Community Development & Capacity Building First Nations & Inuit Health Branch September 2012 Introduce Rhonda. This is a longer deck, but I’m only going to touch on the relevant pieces for you. The whole deck is available from the conference.

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CDCB Framework approach Indigenous community development is dependent on the combined capacities of the community’s individuals, public service and governance – community development happens from within. Role and opportunity for governments and partners - to support the capacity of community individuals, organizations and governance excellence. By supporting capacity which leads to community development, First Nations and Inuit communities will address their own social determinants of health, based on their own assets, including Indigenous knowledge and culture. This is the game-changer to improve health outcomes. For governments and partners - Strengthened knowledge and competencies in effectively partnering with communities (including cultural competence), and strengthened community partnerships are necessary elements for success. 1 minute We know that communities function well together, when individuals have skills, when organizations have the competencies to fulfill their mandates. But we also know that communities do well with the support of others, such as governments and innovative partners like corporations, non-profits. Based on my experience, these partnerships need partners who understand each other, and uphold the value of communities making decisions for themselves. Community development happens within community – external partners cannot “do” community development to a community. So we are undertaking an extensive training approach within FNIHB to build the competencies of our employees, so that they define their roles as supporters and facilitators of what happens in community. We all share the vision of strong vibrant healthy community. ©FNIHB-HC 3

Theory of Change Previous policies to implement community-centred approaches have resulted in momentary shifts, but policy alone does not result in transformative change. CDCB is using an organizational change approach to increase the likelihood of transformative change: Empower community members, FNIHB employees and external partners with knowledge and competencies – “to know more is to do better” (Elder Paul Skanks). Encourage natural networks of people that provide supports and opportunities for discussion on how to implement Indigenous community development Build champions at every level Maintain a vision of the future that generates hope and commitment ©FNIHB-HC 4

Healthy Community is the Vision Adapted from Whanāu Ora, New Zealand approach to Māori family health and wellbeing. Community and family well-being will be realised when [extended] families are: Self managing Living healthy lifestyles Participating fully in society Confidently participating in the First Nations/Inuit world Economically secure and successfully Involved in wealth creation Cohesive, resilient, nurturing Krawl, 1994, Indicators of healthy community people getting involved in their community greater sense of trust, caring and sharing among community members positive parenting sharing of intergenerational wisdom [and culture] openness and communication among community members, without blaming or shame clear role expectations and people taking responsibility sense of connectedness and sensitivity to one another which promotes healthy partnerships and collective action 1minute Here are two different ways to consider what healthy community could look like. Each community defines this for themselves, but here’s some options. The first written by Marcia Krawll a number of years ago, talks a lot about social connections, social networks, and individuals supporting each other. The second comes from our Maori friends in New Zealand. If it were adapted to our world, this is what it would look like: healthy individuals, contributing to community, knowing their own culture, working together. The reason why we always start with the vision, is that it reminds us that we actually are working on something together. So let’s define it – community development. ©FNIHB-HC 5

Working Definition: Community Development The foundational value and belief of community development is that the people themselves can improve their community by working together, building consensus on priorities and actions, building on community assets, and developing individual and community capacity. Community development is a principled, values-based approach to support better outcomes in First Nations and Inuit health, by empowering communities to manage their own services, building on their own strengths including culture. Community development is not a program – the principle is to embed community development knowledge and expertise across the whole branch, in every policy and program. 1 minute How can we strengthen our own internal competencies as employees and as an organization, to be an effective partner with First Nations and Inuit communities? What are the roles for FNIHB to support capacity in communities to address their own social determinants of health, and to work towards the goal of successful and healthy community? ©FNIHB-HC 6

Community development is not new This increasing level of health in Aboriginal communities must be built on three pillars. The first, and most significant, is community development, both socio-economic development and cultural and spiritual development, to remove the conditions of poverty and apathy which prevent the members of the community from achieving a state of physical, mental and social well-being. (1979) 10 seconds 1979 Indian Health Policy. We in FNIHB continue to uphold this policy. ©FNIHB-HC 7

Commitment to Community Development Community development is a priority of the Health Canada Executive Committee workplan. FNIHB ADM’s speech to the AFN’s Health Policy Forum highlighted community development Linked to FNIHB draft Strategic Plan FNIHB Regional Directors have shown their support and commitment to the content and approach, and an RD co-chairs the National Advisory Committee AFN and ITK both participate and are co-chairs of the National Advisory Committee. 10 seconds Just to show the level of commitment to this work, from FNIHB. I’m going to skip this, but encourage you to review it later. ©FNIHB-HC 8

Cultural Competence Community Development and Capacity Building Community Capacity Partnerships for Community Health & Well-being Government & Partners Knowledge & Competencies Community Development and Capacity Building Framework and Principles Strength-Based Indigenous Knowledge & Culture Holistic Health & Well-being Community-Centred 1 minute This is the Framework in one image. See the three pillars on the outside, the principles in red in the inside, all founded on cultural competence. This will be available in the future in a text format. Leadership in Community Cultural Competence ©FNIHB-HC 9

Pillars of the CDCB Framework Pillars or entry points to support Indigenous Community Development (ICD) in communities. Building our own knowledge and competencies in ICD and cultural competence, to be better partners. Working with innovative partners such as other governments, corporations and non-profits to support community well-being. Always supporting ongoing development of capacities in communities. First, the pillars: Community Capacity, Government Partners…., and Partnerships for Well-being. These are entry points into doing the work of community development. How do communities continue to build their own capacity, so that self-determination and excellence in service delivery is achieved? But the way we do the work, is almost more important than the work itself. Process is product? ©FNIHB-HC 10

Principles of the Framework Then, the principles. Many of these will be familiar to you. Let me focus on just a few of them, as you know what many of them are already. I’m going to focus on Indigenous Knowledge and Culture, and Leadership in Community. These are only 2 of the five principles, the rest you can review on your own. I’ll also talk about how we describe Cultural Competence. But first, what’s the point again of community development? ©FNIHB-HC 11

Community Capacity – What is it? Capacity of individuals + capacity of community organizations = building blocks for community development. For example: Capacities in communicating and sharing plans for the future, working together to achieve a shared plan, and evaluating progress. Why is it helpful? Community development is built on individual and organizational capacities. Successful communities have the capacity to identify and address their own determinants of health. In practice – how do we implement? First do no harm – do not compromise community capacity, decision-making, self-determination and hope Focus on opportunities to leverage partnerships to support capacity development in individuals and organizations. 3 minutes The point is to build capacities in communities, so that you can build on your own assets and address your own issues. Capacities are those in individuals, in organizations too. We describe capacities in the widest possible way, whatever is needed for individuals to be ready-to-learn, ready-to-work. And capacities for organizations too, whatever your health centre needs to be excellent at fulfilling its mandate. The key message here for us as external partners and supporters of the work that you do in community, is “first do no harm”. We should not be compromising community capacities, decision-making and planning. Every interaction with community should build its strengths, build towards a hopeful future. [Rhonda, can you insert a story of your own, on how to do that?] ©FNIHB-HC 12

Community Capacity definitions What community insiders need to have, to know, to do, and to be, in order to effectively influence the primary determinants of health that are affecting them (United Nations Development Program). Sometimes described at three levels: Individual Level - development of conditions that allow individuals to build and enhance existing knowledge and skills, the establishment of conditions that will allow individuals to engage in the “process of learning and adapting to change” Institutional Level - aiding and supporting institutions/organizations in forming sound policies, organizational structures, and effective methods of management and controls Societal Level - support the establishment of a more “interactive public administration that learns equally from its actions and from feedback it receives from the population at large.” Capacity building must be used to develop public administrators that are responsive and accountable. 10 seconds I’m going to skip the next 2 slides, all to say that it turns out that FN and I community capacity is pressured to provide the breadth and depth of governance more than the average small Canadian community. ©FNIHB-HC 13

Public Service Capacity Individual Capacity Safety Healing Personal health practices including culture Social supports Ready to learn Ready for work Service Delivery Continuing education for work and career Communication Project management E-technology Sector-Specific Capacity: health, ECD and education, housing & public works, PSE, lands & resources, family & community supports, social development, economic development, policing, membership Governance Policy and decision making Communication and negotiation Organizational design Management & controls Community engagement & moral authority Leadership Partnerships & Collaboration Accreditation Organizational Capacity Public administration Policy and decision-making HR management Financial mgmt & fundraising Strategic Planning Information management Performance measurement Community engagement Public Service Capacity Community Capacities skip 14 ©FNIHB-HC 14

Indigenous Knowledge & Culture - WHAT is it? Culture (traditional and cultural activities, indigenous intelligence) is an important, and perhaps the most important protective factor in community. Culture acts as a buffer against crisis. Cultural discontinuity is a risk factor, particularly in mental health. Why is it helpful? Strength of culture in community is a determinant of community wellness. In practice, how to implement: Culture is an essential determinant of health in communities, and an eligible expense in FNIHB health programs. It is the responsibility of FNIHB and of FNIHB employees to be culturally competent. 3 minutes I said I was going to talk about 2 of the principles? Here’s the first one. The most important principle here. All the rest hinge on this principle for providing the basis of understanding in community. [rhonda-read them through, it’s self-explanatory] ©FNIHB-HC 15

Indigenous Culture & Knowledge The commonalities around which a group of people have developed values, norms, family styles, social roles and behaviours, in response to the political, economic and social realities they face Culture and identity are central to Indigenous perceptions and definitions of health and ill health. History matters: Colonization and residential schools discounted Indigenous cultures, churches and society labelled culture as “evil” and uncivilized, and the federal government criminalized cultural practices. Community healing from colonization and residential schools includes the process to reclaim and revive cultural knowledge and traditions – and this is a foundation for community development. Successful communities Community cultural identity, esteem and strength is associated with strong social support networks, inclusive social structures, and sense of hope for the future. 10 seconds I’m also going to skip this slide, because I know you all understand the importance of culture in our communities. ©FNIHB-HC 16

Strength-based - WHAT is it? A strengths-based or assets-based approach balances risk and protective factors, and respects the resilience of communities. A recognition that every community has assets – some are just more readily identifiable. WHY is it helpful? Builds trust Builds individual and community esteem Supports potential and hope In practice: Design programs and policy starting with community strengths including culture and social connectedness. Always look for strengths and assets. 10 seconds I’m going to skip these slides too, because I want to talk about leadership. ©FNIHB-HC 17

Community-Centred - WHAT is it? Community-based: The majority of health risk and protective factors are local. Capacity and activity to address them must also be local. A community builds on its own strengths and assets to address health risk factors. Community-paced – Sustainable action builds on capacity in the community, at the stage of community development (continuum). Community-led: The community’s sense of ownership and control over activities to address wellness is likely just as important as the activity’s outcomes. WHY is it helpful? We all share a vision of communities self-managing with control over their own social determinants of health, with support from governments and partners. In practice: Facilitate community initiative and ownership, and reduce prescriptive policy and programs. Facilitate community capacity in decision-making, facilitation and strategic planning. Skip ©FNIHB-HC 18

Leadership in Community - WHAT is it? Leaders create vision for the future: “The ultimate task of a leader is to take his or her society to where it has never been.” Community leaders include those paid to lead, and also those who have leadership roles and influence in the community. WHY is it helpful? Formal and informal community leadership is a protective factor against crisis, and an essential factor for success. In practice: Support short- and medium- term leadership development and emerging leaders in communities. 3 minutes Here’s what I want to talk about, the role of leaders in community, and how they contribute to community development. We know that many strong communities have strong leaders, those who put their community first, who are able to lead their community through times of challenge, and remind us that we can achieve our dreams. That first quote on the page, that’s from the past president of ITK, Mary Simon. [read through slide] There’s examples of First Nations and Inuit supporting the development of our own emerging leaders First Nations Health Managers Association [got another? Perhaps your co-management table as a mentoring/learning table?] We can do better. Succession planning for the next health centre director, the next nurse-in-charge in your community – what are we doing as communities, what are we doing collectively to build the skills and competencies of our up-and-coming leaders? I’m going to skip the next couple slides…. ©FNIHB-HC 19

WHAT is it? First Nations, Inuit and Métis define health as holistic (physical, emotional, mental and spiritual), and activities that have impact across the circle of health will have more impact than those which focus on only one. WHY is it helpful? Factors contributing to health and wellness, and healthy communities, are larger than any one department or partner. Successful communities have innovative partnerships with neighbouring communities, NGOs and additional funders. In practice: Leverage commonalities and partnerships within FNIHB, with other departments including AANDC. Facilitate relationships between First Nations, Inuit and Métis - and the NGO and private sectors. Skip ©FNIHB-HC 20

Cultural Competence Important enough to spend much of the afternoon on this foundation of the CDCB Framework. An expectation held by Aboriginal communities and clients A lens – principles are seen and interpreted through it A process - reflected in communications. An indicator and an outcome – evaluated by Aboriginal partners and clients A lifelong learning opportunity. Finally, cultural competence. The Community Development Framework is based in cultural competence. Because it’s an expectation that FNIHB should be culturally competent, and because all the evidence says that culturally competent approaches are the ones that are going to be most sustainable. Lifelong learning….let me just touch on this a bit. Cultural competence as we see it, it’s not a checkbox approach, it’s not a one-time course. It is a lifelong journey, as we all have experiences to learn more about other cultures, to learn how to build more effective relationships across cultures. ©FNIHB-HC 21

FNIHB & AANDC CDCB Framework Goals Employees and organizations have knowledge and competencies in ICD and cultural competence, in order to build effective relationships with communities and clients. ICD and cultural competence is implemented in FNIHB & AANDC daily work to develop policies and programs, and decision-making that affects communities. FNIHB & AANDC are effective partners with communities to support their work to develop and address SDOH. As communities request, innovative corporate and philanthropic partners support the development of community capacities, and contribute to improved health and well-being. Communities have the capacities to plan, deliver and evaluate their own quality services and public administration, and negotiate effective relationships with provinces and territories to adapt the larger systems to better meet their needs (ie. Health, education, etc) FNIHB & AANDC CDCB Framework Goals Supporting Community Capacity and Wellness Improving our Quality to Support Communities Here’s how the Community Development Framework looks, in terms of our goal – healthy vibrant communities. FNIHB has a role, not to lead, but to support you as leaders in community. Communities can support each other to plan for the future, and to bring about a future we all want. So here’s the first step, we’re building our own skills to support you better – the first circle there. The second circle, when policies and programs adhere to community development principles – respect for Indigenous Knowledge, community-centred, holistic. The third circle, we can play a role to support innovative partnerships between communities and corporations and non-profits, to facilitate that win-win concept. And finally, we are all working towards the vision of healthy community. In FNIHB, we know that community leaders are key. My goal in attending this conference is to learn more about what you need, and what FNIHB can do to support your learning needs. I hope that my contribution here in sharing this Community Development approach with you, I hope that you see FNIHB aligning itself with your hopes, so that we can be viewed as an effective partner with you. Because you do the work of community development, and we are a supporter of your work. ©FNIHB-HC 22

For more information: Rose Sones LeMay Branch Lead, Community Development and Capacity Building FNIHB, Health Canada Rose.sones@hc-sc.gc.ca APPENDICES Draft Workplan Lessons learned in CDCB Pilots

Draft Workplan 2012-13 Community Capacity Review options for FNIHB to actively support capacity in communities including emerging leaders, and options on joint work with AANDC Complete pilot with Public Safety on community planning, and report on outcomes FNIHB Knowledge and Competencies Train 20% of FNIHB in Indigenous Community Development course Develop structures to support ongoing learning including GC-Connex, Forums Complete resource kit for regions to support communities in crisis, perhaps with a specific workshop Partnerships for Health Contribute to knowledge translation on building and maintaining effective innovative partnerships Increase corporate and philanthropic contribution to community capacity and health services delivery ©FNIHB-HC 24

Lessons Learned in CDCB Pilots Internal Organizational Change Takes time in focussed training to build champions at every level of organization Indigenous Community Development curriculum Community Capacity is the lever Successful communities have strong capacities in how to do strategic planning Communities plan to their own internal authorities first Community peer support networks can offer immediate and sustainable supports, and better positioned to share messages about effective management and governance Kitigan’zibi, joint funding with Public Safety, FN Health Mgrs Assoc Innovative Partnerships Negotiation skills, shared sense of benefit both important to community partnerships with corporations, non-profits, other governments Ahp-cii-uk ©FNIHB-HC 25