First Nations and Inuit Home and Community Care Program - National
Evaluation Update - Fall 2004
Her Majesty the Queen in Right of Canada
Spring 2004
ISSN 1710-3878 (Print)
1710-3886 (Online) HC.
HC Pub. No.: 9040
Help on accessing alternative formats, such
as PDF, MP3 and WAV files, can be obtained in the alternate
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 (170 KB)
Table of contents
Introduction
Key findings and observations of Study 1: Implementation
Study
What will Health Canada do with these findings?
What is happening next?
How will the study be done?
For further information
Welcome to the second edition of the National Evaluation Update.
This newsletter provides an update on the First Nations and Inuit
Home and Community Care (FNIHCC) program's national evaluation
activities. It describes what is being done now and the plans for
future evaluation activities. Health Canada wants you to be informed
about all evaluation activities of the program. Please share this
newsletter with others in your community.
If you missed the first issue of the newsletter, you can get
a copy from your First Nations and Inuit Health Branch (FNIHB)
regional office (see the last page).
This issue includes a summary of the findings of the Implementation
Study, which was the first evaluation study of the FNIHCC program.
We will also describe the next phase, the Home Care Needs Study,
which will be starting this fall.
The national evaluation of the program includes three studies
in total. The next two studies will look at how well the program
meets community needs. These studies will look at the program to
see how it can support or complement care in other settings. They
will also evaluate the program to see how
successful it is in keeping people in their homes and maintaining
their health. The evaluation recognizes the importance of culture
and community to First Nations and Inuit people.
This was the first of three studies of the program. Many thanks
to everyone who participated. You have helped us to learn more
about how the program was implemented at the community level and
how effective it has been so far.
A copy of the study results, which includes an executive summary,
will be available at your FNIHB regional office and on our website
in October 2004.
The implementation study was set up to answer many questions:
- Were FNIHCC program activities carried out as they were intended,
and are they effective?
- Was the implementation flexible enough so the program could
meet the needs of different regions and communities?
- Was the Planning Resource Kit useful to communities?
- Were there specific program implementation issues among the
First Nations and Inuit communities, and how well were they addressed?
Study participants generally agreed that the FNIHCC has responded
reasonably well to the identified home care needs of First Nations
and Inuit communities. In many communities, there are now at least
basic services in place. Previously, services of any kind wereçunavailable.
They also noted other positive results, such as the ability of
communities to provide services to clients in their own homes,
an improved quality of care, enhanced capacity to provide services,
and improved quality of life and outcomes for clients.
There is also agreement that the FNIHCC is just a beginning,
particularly for those communities that have been able to implement
only minimal services with their funding allocation. Many stakeholders
emphasized the need to examine ongoing funding to sustain and expand
the program and to respond to needs in areas such as respite care,
palliative care, and mental health services.
When asked to identify what worked well about the implementation
of the FNIHCC, program stakeholders often pointed to the collaborative,
consultative approach to program planning, development and implementation.
This approach involved First Nations and Inuit directly in these
activities and resulted in a strong sense of ownership of the program.
Many found that the Planning Resource Kit and the structured planning
process wereçuseful. They also singled out the energy and
commitment of staff at the community level as a significant strength
of the program and as a key factor in its successful implementation.
Some aspects of program implementation that did not work as well
include:
- the funding formula as it applies to small and/or remote communities
- the short time frame for program implementation
- problems with a revised reporting system
- obtaining buy-in at the community level from the political
leadership
- communication issues between the national and regional Health
Canada offices.
Here is a summary of some of the findings:
- Planning Resource Kit: Many communities
found the Planning Resource Kit to be a useful and flexible resource,
but some did not feel it was specific enough or that it was not
appropriate for their community (this was especially true North
of 60).
- Full Service Delivery: The program has
funded 96% of eligible communities. While some of these communities
are still in planning, 78% of communities are in full service
delivery. These communities represent 88% of the eligible population.
However, some communities are not yet funded and/or have not
yet reached full service delivery. Examples of barriers to full
service delivery are access to funding for training, recruitment
and retention issues, and community capacity.
- Training: Many communities need ongoing
funding for training needs, but the FNIHCC does not have access
to funds for this.
- Capital Funding: Many communities need
more capital development funding, but the FNIHCC does not have
access to these funds on an ongoing basis.
- Program Support and Roles: The FNIHCC has
limited resources for the second- and third level of program
support and the roles are not always understood. The roles played
by the national and regional offices of Health Canada and provincial/territorial
organizations and Tribal Councils are not clear to all stakeholders.
- Reporting: Communities have expressed an
interest in receiving regular reports from Health Canada with
an analysis of their program reporting data.
While final recommendations must wait until all three studies
have been completed, Health Canada is committed to using the findings
to improve the current management of the program. For example,
along with our regional partners, we continue to look at how training
and capital issues might be addressed. The FNIHCC has also made
a commitment to provide an analysis of information provided by
communities for community use. Some of these issues are also addressed
in the 2000-2002 and 2002-2003 Annual Reports for the program,
available through your Health Canada's First Nations and Inuit
Health Branch (FNIHB)office.
The Home Care Needs Study will run from September 2004 to January
2005. It will look at the needs for home and community care in
First Nations and Inuit communities and whether the program is
meeting these needs. A resource will be developed that could be
used to learn more about the experiences of clients, care providers
and community leaders across the country.
Training Task Group International, an independent research firm
based in Ottawa , was chosen to carry out the work through a competitive
Government of Canada selection process. The company has extensive
experience in both home care and working with First Nations and
Inuit people.
Here is a profile of some of the team members:
Dr. Emily Jane Faries is from the Moose Cree
First Nation located in the James Bay area. Her academic background
includes four university degrees, with a PhD in Education from
the University of Toronto in 1991. Currently a professor at Laurentian
University, Dr. Faries has extensive experience working with First
Nations people. She was a recipient of the National Aboriginal
Achievement Award in 1998 in recognition of her academic achievement
and contribution to her people.
Kallen Martin is a member of the Mohawks of
Akwesasne and lives in the community. She has spent 10 years in
the health field, where she has been involved in establishing community
addiction and prevention programs, including work with Health Canada
. Throughout her career, Kallen has consulted with a variety of
groups and agencies, mostly at the community level. She has also
done work on environmental issues. Kallen recently began working
on a PhD in Social Science, expecting to complete her dissertation
by early next spring.
The firm also draws on the home care expertise of Dr. Malcolm
Anderson, one of the most internationally well respected leaders
in the home care field, and Donna Nicholson, a health professional
with more than 25 years of experience in home care and health.
We will be asking the Health Canada regional offices to work
with First Nations and Inuit organizations to identify 10 communities
the team could visit. Each of the 10 communities will receive a
letter of invitation to participate which will explain what will
be expected. Community participation is voluntary. Looking at the
program in these communities will help us to paint a picture of
how well the national program addresses the needs.
The researchers will collaborate with communities to develop
a needs reassessment tool which can be used to examine the impact
of the program in their community. The tool will include training
materials so that other communities can use it later if they wish
to find out how well their programs are meeting needs.
In the next step, these 10 communities will use the tool, with
the assistance of the researchers, to conduct a reassessment of
their home care needs. This assessment will be compared with the
situation before the program was implemented. Each participating
community will be compensated, as we recognize that this work takes
time away from other home care activities (up to $2,000 for each
participating community is available). The visits will also include
focus groups and interviews with the communities. These visits
are expected to take place in the fall of 2004.
The study will also include focus groups with service providers
across the country in the fall of 2004 and interviews and collaborative
work with people knowledgeable about the program. Health Canada
regions, Assembly of First Nations and Inuit Tapiriit Kanatami
will be asked to help identify potential participants in the study.
You might be asked for your voluntary participation. Your input
is very valuable to us.
We have also asked the researchers to work with communities to
develop a resource that we could use in the future to gather the
insights of clients, service providers and community leaders on
how the program is working.
It is important to note that this is only a first stage, to find
an information gathering approach that might work and is acceptable
to First Nations and Inuit communities. The methodology and questions
will be developed using a collaborative approach that calls on
the wisdom and expertise of communities across the country. If
it proves successful, Health Canada plans to ask First Nations
and Inuit researchers to work with communities that agree to participate
to collect this information for the first time next year. The plan
is do this every other year.
A report on the results of this study will be published in spring
2005.
Contact the National Coordinator, FNIHCC program at (613) 941-3465
or visit us online.
You can also request more information about the evaluation process
from your FNIHB Regional office.
Pacific
6th Floor, Sinclair Centre - Federal Tower
757 West Hasting Street
Vancouver , BC V6C 3E6
(604) 666-0737
Alberta
Canada Place , 7th Floor, Suite 730
9700 Jasper Avenue
Edmonton AB T5J 4C3
(780) 495-2703
Saskatchewan
18th Floor, 1920 Broad Street
Regina SK S4P 3V2
(306) 780-5449
Manitoba
300 - 391 York Avenue
Winnipeg MB R3C 4W1
(204) 983-4199
Ontario
1547 Merivale Road, 3rd Floor
Nepean ON K1A 0L3
(613) 952-0088
Quebec
2nd Floor, Guy-Favreau Complex
East Tower
200 René-Lévesque Blvd. West
Montréal QC H2Z 1X4
(514) 283-4256
Atlantic
18th Floor, Maritime Centre
1505 Barrington Street
Halifax NS B3J 3Y6
(902) 426-6637
Northern Secretariat ( Yukon ,
NWT, Nunavut )
14th Floor, PL3914 A
60 Queen Street
Ottawa ON K1A 0K9
(613) 946-8102
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