Vancouver Coastal Region 2022-2027 Regional Health and Wellness Plan by vc.communications

Photo credit: Salish Sea off of Í7iy̓el ̓shn, S.Chin

Vancouver Coastal Region 2022-2027 Regional Health and Wellness Plan

FNHA BRAND The First Nations Health Authority (FNHA) brand is based on the thunderbird, a traditional symbol of transformation and healing. The crescent around the thunderbird represents our environment, families, communities and the context in which our health is determined. The thunderbird’s wings reach beyond this crescent, working within our context, but looking to break new ground in First Nations health. The thunderbird is shown looking up to signify a healthy future. The design was created by Andrew (Enpaauk) Dexel, a Nlaka’pamux artist well known for his prints and paintings. Front cover photo credit: Heiltsuk territory, S. Sturrock Print version: Thisisthesecondprintversion.TheQrstversionwasprintedinMay20. The20-7RegionalHealthandWellnessPlan(RHWP)isbestviewedonline: bit.ly/rhwp202 ii FNHA - Vancouver Coastal Region

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Table of contents Territory and land acknowledgment ��2 Regional Elder opening ��3 Community names: Spelling and pronunciation ��4 Greetings ��5 WelcomefromKimBrooks,VicePresident,RegionalOperations ��6 Introduction ��7 Background ��7 FNHA shared vision and values ��10 FNHA guiding principle ��11 VancouverCoastalRegion ��13 Sub-regionsandcommunityproQles ��15 CentralCoastsub-region:CoastalFirst ��1 Nations 7 SouthernStl$atl$imxsub-region ��20 SouthCoastsub-region:CoastSalishNations ��24 2016to201keymilestones ��28 VancouverCoastalRegionFirstNationshealthgovernance ��3 structure 0 PartnershipAccord ��32 VancouverCoastalregionalpartners ��34 Regional health authority partners ��35 VancouverCoastalFirstNationshealthorganizations ��36 partners First Nations engagement and approval pathway ��39 VancouverCoastalengagementapproach ��41 Methodologyandprocess ��43 20-7Regionalpriorities ��44 PrimaryCare:WholisticWellnessandhealthservice ��45 delivery Mentalhealthandwellness ��49 Culturalsafety,humilityandndigenousspeciQcanti ��53 racism Urbanandaway-from-homehealth ��56 Health emergency management ��60 Operationalexcellence ��63 Health governance ��65 Next steps ��67 Appendix �� 69-75 Photo credit: Bella Bella, S.Sturrock

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RHWP 2022-2027

Territory and land acknowledgment

The primary author for the Vancouver Coastal Region 2 0 2 - 2 0 2 7 Regional Health and Wellness Plan would like to gratefully acknowledge the land on which this planning work was conducted. From April 2 0 2 1 to May 2 0 2 , this work was done on the ancestral, unceded and traditional territories of the Sḵwx̱ w ú7mesh , sə̓ lílwətaʔɬ and xʷməθkʷəy̓ ə m peoples. The author also acknowledges the 1 other Vancouver Coastal nations and communities: Gitdisdzu/ Xai$Nuxalk xais, , Haíɫzaqv , ’Wuìk̓ i nux̌ v , N’Quatqua, Samahquam, ̓ at , ɬəʔamɛn and shíshálh. The author of the 2 0 2 - 2 0 2 7 plan Skátin , Xa$ xtsa, Líl w acknowledges the author of Regional First Nations Health and Wellness Plan 2 0 1 6 - 2 0 2 1 for their work. Finally, the regional team extends their gratitude to the health leadership, Health Directors, Elders, traditional Knowledge Keepers and staff who provided their wisdom, guidance and enthusiasm for the 2 0 2 - 2 0 2 7 Regional Health and Wellness Plan.

FNHA - Vancouver Coastal Region

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Regional Elder opening

ElderXwechtáal(DennisJoseph)from Sḵwx̱wú7mesh Úxwumixw provides a blessing. Click image to listen.

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RHWP 2022-2027

Community names: Spelling and pronunciation Central Coast Community Name

Pronunciation

Southern Stl’atl’imx

Pronunciation:Shtl-at-lee-um-x(witha slight throaty sound for the “x” at the end)

Community Name

Pronunciation Ne-Q wh-at-qwh-aor eN-Q wh-at-qwh-a

Community Name ɬəʔamɛn (Tla’amin)

Gitdisdzu (Kitasoo)/ Xai’Xais

Kitasoo

N’Quatqua

Nuxalk

Noo halk

Samahquam Sha-mock-q wh-um(the wh” shíshálh sound is like who/what/ (shishalh) where/etc.)

Haíɫzaqv

hai-lh-zaqv

Skátin

Sh-kaw-teenorSka-teen

Xa’xtsa (Douglas)

Hawk-cha(Xaisathroaty sound in the “Ha” part)

̓ 1 Lílwat (Lil’wat)

Leel-wh-at and said closely together, not Lil-a-watt, Lilwet or Lillooet

(Heiltsuk)

’Wuìk̓inux̌v, O-wik-en-o (Wuikinuxv)

4 FNHA - Vancouver Coastal Region

South Coast Pronunciation tLA’ AH-min

SHEESH-al(thei(sounds like the “ee” in “meet,” the “a” sounds like the “a” in “far,” and the “lh” is pronounced like the “thl” in Kathleen.(Bothsyllables have a strong stress.

Sḵwx̱wú7mesh SKWA-mish Úxwumixw (Squamish) tSLAY-wah-tooth sə̓lílwətaʔɬ (Tsleil-Waututh) xʷməθkʷəy̓əm MUSS-quee-um (Musqueam) Return to Contents Table

Greetings yáu

(Haíɫzaqvḷa/Heiltsuk)

ʔajɛčxʷʊt (ɬəʔamɛn/Tla’amin)

Yaw smatmc (it7Nuxalkmc/Nuxalk)

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RHWP 2022-2027

Welcome from Kim Brooks, Vice President, Regional Operations — Vancouver Coastal

In recent weeks and days, I have found myself contemplating what it means to renew, refresh, andplanforward.ReRectingonthelasttwoyearsandourcollectivecalltoactiontorespond an unprecedented global pandemic in our generation, I have been witness to the overwhelming valueandstrengthofplanningandworkingtogetherwithourpartners.Wehaveclearevidence the ability to make real, immediate and sustainable change when we have clarity about our shared prioritiesandgoals.nthistimeofrenewal,ampleasedtoshareourrefreshedRHWPonbehalfof yourVancouverCoastalregionalteam.Aswemovefromheightenedpandemicresponsetorecoveryandbusinessresumpt cannotthinkofamoreappropriatetimetohavearefreshedRHWPtoguideusinoursharedwork.

Consistent with our commitment to ensure our work is grounded in the priorities of the First Nations communities in this region,youwillseeastrongmethodologyhasbeenimplementedtoensurethisrefreshedregionalplanreRectsthewi and guidance provided by community health leadership. This plan represents countless hours of dialogue, review and feedback. nadditiontoengagementthroughourRegionalCaucuses,Sub-RegionalCaucuses,RegionalTownHalls,andRegionalHeal DirectorMeetings,thisyearweoeredadditionalone-to-onemeetingswithHealthDirectorsandotherkeyleadersh achieve a deeper shared understanding of what we are planning together.

oermysinceregratitudetoeverypersonwhohascontributedtothisrefreshedregionalplan.Thisplanprovidesus a strong foundation from which to continue our partnerships, grounded in the rich cultural diversity of the First Nations communitiesinourregionandhonouringtheirinherentrightsandself-determinationintheirwellnessjourney

alsooerspecialthankstoShareenChin,SeniorPlanner,VancouverCoastal,whoseexpertise,passionanddedicatio made the refresh of our regional plan a reality. Gunalchéesh, (thank you)

KimBrooks 6 FNHA - Vancouver Coastal Region

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Introduction ThisVancouverCoastalRegion20-7 RHWPdeQnesstrategicpriorities,goalsand objectivesfortheVancouverCoastalRegion overaQve-yearperiodfrom20-7. Developed collaboratively with communities andendorsedbytheVancouverCoastal Caucus,theRHWPrefreshesandfollows up from the successes of the 2016RHWP. TheRHWPisintendedtosupport annual regional work plans, align with more detailedsub-regionalplansandactivities, Fraser Salish Region andreRecttheuniqueneedsofFirstNations Interior Region Northern Region communitieswithintheVancouverCoastal Vancouver Coastal Region Region.TheRHWPwillguideapproaches, Vancouver Island Region strategies, partnerships and investments at theregionaland/orsub-regionallevels,and it serves as a common voice for the region and plays a key role in informing strategy and action at the provincial level. TheRHWPaimstoanswerthreekey questions: • • •

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Who is involved? Nations and their health partners. Who does what? Roles and mandates. What are we planning together? Priorities,goalsandobjectives.

RHWP 2022-2027 7

Background Since 205, First Nations in BC, and the federal and provincial governments, have been committed to a shared agenda to improve the quality of life of First Nations people. This shared agenda, described in the Transformative Change Accord , includesQvekeyareasoffocus: •

Relationships; Education; Health; Housing; and Infrastructure and economic opportunities. • • • •

In health, progress has been made through a series of political agreements between FirstNationsinBCandthefederalandprovincialgovernments: • • • • • •

TransformativeChangeAccord:FirstNationsHealth; Plan(206) FirstNationsHealthPlanMemorandumofUnderstanding ; (206) TripartiteFirstNationsHealth; Plan(207) BasisforaFrameworkAgreementonHealthGovernance ; (201) TripartiteFrameworkAgreementonFirstNationsHealthGovernance ; (201) and HealthPartnershipAccord. (201)

Photo credit: Mountain view down to valleyQ’aLaTku7em, P. Aleck and C. Smith

FNHA - Vancouver Coastal Region

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The Tripartite Framework Agreement on First Nations Health Governance (the Framework Agreement) describes the legal commitments of the parties to create a new First Nations health governance structure that consists of: The First Nations Health Authority (FNHA):

The First Nations Health Council (FNHC):

The First Nations Health Directors Association (FNHDA):

The Tripartite Committee on First Nations Health (TCFNH):

The TCFNH was established in The FNHA is a health service The FNHC provides political TheFNHDAisamembership201aspartoftheFramework deliveryorganizationresponsible leadership and oversight basedprofessionalorganization Agreement and its members for administering a variety of for the First Nations health dedicated to supporting Health health programs and services for governanceprocessinBC, Directors and managers working – who are senior leaders of First Nations, federal and FirstNationspeoplelivingin including BC. responsibility to in First Nations communities in provincialgovernmentsfulQla Thisistheorganizationthrough uphold the governance BC.Theirmissionistoadvocate collective mandate to improve which operational and business structure established by for change, build partnerships implementation of health plans BCFirstNations.Thisisthe and support the development of the planning, delivery and evaluation of health services for and agreements occurs. processthroughwhichBC First Nations Health Directors, FirstNationsinBC. First Nations Chiefs speak their mandated health with a common governance organizationsandotherstobuild voice on health matters and competence and excellence in resolve governance matters. traditional First Nations wellness.

ThisistheFirstNationshealthgovernancestructurethatoperatesataprovince-widelevel.tisrootedinandguid andpartnershipprocessesandstructuresinplaceineachoftheFNHA$sQveregionsinBC.

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RHWP 2022-2027

FNHA shared vision and values

ThecollectiveeortsofBritishColumbia(BC)FirstNationsareunitedandguide by a shared vision of “Healthy, Self Determining and Vibrant BC First Nations Children, Families and Communities.” In support of the overall vision, the following shared values are in place: • • • • • •

Respect; Discipline; Relationships; Culture; Excellence, and Fairness.

ThroughcomprehensiveengagementwithBCFirstNationsintheformationof theBCFirstNationshealthgovernancestructure,madeupoftheFNHC,theFNHA and the FNHDA, the following Seven Directives were developed as fundamental standards and requirements for how health governance must operate at the community, regional and provincial levels: • • • • • • •

Directive#1:Community-Driven,Nation-Based Directive#2:ncreaseFirstNationsDecision-MakingandControl Directive #3: Improve Services Directive#4:FosterMeaningfulCollaborationandPartnership Directive #5: Develop Human and Economic Capacity Directive#6:BewithoutPrejudicetoFirstNationsnterests Directive#7:FunctionataHighOperationalStandard

Photo credit: Paqulh trail to Tenas Lake, D.J.

FNHA - Vancouver Coastal Region

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FNHA guiding principle

Reciprocal accountability is a core principle of the First Nations health governance structure. Reciprocal accountability is a shared responsibility that each individual andorganizationhastoachieve,withallinvolvedaccountabletooneanother theeectiveimplementationofthecommitmentstowardsthesharedoutcomes. Everyonehasaroleandeachpartner$sactionsaectsothersandcontributesto outcomes of the interdependent and interconnected system.

Cultural safety and humility is another core principle of working with First Nations communities. Individuals who embrace cultural safety engage in a lifelong process ofself-reRectionandself-critiquetounderstandpersonalbiasesanddevelopa maintain mutually respectful partnerships andi trust. Cultural safety seeks to create an environment free of racism and discrimination where people feel safe receiving health care. Cultural humility enables cultural safety, and when partners arecommittedtoculturalhumility,culturalsafetywillbeimprovedforallBri Columbians.

Photo credit: School under moon Q’aLaTku7em, P.Aleck and C. Smith

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RHWP 2022-2027

First Nations Perspective on Health and Wellness

TheFirstNationsPerspectiveonHealthandWellnessvisuallydepictsanddesc theFNHAVision:Healthy, Self-Determining and Vibrant BC First Nations Children, Families and Communities. The circles in the image below are intended to serve as a starting point for discussions on wellness. As a combination of elements, wellness begins with the person, where each person is a champion of their own wellness. The four realms of wellness – mental, emotional, spiritual and physical – are deeply connected to family, work, communities, institutions, environments and culture.

Photo credit: Bella Coola, S.Sturrock

FNHA - Vancouver Coastal Region

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Vancouver Coastal Region ThissectionprovidesahighleveloverviewoftheVancouver Coastal Region, including the area it encompasses, its governance structure, the 14 First Nations communities it serves, the PartnershipAccordthatgoverns the partnerships between First Nations and health authorities, and a description of the health care partners who are working together to transform health and wellness for First Nations in the region.

AsmostlydeQnedbytheprovince$s regional health authority boundaries, the territorial land base in the VancouverCoastalRegionis53,426 squarekilometresor5.8percent of the total provincial land base. TheVancouverCoastalRegionishometo14FirstNationscommunitymembersoftheCoastal Nations,theSouthernStl$alt$imxcommunitiesandtheCoastSalishNations.FortheVancouv CoastalRegion,thegovernanceofthese14communitiesisreRectedinthreesub-regions:the Central Coast, Southern Stl’atl’imx and South Coast.

Photo credit: ɬəʔamɛn waterfront, S.Tom

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RHWP 2022-2027

Regional profile n2019,accordingtondigenousServicesCanada(SC),theFirstNationspopulation oftheVancouverCoastalRegionwas17,630.Thisconsistsofanestimated9,517 FirstNationspeoplelivingat-home/on-reserveand8,13livingaway-from-home/ o-reserve.Theregion$sFirstNationspopulationrepresents12percentofthe province’s total First Nations population. TheSCRegisteredndianPopulationdataunder-reportsmembershipnumbers. Communities will know the current numbers of their population and are the best source.Therefore,theVancouverCoastalRegionwillfollowthemembershipthat areself-determinedbythecommunities.

Photo credit: Men men (children) on səlilwətaʔɬ and Sḵwx̱wú7mesh territory, E.Joe

14 FNHA - Vancouver Coastal Region

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Sub-regions and community profiles Supportingoneanothersub-regionally, FirstNationsintheVancouverCoastal communities work in partnership and Region are a unique family. Each of collaborate with other service delivery the14communitiesandthreesuborganizationssuchasVancouver regional families are unique in their Coastal HeaIth. These collaborative culture, traditions and geography. This partnerships enable communities isreRectedintheirdiversestrengths, to innovate and leverage new needs and challenges. The Central opportunities,includingJointProject Coastalsub-regionalfamily,for Boardprojects.naddition,sub-regional example, is only accessible by plane gatherings further strengthen political or boat, whereas communities in the engagement and participation in caucus SouthernStl$atl$imxsub-regionalfamily decision-makingprocesses.Finally,as are accessed on long drives on poor describedabove,eachsub-regionalso road conditions. The South Coast makes an appointment to the FNHC. sub-regionalfamilyincludesdiverse communities from both rural and ThefollowingproQleshighlight urbanenvironments.Eachsub-regional aspects of the community or Nation’s family faces health and service delivery past, present and future. The FNHA constraintsthatrequiredierent acknowledges that this information approaches and supports. camefromcommunity-orNationownedwebsitesandKnowledge Sub-regionalgatheringsoccurseveral Keepersandbelongssolelytothem. times annually, bringing together Readers are encouraged to follow the political and technical leaders in a hyperlinks to the community or Nation’s purposeful way to plan, communicate webpage to learn more. and collaborate on shared health priorities. Photo credit: Skatin, A.Lee

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RHWP 2022-2027

Vancouver Coastal Region: Sub-regions and communities

Gitdisdzu/ Xai’xais

Nuxalk

Haíɫzaqv ’Wuìkinuxv

Central Coast sub-region Southern Stl’atl’imx sub-region South Coast sub-region

N'Quatqua Lílwat

Samahquam Sḵwxwú7mesh Ská�n (Valley) Xa’xtsa shíshálh

ɬəʔamɛn

Accessibility to communities in the Central Coast and Southern Stl’atl’imx sub-region is inﬂuenced by season and road conditions. Some communities are only accessible by boat or air.

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Central Coast sub-region: Coastal First Nations The Coastal First Nations are a unique allianceofnineNationslivingonBC$s north and central coast and Haida Gwaii. Each Nation has its own distinct culture, governance and territory. Traditional territories of member communities occupy the Great BearRainforestand102,square kilometres of marine coast. OfthesenineNations,fourresidewithin theVancouverCoastalRegion:the ’Wuìki̓ nux̌v, Haíɫzaqv,Gitdisdzu/Xai$xais and Nuxalk Nation.

Photo credit: Big House Pole, B.Calhoose

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’Wuìk̓inux̌v (Wuikinuxv)

Haíɫzaqv (Heiltsuk)

The HaíɫzaqvNationislocatedinthecentr The ’Wuìki̓ nux̌v are people whose Coast region, centred on Campbell Island traditional territory extends from inthecommunityofWaglisla(BellaBella). KoeyeRivertoCranstonPoint The traditional territory of the Haíɫzaqv totheheadofWuikinuxvLake. encompasses 35,553 square kilometres, They are a people whose heritage, extending from the southern tip of Calvert history and culture, including their sland,uptheDeanandBurkechannelsas language and spiritual practices, farasKimsquitandtheheadofDeannlet are tied to the land, water and tothenortheast,anduptheMathieson naturalenvironment.Located480 and Finlayson channels to the north. kilometresnorthwestofVancouver, Haíɫzaqv speak Haíɫzaqvḷa, a living language that expresses their the ’Wuìki̓ nux̌vNationisonlyaccessiblebyboatandRoatplane. world ThecommunitycurrentlylivesonthebanksoftheWaanukv River,viewandwayoflife.EachofitsQvedialectshasitsowndisti pronunciation, tones and phrases. whichconnectsOwikenoLaketotheheadofRiversnlet.The nearesttownisPortHardylocatedacrossQueenCharlotteStrait HaíɫzaqvḷaAuthorityBoardandtheHeiltsukTriba – and there is no direct transport between ’Wuìki̓ nux̌vandBella nApril2019,the Council approved the Haíɫzaqvḷa Revitalization Strategic Plan: BellaorBellaCoola. Setting Our Course for the Next Five Years 2019-2024.n201,the The ’Wuìki̓ nux̌v Nation is a member of the ’Wuìki̓ nux̌v-Gitdisdzu- HaíɫzaqvNationcelebratedJuly1asHeiltsukDay(withthepurchas andtransferofthe70-year-oldShearwaterResortandMarinausin ̓ la, a Nuxalk Tribal Council. The ’Wuìki̓ nux̌v people speak ’Wuìka funds secured through a reconciliation agreement signed with the northernWakashanlanguage. Canadian government.

The ’Wuìki̓ nux̌v Health Centre provides health services and programs to members of the ’Wuìki̓ nux̌v Nation. Services include general checkups and wellness, pregnancy and prenatal care, mental health and wellness and other health promotion and disease prevention programs.

FNHA - Vancouver Coastal Region

The Hailika’as Heiltsuk Health Centre and its health board are located on-reserveandprovidesvarioushealthservicestothecommu

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Gitdisdzu/Xai’xais (Kitasoo)

Nuxalk

Pre-contact,Nuxalkpeople enjoyedafullydevelopedsociety, Twodistincttribalorganizations culture, economy and system of live in the town of Xmduulxk governance established within (Klemtu):theGitdisdzuNation their four distinct territories of (Tsimshian),originallyfromKitasu Nuxalkmc(BellaCoolaValley), Bay,andtheXai$XaisNationof Talyuumc(SouthBentinck), Kynocnlet.TheGitdisdzu/Xai$xais Kw$alhnamc(Kwatna),andstapeople are the only permanent Suts$lhmc(LowerDean,King residents within the traditional sland,DeanandKimsquitRivers). territories of this First Nation, Geological and historical research and they are members of the has proved that Nuxalk people have ’Wuìki̓ nux̌v-Gitdisdzu-NuxalkTribalCouncil. beeninthisregionforover14,0years.Present-dayNuxalkmcare the descendants of peoples from these four territories who came TheGitdisdzu/Xai$xaisNursingStationservesthecommunity. together at the village of Q’umk’uts after the smallpox epidemic Staedbyacommunityhealthnurse,thestationprovidesprimary of1862.Thiscatastrophereducedtheirpopulationfromaround care services for urgent and emergent conditions. The nurse also 30,toapproximately30survivors. promotes health and wellness by delivering maternal/child health programs,immunizationsanddiseaseandillnessprevention Today,Nuxalkhavesevenreservesintotal,measuringabout2,05 programs. ha;thisisapproximately0.1percentoftheirancestralterritor andtheirpopulationnownumbers1,78people.NuxalkisanonGitdisdzuNation$svisionfortheirlandandresourcesistreaty toensure nation; they view their land as their legal inheritance from thatthewealthofforests,Qshandwildlifeandthecomplexity of the Creator and they will continue to exercise their rights and title alllifewillbehereforever.FortheGitdisdzuandXai$xaispeople to their four territories as entrusted to them by their throughout remain here forever, they must protect and enhance their culture ancestors. andheritage.TheGitdisdzuandXai$xaispeopleacknowledgethat theyliveinthemodernworldandwillhavethejobs,revenue Way!and economic development to sustain the community.

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RHWP 2022-2027

Southern Stl’atl’imx sub-region The St’át’imc are the original inhabitants of the territory that extends north to ChurnCreekandtoSouthFrenchBar; northwest to the headwaters of the BridgeRiver;northandeasttowardHat CreekValley;easttotheBigSlide;south to the island on Harrison Lake and west of the Fraser River to the headwaters of theLillooetRiver,RyanRiverandBlack Tusk. The St’át’imc Nation is made up of 11 distinctself-governingcommunities, including the Líl’wat Nation, a distinct Nation with linguistic, cultural, familial and political ties to the St’át’imc Nation. Five out of 11 St’át’imc communities residewithintheVancouverCoastal Region.TheseQvesouthernStl$atl$imx communities include the N’Quatqua, Samahquam, Skátin,Xa$xtsaandthe ̓ Lílwat Nation.

Photo credit: Paqulh, Samahquam youth camp D.J.

FNHA - Vancouver Coastal Region

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N’Quatqua Located near Anderson Lake and the community of D’Arcy in the southern CoastMountains,the ̓át̓imcetsSt speaking N’Quatqua community is part of the Stl’atl’imx Nation.

Samahquam Samahquam Ucwalmicw is a St̓át̓imcetsspeaking southern Stl’atl’imx community near Lillooet Lake. The Nation is a member of the Lower Stl’atl’imx Tribal Council and is served by the Southern Stl’atl’imx Health Society. Through culture, language and familial ties, SamahquamarerelatedtotheXa$xtsa and Skatin.

As a member of the Lower Stl’atl’imx Tribal Council and the St’at’imc Chiefs Council, N’Quatqua collaborates with fellow St’at’imc First Nationsonavarietyofprojectsandinitiativestopromotetheir physical,economicandsocialwell-being.N$Quatquaisoneoffour As part of the St̓át̓imcets Ucwalmicw, Samahquam’s vision is of nations served by the Southern Stl’atl’imx Health Society and has a continuing and renewed relationship between the St’át’imc also developed many health services through its Health Station and people (ucwalmicw) and the land (tmicw). Child and Family Development Centre. The N’Quatqua vision statement is: We will honour and respect our lands and resources through a holistic approach. We will be committed to a strong, loving, healthy and sustainable community that will have a consistent approach to education, culture and language. A self-governance system that will allow us to grow and meet our needs.

Photo credit: Winter cabin in Q’aLaTku7em, P.Aleck and C. Smith

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Skátin

Xa’xtsa (Douglas)

TheSkátinareUcwalmícwtsspeaking St̓át̓imcets members of the Lower Stl’atl’imx Tribal Council. The community of Skátin is located on the east side of the Lillooet River, on the19-MilePostoftheoldHarrisonLillooet wagon road (about 35 kilometres from the head of Harrison Lake).

TheXa$xtsaconsistsofthePortDouglas andTipellacommunities.Xa$xtsaispart of the Sti’atl’imx linguistic group and is a member of the Sti’át’imc Chiefs Council and Lower Stl’atl’imx Tribal Council. Nearby, theXa$xtsaisrelatedtotheSkatinand Samahquam communities through familial ties and culture and language.

n2015/6,theNationcompleteditschild care centre in Tipella and expanded its BeforethearrivalofEuropeansettlers,thiscommunitywas early childhood development oeringswiththeSouthernStl$at considered the largest on the lower Lillooet River, comparable in Health Society. In addition to early childhood development support, sizetothepre-contactvillageofpresent̓wat. Aday moderately Líl theSouthernStl$atl$imxHealthSocietyensuresXa$xtsamembers sizedwaterfallontheLillooetRiver,aboutonekilometre havenorth access to holistic health services that support the whole person ofthecommunity,hadasigniQcanteectonthesizeofthe in culturally appropriate ways and that consider the land, family, community in prehistoric times and today. Now commonly community and nation. known as Skookumchuck Rapids, the Ucwalmicwts call the waterfallqmemps(k-MEMP-sh).Thissitewasandcontinuesto Xa$xtsa$svision: beanexcellentQshingspot. Focuses to be the community that our members call home. We will Located60kilometreseastoftheSouthernStl$atl$imxHealth create and maintain a healthy lifestyle-sufficiency, promotion of Societyozces,thecommunityisaccessiblebytheLillooet Ucwalmicwts and our culture. With infrastructure and recreation forestryserviceroad;however,thisroadissubjecttowashouts opportunity services, we will be a self-governing, self-supporting, equal and challenging winter driving conditions. and united community. We will be the eyes, the ears and the voice for

the present and the future to protect our children; moreso, to create a secure path for all other future generations to come.

FNHA - Vancouver Coastal Region

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̓ Lílwat

The Líl̓wat Nation, an Interior Salish People,isaprogressiveFirstNations community located seven kilometres northofPemberton.The̓wat7 Lil úl$s 79,13hatraditionalterritoryis aboutone-quarterofthesizeof Vancouversland,extendingsouth to Rubble Creek, north to Gates Lake,easttotheUpperSteinValleyandwesttothecoastal inlets(Tobanlet)ofthePaciQcOcean.However,starting in the late 19th century, the Líl̓wat Nation was increasingly disenfranchisedandconQnedto10reserves,totallingonly 2,930haor0.4percentoftheirtraditionalterritory. Líl̓wat Nation is a member of the Lower Stl’atl’imx Tribal Council.TheQrstlanguageofthe ̓wat,Líl and other Interior Salish people, is Ucwalmícwts. The Líl̓watNationisthethirdlargestFirstNationinBC.ThePqusnalhcwHealthCentre, located within the community, provides various health services. Today,theNationcontinuestoworktowardsselfdetermination and remains committed to the preservation of Líl̓wat lands, language and culture for future generations.

Photo credit: Tszil Mountain, D.J.

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South Coast sub-region: Coast Salish Nations The Coast Salish Nations include First Nations living along the northwest PaciQccoastinBC,fromtheLower MainlandandVancouverslandsouthto westernWashingtonandnorthwestern OregonintheUnitedStates.Although these Nations have distinct customs and traditions and speak various languages and dialects, they share strong ethnic and cultural ties. For example, unlike their northern neighbours, they have a patrilineal rather than matrilineal kinship system. TheCoastSalishPeoplesthatresidein theVancouverCoastalRegioninclude the ɬaʔəmɛn,shíshálh,Skwxwú7mesh, ̓ ətaʔɬ and xʷməθkʷəy̓əm. səlililw̓ Photo credit: Okeover Inlet, S.Tom

FNHA - Vancouver Coastal Region

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ɬəʔamɛn (Tla’amin)

shíshálh

The shíshálh First Nation is The ɬəʔamɛn is part of the located on the scenic Sunshine Coast Salish Indigenous peoples Coast between Queens Reach inhabiting the western coast of inJervisnletandHoweSound BC,locatednorthofPowellRiver. onBC$ssouthcoast.The The traditional ɬəʔamɛn territory sashishalhem language, a Coast was along the northern part of the Salish dialect, is the traditional and distinct language of the shíshálh Sunshine Coast, extending along Nation. both sides of the Strait of Georgia. Asaself-governingtreatynation, n1986,theshíshálhNationbecameanindependentself-governing the Tla’amin Nation is a member body, a unique third order of the Government of Canada. The government of the Naut’sa mawt Tribal Council. The Tla’amin SecheltndianGovernmentDistrictholdsjurisdictionoveri FinalAgreementseekstobringmanybeneQtstotheirpeople and and exercises the authority to provide services and education for future generations and to dramatically – and positively – impact itsresidents.ndependentandself-governing,theshíshálhNat their Nation’s status. chooses to participate in and is welcomed into FNHA governing structures. Tla$aminHealthprovideshealth-careservicestotheTla$amin NationandFirstNationsbetweenSalteryBayandLundand the vision: shíshálh surrounding area. The shíshálh Nation is committed to innovation in program and service AsanAccreditationCanadahealth-careserviceprovider,delivery Tla$amin designed to assist our members and community to achieve Health’s mission statement is: greater interdependence, wellness and self-sufficiency. Foundational to our shared work is the protection, promotion and practice of shíshálh Tla’amin Health continues to support and assist the Tla’amin people culture, language and laws within our swiya. We proudly advance the in creating a healthier community. We are committed to forming work of those that have gone before us. respectful partnerships that maintain and advance our health and wellbeing in an equitable and holistic manner.

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Sḵwx̱wú7mesh Úxwumixw

̓ ətaʔɬ (Tsleil-Waututh) səlililw̓ ̓ ətaʔɬ is located on the The səlililw̓ ̓ ət (Burrardnlet) north shore of səlilw̓ and is surrounded by the City of North ̓ ətaʔɬ is one of Vancouver.The səlililw̓ many groups of Coast Salish peoples living inthePaciQcNorthwest,throughoutBC, WashingtonandOregon.Theknowledge of the lands and waters in their territory has shaped this strong and growing Nation.

TheSkwxwú7mesh Úxwumixw is a vibrant and dynamic Coast Salish Nation with a strong culture, richhistoryandbrightfuture.Skwxwú7meshÚxwumixwspeak the Squamish language and are descendants of the Coast Salish ndigenouspeopleswholivedinthepresent-dayMetroVancouver area, Gibson’s Landing and the Squamish River watershed. The moderneraofSkwxwú7meshÚxwumixwwasdeclaredonJuly23, Community members access services from the health team located 1923,throughthePrayerofAmalgamation.(Thisresultedfrom on-reserveandthroughNorthShorephysicians,VancouverCoast eight years of discussion and planning and a legal agreement Health$sLionsGateHospitalandcommunityservices.Asof201,a signedbythe16Skwxwú7meshChiefs. newTsleil-WaututhNationAdministrationandHealthCentre pointforcommunityandadministrativeaairs,isbeingbuilt. YúustwayHealthServicesprovidesservicetoSkwxwú7mesh Úxwumixw.WiththetraditionalnameYúustway(meaningtaking ̓ ətaʔɬ’s vision for the future is: səlililw̓ care of each other’’), this department strives to improve the health and wellness of its members by providing community To maintain our identity as Tsleil-Wautt people, respecting our past and health services and promoting and supporting access to all health being mindful of our future, sharing a collective vision for a healthy, services. holistic community in harmony with our surroundings, guided by our spiritual, emotional, mental and physical teachings, thriving in our TheYúustwaymissionis: cultural excellence.

Providing quality holistic care in a respectful, safe manner to ensure the health and wellness of all people by empowering our community and offering the tools for living in health from birth to end of life.

FNHA - Vancouver Coastal Region

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xʷməθkʷəy̓əm (Musqueam) The xʷməθkʷəy̓əm are traditional hən̓ q̓əmin̓ əm̓ -speakingpeoplewhose traditional territory occupies what is now Vancouveranditssurroundingareas. Manymemberscurrentlyliveonasmall portion of their traditional territory, known astheMusqueamndianReserve,located southofVancouver$sMarineDrivenear the mouth of the Fraser River. However, xʷməθkʷəy̓əm has always moved through their lands and waters for cultural, traditional and economic practices. The name xʷməθkʷəy̓əmisderivedfromtheRoweringplant, məθkʷəy̓, which grows in the Fraser River estuary. A xʷməθkʷəy̓əm’s ancient history that has been passed on from generation to generation explains how they became known as the xʷməθkʷəy̓əm – Peopleofthe məθkʷəy̓ plant. The xʷməθkʷəy̓əm’s vision is: The Musqueam, a proud and unified people, will, as a self-governing nation, work together to ensure enhanced quality of life for all generations of our people to develop a sustainable, self-reliant, vibrant community that is built upon the historical and traditional values of our community.

Photo credit: Slhx̱i7lsh (Sḵwx̱wú7mesh) or sɬχil’əx (xʷməθkʷəy̓əm), S.Sturrock

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2016 to 2021 key milestones `

2016

2017 TheLu$maMedclinicopens inVancouverimproving access to primary care for Indigenous people.

BCgovernmentbudget includes$32millionto combat the opioid crisis.

BCandHealthCanadasigna new 10-yearhealthfunding agreement,underwhichBC willreceiveanadditional$10 million to help its response to the opioid crisis.

VancouverCoastal2016 -201RegionalHealth andWellnessPlan endorsedVancouver Coastal Caucus.

FNHA - Vancouver Coastal Region

2018

TheBCgovernment provides the FNHA with$20million over three years to supportcommunitydriven culturally relevant responses to the overdose public health emergency. Projectsarefundedforland,waterorblended based healing.

TheMinistryofMentalHealthn2018,aspartofitsongoing and Addictions launches a commitment to First Nations newOverdoseEmergency governance,theVancouver Response Centre. The FNHA’s Coastal Region successfully CEOandchiefmedicalozcer completedaPartnershipAccord provide governance through their positions on the Health SectorOversightCommittee.

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2019

2020

2021

2019ndigenousPeoplesDayofWellnessGrants In Plain Sight: Addressing Indigenoussupportcommunity-ledeventsthataregroundedin specific Racism and Discrimination in ceremony,traditionalpracticesandincorporateBC the B.C. Health Care report released by First Nations cultures. BCMinisterofHealthAdrianDixand ndependentReviewerHon.Dr.MaryEllen The MinistryofHealthandFNHApartner to provide Turpel-Lafond. morethan$1.8millioninongoingfundingandover nPlainSightFullReport $20,inone-timefundingtotheLu$maMedical nPlainSightSummaryReport Centre to expand Indigenous primary care services.

Dental,VisionCare,andMedical SuppliesandEquipmentPlans AftertheWorldHealth AdministeredThroughPaciQcBlueCross Organizationdeclares

COVD-19aglobalpandemic , BCFirstNationsdetermine the actions they will take to protect their communities, with regional and central health authority partners providingsupportwithco-ordination.

TheVancouverCoastalRegionbegins therefreshforthe20-7Regional HealthandWellnessPlan.

Photo credit: Rutherford Creek, Squamish Google Earth, 2021-08-20

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Vancouver Coastal Region First Nations health governance structure

Caucus Regional Table TheVancouverCoastalCaucus The is VancouverCoastalRegional and the region’s First Nations madeupof28representatives Table is made up of three FNHC healthorganizations.naddition from the 14 First Nations governance representatives theVancouverCoastalRegional communities within the fromeachofthesub-regions Table supports the vision of the The First Nations health VancouverCoastalRegion. (whoserveforthree-year PartnershipAccordtoincrease governance structure Each First Nation within the terms) and three technical leads theinRuenceofFirstNations established by First Nations, region uses its own process to fromeachsub-region(who regarding health services in the for First Nations, supports and select or designate one political servefortwo-yearterms).The VancouverCoastalRegionto enablesdecision-makingandrepresentative and one technical Regional Table’s purpose is to attainshareddecision-making inRuenceacrossthehealth(health service delivery lead) carry out the direction of the status. system. As a result, First Nations representative. The Caucus VancouverCoastalCaucus,and are in a position to transform meets approximately twice per toimplementtheVancouver thehealthcaresysteminBC. year, usually in the spring and CoastalPartnershipAccordby TheRHWPwillguidethework the fall. responding to regional issues of the region as the FNHA and working with FNHA regional contributes to this system TheVancouverCoastalCaucus health leads, regional health transformationjourney.Theis the leading regional forum for leads,seniorstaandboard process and work is grounded in communications, collaboration membersofVancouverCoastal the7Directives,sharedvalues, and accountability, creating a Health, and community health theBCFirstNationsPerspective structure for the FNHC, FNHDA and technical leads. onHealthandWellnessand and FNHA to engage directly with guiding principles. First Nations Caucus leadership TheVancouverCoastalRegional about their regional and Table works to improve service provincial work. In addition, the delivery by collaborating with Caucus provides guidance to the VancouverCoastalHealthand Regional Table. the First Nations communities they serve, the FNHC, the FNHA

Photo credit: ɬəʔamɛn fish hatchery, S.Tom

FNHA - Vancouver Coastal Region

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Vancouver Coastal Region health governance structure

Gitdisdzu/Xai'Xais Nuxalk ɫzaqv ' kinuxv

Central Coast sub-region Southern Stl atl imx subregion South Coast sub-region

Lílwat N'Quatqua Samahquam Skátin Xa'xsta

Aboriginal Health Steering Committee (AHSC) VCH senior exec and FNHA reps and FNHA senior execs

FNHA/VCH partnership working groups

FNHA

Vancouver Coastal Health (VCH)

Three FNHC political reps (one per subregion) ɬəʔamɛn shíshálh Sḵwxwú7mesh Úxwumixw səlilwətaʔɬ xʷməθkʷəyəm

Three technical reps (one per sub-region)

Community partnership tables

Providence Health Care (PHC)

Structure as of March 2022

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RHWP 2022-2027

culturally safe health care Strategy, an Urban Aboriginal partnerorganization$s delivery. It sets out a vision of Health Strategy, and a First unique relationships and shareddecision-makingwithNations and Aboriginal Culturally conversations with First The Framework Agreement First Nations regarding health Competent and Responsive Nations. establishes a broad vision for services in the region. Strategic Framework. Current high-functioningpartnerships priorities include: The AHSC oversees the between First Nations and ThePartnershipAccorddirects implementation of the health authorities at a regional partners to develop and • Collaborating on ways to VancouverCoastalPartnership level.TheVancouverCoastal implement strategies for: apply cultural safety and Accord. It serves as a senior PartnershipAccordwassigned humilityandanti-racism forum for providing strategic inMay201bytheFNHC • Jointlyco-ordinating tourbanandaway-from- direction and identifying key regional representatives (on community engagement home settings, including priorities to be advanced through behalfoftheVancouverCoastal activities; decolonizingrelations partnership, and collaboration and Caucus),theFNHAandVCHto • Servingurbanandawaystrengthening Indigenous jointeortsintheregion.The outline what this partnership from-homepopulations representation and AHSC membership includes: lookslikeintheVancouver across the region; self-determination; Coastal Region. A refreshed • Advancing cultural • Updatingourjoint • The three regional PartnershipAccordiscurrently safety and humility and commitments in response representatives appointed being developed by the anti-racism within our to the recommendations to the FNHC; partners. institutions, care settings of the In Plain Sight report • TheFNHACEO,board and engagement with recommendations, the chairandotherdeQned ThePartnershipAccordcalls First Nations; and UN’s Declaration on the executives; for the transformation of the • Collaborating to achieve Rights of Indigenous • TheVCHCEO,board health system in the region the milestones and Peoples(DRPA)and chairandotherdeQned through collaboration between deliverablesoftheRHWP. theprovincialDRPA executives; FirstNations,theFNHA,VCH legislation; and • ThePHCCEO,board and other regional partners. ThePartnershipAccordhas • Co-ordinatingcommunity chairandotherdeQned TheAccordalsodirectscoled to the development of a engagement activities and executives; and operative work with community JointCommunityEngagement events to respect each • Anyex-ozciomembers health leaders to develop more asjointlyappointedby

Partnership Accord

FNHA - Vancouver Coastal Region

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the parties.

fromeachorganization, approvals pathway and is guided as relevant for ongoing by the principle of reciprocal As per the AHSC Terms of discussions. accountability. First Nations Reference, the AHSC Executive Operational-levelco-ordination participateintheirSub-Regional Committeeoperationalizes between First Nations Caucus as well as Regional strategic priorities, ensures communities and partners in the Caucus, where they make executionofjointinitiatives, health system occur at various collective decisions and appoint plans for AHSC meetings and tables and committees that exist representatives to the Regional communicates accordingly to outside of the AHSC’s structure. Table. The Regional Table is all partners. The scope of the Partnerssupportrelationshipresponsible for performing Executive Committee includes building at these spaces the work directed by caucus , leadingoperationaldecisionwherever possible and look for including through participation making related to advancing opportunities to lift priorities in the AHSC. Leadership from the priorities of the AHSC and andconcernsidentiQedthrough partnerorganizationsalso elevating relevant strategic themforactionanddecision-attends caucus to listen to questions and decisions to the making at the AHSC. the community and provide AHSC. The Executive Committee important updates. is comprised of: First Nations in the region ultimately guide all of this The diagram on the following • TheFNHAVicePresident work. Acknowledging that each pagesummarizestheoverall RegionalOperations partnerorganizationhasits regional own First Nations health VancouverCoastal; accountability structure, the governance structure described • TheVCHVicePresident, First Nations health governance above. Indigenous Health; structure serves as the primary • TheProvidenceHealth mechanism through which CareVicePresident, First Nations provide political ndigenousWellnessandleadership on health system Reconciliation; and transformation. The structure • Otherseniorleadership follows the engagement and

Photo credit: Winter road path Q’aLaTku7em, P.Aleck and C. Smith

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RHWP 2022-2027

Vancouver Coastal regional partners ThisimageidentiQesthekeypartners involvedinthedeliveryoftheRHWP. Withthesepartners,theVancouver Coastal Region wisely uses its resources to provide health care to communities based on what each community has identiQedasapriority.

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Regional health authority partners

ofhigh-quality,specializedhealthpatient care and improve professional care services. These include selected satisfaction for physicians. In the services provided in facilities governed VancouverCoastalRegion,thereareQve by other health authorities, as well as DivisionsofFamilyPractice: VCH those programs and services provided As one of the six health authorities through the following provincial • Richmond Division of Family inBCguidedbypolicyanddirections agencies: Practice fromtheBCMinistryofHealth,VCH • VancouverDivisionofFamily covers an area that includes 14 First • BCCancer Practice Nations communities that reside in • BCCentreforDiseaseControl • North Shore Division of Family 12municipalitiesandfourregional • BCChildren$sHospital(and Practice districts.VCHservesover1.2million Sunny Hill Health Centre) • Sea-to-SkyandSunshineCoast residents and is responsible for • BCMentalHealthandSubstance DivisionofFamilyPractice providing services to First Nations Use Services • PowellRiverDivisionofFamily peoplelivingaway-from-home/o• BCRenalAgency Practice reserve(whetherfromBCornot),and • BCTransplant ndigenousPeopleslivingintheregion$s • BCWomen$sHospitalandHealth Rural and Remote Division of Family urban areas. Centre Practice • CardiacServicesBC The Rural and Remote Division of Island Health • PerinatalServicesBC FamilyPracticeisauniquelystructured DuetoitsproximitytoVancouver 13community-basedchaptervoice Island, the ’Wuìki̓ nux̌v Nation receives a Divisions of Family Practice of family doctors who understand range of services from the Island Health TheDivisionsofFamilyPractice the realities of practising in rural and Authority. (Divisions)areacommunity-based remote communities. The Rural and group of family physicians working Remote Division works out of the Provincial Health Services Authority together to achieve common chaptersinPemberton,BellaCoola TheProvincialHealthServices health care goals. Divisions works andBellaBellatosupporttheCoastal AuthorityensuresthatBCresidents collaboratively with community and FirstNationslocatedintheVancouver haveaccesstoaco-ordinatednetwork health care partners to enhance local Coastal Region.

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RHWP 2022-2027

Yúustway Health and Wellness Other service providers and partners Centre (Squamish Nation Health Manyotherserviceprovidersdeliverall Centre) forms of health care for First Nations community members. Some are • ćećǝwǝt lelǝm Helping House under contract arrangements with the (Tsleil-WaututhNationHealth Nations themselves, and some operate Centre) The FNHA also partners and supports independently in towns and cities • Musqueam Health Centre theFirst 1 Nationshealthorganizations located within the region. These service in the region. These health providers include dentists, pharmacists, organizationsprovidecommunity First Nations-led Primary Care optometrists, chiropractors, Initiatives members with access to culturally safe physiotherapists and occupational FirstNations-ledPrimaryCarenitiatives essential health, mental wellness, and therapists.Therearealsonon-proQt (FNPC)areFNHAandBCMinistryof home and community care programs agencies that provide some services for Health initiatives to increase access to on-reserve. culturally safe and appropriate primary First Nations communities. The First Nations health organizations healthcareservices.n20,thereis oneFNPCsuccessfullyrunningand are: • Gitdisdzu Xai’Xais Health Centre another two are planned for Southern Stl’alt’imx and Nuxalk. (FNHA Nursing Station) • Nuxalk Health and Wellness • Lu’ma Medical Centre: • Hailika’as Heiltsuk Health Openedin2016,Lu$maMedical Centre Society CentreistheQrstFNPCannounced • Wuikinuvx Health Centre inBC.LocatedinVancouver,Lu$ma • Southern Stl’atl’imx Health provides health and outreach Society (serving N’Quatqua, servicestourban-basedFirst Skátin,SamahquamandXa$xtsa) Nations,Métisandnuitindividuals. • Líl̓wat Health and Healing • Tla’amin Health • shíshálh Community Services Division Health Department

Vancouver Coastal First Nations health organizations partners

36 FNHA - Vancouver Coastal Region

•

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VancouverCoastalFirstNationshealthfacilities

Gitdisdzu/ Xai’xais

Nuxalk

Haíɫzaqv 'Wuìkinuxv

N'Quatqua Lílwat ɬəʔamɛn

First Nations Health Facilities Health Centre HealthO]ce Health Station Nursing Station

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Sḵwxwú7mesh (Valley)

shíshálh

Samahquam Ská�n Xa’xtsa

RHWP 2022-2027 37

Health facilities Health centres

Health stations

Health office

HealthcentresarestaedbyAhealthstationoersvarious Ahealthozceistypically registered nurses or licensed health services and programs located within an administration practical nurses who provide to First Nation community building, and practitioners a comprehensive range of members. Services include visiting the community may use nursing services, including community health programs, this space to provide services. health promotion and disease Elder and family support, For example, a physician, prevention. The nurses’ housing assistance, nutrition community health nurses and practice aims to build the support, youth activities and traditional wellness practitioners capacity of individual, family wellness programs. In addition, mayuseahealthozce. and community wellness. service providers can travel to Nurses work with communities the community and use health to develop and implement stations to provide their services relevant, culturally centred and programs. interventions, providing services in clinical, home and community settings. Community health nurses at health centres are not on call and do not provide emergency services.

Nursing stations Nursingstationsarestaed byremotecertiQedregistered nurses who work in an expanded scope of practice, providing primary care and emergency care(includingafter-hoursoncall care), as well as public health and health promotion services.

Photo credit: Kunsoot Wellness Centre, M.Martin

FNHA - Vancouver Coastal Region

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First Nations engagement and approval pathway SincetheozcialtransferofHealthThrough past Regional Caucus evaluations and feedback, the FNHC, Canada’s First Nations Inuit Health theFNHAandtheFNHDAjointlyagreed branchtotheFNHAinOctober2013, to evolve the engagement processes to the collaborative discussions about ensure Chiefs and health leadership are health system change have grown in leading the conversation on the social bothspeciQcityandvolume. determinantsofhealthandNationrebuilding, and that meeting spaces The FNHC, the FNHDA and the FNHA are available for discussions on health collectively share the First Nations programs and services. health governance engagement structure, which engages First Nations political and health leadership on various aspects of health transformation. The framework is designed to support and inform province-wideandconsensus-based decision-makingprocessesbasedon the7Directives.Engagementisabroad term that describes a range of activities.

Photo credit: Black bear, Gitdisdzu, T.Mason

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RHWP 2022-2027

IAP2 Spectrum of Public Participation in the First Nations health governance context

IAP2 Spectrum of Public Participation IAP2’s Spectrum of Public Participation was designed to assist with the selection of the level of participation that defines the public’s role in any public participation process. The Spectrum is used internationally, and it is found in public participation plans around the world.

PUBLIC PARTICIPATION GOAL

Asengagement-drivenorganizations, the FNHC, the FNHDA and the FNHA arecommittedtobringingVancouver Coastal First Nations communities together to collect and share wisdom, advice, feedback, guidance and direction on health and wellness issues.

INFORM

CONSULT

INVOLVE

COLLABORATE

EMPOWER

To provide the public with balanced and objective information to assist them in understanding the problem, alternatives, opportunities and/or solutions.

To obtain public feedback on analysis, alternatives and/or decisions.

To work directly with the public throughout the process to ensure that public concerns and aspirations are consistently understood and considered.

To partner with the public in each aspect of the decision including the development of alternatives and the identification of the preferred solution.

To place final decision making in the hands of the public.

We will keep you informed, listen to and acknowledge concerns and aspirations, and provide feedback on how public input influenced the decision.

We will work with you to ensure that your concerns and aspirations are directly reflected in the alternatives developed and provide feedback on how public input influenced the decision.

We will look to you for advice and innovation in formulating solutions and incorporate your advice and recommendations into the decisions to the maximum extent possible.

We will implement what you decide.

PROMISE TO THE PUBLIC

Since the Regional First Nations Health andWellnessPlan2016-,theAP2 We will keep you SpectrumofPublicParticipationisnowinformed. being used to develop the engagement processes. Regional tables, health director tables, working groups, family and regional caucuses, and Gathering WisdomforaSharedJourneyforums are created with the Spectrum’s promise and public participation goals. Along with the good guidance from community leadership, the region adopted using the Spectrum helps to ensure that space is created for each First Nations community voice to be heard and impact transformational change.

FNHA - Vancouver Coastal Region

(c)nternationalAssociationforPublicParticipation www.iap2.org

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Vancouver Coastal engagement approach The regional engagement approach creates and provides intentional spaces to collaborate and address health and wellness issues. The partners that participate in these spaces may include some, if not all, of the following: • • • • • • • •

TheFNHAVancouverCoastal Regional Engagement Team supports communities with improving health for their members through communication, collaboration and planning, and local community engagement activities. This workisguidedbycommunity-driven VancouverCoastalNation and directed processes, and is led by community members the Director, Regional Engagement, Community representatives Regional Health Liaison and three TraditionalKnowledgeKeepersCommunity Engagement Coordinators The FNHC supporting each of the three The FNHDA sub-regions. The FNHA VCH Otherhealthcareandwellness professionals

This approach informs parties involved on when, how and what is engaged in theregion.talsoclariQestherolesand responsibilities of each party. Some of the region’s engagement sessions are formalizedandongoing,whileothers ariseinresponsetocommunity-driven requests, concerns or inquiries.

Photo credit: Spirit bear, Gitdisdzu, T.Mason

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RHWP 2022-2027

Vancouver Coastal Region one-window communication approach Theregion$scurrentexternal-facing communication tools, including the E-NewsletterandE-Bulletin,establish an informative and meaningful public communications stream and bring health and wellness information closer tocommunities.Thisco-ordinated communication approach from the region ensures that communities regularlyreceiveup-to-dateandcurated details on critical issues. AllpastE-NewslettersandE-Bulletins may be found in the newsletter archives.

TheFNHAVancouverCoastalRegional Team is committed to supporting engagement, communication and information sharing that facilitate Nation-baseddecision-makingatthe regional level and create opportunities for partnering pathways.

FNHA - Vancouver Coastal Region

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Methodology and process

Important documents and Phase1:nformation one-on-onemeetingsthrough sources of data included the gathering and initial Zoom were conducted with Regional First Nations Health and dialogue,ApriltoJune Health Directors and leads, WellnessPlan2016-,First TherefreshfortheRHWP 201; FNHC representatives and Nations-LedPrimaryHealthCare beganinMarch201,with • Phase2:Community other community members reporting, community health and the public announcement engagement,Julyto who expressed interest in the wellnessplans,theFNHA$smultithat work was starting at September201; process. Regular updates were year health plans, anti-racism , the Regional Table held on • Phase3:Validationof alsoprovidedthroughVancouver cultural safety and humility April20,1.Theprocess information and draft CoastalE-Newsletters. action plans and other regional began by acknowledging the writing,Octoberto health and wellness plans. successesofthepreviousQveDecember201;and Pleasesee Appendix A for year plan, and this became • Phase4:Finalizationof projectengagementsummary. the foundation for engaging thedraftplan,Januaryto with community members May20. KeycontactsfortheRHWP for their input. Traditional included: KnowledgeKeepersand Elders Althoughtheprojectplan were invited to meaningfully suggests that community • Community Regional participate in the process of engagement happened primarily Table members and developingtheRHWP. inPhase2,engagement Health Directors; occurred throughout the • Elders and Traditional UndertheguidanceoftheVice process, from the initial Regional KnowledgeKeepers;and President,RegionalOperations, Table meeting until the end of • VCH;and a charter and the following Phase4.nadditiontoregular • FNHAstaVancouver four-phasedprojectplanand updates at Regional Tables, Coastal and Central. timeline were developed to HealthDirectormeetings,subguide the work: regional gatherings and Caucus,

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•

RHWP 2022-2027

2022-2027 Regional priorities TheRHWPisaQve-yearlivingdocumentthatwillgrowand develop along with the region’s needs and priorities. At the time of writing,theidentiQedsevenprioritieswereinformedbyreRection onthe2016priorities,communityengagement,regionaland central team consultations and work already underway. The priorities are not meant to be ranked in importance or separatedinsilos.Recognizingthattheseprioritiesareoften connected, readers can imagine the priorities as interconnected circlesthatinRuencethewhole. Three priorities from the Regional First Nations Health andWellnessPlan2016-planning,engagementand communications; data and research; and human health resources havenotbeencarriedforwardasprioritiesfor20-7.These threeprioritieswereoperationalizedoverthelastplanningperiod andarenowsubsumedwithinthe20priorities. naddition,whilethereisaspeciQc cultural safety and humility and anti-racism priority, cultural safety and humility is a core principle for working with First Nations and, therefore, serves as a foundation for all regional work. Cultural safety and humility and anti-racismisfurtherembeddedintotheregion$sworkbecauseof the Anti-Racism,CulturalSafetyandHumilityFramework released jointlybytheFNHA,theFNHCandtheFNHDA.Operatingwithin this framework guides the region in championing cultural safety and humility across the healthcare system.

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Primary Care: Wholistic Wellness and health service delivery

Goal: Through community engagement that identifies community health and wellness needs, improve the quality of culturally safe wholistic wellness and medical services.

Objectives: • Integrate culturally safe practices and approaches for communities orNationsintoFirstNationsPrimaryCareCentres(FNPCC),allowing communities to access family physicians or nurse practitioners closer to home. • Support the active and meaningful engagement of First Nations in their respectivePrimaryCareNetworks. • Prioritizeandimplementinnovativesub-regionalJointProjectBoard initiatives. • Collaboratewithcommunitiestoevaluatetheeectivenessofprograms fundedthroughtheJointProjectBoard. • Collaborate with First Nations communities and Nations to support physicians,nurses,maternalandchildhealthworkersandJointProject Boardteamstodeliverwholistic,culturallysafeservices. • Support healthcare practitioners to access culturally safe training developed, adapted, reviewed and endorsed by local communities. • EnsuretwomoreFNPCCareestablishedandfunctioningathigh operational and culturally safe standards. • CollaboratewiththecentralFNHAozcetoadvocatetheMinistryof HealthformoreFNPCCs. • Ensure all communities, including rural and remote, have community health services in the community or access to services.

Photo credit: N’Quatqua River, C.Thevarge

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RHWP 2022-2027

Primary Care: Wholistic Wellness and health service delivery

Goal: Re-establish reciprocal working relationships with communities and health partners.

Objectives: • Holdregularin-personmeetings,activitiesandeventsincommunities rather than online when safe and possible. • Explore opportunities to communicate the lived experiences of rural and remote communities to stakeholders in transportation infrastructure. • SupportFirstNationstoformalizehealthagreementswithhealth authorities where needed. • Formalizethetransferofservicesbetweenhealthauthoritiesorpartn if communities request support. • Emphasizewithregionalhealthauthoritiesthatthediversityofthe VancouverCoastalcommunitiesrequiresservicedeliverythattakesin account rural and remote realities. Goal: Build the capacity of staff and service providers to improve the workforce’s understanding of culturally safe and humble health services. Objectives: • Advance the cultural humility of practitioners in delivering culturally safe services for First Nations peoples. • Ensure clinicians are aligned with health and cultural safety guidelines and standards. • Provideinputintotheonboardingofnewmedicalstatoensurea culturally safe training component, including information about the First Nations communities the team will be working with. • SupportHealthDirectorsandstatointegratewholisticandclinical models of prevention and wellness and traditional healing into programming,includingnewregionalandsub-regionalservicemode.

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Primary Care: Wholistic Wellness and health service delivery

Goal: Planning within a wholistic healthcare system

Objectives: • Support communities to implement and evaluate community health and wellness plans. • Maintainreportingonhealthstatusandoutcomesandprovidethisdat annually at Caucus to inform planning and investment. • Through strengthened partnerships, identify which FNHA resources may be needed to support the outcomes of the community health and wellness plans. Goal: Operational excellence in a wholistic healthcare system

Objectives: • mproveregionalstrategizingbetweensubjectmatterexpertsinprimar care, health emergency management and rural and remote management to ensure a coordinated approach to supporting communities. • Connect the central FNHA primary care team with the regional FNHA primary care team to support communities. • Ensure the regional primary care team has the internal capacity and stazngneededtomaintainsustainableservicedelivery. • SupportFirstNationscommunitiesthatwanttorunincome-generating healthcare facilities while providing more accessible services for their communities.

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RHWP 2022-2027 47

Primary Care: Wholistic Wellness and health service delivery

FNHA - Vancouver Coastal Region

Goal: Data and research within a wholistic healthcare system Objectives: • EnsurethatcollectionoftheAboriginaldentiQer$$isincludedin the planning and implementation of the new Collaborative Services CommitteeprojectcomprehensiveelectronichealthrecordatVCH. • Support Aboriginal patient navigators to improve the quality of services available to First Nations clients. • Support communities that want to receive and share medical information todevelopdata-sharingagreementswithregionalhealthpartners. • Supportthestandardizationofelectronicmedicalrecords,ifdesired.

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Mental health and wellness

Goal: Advance improvements in mental wellness, traditional wellness, care for vulnerable populations and Elders, and maternal, child, youth and family health throughout the entire life course.

Objectives: • Advance traditional wellness and the wisdom from community Elders andtraditionalKnowledgeKeepersasafoundationofpersonaland community wellness. • SustainandevaluatethedeliveryofthendigenousMentalWellnessand SubstanceUseVirtualTeam(previouslyknownasMentalHealthand SubstanceUseFlagshipProject)toaddresshealthserviceprioritiesan gapsidentiQedintheVancouverCoastalregion. • Continue to support life promotion, intervention and postvention at the community,sub-regionalandregionallevels. • SupportandencouragecommunitiestodevelopspeciQcgoalsfortheir community’s mental health and wellness. • Continuetosupportcommunity-driven,meaningful,Nation-based approaches to addressing trauma from colonialism, residential institution discoveries and other events through an approach grounded in land and culture. • Collaborate with professionals, providers and partners to develop and deliverwholistic,culturallysafeandtrauma-informedservicesandcare • UpdateandcontinuouslyreQneregionalcrisisresponsesystemsto supportcommunitiestorestorebalanceconsistentwithsta,community member and community standards. • Increase access to mental health and wellness providers for community members.

Photo credit: Forest logging roads in Southern Stl’atl’imx, A.Lee

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RHWP 2022-2027

Mental health and wellness

Goal: Improve quality and care for patients requiring culturally safe mental health services.

Objectives: • Engage with communities and patients to highlight and change existing healthcare system gaps. • Address barriers to healthcare access to ensure increased quality support in mental health, substance use and traditional wellness at a community level. • MakeiteasierforpeopletoaccessandnavigatetheFNHA$sComplaints, Compliments and Incidents (CCI) process. • mplementaregionalCCprocessthatincludesVCHndigenousHealth andPHCfollow-up. • Developandimplementanindividually-driven,practicalandtransparent processforcomplaintsintheVancouverCoastalregion,including determiningfollow-upactionsinresponsetoqualitycareconcernsfrom First Nations patients, clients, communities and families. • ncollaborationwithotherFNHAandVCHteams,developandimplement culturallysafe,individual-orcommunity-drivenprocessesforgathering experiencesandfeedback.Thisprocesswillsupportthefollow-uphealing of people who have experienced an incident in the various health and wellness systems.

FNHA - Vancouver Coastal Region

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Mental health and wellness

Goal: Build the capacity of staff and service providers to improve workforce understanding of culturally safe and humble mental health services.

Objectives: • ContinuecollaboratingwiththeNicolaValleynstituteofTechnologyto provide ongoing mental health and wellness workforce development opportunities. • Continue collaborating with other institutions to provide ongoing mental health and wellness workforce development opportunities. • Advance practitioners’ positive attitude and knowledge of cultural humility in delivering culturally safe mental health services for First Nations peoples. • In partnership with regional health authorities, ensure clinicians are aligned with mental health and cultural safety guidelines and standards. • Workwithcommunitiesandserviceproviderstobuildtheircapacity and integrate wholistic models of preventative wellness and traditional healingforHealthDirectorsatthecommunity,sub-regionalandregional levels. • Continuetooeropportunitiesforeducationinculturalsafetyand humility and for other relevant training in mental health and wellness and substance use. • Adopt a “wellness web” approach to improve the interconnectivity of mental health and wellness funding streams to facilitate a coordinated interagency and wraparound approach in the community. • Supportleadershipandcommunitystawellnessatsub-regionaland regional meetings, events, training and opportunities. • mproveregionalstrategizingbetweensubjectmatterexpertsinprimary care and health emergency management to ensure a coordinated approach when supporting communities. • Strengthen reciprocal accountability with regional health authority partners to understand how the FNHA can participate in the circle of care that supports individuals and communities. Return to Contents Table

RHWP 2022-2027

Mental health and wellness

Goal: Increase peer- and community-driven, culturally safe supports to reduce the harm from toxic substances.

Objectives: • Supportcommunity-driven,Nation-basedapproachesusingland,water or blended methods to prevent, intervene and treat people that use substances and also support general mental health wellness. (i.e., Health andWellnessCentres). • Support an Indigenous harm reduction system change that increases supporttoindividualsastheymovefromdetoxtostabilizationandthen to health and wellness. • Increase the knowledge of harm reduction to decrease overdose risks in the region. • SupportacommunityorNation$seortsinthedestigmatizingof substance use.

FNHA - Vancouver Coastal Region

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Cultural safety, humility and Indigenous specific anti-racism

Goal: Guided by collaboration and engagement with the leadership of the VCH governance structures, work with partners in BC to advocate for a racism-free health care system with embedded cultural safety, humility and anti-racist principles, practices and approaches.

Objectives: • Workthroughexistingpartnershiptablesandagreementstoadvance speciQcculturalsafetyhumilityandndigenous-speciQcanti-racism priorities. • Promotecommunity-drivendecision-makingandself-determinationby supportingNation-based,grassrootsworkontheregionalprioritiesand supporting existing partnerships, relationships and innovations at the regional and local levels. • Supportavisionwithinorganizationalculturesofahealthandwellnes systeminBCfreeofracismanddiscriminationagainstFirstNations. • Explore new culturally safe and humble approaches and concepts throughregionalandsub-regionalengagementpathways. • dentifyresourcesneededtosuccessfullysupportaracism-free healthcare system. • Prioritizetheregionalassessmentandidentifyregionalculturallysaf humble activities, initiatives and practices. • Evaluate the performance of regional culturally safe initiatives aligned to provincial and regional health authority measures and indicators. • Recommend and develop new policies ensuring that cultural safety is a core attribute of quality healthcare.

Photo credit: Nuxalk petroglyphs, B.Cahoose

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RHWP 2022-2027

Cultural safety, humility and Indigenous specific anti-racism

54 FNHA - Vancouver Coastal Region

Goal: Enhance and promote community-driven, Nation-based, and regionally led cultural safety, humility and Indigenous specific anti-racism solutions.

Objectives: • MaintainanddevelopsolutionsthataddresseachVancouverCoastalFi Nations community’s diverse and individual needs. • Support and build on Indigenous ways of knowing in the resolution process. • Buildonandcelebratethesuccessoflocalinitiativesthatarecommun drivenandNation-based. • Develop more local initiatives, training and learning opportunities to address racism and further embed cultural safety, humility and ndigenousanti-racismacrossthehealthsystem. • Incorporate cultural exchange and relationship building between First Nations and care providers in the local area into training and learning. • Strengthen regional partnership accords, with solid linkage and alignment to In Plain Sight,DRPAandUNDRP. • EnhanceaccesstocarethatpositivelyazrmsFirstNationscultures, rights and identities. • PromoteaEtuaptmumk(Two-EyedSeeing)approachtocarethat integrates traditional wellness, healing, medicine and the wisdom of KnowledgeKeepersandEldersintoindividualwellnessjourneys.

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Cultural safety, humility and Indigenous specific anti-racism

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Goal: Work with the FNHC, the FNHDA, other FNHA regions and communities to champion cultural safety and humility and Indigenous-specific anti-racism in BC to improve health outcomes for First Nations people.

Objectives: • Developasolidandsaferegionalndigenous-speciQcCCprocess. • Advance the cultural humility of practitioners to deliver more culturally safe health services for First Nations peoples. • Applyadecolonizingapproachthroughthemeaningfulparticipationof FirstNationsasequalpartnersathealthservicedecision-makingtable • Enable meaningful integration of cultural healing and wellness into the health system.

RHWP 2022-2027

Urban and away-fromhome health

AsapartofsupportingVancouverCoastalRegioncommunitiesandnations, theregionalsorecognizestheimportanceoftheurbanandaway-from-home members that live on the North Shore, in the city of Richmond and the city of Vancouver.AsidentiQed Regional in ProQle, theVancouverCoastalRegionwill followthemembershipthatareself-determinedbythecommunities.However, foranurbanandaway-from-homeestimatebasedon2016Censusdata,please go to AppendixB. The following resources guide the work of the priority to support urban andaway-from-homememberstomeettheFNHA$svisionofhealthy,selfdetermining and vibrant individuals, families and communities to achieve and enjoytheirhighestlevelofhealthandwellness: • •

UrbanAboriginalHealthStrategy(UAHS),2018 UrbanandAway-from-HomeHealthandWellnessFramework,January 201

Strategies from the UAHS were woven into this regional health and wellness plan to ensure it aligns with the strategy and framework goals. However, readers areencouragedtoreviewthefullUAHS2018asthefollowingstrategiesarean abridgedversion.Progressinimprovingthehealthandwellnessofurbanand away-from-homeFirstNationsindividualsisreportedoninTripartite theannual Committee on First Nations Health report.

Photo credit: Garden harvest, N’Quatqua, C.Thevarge

56 FNHA - Vancouver Coastal Region

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Urban and away-fromhome health

Strategy one: Strengthen relationships in the urban community •

•

Recognizetheterritories Sḵwx̱ ofthe wú7mesh, sə̓lílwətaʔɬ and xʷməθkʷəy̓əmNationsinurbanVancouverandsupporttheirroleashost nations to embrace and collaborate with Indigenous service providers (e.g.,ceremony,formalizednetworks). CreateandformalizeanurbanFirstNationshealthnetworkconsisting of three First Nations and designated Indigenous service providers to strengthen relationships and collaboration in wholistic primary healthcare. This network would meet regularly with partners to coordinate shared care, referrals and wholistic service development and would include community health centre and mental health and substance use directors, DivisionsofFamilyPractice,VCH,theFNHAandmunicipalities. Invest in training and workforce development to build capacity.

Strategy two: Strengthen access to culturally appropriate primary healthcare • • • •

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Enhance the First Nations and Indigenous urban primary care network to strengthen referrals and information sharing and prevent people from “falling through gaps.” Develop respectful and sustainable contracts with key First Nations and Indigenous service providers in primary healthcare. ntegratecultureintoprimaryhealthservices(e.g.VCH , communityhealth centres) using the best available evidence and expert advice on culturally safe approaches. Consider a shared urban mobile dental and wellness service across Vancouverbetweenthethreehostnations,urbanndigenousservice organizations,theFNHAandVCH.

RHWP 2022-2027 57

Urban and away-fromhome health

Strategy three: Strengthen access to culturally appropriate mental health and wellness services • •

•

Develop respectful and sustainable contracts with key First Nations and Indigenous service providers in mental wellness and substance use. FacilitatelinkageofVCHmentalhealthandaddictionservicesforFirst Nations and Indigenous primary healthcare and mental health and substanceuseservicestodeliverplace-based,communityandoutreach services. SupportculturalintegrationintoVCHandPHCmentalhealthand substance use services using the best available evidence and expert advice on culturally safe approaches.

Strategy four: Promote wellness and prevention of illness •

•

• •

•

FNHA - Vancouver Coastal Region

nvestinawellnessprogramtoaddressservicegapsacrossVancouver (smokingcessation,injurypreventionandalcohol/substanceuse,etc.), particularly with early childhood education and schools and strengthen the role of public health. Workwithmunicipalities,parkboardsandschoolboardstostrengthen theconnectionwithhostFirstNationshealthandwell-beingprograms andinitiatives.ThisisreRectedinozcialcommunityplansandhealthy cities strategies. Identify opportunities for host nations and Indigenous service providers todeliverhealthpromotionandpreventionprogramsaway-from-home. Support reconciliation initiatives that enable the broader community to understandthendigenoushistoryofcolonization,residentialinstitu child welfare impacts and childhood survivors of residential institutions. Develop an advocacy strategy to promote wellness determinants that includes advocacy for improved employment, housing, education and socialsupportoptionsandeortstoaddresshomelessness.

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Urban and away-fromhome health

•

Supportandstrengtheneortstoimprovethehealthliteracyofthe Indigenous population, including information and health education resources.

Strategy five: Increase information about, and access to, services •

•

ExpandtheVCHndigenousPatientNavigatorprogramtoprovide more support in acute facilities across the authority to help “steer” inappropriate primary health care admissions into First Nations and Indigenous primary healthcare networks. Convene the “navigators” forum to better coordinate the navigational resources(people,information,databases)acrossgreaterVancouver (navigate the navigators).

Strategy six: Improve data and information on Indigenous health outcomes • • • • •

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Improve monitoring and reporting on Indigenous health outcomes throughtheroutinecollectionofthendigenousidentiQeratallVCH community-basedandacutesites. Improve reporting and sharing of examples of successful services or initiatives that can be used as best practices for others to learn from. WorkwiththeDivisionsofFamilyPracticetoencourageandadvocate forcollectingandreportingndigenouspatientidentiQcation(and attachment) to member medical practices. Reportonndigenousserviceutilization,admissions(especially emergency)anddischargesforeachcriticalspecialtytomonitorover-or underuse of designated services and any barriers to improving outcomes. Align Indigenous health outcome measurement with those recommended bytheTruthandReconciliationCommission-Recommendation#19 (May2015).

RHWP 2022-2027

Health emergency management

TheFNHAVancouverCoastalRegionhasanopportunitytodesignandbuild aHealthEmergencyManagement(HEM),programsandservicesstructureto support the ongoing delivery and management of regional response to health emergencies, including environmental and natural disasters and public health emergencies such as infectious disease outbreaks, the toxic drug crisis and residentialinstitutiondiscoveries.TheHEMprogramsandservicesstructur work in partnership with the FNHA framework for public health response and strong collaborative partnerships with regional health and emergency agencies, central FNHA services, other regional teams, First Nations communities and other partners. Goal: Through partnership, communication, engagement, information sharing and guidance from the community, develop a region-specific health emergency structure. Objectives: • Ensure that communities have the resources to navigate the provincial and federal emergency management response systems. • Establish liaison roles in regional and provincial response and coordination centres to support community needs during health emergencies. • Ensurehealthsupportsareintegratedintothemulti-agencysupport teams that the FNHA’s agency and government partners formed in responsetoBC$smostrecentclimatecrisisevents. • Improve and streamline communications and engagement between EmergencyManagementBCandFNHAandwithFirstNations,particularly in preparation for and during emergency response.

Photo credit: Flood mudslide path, Q’aLaTKu7em, P. Aleck and C. Smith

FNHA - Vancouver Coastal Region

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Health emergency management

Goal: Ensure the health emergency management approach is traumainformed, culturally safe, humble, anti-racist and respectful of the uniqueness of each Vancouver Coastal community.

Objectives: • WorktogethertoincorporateFirstNationsperspectivesintoprovincia emergency management legislation, strategies, policies and actions. • Designandbuildamultidisciplinaryteamtoprovidewraparoundsubregionalsupportsclosertohomeineachsub-region. • SupportacommitmenttointegratetheFirstNationsPerspectiveon HealthandWellnessintotheprovincialemergencymanagementsystem. • Takeactiontoaddresssystemicanti-ndigenousracismandcontinue to champion cultural safety and humility in the four pillars (mitigation, preparedness, response and recovery) of emergency management. Align with reconciliation goals of the provincial government and signatories commitment to continuously improve the emergency management system to better server First Nations. • Strengthen existing supports for community emergency management coordinators. • Complement existing and future emergency response investments or initiatives originating from the community. • Operationalizeaninternalteamstructurethatensuresfast,respons and continuous health emergency response during a crisis event.

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RHWP 2022-2027

Health emergency management

Goal: Capacity building in health emergency management.

Objectives: • Collaborate on responding to First Nations’ training needs and integrating training materials where possible, including participating in training exercises together to improve collective preparedness. • Increase regional and community capacity through to support logistics andinternalredeploymentofcurrentFNHAstatoprovideemotional, cultural, psychological, nursing and environmental health support. • Establisharegionalstateamtoensurewellnessduringuninterrupted community support during an emergency response. • Provideculturallysafehealthemergencyresponsetrainingtobuild communityandregionalstacapacityduringhealthemergencies. • Supportcommunitiesintheircommunity-driveneortsindeveloping emergency preparedness and response plan. • Developjointplanning,monitoringandreportingmechanismsto measure progress towards health emergency management goals and objectives.

FNHA - Vancouver Coastal Region

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Operational excellence

Goal: Support the development and documentation of operational policies and procedures for First Nations health centres and sub-regional service delivery providers. Objectives: • SupportFirstNationshealthcentresandsub-regionalservicedelivery providers to regularly review and update documented policies and procedures. • Support Nations or communities who choose to go through the Accreditation Canada process. Goal: Promote access to culturally safe and accessible health facilities for programs, health services and sub-regional service delivery.

Objectives: • SupportpartnerstoworkwithandinFirstNationsandsub-regional service delivery models. • WorkwithCommunityCapitalPlanningandOperationstoensurethat adequateandappropriatespacesareplannedandmaintainedeectively andezcientlytoaddressregion-wideneeds. • Continue to support the safety and quality of existing health facilities. • Utilizepartnershipsandinnovativeopportunitiesacrosscommunitie andwithotherstosupportsustainable,high-qualityfacilitiesaligned new service models.

Photo credit: Tsek trees, D.J.

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RHWP 2022-2027

Operational excellence

Goal: Support the region, sub-regions and communities to maximize flexible funding opportunities, including the regional envelope.

Objectives: • Improve collaboration between health partners to leverage funding arrangements. • StrategicallydedicateQnancialandhumanresources,suchastheregiona envelope, focused on achieving regional health and wellness plan priorities. Goal: Support the increase in the number of Indigenous health and wellness professionals delivering health and wellness care services. Objective: • EncourageFirstNationsandsub-regionalservicedeliveryprovider partnershipstoattract,retainanddevelopahigh-qualityworkforce. Goal: Evolve the current regional FNHA operational practices, protocols and processes to include regionalization. Objectives: • Ensure all partners have clear access and understanding of regional operations and engagement pathways. • mprovealignmentofworkbetweenFNHACentralozceandVancouver Coastal regional work. • Improve access to primary care, mental health and wellness services for Indigenous peoples across the region. • EnhancethecapacityoftheVancouverCoastalteamtofulQllQnance, communications and other operational areas. • Continuouslyimproveengagementpathwaysatcommunity,sub-regional and regional spaces.

64 FNHA - Vancouver Coastal Region

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Health governance

Goal: Acknowledge, respect and support First Nations decision-making in health service design and delivery.

Objectives: • RefreshandadoptthePartnershipAccordwithVCH,andsimilar agreements with other regional partners, to enhance integrated and eectiveservicedeliveryinalignmentwithFirstNationsperspectivesa needs. • Continuetosupportcommunities,Nationsandsub-regionsinactively designing and participating in governance structures. • dentifyopportunitiesforpartnerstoparticipateinandcommittosubregionalandregionalgovernanceandeectivelyengagehealthand political leadership in health service design and delivery. • Expand engagement, through the AHSC and the FNHC, with Emergency ManagementBCandotherpartnerswhosemandatesimpactthe determinants of health. • ContinueeectiveregionalparticipationattheTripartiteCommittee First Nations Health. • ContinuetoimprovetheinclusionofFirstNationsintodecision-making andplanningspacesthatimpactthem,includingPrimaryCareNetwork steering committees. • StrengthenrelationshipsbetweenFirstNationsandtheirservice-lev partners in the health system by establishing regular meetings and planning tables.

Photo credit: Office under the moon, Q’aLaTku7em, P. Aleck and C. Smith

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RHWP 2022-2027

Health governance

Goal: Support reciprocal accountability throughout the Vancouver Coastal Region’s health governance structure. • • •

66 FNHA - Vancouver Coastal Region

Ensure reciprocal accountability is upheld through regional table meetings, Health Director meetings, town halls and other engagement pathways. Support the regional table, the FNHC, the FNHDA representatives and the FNHA teams to report back to communities at Caucus, including sharing annual updates and report(s) where required. Collaborate with the regional health partners in obtaining guidance fromcommunitiesatCaucusandseekingcommunityandsub-regional guidance in implementing Caucus decisions.

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Next steps

The20-7RHWPprovidesadirectionforthepriorities,goals,andobjectivesforthenextQveyears.Thisplan livingisa documenttoguideandsupporttheworkoftheregionandhealthpartnersinmeetingVancouverCoastalcommunitie theyareintheirhealthjourneys.Thefuturemaybringunexpectedorunplannedsituations.nthesemoments,theregi team will continue to meet communities where they are and work with them to support the transformational health system work we are doing together.

There will also be a continued development of a reporting framework for critical program areas, such as primary care, mental healthandwellness,healthemergencymanagementandregionalizationthatincludessuccessindicators.Thesesu indicators will be developed with community guidance and will be provided in annual progress reports at Caucus, Gathering Wisdomandotherengagementspaces.

ThisplanreRectstheguidance,directionandwisdomsharedbyHealthDirectors,FNHArepresentatives,pastandcurr staandcommunityleadership.Theregioncontinuestobegratefulforthedirectionprovidedandremainssteadfast unwaveringinthecommitmenttoupholdingFNHA$sSharedVision,Valuesandthe7Directivesthatgroundtheworkonthe journeytowardshealthy,self-determiningandvibrantBCFirstNationschildren,familiesandcommunities.

Photo credit: Wuikinuxv Lake, B.Cahoose

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RHWP 2022-2027 67

Thank you kúkwstum’ckacw

ˇGiásixa

hay č xʷ q̓ ə

ˇGiǎxsixǎ or wṇíxsixǎ

̓ ) (St’át’imcets (Ucwalmícwts)/ Lílwat

(hən̓ q̓əmin̓ əm̓ /Musqueam)

Huy chexw a

(Sḵwx̱wú7mesh/Squamish)

Ǧiànakatsi

(’Wuìka̓ la/Wuikinuxv)

(Xai$xais)

(Haíɫzaqvḷa/Heitlsuk)

čɛčɛhaθɛč or ʔimot

(ɬəʔamɛn/Tla’amin)

Stutwiniitscw

(it7Nuxalkmc/Nuxalk) N.B.: Audio files added upon availability.

FNHA - Vancouver Coastal Region

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Appendix A: Project engagement summary

The 2022-2027 Regional Health and Wellness Plan (Mar 2021-May 2022) 

30+ hours of direct one-on-one health director or FNHC rep meetings  CECs attended 95% of these meetings  If meetings were not possible with HD, email with RHWP information shared to inform.



18+ hours of VC internal staff meetings



Four regional table meeting updates  2021 (July and Oct), 2022 (Jan and March)



Three health director meeting updates  2021 (Sept), 2022 (Feb and May)



Seven E-Bulletin Engagement updates  2021 (August, Sept, Oct and Nov), 2022 (January, Feb, April)



Three April 2021 sub-regionals



October sub-regional program document update



November Caucus 2021 presentation



20+ documents reviewed  RHWP, CHWP, MHWP, MYHP, CDE, UAH, Traditional wellness etc.



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Professionally edited following FNHA editorial and brand guidelines

RHWP 2022-2027

Appendix B HSDA

Total - Census 2016 (based on LHA) First Aboriginal Nations identity identity

On Reserve - Census 2016 (based on CSD) First Aboriginal Nations identity identity

Off Reserve - Census 2016 (based on CSD) First Aboriginal Nations identity identity

FNCF 2017 ALL

HOME

AWAY

30,850

22,085

8,040

7,950

22,745

14,070

24,704

7,591

17,113

1,595

920

1,600

920

774

14,875

9,850

795

785

13,905

8,930

12,405

674

11,731

14,380

11,315

7,245

7,165

7,240

4,220

11,525

6,917

4,608

Vancouver Coastal Region 31 Richmond 32 Vancouver 33 North Shore-Coast Garibaldi Abbreviations: CSD: Census Subdivision; FNCF: First Nations Client File; HSDA: Health Service Delivery Area; LHA: Local Health Area;      



Please note that Census values for On Reserve and Off Reserve may not add up to Total Census because they are derived from different geographies (i.e. health boundaries versus census subdivisions). Census gives populations for individuals self-identifying as Aboriginal or First Nations. People are considered as living On Reserve if they live within the strict boundaries of CSDs classified as reserve lands. People living just outside of these borders would be considered as living Off Reserve even if they engaged in community life in all other ways. Living On Reserve does not necessarily mean living in a rural area and living Off Reserve does not necessarily mean living in an urban area. The FNCF identifies Status/Status-eligible First Nations who either live in the same LHA as their registered community (i.e. Home) or in a different LHA than their registered community (i.e. Away from Home). "Away from Home" does not necessarily mean living Off Reserve as someone could be living in a different LHA than their registered community, but on the reserve lands of another band. * The populations for Ulkatcho is included in On Reserve populations by CSD even though the community is affiliated with FNHA Interior. Geographically, its reserve lands are located within the borders of Vancouver Coastal Health Authority.

FNHA - Vancouver Coastal Region

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Appendix C: Glossary of terms

Anti-racism is the practice of actively identifying, challenging, preventing, eliminating and changing the values, structures, policies, programs, practices andbehavioursthatperpetuateracism.tismorethanjustbeingnotracist( but involves taking action to create conditions of greater inclusion, equality and justice(p.8). Cultural safetyisanoutcomebasedonrespectfulengagementthatrecognizes and strives to address power imbalances inherent in the healthcare system. It results in an environment free of racism and discrimination, where people feel safe when receiving health care. Cultural humilityisaprocessofself-reRectiontounderstandpersonaland systemic conditioned biases and develop and maintain respectful processes and relationships based on mutual trust. Cultural humility involves humbly acknowledgingoneselfasalife-longlearnerwhenunderstandinganother$s experience. Etuaptmumk isaMi$kmawwordthatreferstolearningtoseefromoneeyewith the strengths of Indigenous knowledges and ways of knowing, and from the othereyewiththestrengthsofWesternknowledgesandwaysofknowing,and tousebothoftheseeyestogetherforthebeneQt Etuaptmumk ofall.( is a guiding principledevelopedbyMi$kmaqElderAlbertMarshall.

Racism is the belief that a group of people are inferior based on the colour of their skin or due to the inferiority of their culture or spirituality. It leads to discriminatorybehavioursandpoliciesthatoppress,ignoreortreatraciali groupsaslessthan(non-racializedgroups. Systemic racism is enacted through routine and societal systems, structures, and institutions such as requirements, policies, legislation, and practices that perpetuate and maintain avoidable and unfair inequalities across racial groups includingtheuseofproQlingandstereotyping. Return to Contents Table

RHWP 2022-2027 71

Appendix C: Glossary of terms

Traditional knowledge willbedeQneddierentlybyeachFirstNations community according to their own philosophies, language, practices and context, and will be interpreted according to their own protocols and preferences. TheWHOTraditionalMedicineStrategyprovidesausefulandcomprehensive deQnitionofTraditionalKnowledge,whichis: “the sum total of knowledge, skills, and practices based on the theories, belief andexperiencesindigenoustodierentcultures,whetherexplicableornot, used in the maintenance of health as well as in the prevention, diagnosis, improvement of treatment of physical and mental illness”.

Traditional Knowledge Keepers areknowledge-keepers,spiritualguideand practitioners who possess the gifts passed down from time immemorial to share traditionalhealingpractices.Theyareacknowledged,recognizedandrespecte by the people in the communities that they live and/or practice in.

Traditional wellness can mean taking care of one’s self spiritually, physically emotionally and mentally. It meant living a good balanced lifestyle and practicing the traditions, beliefs and culture of First Nations to ensure the connection to the land and generations past and future. As one respondent put it “if the land iswellthepeoplewillbewell(.ManybelievewellnessisindividuallydeQnedand holisticinnature.ThefouraspectsofthemedicinewheelwerealsoidentiQeda importanttoensurecommunitywellness.SomedeQnedwellnessinoneword answerssuchas)happiness;respect;nation-buildingandinspiration.

FNHA - Vancouver Coastal Region

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Appendix C: Glossary of terms

Wholistic program servicesaredeQnedbythe FirstNationsPerspectiveon HealthandWellness and by the following:

Toguideeortstowardsincreasingaccesstoquality,culturallysafecare,FNHA envisions a wholistic approach to primary health care for First Nations, informed byadecadeofengagementwithFirstNationsinBC.ThePrimaryHealthCare++ (PHC++)Approachplacestheindividual,familyandcommunityatthecenter, supportedbyinterdisciplinaryteam-basedcareandwrap-aroundservices provided at primary, secondary and tertiary levels with seamless integration enabledbytechnology.The#+$representsuniqueperspectivesonhealthand wellnessforFirstNationslivinginBC,including:theimportanceofculturalsa andhumilityaswellastrauma-informedLcare;theprovisionoftraditional wellness, oral health and mental health and wellness at the primary care level; and strong integration with upstream community public health, allied health and wellness services. “ Source: Indigenous Engagement and Cultural Safety Guidebook:AresourceforPrimaryCareNetworks

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RHWP 2022-2027 73

Appendix D: Hyperlinks to external documents or news articles Name 10-year health funding agreement

Hyperlink https://www.canada.ca/en/healthcanada/news/2017/02/canada_reaches_healthfundingagreementwithbritishcolumbia.html

2016-2021 Vancouver Coastal Region Health and Wellness plan 2019 Indigenous Peoples Day of Wellness Grantss WHO Global Pandemic

https://www.fnha.ca/about/news-and-events/news/2019-indigenous-peoples-day-of-wellness-grants https://www.fnha.ca/Documents/FNHA-Vancouver-Coastal-Regional-First-Nations-Health-and-Wellness-Plan-2016-2021.pdf https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-oncovid-19---11-march-2020

Anti-racism, cultural safety and humility framework FNHA Health Benefits announcement

https://www.fnha.ca/Documents/FNHA-FNHC-FNHDA-Anti-Racism-Cultural-Safety-and-Humility-Framework.pdf

First Nations Perspective on Health and Wellness Health partnership accord 2012

https://www.fnha.ca/wellness/wellness-for-first-nations/first-nations-perspective-on-health-and-wellness

In Plain Sight Full Report

https://engage.gov.bc.ca/app/uploads/sites/613/2020/11/In-Plain-Sight-Full-Report.pdf

In Plaing Sight Summary Report

https://engage.gov.bc.ca/app/uploads/sites/613/2020/11/In-Plain-Sight-Summary-Report.pdf

Lu’ma Medical Centre gifted $2 million from

https://globalnews.ca/news/5905690/bc-luma-medical-centre-expansion/

https://www.fnha.ca/Documents/FNHA-First-Nations-Health-Benefits-Pacific-Blue-Cross-Fact-Sheet.pdf

https://www.health.gov.bc.ca/library/publications/year/2012/health-partnership-accord.pdf

BC MoH and FNHA Lu’ma Medical Centre

http://lnhs.ca/luma-medical-centre/

Nuxalk Radio

http://nuxalkradio.com/programs/it7nuxalkmc-eWN

$322 million to combat opiod crisis

https://archive.news.gov.bc.ca/releases/news_releases_2017-2021/2017PREM0089-001647.htm

$20 million to support community driven

https://www.fnha.ca/about/news-and-events/news/$20-million-to-support-community-driven-solutions-to-overdose-

solutions to overdose emergency

emergency

Lu’ma Medical Centre opens in Vancouver

https://news.gov.bc.ca/releases/2019HLTH0129-001783

Tripartite Committee on First Nations Health

https://www.fnha.ca/about/news-and-events/news/the-tripartite-committee-on-first-nations-health-releases-2019-2020annual-report

Urban Aboritinal Health Strategy (UAHS)

https://www.fnha.ca/Documents/FNHA-2018-Vancouver-Coastal-Caucus-Spring-Draft-Urban-Aboriginal-Health-Strategy-

2018

2018.pdf

FNHA Urban and Away from Home Health

https://www.fnha.ca/WellnessSite/WellnessDocuments/FNHA-Urban-and-Away-From-Home-Health-and-Wellness-

and Wellness Framework

Framework.pdf

2016-2021 First Nations Health and

Vancouver Coastal 2016 - 2021 Regional Health and Wellness Plan endorsed by Vancouver Coastal Caucus

Wellness Plan Sound clip for Xlmduulxk

FNHA - Vancouver Coastal Region

https://soundcloud.com/firstnationshealthauthority/xlmduulxk

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Version control Section

Version

Description of change

Contributors

Cultural components

1.0

Added for RHWP 2022-’27

Introduction, background and

2.0

Updated from RHWP 2016’21. Tone match and orthographic spellings used. Updated map. Updated by Communication Manger, Nuxalk

Senior Planner, TKK Coordinator, Engagement team, VPRO Senior Planner

FNHA, and Vancouver Coastal Region context information Update to Central Coast

2.0

Communities Vancouver Coastal Region First

Date of contributor review Apr 2021 – Apr 2022

Date of a professional edit Apr 2022

July 2021

Apr 2022

Senior Planner, Nuxalk

May 2022

2.0

Updated from RHWP 2016’21. Tone match and governance structure image updated.

Senior Planner, a/Dir. Engagement, a/Manager Primary Care, Regional Advisor

Apr 2021 – Apr 2022

Apr 2022

2.0

Updated from RHWP 2016’21. Permission to use the Spectrum image was formally granted Feb 2022 by IAP2

Senior Planner, a/Dir. Engagement

Feb – March 2022

Apr 2022

2.0

Updated from RHWP 2016-’21

Senior Planner, Health Directors, FNHC reps, VPRO, a/Dir Engagement, a/Dir. Primary Care, a/Mgr. Primary Care, Reg. Mgr. Mental Health and Wellness, Reg. Mgr. Health Emergency Management, Engagement team, Regional Advisor. Senior Planner, VPRO, FNHA Communications

June 2021 – Apr 2022

Apr 2022

June 2022

July 2022

Nations health governance structure, partnership information and health facilities information First Nations engagement and approval pathway, IAP2 and Vancouver Coastal engagement approach Vancouver Coastal Region 2022-’27 Regional Health and Wellness Plan priorities

Second print edits

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Minor edits for job titles, table headings and editorial brand.

RHWP 2022-2027 75

FNHA - Vancouver Coastal Region

Photo credit: Salish Sea off of Í7iy̓el ̓shn, S.Chin

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