Program
PRE-CONFERENCE WORKSHOPS
Tuesday, November 1
8 am to 4 pm
Important: The pre-conference workshops are not included in the conference activities. If you would like to attend one of these workshops, you must register and pay for it separately to the conference. Please visit the pre-conference workshop page for details.
CONFERENCE
Tuesday, November 1
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2:00 – 6:00 pm Registration
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1:00 – 4:00 pm Movie Screening and Conversation with Dr. Esther Tailfeathers
Kímmapiiyipitssini: The Meaning of Empathy (Kímmapiiyipitssini is a Blackfoot word meaning “giving kindness to each other”) In Conversation with Dr. Esther Tailfeathers the lead participant in the movie Dr. Esther Tailfeathers, Doctor, Kainai First Nation and Medical Lead for the Population, Public and Indigenous Health Strategic Clinical Network, Alberta Health Services In recognition of her substantial contribution to improved Indigenous healthcare in Canada, Dr. Tailfeathers was the recipient of the 2019 Royal College Dr. Thomas Dignan Indigenous Health Award.
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4:00 – 5:00 pm Meet and Greet for FNHMA Students
Individuals who have taken FNHMA course(s) during 2020 – 2022 through the online hybrid cohort, are invited to gather with other students during this informal “meet and greet” gathering! Come connect with your old classmates and meet many for the first time in-person! Snacks and drinks will be served.
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5:00 – 7:00 pm Opening Reception with Exhibitors and Artisans
Performance by: Fawn Wood, Cree and Salish musician from St. Paul, Alberta
Fawn is most noted for her album Kakike, for which she won a Juno Award for Traditional Indigenous Artist of the Year earlier this year.
Wednesday, November 2
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7:00 am - 4:00 pm Registration
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7:00 - 8:00 am Wellness Activities
Start your day off right with a wellness activity! Either activity is sure to leave you with a great sense of wellbeing and full of energy for the day.
Medicine Walk - Join Elder Della Rice Sylvester for a morning walk and learn about plants as food and their healing properties.
PowWow Workout - Join Amanda Fox, for a PowWow workout! -
8:00 - 9:00 am Networking Breakfast with Exhibitors and Artisans
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9:00 – 9:30 am Prayer / Greetings/ Welcome
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9:30 - 10:30 am Opening Plenary -The History of the Australian Aboriginal Community-Controlled Health Organisation Sector and the Role of the Aboriginal Health and Medical Research Council
Keynote Speaker: Robert Skeen, Chief Executive Officer, Aboriginal Health and Medical Research Council of North South Wales, Australia
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10:30 – 11:00 am Health Break with the Exhibitors and Artisans
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11:00 am – 12:30 pm Concurrent Workshops
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Workshop A - YSAC LIFE IS SACRED: Life Promotion Training Program (Youth Solvent Addiction Committee)
Suicide rates among Indigenous populations still exceed that of the national average, and most alarming is that the younger Indigenous population between the ages of 15-29 are the most vulnerable. YSAC’s Life is Sacred life promotion training program is a 12-unit national training program. This comprehensive community-based life promotion initiative utilizes an existing body of work (culturally based suicide fact sheets) which was developed in 2011 by a national committee of First Nations and Inuit health practitioners. This program is certified through the Indigenous Certification Board of Canada (ICBOC), and is based on the perspective, experience, and knowledge of Indigenous communities throughout Turtle Island. The 12-units include: Introduction; Myths & Facts; Decreasing Stigma; Colonization; Risk Factors; Media Guidelines; Warning Signs; Engaging Youth; Why Youth Seek Help; Protective Factors; Getting Help for Someone; and Helper Self-Care. Learning objectives include suicide is preventable, understanding what suicide is, underlying reasons for suicide, warning signs, and protective factors in preventing suicide. This training provides community-based workers with the skills and confidence to recognize suicide warning signs and how to take appropriate early intervention. Speakers will engage the participants with some condensed portions of the program to allow them to experience what the full two-day training would offer.
Moderator: Christine Mahoney, Chief Executive Officer, Canadian Accreditation Council
Speakers: Elder Harry Francis, Leading Thunderbird Lodge
Karen Main Associate Director, YSAC
Melvin Taypotat, Outreach/Intake Worker, Leading Thunderbird Lodge -
Workshop B - Building Partnerships and Relationships for Maximizing Advocacy Efforts
First Nation Health Managers are advocates for improving the wholistic wellness of people in communities. Their relationships with clinical staff, chief and council, and regional health authorities, are imperative but what are the best paths to build and foster relationships beyond their community? We are currently witnessing a growing momentum of non-Indigenous organizations seeking to work in partnership with First Nation communities and representatives from medical-related institutions, pharmaceutical companies, academia, amongst others are pursuing engagements with First Nations. This workshop will help identify positive reconciliatory actions vs self-interested capitalist conduct and outline healthy culturally grounded initiatives that focus on improving First Nations’ wellness. The speaker will provide a recent example of lessons learned from a mutually beneficial relationship that has led to expanded advocacy opportunities. This workshop will be interactive, provide effective partnership recommendations and explore potential outcomes from strengths-based associations.
Moderator: Dr. Yasmin Razack, Chief Diversity Officer, Canadian Blood Services (invited)
Speakers: Jonathan Dunn, Senior Policy Analyst, Health Department, Assembly of First Nations
Marlene Larocque, Senior Policy Advisor, Health Department, Assembly of First Nations -
Workshop C - Attraction and Retention in “The Great Resignation” Era
Successful attraction and retention in todays’ environment has become ultra-competitive in the pandemic era. Consequently, attracting and hiring qualified candidates and retaining them as committed employees, has been negatively impacted by the current environment where job seekers are able to pick and choose where they work and current employees leave to accept external jobs at organizations with working conditions and organizational cultures that best meet their personal and professional needs. Developing a robust and flexible attraction and retention process will ensure that managers select the right candidates for the right jobs, and manage those employees in a respectful and forward-looking manner. Underlying this is the need for a healthy organizational workplace culture that aligns with organizational vision, mission and values, and where employees are valued as integral to organizational success. This session will provide you with an overview of an effective attraction and retention process and how to ensure that qualified candidates are vetted appropriately throughout the interview process, are onboarded correctly to prepare them for the work their job requires, and supported throughout their employment to allow them to do their jobs to the best of their ability, which will result in long-term, satisfying and committed employment relationships. This workshop is designed for managers who have recruitment and supervisory responsibilities, who have some human resource management experience, and who wish to learn more about attraction and retention and how, when done effectively, is critical for the attraction and retention of qualified, committed employees.
Moderator: Lisa Main, Client Engagement Lead, Indigenous Health Services, Accreditation Canada
Speaker: Robin Henry, Two Eagles HR Consulting -
Workshop D -Jordan’s Principle: Key Findings on the Implementation of Jordan’s Principle across Canada
Jordan’s Principle, Child First Initiative, is an important initiative of Indigenous Services Canada (ISC) in addressing the health, education and social needs of First Nations children and their families. In the fall of 2020, ISC approached the Alberta First Nations Health Consortium (FNHC) to conduct a project to gather data on the implementation of Jordan’s Principle across Canada. A national survey accompanied by regional focus groups and interviews was conducted to gather as much information as possible, and to hear firsthand the experiences of those involved in implementing Jordan’s Principle. This session will give an overview of the key findings on the implementation of Jordan’s Principle across Canada. We’ll explore the successes and achievements, identify some of the most promising practices in implementing Jordan’s Principle and highlight those areas that continue to need improvement. This information is intended to inform and support all First Nations health managers involved in the day-to-day administration of Jordan’s Principle and to provide insights to further the promise of Jordan’s Principle across Canada.
Moderator: Patricia Thomson, CFNHM, Secretary-Treasurer, FNHMA Board of Directors and Executive Director, Leading Thunderbird Lodge Speakers: Carol Blair, Chief Executive Officers, Carol Blair and Associates Inc. and Project Manager and Lead Consultant for the First Nations Health Consortium for the National Project on the Implementation of Jordan’s Principle across Canada
Lorinda Patterson, Enhanced Service Coordination Manager, First Nations Health Consortium -
12:30 – 2:00 pm Luncheon and Presentation by Canada’s First Indigenous President of the Canadian Medical Association
Remarks: Patrick Gushue, Business Operations, Emergent BioSolutions Inc.
Keynote Speaker: Alika Lafontaine, President, Canadian Medical Association -
2:00 – 3:30 pm Concurrent Workshops
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Workshop E -Indigenous Perspective in Self-Care
This workshop will provide participants with the opportunity for increased insight regarding Indigenous practices around wellbeing and healing. George Jeffrey is of Tsimshian and Gitxsan ancestry and a member of the Raven Clan. George brings a holistic and traditional perspective of health and wellness, along with a deep understanding of healing complex trauma. George carries traditional teachings around Spruce, Cedar, Hemlock, Balsam, and water; and he follows cultural protocols while carrying out his healing work. During the workshop, George will share an Indigenous perspective specific to cultural protocols regarding brushings using plant medicines. This information will be helpful for participants to enhance their wellbeing and self-care practices. Moderator: Kristina Crooks, Indigenous Consulting Services, MNP LLP
Speaker: George Jeffrey, CSP Team, Tsow Tun Le Lum Society -
Workshop F -The Benefits of Having a Community-Controlled Sector Within Health
A discussion on the future of community-based workers. Join us as we hear from Australian successes while considering Canadian impacts. We will chat about the demands of the mainstream health system in responding to the TRC Calls to Action, First Nations Health Advocates, Patient Navigators, community perspectives and training opportunities.
Moderator: Joshua Tobias, Manager, First Nations, Inuit, & Métis Engagement and Integration, Canadian Partnership Against Cancer
Panelists: David McLaren, CFNHM, President, FNHMA Board of Directors, and Health Director, Kebaowek First Nation, QC
Lorraine Muskwa, CFNHM, Vice-President, FNHMA Board of Directors and Chief Executive Officer, Bigstone Health Commission
Phillip Naden, Chair of the Board, Aboriginal Health and Medical Research Council of New South Wales, Australia
Robert Skeen, Chief Executive Officer, Aboriginal Health and Medical Research Council of New South Wales, Australia
Patricia Thomson, CFNHM, Secretary-Treasurer, FNHMA Board of Directors and Executive Director, Leading Thunderbird Lodge -
Workshop G - Out of the Frying Pan, Into the Fire: Preventing Further Harm in First Nations Emergency Preparedness and Disaster Response
This workshop will use interactive role play of an imminent wildfire approaching a First Nation community to build core management competencies and skills specific to culturally safe emergency preparedness and disaster response. A brief examination of colonial policies and racist practices that undermine the safety of First Nation communities in natural disasters will be followed by the role play. Participants will work in teams to build a disaster response using Indigenous knowledge and First Nations’ control. Participants will be provided leadership skills across a range of management roles (operations, planning, logistics/finance, safety/risk management, communications, and liaison). They will then practice these skills in a full management team with the task of developing their coordinated disaster response. This exercise increases interaction and interprofessional learning among participants. The objectives of the workshop are to build skills in culturally safe emergency preparedness and disaster response, and core competencies in leadership and governance, professionalism, partnerships, health services delivery, quality improvement, planning, and communication. Embedding these skills within a culturally safe approach to emergency preparedness and disaster response will ensure participants have take-away tools relevant to specific challenges First Nation communities face.
Moderator: Shelley Cardinal, Consultant, Indigenous Affairs, Canadian Red Cross
Speakers: Alana Kehoe, Research Assistant, Health Equity Action Research Team, Western University
Danielle Robinson, Senior Advisor, Indigenous Relations, Canadian Red Cross and member of the Biigtigong Nishnaabeg First Nation (Ontario)
Lloy Wylie, Associate Professor, Public Health, School of Medicine and Dentistry, Western University -
Workshop H - Moving Toward Cultural Safety in the Dental Clinic
This workshop aligns with FNHMA’s core competencies of health services delivery and advocacy through innovative practices. Dental services are not a covered benefit in Canada’s universal healthcare system and this can often result in a business-oriented approach to oral healthcare delivery. While registered First Nations’ individuals can receive benefits under the Non-Insured Health Benefits (NIHB) program, the standard of care in dentistry is aimed to deliver dentistry to Canada’s dominant society. This method of delivery, in addition to Indigenous specific racism in healthcare can result in detrimental oral healthcare delivery in First Nations communities and this aligns with the theme of rise against racism! Presenters from the Indigenous Dental Association of Canada (IDAC) will share examples of their own lived experiences in dentistry, invite attendees to contribute to detrimental oral healthcare delivery practices, and lastly create an interactive session to reconsider contemporary approaches in dentistry toward culturally safe oral healthcare delivery for First Nations communities. This workshop will encourage attendees to rethink how oral healthcare is currently delivered, so that we can all participate in creating a culturally safe dental environment in First Nations communities.
Moderator: Calvin Morrisseau, CFNHM, FNHMA Board Member
Speakers: Sheri McKinstry, Indigenous Dental Association of Canada
Natacha Tanguay, Manager, Indigenous Services Canada -
3:45 – 4:45 pm Annual General Meeting (for FNHMA members in good standing only)
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5:30 - 6:30 pm Reception with Exhibitors
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6:30 – 10:30 pm Banquet, Awards Presentation and CFNHM Convocation
Drumming and Honour Song: Wayne Seward, Snuneymuxw First Nation, BC
Presentation of the Doris Bear Student Awards
Presenter: Doris Bear, CFNHM, Health Director, Peguis First Nation, MB
Presentation of the FNHMA-HEC Excellence in Health Leadership Award
Presenter: Jennifer Zelmer, President and Chief Executive Officer, Healthcare Excellence Canada
After-dinner entertainment: George Leach, Juno award winning artist from the Sta’atl’imx Nation, BC
Thursday, November 3
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7:00 – 8:00 am Wellness Activities
Start your day off right with a wellness activity! Either activity is sure to leave you with a great sense of wellbeing and full of energy for the day.
Medicine Walk - Join Elder Della Rice Sylvester for a morning walk and learn about plants as food and their healing properties.
PowWow Workout - Join Amanda Fox, for a PowWow workout! -
7:30 am - 12 pm Registration
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8:00 - 9:00 am Networking Breakfast with Exhibitors and Artisans
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9:00 - 10:00 am Plenary – Reflections on the Covid 19 Pandemic Response
Join us for an intimate panel reflection on the Covid 19 pandemic response. Hear from community health leaders on some of the responses to Covid 19 and how we continue our preparations for another pandemic. What did we learn? What worked well? How did we combat vaccine hesitancy?
Moderator: Marion Crowe, CFNHM, CAFM, CAPA, Chief Executive Officer, First Nations Health Managers, Association
Panelists: Melissa Bryan, Executive Director, Mawiomi Treatment Services
Kim Fisher, CFNHM, Health Director, Chippewas of the Thames First Nation
Bonnie Healy, Health Director, The Blackfoot Confederacy Tribal Council -
10:00 – 10:30 am Health Break... Last chance to visit exhibitors and artisans!
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10:30 am – 12:00 pm Concurrent Workshops
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Workshop I - First Nations Health Ombudsperson's Office
In May 2017, Chiefs-in-Assembly passed Resolution 2046 calling for the development of a First Nations Health Ombudsperson Office citing systemic racism and discrimination in the health system and referencing the Truth and Reconciliation Commission Calls to Action. Come hear and learn from the first Health Ombudsperson about this office and what it means for you and all First Nation communities.
Moderator: Lorraine Muskwa, CFNHM, Vice-President, FNHMA Board of Directors and Chief Executive Officer, Bigstone Health Commission
Speaker: Dianne Lafond, Interim Health Ombudsperson, Ombudsman Office, Federation of Sovereign Indigenous Nations -
Workshop J - The Rainbow Connection
Learn about the fabulous colours of 2SLGBTQIAP+ culture with The Rainbow Connection! This workshop will focus on diverse identities and relationships, intersectionality, and ways in which we can increase relationships and support for 2SLGBTQIAP+ folx. Within this interactive workshop, participants will learn the differences between sexual orientation, gender identity, and gender expression. We will walk over the rainbow, understanding and creating meaningful connection to the utilization of pronouns and neopronouns. We will identify how we can support and nurture these relationships in a safe way. This will be the ultimate workshop for raising awareness of 2SLGBTQIAP+ culture! Take-away lessons and tools include:
- Utilization of pronouns and neopronouns in a safe way.
- The Binary - Participants will begin to understand the binary and how it impacts not only 2SLGBTQIAP+ individuals and communities, but everyone on Turtle Island.
- Intersectionality - Participants will begin to understand a concept known as “intersectionality” and its importance when supporting resilient populations in different capacities. This includes Indigenous folx.
-Gender identity vs. sexual orientation vs. -gender expression.
- Increasing Allyship - Participants will be equipped with tools to bring back to their workplaces, homes and communities that support 2SLGBTQIAP+ individuals in a safe way.
- 2SLGBTQIAP+ identities and healthcare systems.
- Niizh Manidoowag - 2-Spirit - Participants will be provided with teachings of 2 Spirit folx and their roles and responsibilities within First Nations and/or communities prior to the process of Colonization.
Participants will converse in dialogue, and will be invited to ask questions in a safe and healthy way, as well as watch self-shot short videos.
Moderator: James Bone, CFNHM, FNHMA Board Member and Health Director, Keeseekoowenin Health & Wellness Centre, MB
Speakers: Bobby Hudon, Wellness Helper, Binesiwag Center for Wellness
Mandi Olson , CFNHM, Vice-Chief Executive Officer, Binesiwag Center for Wellness -
Workshop K - The First Nations Principles of OCAP®: A Framework to Support First Nations Health Data Governance
The First Nations Principles of OCAP®: A Framework to Support First Nations Health Data Governance workshop will introduce participants to the work of the First Nations Information Governance Centre and will explore the concepts of First Nations data sovereignty, information governance and the Principles of OCAP®. Participants will learn how these concepts are relevant to the First Nations health management field and why they are needed. The history of research on First Nations, including stewardship of First Nations data and information, will be explored, with discussion opportunities for workshop participants to consider how these concepts apply within the work of First Nations health managers. This session will challenge health managers to consider how research and data management is practiced in, by, and/or for their community, and how First Nations data sovereignty and the Principles of OCAP® can support quality, community-driven research and data for their health planning and programming. Finally, participants will be introduced to information governance tools and will walk away with an understanding of the importance of data sovereignty and the Principles of OCAP®.
Moderator: Perry Kjargaard, Senior Regional Account Director, Mid-West, Canada Health Infoway
Speaker: Kristine Neglia, Senior Manager, Education and Training, First Nations Information Governance Centre -
Workshop L - Disparities by Design: Addressing Racism in Indigenous Health
Health leaders have prioritized dismantling anti-Indigenous racism in healthcare systems. One of the most important settings for this work is medical education. To bridge the healthcare gap, we suggest leaders address racist approaches, behaviours and teachings, some of which occur unconsciously. One method is to assess current medical education curriculum delivery of Indigenous health topics and anti-racism teachings as these shape the identity of our independent practitioners in medicine across Canada. This workshop will provide a brief overview of Indigenous health education topics in medical education and share experiences from the perspective of a First Nations person. The speakers will also explore anti-racism strategies that could be employed towards bridging the gap of Indigenous health inequalities by completing a group exercise and round-table discussions. The participants will leave the workshop with a better understanding of Indigenous health education topics covered in medical education and will be positioned to recognize essential components to evaluate Indigenous racism within their institution.
Moderator: Georgina MacDonald, Vice-President, Western Canada, Canada Institute for Health Information
Speakers: Amanda Larocque, Director of Health and Social Services, Gesgapegiag Health and Community Services, Gesgapegiag First Nation
Maddie Venables, PhD, Senior Research Associate and Academic Research Advisor, Department of Family Medicine, University of Ottawa -
12:00 – 2:00 pm Luncheon – Laughter is the Best Medicine!
Comedy by Native American comedian, Howie Miller is a First Nation descendant of the Cree Nation. He has performed at all the major Canadian comedy festivals including the “Winnipeg Comedy Festival”, the “Halifax Comedy Festival” and the prestigious “Montreal Just for Laughs Festival”.
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2:00 – 3:30 pm Concurrent Workshops
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Workshop M - Supporting First Nations Health Managers – Improvising Community Diabetes/Vascular Management Techniques
Using a culturally safe and strengths-based approach, this workshop aligns with community self-wellness through a sharing of successful approaches specific to chronic disease management in First Nations communities. With the pandemic receding, focus will be to decrease fear of community members accessing health services from a patient and management perspective. Participants will be shown samples of culturally safe peer support group development, community screening approaches and other successful community diabetes/vascular disease management approaches. Audience engagement enhances dialogue and will provide an interactive dialogue in the workshop. This workshop will benefit health managers and staff working in small, rural, and remote communities who face challenges with limited community health resources. The speakers will also discuss how to develop a collaborative network of support for health managers and staff. Participants will leave the workshop with concepts to enhance community health services dealing with diabetes and vascular diseases.
Moderator: Darlene Anganis, CFNHM, FNHMA Board Member and Director of Health, Membertou Wellness Home, NS
Speakers: Elaine Allison, CFNHM, Health Director, Wagmatcook First Nation
Keith Leclaire, CFNHM, Director General, CLSC Naskapi and Member of the Kahnawake First Nation -
Workshop N - Framework Policy on Continuing Care for Persons with Decreasing Independence: For and By Firsts Nations
Local First Nations governments must cope with the aging of their populations including the needs of those who are faced with decreasing independence, while providing them with continuing care in their respective communities. In this context, six First Nation communities started to work on the development of a framework policy to guide the current and future actions of federal, provincial and First Nations government partners to implement continuing care for persons with decreasing independence residing in First Nations communities. In 2015, following a mutual agreement between those communities, the Chiefs Assembly of the Assembly of First Nations Québec-Labrador (AFNQL) passed a resolution to transfer the file to the First Nations of Québec and Labrador Health and Social Services Commission (FNQLHSSC). The purpose of the framework policy on continuing care is to put in place mechanisms to promote a holistic continuum of equitable services for persons with decreasing independence. To do this, a transparent and open process for improving the health and social services system in First Nations communities must be established and five main areas are targeted: 1- Accountability, roles and responsibilities; 2- Partnerships and information sharing; 3- Access to quality services; 4-Capacity-building and development; 5- Culturally appropriate services. In October 2021, the framework policy was ratified by the AFNQL. In this workshop, speakers will present the framework policy on continuing care, the issues that it addressed, and lessons learned in its development, and they will discuss the implementation at the regional level and the local.
Moderator: Nicole Robinson, Director, Northern and Indigenous Health, Healthcare Excellence Canada
Speakers: Julie Duplantie, Services for Persons With Decreasing Independence Advisor, First Nations of Québec and Labrador Health and Social Services Commission (FNQLHSSC)
Michael T. Horne, Manager, Home and Community Care Services, Kahnawà:ke Shakotiia’takehnhas Community Services
Rosalie Sioui, Social Development Manager, First Nations of Québec and Labrador Health and Social Services Commission (FNQLHSSC) -
Workshop O - Supporting Healthy Housing
A joint workshop with the First Nations Health Managers Association and the First Nations Housing Professional Association! In celebration of our recent partnership agreement, the FNHMA and FNHPA invite Health Managers to participate in a workshop to discuss how we can support housing managers and health managers to work together and learn from one another. Safe and healthy housing plays a vital role in the health and wellbeing of individuals, families, and communities. But far too often, because of funding structures, a stretched workforce and siloed colonial systems, housing and health departments in communities do not work together. FNHPA will share the challenges and the strengths of their housing managers as they work to support healthy housing in communities so that health directors better understand the realities they face. Workshop participants will be asked to engage in dialogues to explore how health and housing could better work together, what knowledge gaps health managers face with respect to housing, how health directors can support healthy housing, and what tools would support them in strengthening their understanding of the housing landscape and building those relationships.
Moderator: Selena Willier-Schmidt, Education Specialist, First Nations Health Managers Association
Speakers: Candace Bennett, Executive Director, First Nations Housing Professionals Association
Tabitha Eneas, Housing Administrator, Penticton Indian Band
Donna Van Tunen, Housing Manager, Witset First Nation
Selena Willier-Schmidt, Education Specialist, First Nations Health Managers Association -
3:30 – 4:15 pm Closing Plenary – Supporting Workforce Wellness
The health and wellbeing of the health services workforce is of critical importance, especially with the significant demands that has been placed on the workforce as the result of the pandemic, the uncovering of mass graves at former Indian Residential Schools and significant losses experienced in First Nation communities. Ensuring a workforce that is healthy and well must consider actions to support individual worker wellness but also policy and system action to ensure the sustainability of our health services workforce. This presentation will share key principles and recommendations from work done by the Mental Wellness Task Force that examined key areas impacted by the pandemic in remote, isolated and northern First Nation, Inuit and Métis communities.
Keynote Speaker: Brenda Restoule, Chief Executive Officer, First Peoples Wellness Circle -
4:15 – 4:30 pm Wrap-Up and Draw for Prizes
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4:30 pm Closing Prayer