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NODIN CFI
SERVICES
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Referrals:
Referrals to the Acute Care
service in Sioux Lookout increased dramatically with the
introduction of children’s services. Adherence to NIHB
policies, however, will affect the ability to bring clients
and escorts to Sioux Lookout for non-emergency counseling.
While the Sioux Lookout workload may decrease, the
workload in the communities will increase.
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Service Integration:
The integration of services
presented challenges that are being addressed. Integration
has occurred in several program areas. Both the Crisis
Coordination program and the Traditional Healing program are
provincially funded endeavors and the Traditional Healing
Program is also funded by Nishnawbe-Aski Nation. Both of
the these programs are used by adults, children, Northern
service and Sioux Lookout service. A major undertaking was
the integration of the Intake departments of Acute Care and
the Children’s Mental Health service.
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Psychological Services:
Psychiatric Clinics remain the adhoc service
of Nodin/CFI Clients.
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Application of Data:
Annual reviews of our
statistics identify emerging needs. Matching suicide data
with service delivery data enlightens us to how high
priority groups use services. We learn that males are a
high risk group while noting that they use individual
counseling far less than women. However, males access the
Traditional Healing far more than women. Such information
challenges us to improve our planning and development
processes as well as manage our resources so as to reach
these high priority groups.
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Crisis Response:
The Crisis Response
Coordinator devoted more time to assist communities in
coordinating their own crises and this support can be
provided in conjunction with NAN Crisis Team Coordinator.
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Crisis Management Procedure:
is implemented when a community encounters a crisis and
requests crisis support from Nodin CFI. Example of Crisis
that are responded to include suicide, unexpected loss of
life, trauma contributed to any community being unable to
respond to their crisis or to mobilize their combased
response
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Training:
Through in-services, retreats, orientation and on going
staff development is consistent with program direction to
promote mental health; mentor other community based workers
and to utilize other therapeutic approaches.
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Service Agreement:
The Sioux Lookout First
Nations Health Authority and Tikinagan Child and Family
Services developed a Service Agreement that outlines the
mutual responsibilities. The agreement for childrens mental
health services is now between MCFCS (MCSS) Sioux lookout
First Nations Health Authority.
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Protocol Agreement:
is an example of a
working protocol between Nodin
Child and Family Intervention Services, Sioux Lookout First
Nations Agreement and Tikinagan Child and Family Services.
This document lays out the current mandates and services of
each agency, case management and communication strategies
and the ongoing working partnership. The priority clients
are children in care requiring mental health services. This
protocol includes the High Risk Children in Care Review
Committee.
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Contribution Agreement:
FNIHB contributes funds to Sioux Lookout First Nations
Health Authority for delivery of Mental Health Services to
Sioux Lookout area communities.
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Statistical Trends:
Suicides:
Suicides continue to be a major
service area for Nodin CFI and First Nations communities. For
example in 2003-04, there were 16 suicides this year. Although a
third were between 16 and 18, the average age was 23, older than
previous years. There were 2 over the age of 35, and none under
16. The male: female ratio was 2:1. Over a 17year period, the
rate in the 0-14 age groups is 47 times that of the general
population, although this year there were no suicides in that
age group. The age and gender distribution of suicide more
closely resembled that of the general population.
Suicide Attempts:
Another area of focus by both
Nodin CFI and First Nations Communities are the suicide
attempts. Self inflicted harm was the most common reason for
service in the Acute Care service. Of 313 attempts seen by Acute
Care, 180 (58%) were from the CFI age group of which 120 were 16
and under. Attempts outnumbered completed suicides 23 to 1
overall (compared to 10:1 in the general population), In the 16
and under group, the ratio was 30 to 1. The ratio was 8:1 for
males and 45:1 for females. The female: male ratio for attempts
was about 2.5:1. Not all suicide attempts are documented as
some clients making serious attempts are rerouted to major
health care centers. Nodin CFI with AHWS funding looked at
suicide stats and attempted to define categories and definitions
so that reporting on suicide attempts and query suicides is
clarified.
Referrals:
Intake continues to process
referrals for Adult and Children. Over 51% of new referrals to
Acute Care were from physicians treating the client at the
hospital reflecting the serious nature of referrals, followed by
community mental health workers and community nurses. Most of
the referrals of children to CFI were from Acute Care requesting
follow up of a suicide gesture or attempt, followed by Tikinagan
referrals. Acute (Urgent) Referrals are seen at the Nodin Sioux
Lookout Unit or at Meno-Ya-Win Health Centre or as electives in
the First Nations Communities during regularly scheduled
community visits.
Nodin CFI collects data to ensure it is
consistent with Funders reporting requirements & planning. The
following is an example of data collected in 2003-04
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General Data:
From a total of 3390 referrals
to Acute Care, 1192 were seen in Acute Care, and 1277 seen in
the community. Of the 1192 seen in Acute Care, 463 (37%) were
in the CFI age group. The most frequent reason for service in
Acute Care for this age group was a suicide gesture or
attempt. A total of 535 referrals were made to CFI, the
largest number from Acute Care for suicidal behavior or from
Tikinagan. In both the Sioux Lookout service and community
service, the number of females outnumbered males about 2:1.
This trend was reversed in the usage of Traditional Healing
services.
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Presenting Problems
and Diagnoses: Suicidality,
grief and depression - all interrelated problems – were the
major reasons cited for service in all aspects of the NCFI
service. The most common reason cited in Acute Care was
suicidal behavior (26%) followed by grief (19%). The numbers
are similar for referrals to CFI: suicidal behaviour
constituted 25% of the presenting problems upon referral, and
grief, 18%. For clients seen in the community, grief was the
presenting problem in 35% of cases. For psychiatric
referrals, some form of depression was the diagnosis in 70% of
cases for all ages and 78% for youth.
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Crisis Responses:
There were 27 crises in 19
communities, involving 16 suicides, 2 homicides and 9
accidental deaths. In 9 cases, the victims were in the CFI age
group. Nodin responded to all of these, however, crisis teams
were not approved in 2 instances. Nibinamik and Pikangikum
each had multiple suicides and 1 other death not by natural
causes.
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Consultant
Referrals: About 350 persons
accessed consulting services of Psychiatry, Psychology, Art
Therapy and Traditional Healing. Just under half were under
20. About 38% of referrals to psychiatrists were of those in
the CFI age group. All referrals to the psychologist and art
therapist were 16 and under, and 18% for the Traditional
Healer. There were a significant number (16) of persons
referred to the Traditional Healer for whom the presenting
problem was sexual abuse. Some are known to be male victims.
It is notable that males outnumbered females in the usage of
Traditional Healing services.
Listed below
are new directions which have emerged since 2002:
- Creation of the mission
statement and guiding principles for the enhanced services.
- Integration of NCFI infrastructure i.e..
Intake, database, file management, procedures & forms.
- Development of mental health
preventative programming such as the family treatment models
in that will be applicable for implementation in the Northern
Communities.
- Creation of a single point
of entry system referrals (Ongoing).
- Focus on continuation of care for clients
- Hospital Based Services
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