SIGNPOSTS ON THE RED ROAD

AN ASSESSMENT GUIDE FOR FAMILY RESIDENTIAL TREATMENT

CENTRES

Graphic image derived from: http://sydco2wdvv.multiply.com/journal/item/669/DPT-Circles

A guide to the evaluation of Indigenous Family Residential Treatment Centres based on the
wellness indicators of the Summary of Community & Stakeholder Input Survey for First
Nations and Aboriginal Mental Wellness and Substance Use by the Tripartite Strategy
Council on Mental Wellness and Substance Use (April 27, 2012) using a Medicine Wheel
Framework
 Table of Contents

I. Introduction
A. The Summary of the Tripartite Strategy Council on Mental Wellness
and Substance Use survey and the five major
themes it revealed 3
B. The Medicine Wheel Format and recommendations for use of
the guide 3

II. Evaluation pages for client programming

A. Theme One 6-8
B. Theme Two 9
C. Theme Three 10

III. Evaluation pages for services in support of staff and community:

A. Theme Four 12-13
B. Theme Five 14-15
C. Other considerations 15

IV. Summarizing The Evaluation 16

V. Envisioning change 17
Further information 18

VI. Appendices 19-23

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Introduction

The interim First Nations Health Authority, the Provincial Government of BC and Health
Canada initiated a project of collecting “wisdom, advice and guidance” that began through
forums, meetings and regional caucus sessions hosted by the interim First Nations Health
Authority (iFNHA) between 2007 and 2011. In 2012 they collected input through an online
questionnaire, with the goal of identifying collective solutions to improve First
Nations/Aboriginal mental wellness and address substance use challenges in BC. All
interested and willing persons wanting to provide input were welcome to participate. From
the data collected in this questionnaire a summary document was produced that identified
themed key concepts, strategies and solutions to improve First Nations/Aboriginal mental
wellness and address substance use challenges in BC. The summary gathered a wealth of
knowledge and expertise on perceptions around mental wellness and substance use and
related service approaches.

The Tripartite summary provided intriguing insight into how an Indigenous mental health
and wellness strategy might differ from that of the mainstream and might evolve in a way
that is grounded in an Indigenous holistic world view. From this perspective the
importance of community and communal wellbeing assumes importance. In applying this
perspective to the treatment of substance misusing parents, the relevance of family
residential treatment stands out. The treatment of individuals and families within the
context of their extended families and communities must be envisioned and
simultaneously, the social conditions surrounding families cannot be ignored. The study
showed that such conditions as poverty and a lack of preventative resources are impossible
to ignore in the creation of conditions for mental wellness. The interweaving of individual
health and community wellness is essential. The summary document identified five main
themes . Three of the five themes directly relate to the community concerns and point to a
delivery of services that cannot be solely focused on individuals.

The Medicine Wheel Format and General Recommendations for Use of the Guide

This self-assessment manual, written to enhance the work of family residential treatment
centres, therefore, is based on the examination of the five themes identified by the
Tripartite Summary and explores how the five themes are addressed when the Centre
conducts the assessment’s programming. The programs are then viewed through the lens
of the Cree Medicine Wheel paradigm of holistic health and balance, i.e., the mental,
physical, emotional and spiritual aspects. The ways that the Centre fulfills the mandate of
each of the five themes are identified in each of the quadrants of the medicine wheel.

This self-assessment manual is written from the perspective of “ideal” or “best practices”. It
is acknowledged that the contextual delivery of services is dependent on a constellation of
factors and available resources of which the allocation of funding is a central consideration.
The self-assessment should be conducted with the intention of identifying and celebrating
strengths as well as promoting self-reflection, innovation and growth. It may also be useful
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in presenting a case for resources that support the expanded vision of health that includes
community.

Let us reflect for a moment on the nature of assessment. This guide is intended to provide
insight into current operations of family residential treatment centres, not in the interests
of perfection but in the pursuit of excellence. There is a decided difference between these
two concepts. Perfection implies a static condition where there is nothing further to be
achieved or gained whereas, excellence is open ended, and is responsive to conditions that
change and implicates intention and motivation as foundational to the process. The guide is
intended to be employed as a strengths-based assessment. The model has some similarity
to the philosophy of appreciative enquiry, wherein what an agency or organization does
right is identified and amplified rather than focusing on deficits.

The guide could be employed in a variety of ways, such as an awareness/assessment

tool to collect input from groups such as staff, or communities, or as an overall agency
annual assessment. It may potentially also be useful for such purposes as promoting the
community profile of a Centre or for providing information to funders. The structure of the
guide is intended to be adapted to the specific needs of a centre and should be modified and
augmented as the assessing groups see fit.

Steps in a suggested method for employing the guide follows:

 Composition of an assessing group, individual or committee [the asessors (s)]should

be agreed upon by the board of the society governing the centre.

 The committee should familiarize themselves with the thematic information

embedded in the Tripartite study and the structure of the assessment guide.

 The assessor(s) can then use the guide to compare the centre’s actual programming
to the suggestions that are arranged in the four quadrants of the medicine wheel
under each of the five themes in the guide.

 The assessor(s) may then find that the centre has additional programs that should
be noted in their assessment summary or they may find that areas are identified
where the centre may wish to expand activity. This assessment guide, in its
electronic form may be used as a template where information may be typed into the
various categories and the final summary and comments may be included.

 The findings of the assessor(s) may then be summarized and a final report made.

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 EVALUATION PAGES FOR CLIENT PROGRAMMING

Theme One: Emphasis on collective (family-community-society) aspects of mental

wellness.

Theme Two: Cultural emphasis of mental wellness

Theme Three: Individual emphasis of mental wellness

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I. Emphasis on collective (family-community-society) aspects of mental
wellness.

The Summary identified policy and planning implications of this principle as “…. the degree to
which planned services, programs, policies and investments in Mental Wellness really target
promoting and strengthening the collective relationships of family, extended family,
community, and society. Do strategies proportionately focus on these core dynamic
relationships and the aspects of belonging they entail, or is there disproportionate emphasis
on “individual” mental wellness and supports?” (p. 13)

The foundational rational for family treatment centres is the belief that the treatment of
individuals is most effectively addressed in the context of family and that children benefit
through the strengthening of the family relationships. In this sense, the Policy/Planning
Implications above are immediately addressed in the intrinsic nature of family residential
programming. The details of the way that this is addressed is the focus of the following
section: it guides one to examine programming in the holistic context of the medicine
wheel.

The following statements are guidelines to examine current programming. List current and
wished for programming under the appropriate topics.

Mental

 The centre supports cognitive awareness of the connections of individual

participants to family, to community and to society.
 Programming encourages exploration and creation of awareness of history at each
of these levels. Teaching is provided about the historical conditions that affect
Indigenous families. Families are encouraged to consider their own multiple
generations in producing this awareness.
 Training in communication skills is provided
 Family therapy is available to assist in examining family dynamics and in
strengthening connections.
 The centre provides training in parenting techniques that are culturally relevant.
This training involves instruction by elders as well as contemporary thought.
 The centre addresses the age appropriate learning needs of participant children and
provides modeling and instruction to parents in ways to support their children’s
learning.

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Emotional

 The centre expands an individual’s capacity to work in a positive manner with

emotional energy.
 Programming addresses emotions engendered regarding the past, present and
future conditions of the family and individual through group sessions and individual
and family therapy.
 The centre provides emotional safety for families during sessions and during free
times in the following ways:
 Therapy and group sessions for children and youth encourage them to identify
emotions and possible responses to these emotions.

Physical

 At times, attending the centre may be certain participant families who are actively
addicted and have not detoxed prior to coming. The centre maintains flexible policy
and has developed consistent protocols around these issues.
 Families are encouraged to work and play together. The living quarters are
maintained according to strict guidelines and the requirement of communal chore
performance is enforced.
 The physical shelter provided for the families is adequate to ensure comfort of all
family ages.
 Outside distractions are reduced or eliminated during stay. Use of electronic
distractions is permitted only according to guidelines generated by centre policy.
 Families are provided with recreational activities and encouraged to find ways to
engage all ages in play and sport.
 Families are guided to examine nutritional needs of various members and to budget
food money effectively.
 Medications and medical conditions are reviewed for all family members.
 Emergency and medical conditions that arise are addressed through established
protocols.

Spiritual

 Families from diverse Indigenous nations are encouraged to understand their own
family practices of spirituality and to explore cultural connections:
 Families are encouraged to engage in spiritual practices together.
 Ways in which provisions are in place to respect differences in spiritual practice.
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  Elders in residence are an integral part of all programs and are available to meet
with participants in their family residential homes.

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II. Cultural emphasis of mental wellness

Policy/Planning Implications

Many of the respondents to the Tripartite summary stressed that cultural aspects or
dimensions of mental wellness are of great importance to Indigenous people. This is a
divergence from mainstream characterizations of mental wellness. The centre’s programming
should receive careful attention in assessing how culture is incorporated.
A strong sense of identity was identified in this theme of the summary as a critical component
of mental wellness. Culture and cultural identity are vehicles through which the enhancement
of family, community and other relationships mentioned in the previous section are realized.
The emphasis of culture in providing healing teachings, activities and medicines is of great
importance. (p.13)

Mental

 Centre has knowledge of some of the cultural practices of First Nations in the
territory on which the centre is located. The centre respects, shares and employs
some of these practices in its programming.
 Each family’s cultural knowledge is explored with them and efforts are made to help
them to self-identify cultural resources in their own communities.
 The centre has initiated and continually adds to a database of resources for all
participants some of whom are from very diverse cultural backgrounds.

Emotional

 The centre assists in individuals and families processing their memories of cultural
losses and abuses.

Physical

 A database of traditional games is maintained and updated to by the centre.

 Participant families are encouraged to create cultural sharing events during their six
week residence.

Spiritual

 Daily observance of spiritual practice is part of centre program.

 Individual families are encouraged to employ their own cultural rituals and
traditions.
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III. Individual emphasis of mental wellness

This theme recognises individual characteristics such as resiliency and forgiveness. An individual’s
ability “to learn from challenges and to move forward in a constructive and even enriched manner” is
recognised as important. The question of individual balance, and an individual’s own medicine wheel,
in the mental-emotional-physical-spiritual aspects must be examined. From the individual perspective,
mental wellness is seen as more inclusive than the merely cognitive-emotional perception of mental
health. It is seen as a state encompassing the physical and spiritual also and is indicative or harmony
and balance.

Mental
 The centre’s programming brings about self-reflection on various aspects of
wellness for each individual and family.
 Individual treatment plans are created with all addicted participants, including
youth.
 Ways that the centre encourages awareness of and education about addicted family
systems.
 Ways that the centre explores community structures, systems and organizations
that affect families living with addictions.

Emotional
 Ways that the centre addresses individual substance abuse assessment, including
standardized quantitative assessments such as MAST or SASSI, and how the pattern
of substance use is connected to personal history and triggers.
 Ways that the centre provides support to addicted individuals and family systems
in understanding the effects of substance use on their families.
 Centre encourages individual participants and families to identify and understand
strengths and opportunities.

Physical

 Centre provides training in nutrition and shopping skills and works one on one with
families to assess food sources and utilization.
 Centre provides an assessment of physical health of participants and helps them to
design fitness plans.

Spiritual

 The centre helps individuals to integrate all aspects of self and identify personal
needs for balance.
 Centre incorporates prayer and ceremony into daily group rituals.

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 EVALUATION PAGES FOR SERVICES IN SUPPORT OF STAFF AND
COMMUNITY

Theme Four: Emphasis on basic needs as a pre-condition of mental wellness

Theme Five: Emphasis on access to service provision for mental wellness

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IV. Emphasis on basic needs as a pre-condition of mental wellness

Policy/Planning Implications

The Tripartite summary drew attention to the fact that basic needs must be adequately addressed and
met as a condition of mental wellness for individuals and families. Employment and financial stability,
housing, transportation, and education are important factors and while centres have little ability to
directly address these conditions they must be understood and considered if treatment is to be
effective. There is also a need for education and engagement of centres and staff in order to more
evaluate the circumstances of families and to advocate for macro level efforts to address above stated
conditions of economic security, housing, education, and other fundamental determinants of health
generally.

Mental
 The Centre participates in the collection of information that informs mental health
planning and programming by providing statistics to Mental Health agencies.
 The Centre participates in conferences and planning activities sponsored by mental
health service agencies.
 The Centre integrates information on social justice issues into programming for
participants and into training for staff.
 The Centre encourages community engagement by participants through education
on social issues and activism.
 The Centre reviews and manages its own need for new programming and growth,
doing so through self-evaluation and forward planning activities.

Emotional

 The Centre fosters communication with isolated support workers in communities

and provides information, including Centre schedules, activities and intakes, and
also shares information about best practices.

 The Centre interacts with and lends support to local reserve and off reserve
agencies to advocate for housing and programs that enhance the wellbeing of
participants and their extended families.

 The centre recognises, provides education around and helps individuals to assess
the impact of economic violence in their lives.

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Physical

 Centre counsellors preform individual assessments of families’ basic nutrition,

housing, child protection and medical needs in order to work with them in creating
plans for future growth. The Centre staff is aware of community resources to
support families in these matters.
 The Centre performs outreach activities in local communities, making visits and
giving workshops.
 Centre provides access to their facilities for community gatherings where
appropriate.

Spiritual

 The Centre has is aware of key spiritual resources in communities served. It

provides integrated post treatment plans to participants including these resources.
How does the centre integrate services to participants pre and post treatment?
 Does the centre participate in community social initiatives that may impact the
wellbeing of their service population?

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V. Emphasis on access to service provision for mental wellness

Policy/Planning Implications

Access to appropriate health and mental wellness programming is essential for ongoing
personal and familial health. Awareness of a range of accessible support services, can
contribute to individual and community mental wellness.

Mental

 The centre recognises professional and agency boundaries regarding competency of

staff in dealing with serious mental health concerns. Referrals to assessment with
affiliated professionals are made when necessary.
 The Centre supports community based aftercare in the following ways….
 The Centre provides outreach support to communities in the form of workshops for
former program participants and workshops for community based professionals.
This includes assisting in training drug and alcohol counsellors.
 Community aftercare workers are notified of the discharge dates of families in a
timely fashion to ensure they are best prepared to support them on their return
home.

Emotional

 The Centre has strong connections to community intake workers who provide pre
and post treatment counselling services to participant families.
 Centre staff provide peer mentoring and support to community based professionals.
 Centre staff have access to counseling and clinical supervision support for
themselves.

Physical

 The Centre is able to make referrals to community supports for participant nutrition
and fitness.
 Clear communication with community professionals regarding services is fostered
and updated regularly.
 An electronic forum page for community and Centre professionals is maintained by
the Centre and is encouraged to be used as a place to share best practices

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  The structure of the board of the Centre has diverse representation from First
Nations that send participants to the Centre.

Spiritual

 The Centre’s community portfolios identify community resources for spiritual

practice.
 The Centre maintains a database of possible supportive elders within communities.

Other Considerations:

The unique characteristics of each family wellness centre implies that there must also be
considerations unique to that setting that are identified by the administration and staff of
the centre. These may be grouped within the medicine wheel quadrants or summarized in
this area. For example, one aspect of centre operation that could be addressed is the
support of staff in the four quadrants of the medicine wheel. The mental, spiritual,
emotional and physical capacity and health of the individuals delivering services in the
centre are unquestionably important. Concerns such as high staff turnover or burnout
should be carefully analyzed and individual centres may wish to address this as a sixth
section.

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IV. Summarizing the evaluation

The collation of information from the assessment guide themes can be organized as

comments within each of the quadrants of the medicine wheel. Similar comments can be

collapsed into themes and analyzed for content. For example, if the Centre appears to be

particularly strong in supplying services in a certain area, the essence of those comments

can be expressed as one statement or paragraph. Of course, the same applies where areas

for development are identified. Under each of the five themes of the Tripartite Summary

there will emerge a profile of services provided or missing from the service delivery of the

Centre. A report can then be created that provides an appreciative and yet analytical profile

of the function of the Centre.

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V. Envisioning change

A truly exciting part of the evaluation process is the translation of the study into

recommendations for future growth. In this area, it is suggested that no idea of vision for

change be rejected out of hand in the initial process. Make a vision board that includes all

ideas under the specific categories of the five themes. Divide the ideas into two additional

categories: category A would include those ideas that can be easily carried out and for

which resources already exist, and category B would include those that are truly more

difficult to achieve. Make specific plans for achieving the ideas in category A. Examine

category B: what are the possible barriers to achieving the more visionary or difficult

ideas? Is there a way to begin working on overcoming those barriers?

For example, if one of the visions that would be good to achieve is a closer working

relationship with specific community workers, what resources exist or could be re-

allocated to accomplish this? (category A solutions). If funding could be accessed to provide

transportation and resource costs for community visits, would such activities benefit?

(Category B solutions).

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Further information:

Loiselle, Margot, & McKenzie Lauretta. (2006). The Wellness Wheel: An Aboriginal
Contribution To Social Work. From a workshop conducted on May 27, 2006 at the First
North-American Conference on Spirituality and Social Work, held at the University of
Waterloo, Renison College, in Waterloo, Ontario, May 25-27, 2006 Entitled “Breaking
Barriers and Creating Common Ground Through a Holistic Approach: The Medicine
Wheel”

Tripartite Strategy Council on Mental Wellness and Substance Use. (2012). Summary of
Community & Stakeholder Input Survey for First Nations and Aboriginal Wellness and
Substance Use. Retrieved on July 27, 2012 from:
http://www.fnhc.ca/pdf/MWSU_Input_Summary_Document_Final.pdf

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