Facilitating the continuity of care for First Nation clients within a regional context. Canadian Health Services Research Foundation: Ottawa, ON.Google Scholar
  17. National Collaborating Centre for Aboriginal Health (NCCAH). (2012). The sacred space of womanhood: mothering across the generations. Prince George, BC: National Collaborating Centre for Aboriginal Health.Google Scholar
  18. Poissant, J. (2014). Les conditions de succès des actions favorisant le développement global des enfants: état des connaissances. Québec, QC: Institut national de santé publique du Québec.Google Scholar
  19. Richer, F., & Robert, E. (2016). Â Mashkûpimâtsît Awash process evaluation—final report. Cree Board of Health and Social Services of James Bay: Chisasibi, QC.Google Scholar
  20. Schinazi, J. (2002). An analysis of the maternal and child health programme in three Cree communities of the James Bay and the conditions for implementing a Naître Égaux—Grandir en Santé-type programme in the region. In Unpublished report to Cree Board of Health and Social Services of James bay.Google Scholar
  21. Sims, M. (2011). Early childhood and education services for indigenous children prior to starting school. Australian Institute of Health and Welfare: Canberra.Google Scholar
  22. Sioui, N. (2008). Analyse de besoins des femmes enceintes et des mères ayant des jeunes enfants à Mistissini. Conseil cri de la santé et des services sociaux de la Baie James: Chisasibi, QC.Google Scholar
  23. Wade, K., Cava, M., Douglas, C., Feldman, L., Irving, H., O’Brien, M. A., et al. (1999). A systematic review of the effectiveness of peer/paraprofessional 1:1 interventions targeted towards mothers (parents) of 0–6 year old children in promoting positive maternal (parental) and/or child health/developmental outcomes. Hamilton, ON: Effective Public Health Practice Project.Google Scholar
  24. World Health Organization. (2012). WHO recommendations: optimizing health worker roles to improve access to key maternal and newborn health. Geneva: World Health Organization.Google Scholar

Copyright information

© The Canadian Public Health Association 2018

Authors and Affiliations

  • Faisca Richer
    • 1
    • 2
  • Emilie Robert
    • 3
  • Michèle Boileau-Falardeau
    • 1
  • Anne-Lou McNeil Gauthier
    • 4
  1. 1.Department of Aboriginal HealthNational Public Health Institute of Quebec (INSPQ)MontrealCanada
  2. 2.Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontréalCanada
  3. 3.Research Institute of McGill University Health Centre (RI-MUHC) / Equipe de Recherche et d’Intervention Transculturelles (ERIT)MontrealCanada
  4. 4.Sherbrooke UniversitySherbrookeCanada

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