Jessica Ball, M.P.H., Ph.D.

Early Childhood Development Intercultural Partnerships

School of Child and Youth CareUniversity of Victoria

Intersectoral Action for Indigenous Children’s Health and Development

Children’s health & well-being are multiply determined

Coordinated action is needed across all levels

(J. Evans 2005)

Multiple entry points to harness the ecology of children’s health &

development

Adapted from Bronfenbrenner (1979)

CHILD

MICROSYSTEM

Schools Family

Peers

EXOSYSTEM

MACROSYSTEM

Neighbors

Policies

ExtendedFamiy

Beliefs

SocialAttitudes

MESOSYSTEM

NEIGHBORHOOD

HEALTH SERVICES

VALUES

SLP SERVICES

Daycare

MassMedia

SocialClass

PARENTCulture Culture

Key messages from researchwith First Nations in B.C.

Early Childhood Care & Development Programs can serve as a socially accessible & culturally resonant entry point for promoting health & delivery health services

Community development supports child health & development

One model does not fit all contexts (no ‘best practices’)

Research helps to identify promising practices

Some Aboriginal communities are demonstrating promising community-led, community-paced, community-fitting practices

that engage recommendations

of the AFN, NAHO & Romanow

Commission, Pop Health . .

Prevailing Individual-Centred, Fragmented Services

School

ChildCare

Centre

CommunityHealthRep.

PublicHealthNurse

Speech-LanguagePathologist

DentalHygienist

OccupationalTherapist

PhysicalTherapist

EmergencyServices

CommunityMembers

GP/MD

Parent: Good luck trying to make it to your child’s appointment with a dental hygienist

SLP: Good luck trying to find the child who has been referred for early intervention!

Community-Admin: Good luck filling out all the forms to appeal & account to many

different authorities

Single-focus programs have limited effects

Nutrition programs must be combined with stimulation (parent coaching, preschool, play spaces) in order realize significant gains in physical growth, health, learning & development

Programs to stimulate cognitive development do not have desired impacts if the child has a language delay due to hearing loss due to ear infections due to mold growing in their sub-standard housing in a wet climate.

Supporting families

• Most families want to meet ALL of a child’s many different kinds of needs

• Policies & service systems that require parents to engage many different professionals and programs create barriers (travel, scheduling, economic, organizational, social, cultural)

• Program coordination supports family life & increases the chances of children’s needs being met.

First Nations Early Learning & Child Care Action Plan (AFN – 2005)

“sustainable, flexible funding…

community driven…

Integration would empower First Nations to integrate child care services and programs across jurisdictions to create a new holistic framework of First Nations child care programming.”

Coordinated programming…

Supported by: Common sense Ecological perspective on change Population health model Cultural concepts Research Families Aboriginal recommendations

What more do we need to make it happen?

Making it happen: Research in Rural First Nations

Making It Happen: ►Starts with long range VISION

Communities all had:

• VALUE that ‘Children are our future.’

• COMMITMENT to invest in early years to create a foundation for adult health, achievement and economic security

• HOLISTIC UNDERSTANDING of health & development

• PLAN for coordinated programs

• FUNDING– soft infrastructure: training, policy development,

community awareness

– hard infrastructure: buildings, equipment, buses, supplies

What is happening in these communities now?

From vision to action

► Starts with capacity building

• Community - University Partnerships

• Community-based, culturally specific as well as ‘mainstream’ training

Moving towards community centred, coordinated programs with ECCD as

“Hook and Hub”

Features of Hub Approaches

Family-centred

Relationship-oriented (cultural safety)

Population-based & streamed to target programs

Strength-focused rather than deficits oriented

Efficient

Coordinated or Consolidated funding

From Dreams to Reality at Lil’wat Nation

Mount Currie, B.C. 140 km NW of Vancouver, near Whistler

Supporting children’s health & development where they are . .

On their traditional territories . . .

In their community . . .

Pqusnalhcw multi-service community centreOpened May, 1999

In the families they have . . .

Partnership to develop community capacity Training – UVic partnership

Incremental implementation Starting with child care as a ‘hook’ Community kitchen & cultural events

bringing Elders to the centre Incremental addition of programs & services Creative work to push the envelope

with funders & agencies

Planned Integration, Coordination, & Co-location

School

EmergencyServices

GP/MD

HeritageLanguage Nest

Child CareCentre

HealthPromotion

Centre

After SchoolCare Centre

CommunityKitchen

Child &Family

DevelopmentServices

HealthServicesCentre

CommunityHealth Rep.

Public HealthNurse

DentalHygienist

OccupationalTherapist

PhysicalTherapist

Speech-LanguagePathologist

Specialist Diagnostic Services

CommunityMembers

From child care & community kitchento….

• Child development pre-school & after-school• Drumming, dancing, pow wow• Supported Child Care (special needs)• Uscalmicts language immersion/exposure• Early Intervention Therapists (SLP, OT, PT,

dental hygienist)• Family Wellness Worker• Community Health Representatives• Community Health Nurse• Paediatrician• Counsellors (NNADAP & Residential School)• Dentist• Chiropractor• Elders Activity

Coordinator• Home Care Nursing• Child welfare

Working together & learning across professional disciplines & services

A mutually supportive community of workers with ongoing professional development opportunities yields high staff retention

Many pathways

“Finding our way to supporting wellness among diverse communities of children and families requires many pathways. No one approach, no one program model, will reach or work for everyone.”

Meadow Lake Tribal Council Administrator

Local innovation & resourcefulness can combine the ‘right’ number & variety of people, professions, services that a community wants & needs to achieve their own ECCD goals

Research: compare remote, rural & urban hub potentials & demonstration projects

Key messages from researchwith First Nations in B.C.

Early Childhood Care & Development Programs may be an especially strategic entry point for Aboriginal health initiatives

Planned ECCD training & services are effective components of Aboriginal community development

One model does not fit all contexts (no ‘best practices’)

Research with Aboriginal communities can explore & demonstrate exciting new ways to think about community-driven designs for action to promote child & family health & quality of life