Chiefs of Ontario Annual Health Forum February 24, 25 and 26, 2015 - Bonnie Beach A/Regional Executive Officer FNIHB Ontario Region

Chiefs of Ontario
                       Annual Health Forum
                    February 24, 25 and 26, 2015

Bonnie Beach
A/Regional Executive Officer
FNIHB Ontario Region

Contents

•   2014-15 Key Accomplishments
•   Management Operational Planning (MOP)
•   Prescription Drug Abuse (PDA) Update
•   Plans and Priorities for 2015-2016

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2014-15 Key Accomplishments
• Minister’s PDA Roundtable
    Resulted in the NIHB Joint Review - including Suboxone pilot projects and
     evidence-based decision on listing criteria
    Expanded scope of the National Anti-Drug Strategy to include PDA
    A broader Government of Canada approach that includes enhancing community
     safety and addressing special education needs
• PDA Programming
    38 community-based projects funded; focus is on community development,
     prevention and health promotion programming, treatment and aftercare
• NIHB
    Client newsletter created and a monthly teleconference established with internal
     and external partners, to optimize communications, share information and remain
     current on Program/policy changes

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2014-15 Key Accomplishments (cont’d)
• Trilateral Discussions
    Ontario Region continues to promote and support extensive and active participation
     with all partners
    Continued work with the Trilateral First Nations Senior Health Officials Committee
     (TFNHSOC) and the establishment of the Keewatin (Northern) Senior Trilateral
     Health Table to address Northern and North-Western Ontario health challenges
    Strengthening trilateral initiatives, such as the Federal/Provincial/Pikangikum
     Working Group, Sioux Lookout Four Party Agreement, and the Weeneebayko Area
     Health Integration Framework Agreement

• Children’s Oral Health Initiative (COHI)
    Tele-oral-health screening and education initiative launched in an effort to improve
     oral health in First Nation children and communities
    Development of the ‘Interim Stabilization Therapy’, a clinical procedure to relieve
     pain and tooth loss in children
    In partnership with the COO, the results and recommendations of the Ontario First
     Nations Oral Health Survey were published

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2014-15 Key Accomplishments (cont’d)

• Nursing
   Integration of Nurse Practitioner role into community primary care teams
    (currently in 6 communities)
   Transformed nursing structures/processes to align with Regional
    Transition plan for enhanced client health outcomes
   Implemented Service Administration Log, to capture nursing data to
    inform future policy and clinical decisions
   Continued work with provincial partners (e.g. NWLHIN) to improve client
    health outcomes
   Nursing administration policies developed
   Working with Accreditation Canada to begin accreditation process for
    nursing stations

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2014-15 Key Accomplishments (cont’d)

• Public Health Unit
      Infection Prevention and Control
      Pandemic Preparedness
      HIV/Sexually Transmitted and Blood Borne Infections
      Tuberculosis
      Immunization
      Communicable Disease

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Background on MOP

• May 2014
  • Presentation of the Management Operational Plan (MOP)
  • MOP process aligns with FNIHB’s Accountability Framework and
    the FNIHB Strategic Plan – A Shared Path to Improved Health
• October 2014
  • Joint MOP planning process
  • Participants included COO, PTO’s, Independents and Grand
    Council Treaty #3 (GCT#3), as well as FNIHB’s Regional
    Management Team
  • The Nishnawbe-Aski Nation’s (NAN) presentation was done
    separately due to their unavailability for the meeting

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2015-16 MOP Approach
• Joint Planning:
   • Initial focus on upstream programs and some programs with
     funding flexibilities
   • Expectation to annually expand areas of joint planning
• The planning approach aims to:
   • Seek to balance multi-year commitments with increased access
     and efficiency in priority areas (Primary Care, NIHB, Mental
     Health)
   • Ensure better inter-jurisdictional planning and coordination
     (Strategic Plan)
   • Plan from a zero-based budget for new activities and projects

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Next Steps

• November 2014
  • A draft MOP was submitted to Headquarters (HQ)
  • Comprehensive review by Assistant Deputy Minister (ADM)
    resulted in some changes
• January 2015
  • Second draft submitted to HQ
• March 2015
  • Anticipate approval of MOP and proposed budget

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Prescription Drug Abuse (PDA): Background

• As early as 2008, the Chiefs of Ontario expressed concerns that the
  abuse of prescription drugs had become epidemic in First Nation
  communities.
• In November 2010, the Chiefs of Ontario released “Take a Stand”, a
  prescription drug abuse strategy intended to increase the success of
  community programming in the prevention, reduction and eventual
  elimination of prescription drug abuse.
• PDA activities are further informed by the national document,
  “Honouring our Strengths: A Renewed Framework to Address
  Substance Use Issues Among First Nations People”.
• Also, in March 2013, the Canadian Centre on Substance Abuse
  (CCSA) released a 10-year strategy, First Do No Harm: Responding to
  Canada’s Prescription Drug Crisis.

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Minister’s Roundtable on Prescription Drug Abuse

• January 2014: Minister Ambrose co-hosted the National
  Symposium on Reducing Misuse of Prescription Drugs with the
  Canadian Centre for Substance Abuse
• June 2014: Minister Ambrose hosted a Roundtable discussion
  on PDA with Ontario First Nations leadership
• Continuous improvement through a PDA Action Plan that will
  lead to improved collaboration and strengthen responses to
  better support individuals and their families in addressing PDA

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PDA Roundtable – Priority and Actions

1. NIHB Joint Review
2. Community-based PDA approaches grounded in cultural/
   traditional knowledge and practices
3. Training and professional support for addictions workers
4. Improved linkages with broader strategies
5. Awareness and prevention initiatives for youth and children
6. Knowledge gathering to understand the impacts of PDA on
   newborn babies throughout infancy and childhood
7. Enhance community safety
8. Increased awareness of special education specific to PDA

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Addressing PDA
•   In 2014-2015, Health Canada invested a total of $4.5M in Ontario for
    community-based PDA projects
          $4M for community-based programming in Ontario First Nation communities
          $500K to support Community Wellness Development Teams

•   Based on a Call for Proposals, Health Canada approved 38 community-
    based PDA projects that focuses on community development, prevention
    and health promotion programming, treatment and aftercare

•   In January 2015, the First Nations Mental Wellness Continuum Framework
    was developed in partnership with First Nations to improve mental wellness
    outcomes for First Nations

•   The Framework will assist communities in adapting and realigning their
    mental wellness and addictions programming, based on their own priorities,
    to address PDA

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2015-16 PDA Priorities

• Health Canada, Ontario Region continues to identify
  Prescription Drug Abuse as a priority
• The First Nations Mental Wellness Continuum Framework will
  assist current programs to be more responsive and flexible in
  meeting the needs of First Nations communities
• Health Canada is revising the annual call for proposals based
  on feedback from First Nations
• First Nations have asked for funding to be more responsive to
  the unique needs in their community and allow for multi-year
  funding
• We expect to have a draft approach to share before April 1,
  2015

Keewatin (Northern) Table update

• The Keewatin Senior Officials Trilateral Health Table has
  been meeting since July 2014
• Terms of Reference and Mental Health and Addictions Action
  Plan are currently being prepared by the Technical Working
  Group for review/approval by the senior officials at their next
  meeting
• Next meeting of the Keewatin Senior Officials Trilateral Health
  Table will take place on March 31, 2015

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Non-Insured Health Benefits (NIHB) Funding
•   Health Canada was successful in securing stable funding for NIHB for five years
    rather than annual federal Cabinet processes

•   Health Canada is expected to manage total NIHB national expenditures within a
    maximum of 5% annually

•   Multi-level integration approach to managing future annual total NIHB Program
    expenditures efficiently

•   It will also require increased collaboration in the analysis and consideration of
    amendments to NIHB processes or benefits

•   Increased opportunities for open and transparent decision making, as well as a
    renewed focus on client health and safety, reduced administrative costs, and
    more rigorous tracking, monitoring and reporting on expenditures.

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Non-Insured Health Benefits (NIHB)
• Pharmacy
   •    New measures to support the PDA Strategy, including improved access to
        Suboxone used to treat opioid addiction, and dose limit for stimulants (e.g. Ritalin)
• Ostomy
   •    A national price file and benefit codes are being implemented for selected ostomy
        supplies (e.g. ostomy pouches and flanges)
   •    Effective March 2015, clients with permanent conditions can obtain ostomy
        coverage for a two (2) year period (to be renewed every 2 years rather than every
        year)
• Vision Provider Re-enrollment
   •    A new, standardized way to enroll vision care providers who provide services to
        NIHB clients is being implemented
• Direct Deposit
    •   Direct deposit is currently available for clients and providers. By April 1, 2016, the
        majority of Government of Canada payments will be made by direct deposit

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NIHB (cont’d)
• Mental Health Re-enrollment and Prior Approval Form
   • A standardized mental health counselor enrolment form and process has
     been developed to:
      • Bring consistency to the determination of eligible mental health
        providers; Traditional healers do not have to register with the NIHB
        program when treating IRS clients
      • Enhanced alignment with the First Nations Mental Wellness
        Continuum Framework - includes cultural competency section and
        linkages with community mental health supports
      • A single prior approval form has been created for both NIHB and IRS
      • Requires schedule of counselling sessions, but no details of client’s
        assessment or treatment plan
      • Allows counselling via tele-health if/as appropriate and available

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Health Services Integration Fund (HSIF)

• HSIF will expire March 31, 2015; there is no automatic roll-over
  on April 1, 2015

• FNIHB hopes a source of funds for HSIF will be renewed in
  2015/2016 fiscal year however it is uncertain at this time

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THANK YOU – QUESTIONS?

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