Developing and Evaluating a Community Rehabilitation Facilitator Training Program to support Elders Living with Frailty in Remote Indigenous Communities

About the Project

A robust project team has been assembled including health directors and health care providers from Indigenous communities, academic institutions, regional rehabilitation networks as well as the Ontario Region – Home and Community Care – Regional Coordinator, Indigenous Services Canada (Appendix A). In keeping with the recommendations of the Northern Ontario School of Medicine Indigenous Research Gathering, the team has ensured and will continue to ensure that partner communities which have co-designed this proposal will continue to have a strong voice in the project. Representatives from the participating communities will be asked to serve on the project advisory group, which will guide the implementation of the study and the interpretation of findings.

Using methods that have proven valuable in assessing Indigenous health strategies, the project team will: develop the curriculum with the participating communities; evaluate the CRF training; and develop program and policy recommendations. At the conclusion of the evaluation process, an integrated knowledge translation strategy will be employed to ensure that findings are returned to all the partnering communities in a timely and culturally appropriate manner.

The Clinical Frailty Scale (CFS) will be taught as an assessment measure to the learners and utilized during Elder interactions as appropriate. It is expected that the CFS would be incorporated as a standard of care by CRFs and used to document and monitor levels of frailty in their community.

Both process and outcome measures will be used to evaluate the project using qualitative and quantitative research methodology. Qualitative research methods will evaluate the CRF training program through interviews with Elders and other potential recipients of care, community health team professionals and staff, educators, potential learners and employers, as well as members of the Canadian Interest Group for Rehabilitation Support Worker Programs. The interviews will be conducted using acceptable Indigenous qualitative methods, including talking circles and individual or group storytelling. Quantitative measures will also be collected to evaluate the training program by administration of a curriculum review survey to selected representatives of the groups referenced above.

Project Team

Principal Investigator:

Community Leads:

  • Robert Baxter — Eabametoong First Nation
  • Joan Rae — Sandy Lake First Nation

Partners & Stakeholders:

  • Robin Cano — Health Canada
  • Alison Denton — St. Joseph’s Care Group
  • Patty Everson — Windigo First Nations Council
  • Esmé French — Thunder Bay Regional Health Sciences Centre
  • Mary Ellen Hill — Lakehead University
  • Cindy Hunt — Sioux Lookout First Nations Health Authority
  • Taryn Klarner — Lakehead University
  • Kirsti Reinikka — Eabametoong First Nation/Sandy Lake First Nation
  • Shane Strickland — Confederation College
Rationale

The North West (NW) region of Ontario has the highest regional proportion of Indigenous people across Ontario. Nationally, the proportion of Indigenous populations 65 years of age and older could more than double by 2036. Frailty among Indigenous people occurs earlier compared to the general population, with Indigenous frailty levels in the 45–54-year-old age group reported as similar to those for aged 65–74 in the general population. Additionally, seniors in the NW aged 75 or older are 45-55% more frail than the average senior in Ontario. In 2017, the region identified significant gaps in rehabilitative services throughout remote Indigenous communities, and a need to focus on preventative, and rehabilitative self-management programming to support healthy aging to reduce chronic disease. As essential rehabilitation programs common in an urban context are not available in rural and remote communities, Indigenous Elders are particularly at risk of frailty and compromised health when disabilities occur. Additionally, Indigenous people may experience isolation from their home community and support system, as it is often necessary for them to transfer out of community to receive specialized care in urban centres.

This project will empower remote Indigenous communities, through capacity building to improve care and supports allowing Elders to remain in their home and community. This project aligns with the Truth and Reconciliation Calls to Action #19 “to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities” and #23 “to increase the number of Aboriginal professionals working in the healthcare field”. The Community Rehabilitation Facilitator (CRF) role is vital in supporting Elders by addressing factors affecting frailty such as community participation in traditional activities, safe mobility, fall prevention, environmental modifications, activities of daily living (ADL) and personal care, exercise and healthy living. All these factors are highlighted as crucial for the health and well-being of Indigenous seniors in the Canadian House of Commons’ Standing Committee on Indigenous and Northern Affairs 2018 report: The challenges of delivering continuing care in First Nation communities.

Creative local solutions have been developed in regions with similar access challenges such as South Africa, Australia, Nunavut, Northern British Columbia, Northern Quebec and Northwestern Ontario. These regions have used a community-based therapy assistant model to support people with disability. The project team has representation on the ‘Canadian Interest Group for Rehabilitation Support Worker Programs’ which is comprised of educators and health care professionals from across Canada. This group supports networking and provides peer support and guidance for those looking to implement similar models in their regions.

Training local people who have an understanding of the environment and social conditions of the area, helps to build community capacity, fosters a person-centered approach, and enhances effectiveness of rehabilitation efforts. This approach has been used in the Community Health Representative training curriculum. Some communities in Northwestern Ontario have developed informal rehabilitation assistant training for their Jordan’s Principle programs for pediatric healthcare delivery and support. Community capacity-building supports improved retention rates, thus providing a measure of stability and continuity of care.

Preliminary work towards this model of care has been undertaken by members of the project team. Two recent projects, supported by the Ontario Seniors Community Grant Program, “Building Capacity for Elder Exercise Programming in Northwestern Ontario’s Remote and Rural Indigenous Communities” and “Supporting Elders’ participation in remote Indigenous communities in Northwestern Ontario: Exploring the role of a Community Rehabilitation Support Worker” have provided a valuable foundation for this proposal. Community engagement sessions in four communities have confirmed a need for the CRF role in supporting and enhancing community participation in traditional activities, safety and well-being among Elders. Communities identified the following required skills and knowledge: communication in both traditional language and English including medical terminology; knowledge of common chronic conditions; ways of assisting Elders with mobility, safety and ADLs; identification of mental health concerns and appropriate resources; as well as facilitation of social and exercise groups. The sessions also identified preferences for the receipt of rehabilitation support: community face-to-face; in the home; in groups or individually; and over telehealth as appropriate. Finally, the sessions identified preferred mode, timing and delivery of training. Currently underway is a literature review to identify best practices and validated models for delivering community-based rehabilitation support in rural and remote Indigenous communities.

Objectives & Deliverables
  1. Develop a community-informed, culturally appropriate curriculum for training Indigenous community members in the CRF role and work with academic partners for curriculum credentialing.

2. Evaluate the CRF training program from the perspective of potential learners and employers, educators, Elders and family/caregivers, and community members.

3. Develop program and policy recommendations regarding the CRF role.