Aboriginal Children’s Hurt & Healing Initiative: Art from ...N=2631. ACHH: Health Utilization Data . ACHH IMICH April 2, 2017. Higher Rates of Physical Pain Diagnoses in FN Children

Aboriginal Children’s Hurt & Healing Initiative: Art from the

Heart

John R. Sylliboy & Margot Latimer Aboriginal Children’s Hurt & Healing

Dalhousie University, IWK Health Centre

International Meeting on Indigenous Child Health, March 31-April

2, 2017, Denver, Colorado

@ACHHInitiativeACHH Indigenous Child Health Denver – March 29 – April 1 2017

Ownership & Control

We have the consent from community members and all data, photo images and video footage are owned by the First Nation community members who participated in this initiative.

ACHH IMICH April 2, 2017

Faculty/Presenter Disclosure

Aboriginal Children’s Hurt and Healing ACHH) Initiative, John R. Sylliboy and Margot Latimer have no financial relationships with the manufacturer(s) of commercial services discussed in this CME activity.

The authors do not intend to discuss unapproved/investigational uses of any commercial products in this presentation.

“

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Everybody in the family tries to understand where the pain is coming from…some kids deal with it differently. …some families minimize pain. I don’t know if it’s just in our culture.. we’re taught to keep our pain inward and not outward. So we’re able to deal with more.

ACHH Indigenous Child Health Denver – March 29 – April 1 2017

-First Nation Community Member

Margot Latimer Sharon RudderhamJohn R Sylliboy Katherine HarmanAllen Finley Tara HatfieldAnita MacKinnon Daphne Hutt-MacLeodEmily MacLeod Lisa Perley-DutcherKara Paul

ACHH

www.achh.ca


ACHH is guided from our spiritual knowledge and tribal consciousness

Two Eyed: balancing knowledges in research

Balancing Act of Knowledge & Process

Community Engagement –Protocols - Partners

Questions – Methods – Relevance –Culture

Ethics – Community Protocols

Research Capacity & Collaborators, Committees

Data Gathering – Aboriginal kids safe space, art and narratives

Data Analysis – Interpretation –Elder input, community approvals

KT – dissemination, art work, presentations

Healing and Further Research


Developing Relationships

Nurturing Process of Learning

Our research is part of that spirit of knowledge…

Bombay, Matheson, & Anisman, 2014

Current Intergenerational Effects of Residential Schools

6

6.5

7

7.5

8

8.5

9

Non-IRS (0 previous generations)

Parent or Grandparent (1 previous generation)

Parent & grandparent (2 previous generations)

Psyc

holo

gica

l Dist

ress

History and Culture

Familial IRS Attendance(no. of previous generations who attended IRS


Aboriginal Children - High Rates of Pain Conditions

Musculoskeletal (Exercise & Play)Dental/Stomach (Eat) Chest (Breathe)Headache (Think)Ear (Hear)

Pain-Related Conditions


Untreated Pain Negatively Influences…

growth

behavior

social development

mental health

substance use

risk for future illness

future experiences with pain

participation in play

physical activity

academic performance

language development

sleep patterns

ACHH, June 2016



1/5 Canadians (3.6M) 12-44 years experience Chronic PainIncidence is highest in:

Aboriginal householdsAboriginal women <65 years2

1. (Cdn Community Health Survey, 2012)2. (Meana, Cho & Desmeules, 2004)

Chronic Pain and Aboriginal People



StoicBrave

Don’t CryDelay

Express/AssessDisconnectStorytellers

Unrelieved PainMissed School

FrustrationRepeat Visits

Express Seek Outcome

Residential Schools, Cultural Beliefs, Language

Understanding Pediatric Pain


IMICH-ACHH-March 31, 2017

8 First Nation Communities in 3 Maritime Provinces Canada

Nova ScotiaCape Breton (5)

PEI

New Brunswick

ACHH


Linking of Data to Understand Child Hurt

Conversation Session Themes

Youth Art Themes

Health Utilization Data (First Nation vs Non

First Nation)

ACHH


5 First Nation Communities Vs Non FNAge, Sex & Location Matched

Health Utilization

Data

First Nation N=2631

Non First Nation N=2631

ACHH: Health Utilization Data


Higher Rates of Physical Pain Diagnoses in FN Children Compared to non-FN Children(ACHH N=5262)

Significantly higher rates of dental, ear, headache, throat for FN

Significantly more visits to ER for dental pain for FN

First Nations with pain-related ear diagnosis were significantly less likely to be referred to specialist


Youth Art Themes

Health Utilization

Data

More were not attending school than were (31% vs. 19%)

More had problems learning at school (28% vs. 17%)

More had self-rated fair/poor mental health vs excel/good (35% vs. 24%)

More felt depressed for 2+ weeks in a row in the last 12 mths (35% vs. 16%)

21% of 4700 First Nations youth reported dental pain in the month prior to the survey. Of these 4700 youth …

First Nations Regional Health SurveyDental Pain & Wellness

FNRHS, 2012


Childhood Pain Associated with Youth Diagnoses of Abdominal & Headache in First Nation (FN)

FN children with ear diagnosis in childhood (0-9 yrs) were almost twice as likely to have either abdominalpain or headache diagnosis in adolescence (10-17 yrs).

The same not true for Non FN

Ear Diagnosis FN OR 1.85 (CI.1.38-2.99, p<.01)]; [Non FN OR 1.27; (CI1.083-1.94; p<.27)


Youth Art Themes

Health Utilization

Data

*Recurrent ear infections can lead tohearing loss, language & literacy

issues, concentration, behavior, and learning disabilities, and problems

with socialization and overall academic performance.

Bidadi et al., 2008; Bowd, 2005; Langan, et al., 2007; Thorne, 2004; Zumach et al., 2010

ACHH: Health Utilization Data

ACHH: Youth Art Themes

Youth Art ThemesYouth Art Themes


Disparity between Mental Health Diagnosis & Actual Experience in FN Youth

First Nation (FN) Youth Significantly less likely to Receive a Canadian Chronic Disease Surveillance System Mental Health (CCDSS) Diagnosis


Emotional 74% Physical 50% Mental 40% Spiritual 15%

Youth Art Results (N= 42)Health Utilization Results (N= 5200)

Child physical pain dx was associated with

Youth MH dx *Only in Non FN

Why?

Access, Culturally appropriate assessment, Culturally safe care, Stigma, Treatment

Youth Art Themes

Health Utilization Data


Imbalance

EmotionalPhysical

MentalSpiritual


Recommendations for Professionals: Apply the ‘FIRST’ Approach

Consider Family

It’s beyond immediate, kinship

Provide a family-clinician approach

Tribal consciousness is source of empathy

Consider how Information is shared

Pain expression: Verbal & non verbal

‘it just hurts’

Stoicism, anger, story

Ask questions

Listen to Understand

ConversationSession Themes

1

2


Recommendations for Professionals: Apply the ‘FIRST’ Approach

Build trustful RelationshipsTake interest to show you care, share a storyGauge when ready - take a ’permissive approach’

“I would like to examine your belly, is that ok?’

Create a culturally ‘Safe’ spaceThrough language

i.e greet in first language

‘Welcoming’ environment

Make a feasible Treatment & follow up plan TogetherIncorporate ‘Two-Eyed Seeing’ care

Who will support and facilitate this plan?

ConversationSession Themes

3

4

5


Integrating Knowledge to Balance Health & Wellbeing

Indigenous Knowledge &Western Perspectives

2-Eyed Knowledge

PracticePolicy

Research

Child/Community Wellbeing


HISTORICAL EXPERIENCE & TRAUMA

DELAYEDTREATMENT,

SELF-MEDICATION

DECISION TO SEEK

CARE, RELUCTANCE, LAST RESORT

GEOGRAPHY AND TRAVEL

RacismFeeling

UnwelcomeEXPERIENCE ON

ARRIVAL

HEALTH CARE ENCOUNTER

Time between child pain &

Health Encounter is Longer

FOLLOW UPWestern/Two-

eyed care application

1 2 3 4 5 6 7

Health Professional to Consider Child/Family/ Community Context

Steps Towards WellnessConversation

Session Themes

IMICH-ACHH-March 31, 2017

TRIBAL CONSCIOUSNESS

Knowledge Exchange GoalsCreate a groundswell of champions!!

Practice• Increasing

knowledge/awareness

• Training modules

• Using ACHH App

• Increasing community resources

• Leave a Legacy-Art

• Culturally safe service delivery

Policy• TRC Calls to Action

• Formalizing online training delivery

• Creating accreditation for professional groups

• First People involvement in strategic planning

Future Research• National expansion to six

additional communities

• Indigenous research methodology, capacity

• Further development ACHH App

• Pilot training modules

• Evaluating implementation of new policy & care practices


Wela’lin - Thank you!

Thank You to Our Community Members &

Funders

Documents

Aboriginal Children’s Hurt & Healing Initiative: Art from ...N=2631. ACHH: Health Utilization Data . ACHH IMICH April 2, 2017. Higher Rates of Physical Pain Diagnoses in FN Children