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Being Least Intrusiveli update march 27 2014 [1]

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Orientation to using tool for cross cultural practice. Tool available at www.nicenet.ca.

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Being Least Intrusiveli update march 27 2014 [1]

  1. 1. Wise Practice across Difference April Struthers, M.Ed RCC & Lindsay Risk, MSW RSW Powell River, BC March 2014
  2. 2. 10:00 am Welcome & Introductions : who is in the room Framing the Day: Process to Practice – a brief history Working across Difference & “Wise Practice” 11:00 am Break 11:15 am Being Least Intrusive: an introduction to the tool Concepts & Context Questions & Feedback 12:00 pm Lunch 1:00 pm Core Concepts Revisited & Applied Cultural Safety (you & me) 2:00 pm Break Shared Meaning (the space between) 3:30 pm Wrap – up 4:00 pm Close
  3. 3. Framing the Day How did we get here: from process to practice Working across Difference Wise practice
  4. 4. SharedWork, Different Perspectives  Adult Guardianship Legislation  CRNs, PGT, Health Authority,  Contracted work SharedVision, Common Interests  Prevention Collaborative, First Nation Working Group  Education of frontline clinicians & community members  National work/research Interprofessional approach
  5. 5. SharedValues & Principles  Critical Analysis,  Cultural Safety,  Social Determinants,  Aboriginal Understanding of Health,  Human Relations as universal,  Empowerment, Advocacy & Change  AND Collaboration
  6. 6.  Lack of tools and practice provided freedom to do what we thought was the right thing  Created a cross professional / cross cultural community of practice- deliberate action and discernment of critical differences in action and practice  Managed up at every opportunity (audaciously) Social Policy Lessons: Elements of Success THIS IS EMERGENT SOCIAL POLICY
  7. 7. Diversity and cultural safety  Opportunity to get diversity funds to illustrate how using Community Development model can lead to practical tool (locally /regionally created)  Tool may be used in a variety of ways.  Organic development adds to sustainability, authenticity, capacity building  This tool can be nested inside the concepts of theVIU/PRDI/UVIC curriculum
  8. 8. Locally produced curriculum  Powell River as leader in inclusion, using local assets  Concepts as background to doing more diversity based practice:  Communities of difference  Wise practices  Assessment  Diversity based interpersonal practice
  9. 9. Wise Practice vs Best Practice Heirarchy, cookie cutter, context bound  ‘‘Wise practice’ as a way to foster culturally appropriate support and healthcare”  Not working with pre-determined best knowledge In our terms-hybrid practice, iterative appreciative asset based , meaning centered – asking and being known ‘Ways of engaging that enable us to be responsive to diverse needs and strengths’ A ‘wise practice ‘ is an orientation of engagement
  10. 10. Wise Practice vs Best Practice Assessment Based on AFN worldview depiction- holistic, relational, community at centre, links to family, land, heart, mind, spirit, body Identifies the context! Hybrid of different ways of knowing Aboriginal aspects Western social science evidence base (Research Director, U of Toronto Institute of Aging) Shared Meaning Interpersonal practice (meaning centered practice) Learning to be de-colonial
  11. 11. Tools and practice emerge from multiple and intersecting points.  Structured by provincial legislation  Enriched and supported by national research projects and community based response and prevention strategies  Informed by the realities of frontline practice  Founded on principles and values honoring self-determination, autonomy and empowerment  Grounded in a critical awareness of the cultural, social and historical context in which adult abuse and neglect emerges and is experienced.
  12. 12. An orientation to practice in responding to situations of abuse & neglect of vulnerable First Nation adults. April Struthers M.Ed. RCC Lindsay Risk (Neufeld) MSW, RSW Powell River, 2013
  13. 13. Authors April Struthers M.Ed, RCC Lindsay Risk (Neufeld) MSW, RSW Developer National Initiative for the Care of the Elderly (NICE) Elder Abuse Knowledge to Action Project Alison Leaney, National Project Coordinator Being Least Intrusive: an orientation to practice
  14. 14. ‘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 Hutchinson Home and Community Care Director Peter Valentine reserve Grand Rapids, Manitoba
  15. 15. Being Least Intrusive (BLI) is a tool developed to assist front line, primarily non-aboriginal clinicians and service providers to respond to situations of abuse, neglect and self-neglect of vulnerable First Nation adults in a way that is : Least Intrusive yet Most Effective Culturally Safe & Appropriate
  16. 16. Being Least Intrusive
  17. 17. BLI emerged from 5 years of collaboration on the issue of adult abuse & neglect across multiple dimensions: Partnerships between Provincial Health Authorities and First Nation Health organizations (eg.VIHA & KDC). Collaborative between frontline service providers and BCCRN regional mentor in providing awareness education to First Nation communities. Regional, Provincial and National Dialogues exploring and identifying issues and service gaps related to adult abuse & neglect in First Nation Communities. National research and project outcomes identifying ‘promising approaches’ and ‘best practice’ in elder abuse awareness, intervention and prevention.
  18. 18. Being Least Intrusive was envisioned and developed within the practice context of NorthernVancouver Island, British Columbia. Social – Legal Context:  The BC Adult GuardianshipAct (AGA) provides for the support, assistance and protection of vulnerable adults who are being abuse and neglected. The provincial health authorities are named in the AGA as designated agencies and have the mandated responsibility to investigate reports of abuse and neglect of vulnerable adults.
  19. 19. Cultural - Geographical Context  There are approximately 40,550 Aboriginal people living in communities served by the Island Health (formerlyVIHA).  The majority – 28,000 (69%) – identify as belonging to three First Nations with traditional territory onVancouver Island: the Coast Salish, the Nuu-Chah-Nulth, and the Kwakwaka’wakw Nations; 10,980 (27%) are Metis people; and the rest (4%) are aboriginal people who have come from other areas. (see map) (fromVIHA – Aboriginal Health Plan, 2011- 2014)
  20. 20. Being Least Intrusive
  21. 21. We believe that the principles and concepts underpinning this orientation to practice and process of engagement are applicable ▪ Across jurisdiction and geographic region. ▪ In work with First Nation, Inuit and Metis people living in reserve communities, as well as those living in rural, urban and remote settings. While BLI represents advanced practice with a target audience of health care clinicians (eg. RNs, SWrs, OTs & PTs) it can be used to educate and build capacity among other frontline care providers (eg. elder workers, care aides and volunteers) involved in providing care to vulnerable adults.
  22. 22. Being Least Intrusive, as an orientation to practice, has resonated with clinicians and service providers working in a variety of areas related to vulnerability, abuse and cross cultural practice.  RCMP, Provincial Police Services & First Responders  Child Protection Agencies  Multi-culturalAgencies  Women’s Shelters  Community Response Networks (CRNs)
  23. 23. Being Least Intrusive
  24. 24. Being Least Intrusive (BC AGA)  Guiding principles in adult guardianship legislation are intended to safeguard an adult’s right to autonomy and self-determination. ▪ Adults are presumed capable and have the right to live independently, to choose for themselves how, where and with whom they want to live - even if that means living ‘at risk’. ▪ Interventions to mitigate risk and vulnerability must be balanced with a respect for client’s autonomy and self-determination. ▪ Being least intrusive in the context of First Nation adults requires clinicians to develop a critical awareness of cultural history and the intergenerational impacts of colonization. Whether I am invited to do so or I am required by law to intervene, how do I engage with clients, families and communities in a way that is least intrusive, most effective?
  25. 25. Re- ConceptualizingVulnerability & Capability (Vanguard Project, 2009)  Definitions of vulnerability and capability vary across jurisdiction, institutions, clinical disciplines and culture.  Vulnerability and capability are not determinative of each other, but they are intrinsically linked and intersect along a continuum. ▪ A person may be quite ‘incapable’ without being particularly vulnerable, or very capable but highly vulnerable. ▪ The presence of vulnerability may suggest the need for support, assistance even if the adult is capable. ▪ The absence of vulnerability may alleviate the need for intervention even if there is suspicion of incapability.
  26. 26. Vulnerability  is RELATIVE and DYNAMIC: it can fluctuate depending on circumstance.  is RELATIONAL: a person is vulnerableTO something.  is a SOCIAL CONDITION: because of stigma and structural inequality social factors such as poverty, isolation, lack of education, homelessness, addiction, mental illness, gender, age, and culture are indicators of vulnerability.
  27. 27. Capability  is NOT STATIC or FINITE: it can change depending on circumstance, situation, over time  refers to capacity for DECISION MAKING in SPECIFIC aspects of life and functioning ▪ a person may be capable of making decisions about certain aspects of their life (eg. Personal Care) but incapable of making decision in other areas of their life and functioning (eg. Financial and legal affairs). Does the client understand the information being presented and the services being offered? Does she understand the concerns and why the support is being offered? Does she understand the consequences of not accepting the support and continuing to live at risk?
  28. 28. Cultural Safety (Jessica Ball, MPH, PhD)  Cultural Safety is an outcome determined solely by the service recipient.  Cultural Un-Safety: Stigma, stereotypes and embedded structural inequality & discrimination are barriers for indigenous people seeking health care services.  these barriers create environments of care that have historically been experienced by many aboriginal people as unsafe, risky and dangerous.  cultural identity and way of being are disregarded, challenged or harmed in encounters with individual service providers, organizations and/or systems.
  29. 29. Cultural Safety (Jessica Ball, MPH, PhD)  Creating Culturally Safe encounters is contingent upon: ▪ Respectful relationships ▪ Equitable partnerships ▪ Reciprocal learning ▪ Collaborative problem-solving ▪ Sharing knowledge ▪ Listening to and respecting diverse ways of knowing What is my role and responsibility in creating encounters and environments that are experienced as culturally safe? What can I do to help reduce the sense of personal risk for my clients in encounters with health services, organizations and systems?
  30. 30. Aboriginal Understanding of Health (AFNWholistic Planning Model and Cultural Framework)  Central belief in the interconnection of all that is in existence  a reverence for the intrinsic wholeness and sacredness of self and others.  Health and well-being: understood as a harmony and balance across multiple and intersecting dimensions. ▪ total health: (physical, emotional, mental, spiritual) ▪ total person: (body, mind, heart, spirit) ▪ total environment: (social, cultural, natural world) The health of an individual is reflected in the health of the community as a whole; the health of the community is reflected in the health of individuals and families.
  31. 31. Collaborative Meaning Centered Practice (Janet Clarke, PhD)  Inquisitive and Curious stance towards practice ▪ acknowledges that client is author and narrator of own story ▪ honors diverse ways of knowing and being  Engage as “humble knower”, acknowledging the biases of his/her knowledge, perspective and meanings ▪ allows for client’s voice to be heard and valued ▪ collaborative and reciprocal process of sharing knowledge and exploring meaning  Requires critical reflexivity – a cultivation of self-awareness in terms of understanding the ways in which location, power and interpretive frames influence what is seen and not seen, heard and not heard.
  32. 32. Being Least Intrusive
  33. 33.  A need was identified through frontline practice, forums, dialogues and research for a concrete, practical and accessible tool that would assist frontline responders orient themselves to case work and engage with First Nation clients, families and communities differently. ▪ Critical understanding of self, culture and context. ▪ Collaborative engagement & partnership. ▪ Broader , more holistic assessment : integrating western and indigenous world view & understanding of health and wellness.
  34. 34. Intentional practice – a way of being • Slowing down, being grounded and present. • The way you proceed may have more chance of creating conditions of cultural safety (defined by your clients and their families). • developing good cross cultural habits. • If things do not go well in these cases, it is a huge resource drain for workers and authorities- and relational barriers are created towards further work, trust is erased.
  35. 35.  BLI guides frontline responders through a process of critical preparation, assessment and reflection.  It is divided into three sections, each with a series of questions to assist clinicians: ▪ Develop critical self-awareness; ▪ Gather information that will inform a more holistic assessment; ▪ Engage with clients, families and communities in ways that are culturally safe and appropriate.
  36. 36. Orientation to Self Encourages the development of critical self awareness by asking the clinician to reflect on:  who they are: professionally, personally, culturally, etc.;  what values, beliefs, worldview they hold;  what assumptions and attitudes they have towards vulnerability, abuse and neglect, First Nations people, etc.;  How these things influence interaction with client/family/community and shape the healthcare encounter.
  37. 37. Orientation to Context Encourages a critical awareness of context, which broadens the scope of understanding of :  Community:What are the existing social, healthcare resources?  Culture: Are there protocols of engagement?Who can mentor/guide me?  History: How has service delivery been experienced in the past?  Relationships: How is my role understood? Is my involvement welcome?  Assessment: ▪ What does the client think, feel, say, experience of/about the current situation? ▪ Who with and in what way does the client experience connection (family, community, etc)? ▪ What factors contribute to the client’s vulnerability?What are the client’s strengths? ▪ What are the client’s values, beliefs, worldview? What is important to know about their way of being in the world?
  38. 38. Orientation to Reflection Encourages reflection and the development of a critical awareness of self in practice; facilitates learning and growth.  Was I least intrusive/most effective in my intervention?  Did the client experience the encounter as culturally safe? How do I know?  What did I learn about myself in this process?  What is the feedback I have received from client/family/community?  How could I improve my practice?
  39. 39. Being Least Intrusive
  40. 40.  Being Least Intrusive emerged and took shape over time as a result of the rich and insightful wisdom gleaned from Conversations that Matter  Conversations that Matter have included varied participants along the way, whose thoughtful input, feedback and questions have helped make the BLI tool accessible, respectful and effective. ▪ Frontline health care workers (broad spectrum of disciplines) ▪ Engaged First Nation community members, Elders and leaders ▪ University Educators and Students
  41. 41. Core Concepts Revisited & Applied Cultural Safety (you and me) Shared meaning (the space between)
  42. 42. Cultural Safety (Jessica Ball, MPH, PhD)  Cultural Safety is an outcome determined solely by the service recipient.  Cultural Un-Safety: Stigma, stereotypes and embedded structural inequality & discrimination are barriers for indigenous people seeking health care services.  these barriers create environments of care that have historically been experienced by many aboriginal people as unsafe, risky and dangerous.  cultural identity and way of being are disregarded, challenged or harmed in encounters with individual service providers, organizations and/or systems.
  43. 43. Cultural Safety (Jessica Ball, MPH, PhD)  Creating Culturally Safe encounters is contingent upon: ▪ Respectful relationships ▪ Equitable partnerships ▪ Reciprocal learning ▪ Collaborative problem-solving ▪ Sharing knowledge ▪ Listening to and respecting diverse ways of knowing What is my role and responsibility in creating encounters and environments that are experienced as culturally safe? What can I do to help reduce the sense of personal risk for my clients in encounters with health services, organizations and systems?
  44. 44. Collaborative Meaning Centered Practice (Janet Clarke, PhD)  Inquisitive and Curious stance towards practice ▪ acknowledges that client is author and narrator of own story ▪ honors diverse ways of knowing and being  Engage as “humble knower”, acknowledging the biases of his/her knowledge, perspective and meanings ▪ allows for client’s voice to be heard and valued ▪ collaborative and reciprocal process of sharing knowledge and exploring meaning  Requires critical reflexivity – a cultivation of self-awareness in terms of understanding the ways in which location, power and interpretive frames influence what is seen and not seen, heard and not heard.
  45. 45. Being Least Intrusive April Struthers, M.Ed, R.C.C. Wit Works Ltd Email: witworks@dccnet.comwitworks@dccnet.com Telephone: (604) 885- 0651 Lindsay Risk (Neufeld) , MSW, RSW Email: lindsayrisk@icloud.com Telephone: (250) 871-1005 BLI Training Video: Find it at: http://www.youtube.com/watch?v=bGLhdP3nBJI
  46. 46. References  Ball, J. (2008). Cultural Safety in practice with children, families and communities. Early Childhood Development Intercultural Partnerships, University ofVictoria.Victoria, BC. Retrieved from www.ecdip.org/culturalsafety/  Poster at www.ecdip.org/docs/pdf/Cultural%20Safety%20Poster.pdf  Clark, J. (2006). Listening for Meaning:A Research Based Integrative Model for Attending to Spirituality, Culture andWorldview in social work practice. CriticalSocialWork, Vol. 7, No. 1.  Reading, Jeffrey L.; Andrew Kmetic,Valerie Gideon. (2007). First NationsWholistic Policy and Planning Model: Discussion Paper for theWorld Health OrganizationCommission on Social Determinants of Health. Assembly of First Nations, Ottawa, Ont. Available from: http://ahrnets.ca/files/2011/02/AFN_Paper_2007.pdf  Struthers, A., L. Neufeld. (2010). Being Least Intrusive: an orientation to practice in responding to situations of abuse, neglect and self-neglect of vulnerable First Nation adults (Working Paper). www.bccrns.ca/projects/index.php  (2009). Provincial Strategy Document:Vulnerability and Capability Issues in British Columbia. BCAdult Abuse / Neglect Prevention Collaborative.Vancouver, BC. From www.bcli.org/ccel/projects/vanguard
  47. 47. Abuse & NeglectTools Flowchart of Intervention: www.bccrns.ca/projects/docs/promising_approache_asdressing_ preventing_abuse.pdf First Nation Re:Act: Assessment and reporting information/ process for Designated Agencies (as identified in the BC Adult Guardianship Act) investigating reports of adult abuse and neglect, adapted for use with First Nation’s individuals and communities. www.vchreact.ca/aboriginal_manual.htm
  48. 48. www.nicenet.ca Tools for addressing, detecting and preventing abuse of older adults.  Indicators of Abuse (IOA)  An Ethical Decision-Making Framework (IN HAND)  Elder Abuse: Assessment and intervention Resource Guide
  49. 49. Elder Abuse KnowledgeTo Action ProjectTool Kit NICE – National Initiative for the Care of the Elderly Prevention  Coordinated Community Response to Abuse of Seniors – A whole CommunityApproach Detection  Elder Abuse Suspicion Index (EASI) – for Physicians  Brief Abuse Screening for the Elderly (BASE) – triaging in health care  Caregiver Assessment Screen (CASE) – screen for caregiver burnout  Indicators ofAbuse (IOA) – psychosocial clinicians  Resources for OlderWomen (ROW) –developed by older women for older women Intervention  Being Least Intrusive (BLI) – for non-aboriginal workers responding to situations of abuse and neglect in First Nation communities  In Hand – An ethical decision making framework – psychosocial clinicians  Elder Abuse Assessment and Intervention Reference Guide – for police  Theft by Persons Holding POA investigation guide – for police  Elder Abuse Risk Assessment – safety planning risk assessment tool All of these tools are available from NICE at their website: www.nicenet.ca
  50. 50. Elder Abuse Knowledge Informing BLI Prevention

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