bli bcasw conference nov 5 2010 (update nov3)
Post on 13-Jul-2015
213 Views
Preview:
TRANSCRIPT
BEING LEAST INTRUSIVEApril Struthers M.Ed, R.C.C. & Lindsay Neufeld, MSW RSW
An orientation to practice in responding to situations of abuse and neglect of vulnerable First Nation adults
21
‘Our Elders have for so many years had people push into their lives. We as health professionals think we have authority to do that. We need to remember it is a privilege and honor to be involved in Elders’ lives – we need to give honor and dignity.’
‘You can be accepted by Elders so you can do your job – make yourself present and you will know when they accept you.’
Dorothy HutchinsonHome and Community Care Director
Peter Valentine reserveGrand Rapids, Manitoba
Introduction
Emerged from 5 years of collaboration on the issue of Abuse and Neglect of older adults, across multiple dimensions
Practice implications of BC Adult Guardianship legislation for FN individuals and communities
What does it mean to be “least intrusive” What is our role and responsibility in facilitating culturally safe
encounters and environments
The use of CRN model in developing collaborative response to abuse & neglect in FN communities
Lots of interest in the model and approach
32
Introduction
The development of working partnerships between Health Authorities (designated agencies) and FN health organizations in responding to situations of abuse & neglect of older adults in FN communities.
Building mutual capacity to respond to situations of abuse and neglect in culturally relevant and safe ways
Identification of ‘promising approaches’ utilized across Canada by service providers working in the area of abuse and neglect of adults
Few tools identified used to specifically address abuse and neglect of vulnerable adults. No assessments reflecting aboriginal point of view
43
Being Least Intrusive: the working paper
Desire to articulate the foundational concepts underpinning a different orientation to practice in responding to situations of abuse and neglect of vulnerable FN individuals.
Being least intrusive
Re-conceptualizing Vulnerability and Capability to reflect the social, cultural and historical context in which vulnerability, risk emerge
Cultural Safety: a critical outcome of encounters
Integrating Mainstream and Indigenous knowledge and practice theory to develop a more holistic epistemological approach
Collaborative, meaning centered approach
54
Being Least Intrusive: the working paper
Informed by direct and comprehensive feedback, frontline experience, dialogue and collaboration with FN partners and colleagues.
KDC Health and HCC partnership in Campbell River
4 Provincial dialogues with 20 First Nations communities (PGT /BCACRNS /HA)
2 regional video conferences with ITHA / WHRN
Introducing Re:ACT & FN Re:ACT materials to First Nations communities & health authority staff (VIHA)
WEAAD events / BCACRN outreach
Participation/Dialogue at First Nation Health Forums (KDC)
Direct review of BLI paper by clinicians, FN colleagues
Issues raised at VIHA Aboriginal Health Council
65
A coalescing of ideas, collaborative work, and intentional partnerships
BCACRN was commissioned by FNIH and PHAC to do a scan of national tools and promising approaches, specific to adult abuse and neglect.
The ideas behind “Being least Intrusive” and the findings of the ‘Promising Approaches” scan came together rather unexpectedly
the ‘Flowchart of Intervention’ blended the findings, feedback and approach of both projects
Public Guardian and Trustee of BC commissioned work to develop a provincial template for an interagency protocol between provincial health authority and First Nation communities specifically addressing the issue of adult abuse and neglect.
It is being piloted and adapted to an existing partnership between VIHA and KDC Health (North Vancouver Island)
76
Flowchart of Intervention
Outcome of BCACRN project commissioned by FNIH and PHAC: Maps where different tools and promising approaches could be used within an over process / flow of response
Outcome of Being Least Intrusive: Illustrates a front line response process internal to FN reserve communities (non-designated agency)
Defines a coordinated and intentional process of response. Encourages collaboration within communities as well when
communities and ‘outside’ agencies partner to respond together. Identifies community strengths, gaps in resources, Builds Capacity to respond more effectively (case/community)
87
Key Question
What is my role in facilitating a culturally safe encounter and experience?
9
When Concern Arises re Possible Abuse(Action internal to FN Community)
Indicators- FN
ReACT
Monitor
Nurse
Concernarises
Family
Referto ...
Team Mtg ordo nothing, -
CRN
No
No
Deeper/wider
assessing
Less or noconcern
Monitor
Yes
OtherSocialWkr
Yes
No
Yes
Approach based on AFN Balance Wheel and'hybrid' working
Support Plan includes holistic elements,cultural practices and other healing
Outsider is consulted with, 'invited in', or inBC must visit because of investigatingreports (least intrusive)
Cultural safety is an outcome - outsider andothers are / are becoming, more culturallysafe.
Note: Assessments may not be cultureneutral or culturally appropriate
10
When Concern Arises re Possible Abuse(Action internal to FN Community)
Indicators- FN
ReACT
Monitor
Nurse
Concernarises
Family
Referto ...
Team Mtg ordo nothing, -
CRN
No
No
Deeper/wider
assessing
Less or noconcern
Monitor
Yes
OtherSocialWkr
Yes
No
Yes
Approach based on AFN Balance Wheel and'hybrid' working
Support Plan includes holistic elements,cultural practices and other healing
Outsider is consulted with, 'invited in', or inBC must visit because of investigatingreports (least intrusive)
Cultural safety is an outcome - outsider andothers are / are becoming, more culturallysafe.
Note: Assessments may not be cultureneutral or culturally appropriate
Being Least Intrusive: the tool
Developed to assist front line service providers (primarily non-aboriginal) in orientating themselves to respond to situations of abuse and neglect of vulnerable FN adults in a way that :
Is Culturally Safe
Facilitates a more holistic understanding of health and wellness
Honors cultural and spiritual diversity
Creates Space for collaboration and partnership, and the development of deeper understanding
1211
Being Least Intrusive: the tool
Challenges clinicians to
engage in critical practice
understand vulnerability, abuse and neglect in the social, historical and cultural context within which it emerged and is experienced
be reflexive and develop critical self-awareness of social location and power
be thoughtful, intentional, respectful in their engagement with clients, families and communities
1312
Being Least Intrusive: Core Concepts
Most Effective, Least Intrusive BC Adult Guardianship Legislation
Cultural Safety Jessica Ball, UVIC
Vulnerability and Capability (re-conceptualized): Vanguard Project, BC A&N Collaborative
Aboriginal Understanding of Health: Assembly of First Nations : Social Determinants of Health
Meaning Centered Practice: Clark
Social Work Theory: Anti-Oppressive Practice
1413
14
Being Least Intrusive: the tool
1615
17
Being Least Intrusive: the questions16
Orientation to Self:When: prior to engagement
4.Who am I (personal and professional role, socio-economic status, cultural affiliations, worldview, etc)?
• What is/are my understanding, attitude, assumptions about the issue of abuse, neglect and self-neglect of vulnerable adults? and of vulnerable First Nation adults?
18
Being Least Intrusive: the questions17
Orientation to Self:
3.Will any of my values or biases impede my role/responsibility in creating a safe environment or safe encounter for the client/family with whom I am working?
5.Who am I in relationship to the client/family/community with whom I am working? (How do they see me? understand my role? What is the power differential?)
19
Being Least Intrusive: the questions18
Orientation to ContextCommunity and CultureWhen: before casework begins.
5.What are the resources within the community (eg. social & health care services, eldercare services)?
7.Are there specific protocols of engagement (eg. cultural traditions, values) with/within this community that I need to be aware of and incorporate?
2 0
Being Least Intrusive: the questions19
Orientation to ContextCommunity and Culture
4. Who can I partner with in this community – who is the most appropriate person (has a knowledge of and connection to the client/family, is in a position of trust, can act as a cultural guide and can assist in developing a culturally safe and appropriate support and assistance plan)?
6. What is the history of engagement, collaboration that my organization (eg. community health agency) has had with this specific community regarding service delivery?
2 1
Being Least Intrusive: the questions2 0
Orientation to ContextSpecific SituationWhen: prior to engaging with client/family/community
5. What are the objective details of this situation? (What are the facts, overarching or specific concerns reported, who is involved)?
7. Who reported the concerns of abuse & neglect (e.g. family, client, community member, service provider) and what is their connection to the situation?
9. Will my involvement with client/family/community be welcome?
2 2
Being Least Intrusive: the questions2 1
Orientation to Context:Gathering InformationWhen: over the course of multiple interactions with client/those involved
5.How does the client experience his/her own Physical, Mental, Emotional and Spiritual Health?
• What are the words they use to describe their current state of well-being and functioning across these dimensions?
• How do they make sense of the current situation?• Do they have any specific concerns about any aspects of
their health and well-being?• How do the client’s perspective, experience and meanings
differ from those of their family, caregivers and service providers?
2 3
Being Least Intrusive: the questions2 2
Orientation to Context:Assessment3.What are the specific factors in the following holistic dimensions that contribute to the client’s vulnerability or act to protect against or mitigate client’s risk? • Physical well-being (physical functioning, health issues, activity
level)• Mental well-being (cognitive functioning, education, mental health)• Emotional well-being (self-esteem, sense of control over forces
affecting one’s everyday life, livelihood and health)• Spiritual well-being (cultural identity, engagement, integration -
past/present)• Relationships (connection and belonging to family, extended
family, community, land, environment/creation)• Social Well-being (income, security of shelter and food, language,
access to support and resources)
2 4
Being Least Intrusive: the questions2 3
Orientation to Context:Assessment
4.How will I distinguish between my understanding/definition of health, well-being and risk from those of the client/family/community/culture with whom I work?
6.How will I distinguish between my values regarding standards of care, family relationships, physical surroundings and those of the client/family/community/culture with whom I work?
2 5
Being Least Intrusive: the questions2 4
Orientation to Reflection Process:
3.Was I least intrusive/most effective in my intervention (e.g. was the client’s autonomy respected, was the client’s self-determination and right to live at risk balanced against the need for support and assistance)?
5.Was my involvement experienced by the client as culturally safe (was client’s cultural identity, values and preferences taken into account in the service encounter; was the client engaged in the encounter; was the client involved in developing a respectful and appropriate support and assistance plan, did the client welcome my involvement, was I invited back for further engagement)?
2 6
Being Least Intrusive: the questions2 5
Orientation to Reflection Process:
4.What did I learn about myself (were my values and assumptions about the situation, client, culture, etc challenged?)
6.What is the feedback I have received from client, family, community, colleagues about the process?
8.How could my practice improve?
2 7
Thank You
An Invitation Feedback is welcomed - it will shape our final tool version –
being formed through action research; to be distributed nationally
Focus Groups Fill in evaluation and feedback form
One of 9 tools being developed by NICE through the Federal Elder Abuse Initiative
Please visit us at the NICE table or contact one of us
2 6
2 8
Thank You
April Struthers Email: witworks@dccnet.com Tel: 604 885 0651
Lindsay Neufeld Email: lindsay.neufeld@viha.caTel: 250 850 2172
2 7
Reports Available
Promising Approaches for Addressing / Preventing Abuse of Older Adults in First Nations Communities
Being Least Intrusive: An Orientation to Practice
www.bccrns.ca/projects/index.php
top related