Ministry of Community Safety and Correctional Services :: Part I: Consolidated Recommendations

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Office of the Chief Coroner

Publications & Reports

The Office of the Chief Coroner’s Death Review of the Youth Suicides at the Pikangikum First Nation

2006 – 2008



Part I: Consolidated Recommendations

Theme: Health Care

Government of Canada, Health Canada
  1. The Government of Canada, working with the Provinces, Territories and Aboriginal Leadership groups such as the Assembly of First Nations, should create a National Suicide Prevention Strategy, as currently exists in other developed countries.
  2. The Government of Canada, in developing its National Suicide Prevention Strategy, should liaise with Aboriginal Leadership to ensure that the Strategy considers, accepts and respects cultural diversity, and specifically acknowledges the extraordinary excess contribution of Aboriginal Peoples to the Canadian national suicide rate.
  3. In developing its National Suicide Prevention Strategy, an exploration of the catastrophic contribution of First Nations mortality of adolescents and youth living on reserve should be considered, the reasons for the excess mortality clearly understood, and recommendations evolved which address this issue.
  4. As a component of its National Suicide Prevention Strategy, the Government of Canada should consider the development of population level mental health indicators so that future decisions on mental health strategies will be data driven. An example would be to develop the capacity, through Health Canada, First Nations, and Inuit Health Branch of tracking, in real time, deaths due to suicide in Aboriginal communities. This would allow for the identification of those communities including First Nations reserves, where deaths due to suicide occur in excess and therefore, targeted strategies and enhanced resources may need to be provided to assist these communities in crisis.
  5. The Government of Canada, through Health Canada, First Nations, and Inuit Health Branch should provide targeted funding to communities and reserves experiencing excess cases of child and adolescent suicides, including First Nations reserves to assist in developing solutions directed to the prevention of these deaths. The current National Aboriginal Youth Suicide Prevention Strategy is not apparently meeting the needs of these individual First Nations.
  6. This funding should be appropriated to create comprehensive suicide prevention programs in these communities and reserves, led by the local health authority, in partnership with representatives from Health Canada, First Nations, and Inuit Health Branch, and the provincial Local Health Integration Network.
  7. Qualified expertise to create and implement comprehensive suicide prevention programs in communities and reserves should be retained. Healthcare experts, such as nurses educated to a Masters Degree level in health science with an interest in project management would ensure that the components of the comprehensive suicide prevention programs were implemented, and that the children, youth, and families in these communities would benefit from the provision of enhanced resources. Data should be collected, and benchmarks and key performance indicators developed to track and measure outcomes, and accountability targets should be set. (Cross referenced to recommendations 24, 25 and 29.) Funding for these nurse manager experts could come from the newly created National Aboriginal Youth Suicide Prevention Strategy.
  8. Health Canada, First Nations and Inuit Health Branch should develop an electronic medical record (EMR) which can link health systems to ensure proper transfer of information between all care providers operating in the “circle of care.” This system should be created in consultation with the provincial Local Health Integration Network and eHealth Ontario and is vital to proper care of all Aboriginal peoples who receive components of their health care from both federal and provincial providers.
  9. Health Canada, First Nations and Inuit Health Branch should provide funding to ensure that Pikangikum’s Comprehensive Mental Health and Addictions Program, including the Community Suicide Prevention Program, can be created and function. (Cross referenced to recommendation 24.)
Government of Ontario, Ministry of Health and Long-Term Care
  1. The Province of Ontario, Ministry of Health and Long Term Care (MOHLTC) in collaboration with other ministries should create a Provincial Suicide Prevention Strategy.
  2. The Province of Ontario, Ministry of Health and Long-Term Care (MOHLTC) in developing its Suicide Prevention Strategy, should liaise with Aboriginal Leadership groups to ensure that the strategy considers, accepts and respects cultural diversity, and specifically acknowledges the extraordinary excess contribution of Aboriginal peoples to the national suicide rate. The province should not allow jurisdictional tensions over First Nations between the federal government and the province to delay the creation of its Suicide Prevention Strategy.
  3. The Province of Ontario, Ministry of Health and Long-Term Care (MOHLTC) in creating its Suicide Prevention Strategy, should liaise specifically with:

• First Nations’ Leadership, including the Chiefs of Ontario,

• The First Nations political leadership for Northern Ontario, specifically the Nishnawbe Aski Nation, Grand Council Treaty #3

• Health Canada, First Nations and Inuit Health Branch,

• Local Health Integration Networks, specifically, those in the North West and North East of Ontario,

• Aboriginal Children’s Aid Societies to identify communities and reserves where the rate of suicide for children and youth is excessively high.

  1. The Province of Ontario should cultivate its strategic direction with respect to enhancing mental health and addiction services over the next ten years to ensure that this includes the development of a provincial suicide prevention plan, and the reduction of suicides in children and youth. Components of this plan should consider promotion, prevention and early intervention in mental health for children and youth, with targeted efforts to reduce the stigma and discrimination associated with mental and substance abuse disorders.
  2. As a component of its Suicide Prevention Strategy, the Province of Ontario should develop population-level mental health indicators so that future decisions on mental health strategies will be data driven. An example would be to develop the capacity of tracking, in real time, deaths due to suicides in Aboriginal communities including First Nations on reserves.
  3. The Province of Ontario, Ministry of Health and Long-Term Care should create a telehealth consulting service for psychiatric care to remote First Nations communities. This service should allow for prompt (same day) access to child and adolescent psychiatrists for children in crisis. To ensure availability of psychiatrists to fulfill this role, the Ministry should provide a significant premium to physicians. The Ministry should partner with academic health science centres to create this service.
  4. The Province of Ontario, Ministries of Children and Youth Services and Health and Long-Term Care should develop an integrated mental health service strategy stressing accessibility and program delivery for children and youth in northern Ontario (Northern Ontario Aboriginal Child and Adolescent Psychiatry Outreach Program). Some stakeholders identified to assist in the development of this strategy would be:

• North West and North East Local Health Integration Networks

• Health Canada

• Ministry of Children and Youth Services

• A representative from the Sioux Lookout Regional Physicians’ Services Inc. (SLRPSI)

• Representatives from Meno-Ya-Win, Thunder Bay Regional Health Sciences Centre, Lake of the Woods District and Weeneebayko Hospitals

• Representatives from the Sioux Lookout First Nations Health Authority and the Weeneebayko Area Health Authority

• A representative from Nodin Child and Family Intervention Services

• A paediatric psychiatrist who provides service to First Nations Youth in the North West

• Health Canada, First Nations and Inuit Health Branch

• Indian and Northern Affairs Canada

• Non-Insured Health Benefits (NIHB)

• Tikinagan Child and Family Services, Dilico Anishinabek Family Care, and other children’s aid societies

• A representative from the Ontario Child and Youth Telepsychiatry Program

• A representative from the Nishnawbe Aski Nation

• A representative from each of the Tribal Councils of the north

  1. This Northern Ontario Aboriginal Child and Adolescent Psychiatry Outreach Program should be resourced jointly by the Ministry of Children and Youth Services, MOHLTC and Health Canada, First Nations and Inuit Health Branch and should endeavour to deliver culturally competent evidence-based child psychiatry incorporating flexible mixed models of service delivery, including:

• Triaging of direct referrals for children and youth in crisis

• Indirect referrals including support to family physicians and therapists

• Shared-care models

• Telepsychiatry, available 24/7, including ready access for children and youth in acute crisis at risk for suicide

• Mechanisms for communication between therapists, family physicians and psychiatrists

North West and North East Local Health Integration Network (LHIN)
  1. The North West and North East LHIN, working with Health Canada, First Nations and Inuit Health Branch, the Nishnawbe Aski Nation and other political First Nations leadership, should create an integrated and seamless Mental Health and Substance Abuse Strategy. This program should identify all service providers, both federally and provincially, and create care paths for First Nations living on reserve, particularly for youth who require placement out of their home communities.
  1. The North West and North East LHIN working with Health Canada, First Nations and Inuit Health Branch should endeavour to create a crisis telephone line and/or Internet service for the North West and East regions.
Sioux Lookout First Nation Health Authority (SLFNHA), Nodin Child and Family Intervention Services
  1. The Sioux Lookout First Nations Health Authority, Nodin Child and Family Intervention Services should conduct a review of open and waiting list cases, for the purpose of benchmarking with other organizations providing these types of services, to determine an acceptable caseload for its counsellors.
  2. Based on this benchmarking exercise, SLFNHA should create a business case to present to the Ministry of Children and Youth Services, the Ministry of Community and Social Services, and Health Canada, First Nations and Inuit Health Branch, who fund Nodin, to ensure that adequate resourcing is provided to address the needs for the enormous backlog that currently exists. This will likely require additional full time equivalents for both counselling and supervising.
  3. Nodin Child and Family Intervention Services should consider developing a model, (when adequately resourced), that is not limited to crisis intervention, as currently exists. Given their dedication to ensuring duly qualified staff, with accountability and supervision processes, consideration should be given to Nodin providing overall mental health case management to children and youth from the First Nations communities it currently services, including Pikangikum.
Pikangikum First Nation and the Pikangikum Health Authority (PHA)
  1. The Pikangikum Health Authority should develop a mission statement and clearly define its vision and values.
  2. The Pikangikum Health Authority should develop a Comprehensive Mental Health and Addictions Program for children, youth and adults. This program should consider;

• a Comprehensive Community Suicide Prevention Program,

• developing plans to address the solvent and alcohol abuse crises, and

• the need for integrated provision of mental health services including models which incorporate traditional practices, defined by the Pikangikum First Nation.

  1. In developing its Comprehensive Mental Health and Addictions Program, the PHA should retain nursing expertise to assist in the development of the Program. Funding for this nurse manager expert could come from the newly created National Aboriginal Youth Suicide Prevention Strategy, the Health Canada, First Nations and Inuit Health Branch, and/or the Aboriginal Health and Wellness Strategy. Invited participants to ensure a truly integrated program might include:

• Representatives from the Pikangikum Social Health, Education and Elders Committee

• Representatives from the Pikangikum Nursing Station

• Representatives from Pikangikum Mental Health and Addictions Programs including a mental health worker, youth patrol, solvent abuse worker, NNADAP, crisis team and community health nurse

• A representative from AMDOCS

• A representative from the Sioux Lookout Regional Physicians’ Services Inc. (SLRPSI)

• Representatives from Meno-Ya-Win Hospital

• A representative from the Sioux Lookout First Nations Health Authority

• A representative of the First Nation Family Physician Health Services branch of the Independent First Nations Alliance (IFNA)

• A representative from Nodin Child and Family Intervention Services

• A paediatric psychiatrist who provides service to First Nations youth in the North West

• Health Canada, First Nations and Inuit Health Branch

• Indian and Northern Affairs Canada

• Non-Insured Health Benefits (NIHB)

• The Ministry of Children and Youth Services

• The Ministry of Aboriginal Affairs

• The Ministry of Health and Long-Term Care

• The North West Local Heath Integration Network

• Tikinagan Child and Family Services

• Ontario Provincial Police

  1. Until the Comprehensive Mental Health and Addictions Program is functional, the NNADAP, Solvent Worker and Youth Patrol programs should be examined and either augmented or reconstituted to provide meaningful assistance to the community. Job descriptions should be written so that targets and accountability expectations are clearly set out.
  2. The Pikangikum First Nation, Chief, Council and the Pikangikum Health Authority should create a Community Suicide Prevention Program, to be delivered as a community program, under the Health Authority’s current Chair and Directorship funded by Health Canada, First Nations and Inuit Health Branch.
  3. The creation of the Community Suicide Prevention Program will require expertise in health care and project management that currently does not exist within the community. To achieve the necessary level of expertise, the Pikangikum Health Authority under its current Directorate, should partner with Health Canada, First Nations and Inuit Health Branch, and the North West Local Health Integration Network for the planning and delivery of the program.
  4. The Pikangikum Health Authority should approach Health Canada, First Nations and Inuit Health Branch to provide funding to retain medical expertise, such as a nurse manager educated to a Masters Degree level in health science with expertise in project management to assist with creating and implementing the Community Suicide Prevention Program. The job specifications, qualifications, accountabilities and contract should be agreed upon by all three members of the tripartite partnership, that is, the Pikangikum Health Authority, Health Canada, First Nations and Inuit Health Branch, and the North West Local Health Integration Network.
  5. The Community Suicide Prevention Program should be created by the Pikangikum Health Authority and their Nurse Manager Expert incorporating a steering committee model with invited participants and stakeholders including such interests as,

• representatives from the Pikangikum Nursing Station,

• representatives from Pikangikum Mental Health and Addictions Programs including a mental health worker, youth patrol, solvent abuse worker, NNADAP, crisis team and community health nurse,

• a representative from the Pikangikum Education Authority,

• a representative from AMDOCS,

• a representative from the Sioux Lookout Regional Physicians’ Services Inc. (SLRPSI),

• representatives from Meno-Ya-Win Hospital,

• a representative from the Sioux Lookout First Nations Health Authority,

• a representative of the First Nation Family Physician Health Services branch of the Independent First Nations Alliance (IFNA),

• a representative from Nodin Child and Family Intervention Services,

• a paediatric psychiatrist who provides service to First Nations youth in the North West,

• Health Canada, First Nations and Inuit Health Branch,

• Indian and Northern Affairs Canada,

• Non-Insured Health Benefits (NIHB),

• the Ministry of Children and Youth Services,

• the Ministry of Aboriginal Affairs,

• the Ministry of Health and Long-Term Care,

• the North West Local Heath Integration Network,

• Tikinagan Child and Family Services,

• Ontario Provincial Police,

• Lachie Macfaddin land-based detoxification program.

  1. The Community Suicide Prevention Program should seek methods to de-stigmatize the seeking of help by clients for mental health-related issues, and improve health privacy. Community members must be ensured of confidentiality in counselling sessions so that they will be more willing to seek out help and confide their concerns.

Theme: Suicide Prevention

Primary Prevention Strategies
School-based Prevention: The Pikangikum Education and Health Authority
  1. The Pikangikum Education and Health Authority should cooperatively develop as a component of the Community Suicide Prevention Program, a school-based student health and suicide prevention program. This program should be a component of the health education curriculum, and should include a variety of health and social issues of which suicide would be one. The program should seek to enhance the capacities of the children in coping with stress, conflict resolution, problem-solving and communication. The fundamental purpose would be to build resiliency and self-esteem in the children, so that they would be better able to withstand the rigours of the crisis and conflict that may arise in their lives.
  2. The school-based curriculum should incorporate traditional and cultural knowledge and should utilize the resource of incorporating elders when teaching the youth about such issues as cultural identity and self-pride. It should focus on mental, emotional, spiritual and physical well-being, and particularly discuss the dangers of solvent abuse and emphasize the recognition of suicidal behaviours.
  3. The school-based health program should address such issues as alcohol and substance abuse, depression and suicide, domestic violence, sexual and/or physical abuse, and bullying. It must convey and communicate, in plain language to the children, strategies for help-seeking where these issues exist in their lives, and de-stigmatize and dispel attitudes and dispositions which portray the seeking of help in a negative light.
  4. The school-based health program should seek to identify high risk youth for suicide by developing and utilizing a school-based screening program and refer high risk youth for intervention. Intervention for children who are identified as high risk for suicide might include one-to-one counselling, as well as small-group interventions based on skills building.
Peer Support Programs
  1. The Pikangikum Education Authority and the Pikangikum Health Authority should develop a peer support program operated through the school by senior students called the Peer Support Youth Council. This program should seek to engage children who are identified as “at risk” for suicide and create bridges and ease for the “at risk” child to seek assistance appropriately. The peer counsellors should be trained in basic listening skills and identified as resource people for the youth in crisis. Oversight, management and debriefing for the Peer Support Youth Council could be provided by Nodin Child and Family Intervention Services.
Community-Based Programs: The Pikangikum Health Authority
  1. The Pikangikum Health Authority should develop a community-based program to address suicide as a component to their suicide prevention strategy. The components could consist of:

• Education programs for youths and adults on topics including suicide, parenting and life skills. The educational programs directed toward suicide prevention should have mental health literacy tools for parents promoting the identification of undiagnosed or untreated mental health disorders so that professional assistance will be accessed.

• Creating peer counsellors to respond to young people in crisis, and bringing them to the attention of healthcare providers.

• Outreach to families after a suicide or traumatic death.

• Immediate response to a youth at risk.

• Creating suicide risk screening programs in mental health, addiction and social service programs.

  1. As a component of the community-based program, the Pikangikum Health Authority and Education Authority should develop and deliver workshops on life skills, parenting and problem solving, and communication with the children and youth, to parents and young adults in the community. These should be based on culturally sensitive models of roles and responsibilities.
Means Restriction
  1. Given that means restriction, or eliminating access to specific lethal means of suicide has been proven to be effective in reducing suicide rates, and given that hanging was the method utilized in all the suicides examined, educational programs directed toward prevention should acknowledge the roles of limiting access to items that could be utilized as ligatures in children expressing suicidal ideation. It is acknowledged that given the ready availability of these items in a household environment, for example shirts, sheets, and shoelaces, it is likely to play a limited role.
Gatekeepers
  1. The Pikangikum Health Authority should develop a role for community gatekeepers, such as elders, community leaders, police, social workers, counsellors, teachers and clergy to be taught to identify youth at risk for suicide, and refer them for treatment. The community-based gatekeeper training programs should seek to improve identification and recognition of suicidal behaviour to allow for prompt referral.
Communication and Media Handling of Suicides in Pikangikum: The Pikangikum First Nation, Chief and Council
  1. The Pikangikum First Nation should convene a committee for the purposes of reviewing and developing policies on how it will communicate to the community the tragedy of suicides when they occur. Invited stakeholders might include the proprietors of the local radio station and newspaper, and representatives from the Pikangikum Nursing Station, the Pikangikum Mental Health and Addictions Programs, Nodin Child and Family Intervention Services, Tikinagan Child and Family Services, and the Ontario Provincial Police. The policy should be directed at diminishing the intense community focus on the death, and promoting mental health and coping strategies around suicide.
Programming for Children: The Pikangikum First Nation, Chief and Council
  1. The Pikangikum First Nation should develop a project to create, with the assistance, support and aid from INAC, an athletic field, with a children’s playground, including a basketball court and baseball and soccer fields to allow for children’s programming.
Secondary Prevention: Early Intervention and Treatment
Health Care Professionals and Mental Health Services: Health Canada, First Nations and Inuit Health Branch
  1. The Pikangikum Nursing Station should develop an emergency room suicide response protocol. This protocol should contemplate identification of those who require emergent hospitalization and how this will be achieved, and those that can be discharged from the Nursing Station. Where appropriate, discharge from the Nursing Station should consider;

• notification of the child or youth’s parent and guardian,

• creation of a safety plan,

• immediate notification of the community mental health team, and Tikinagan Child and Family Services, where permitted by the Personal Health Information Protection Act,

• provision of the discharge summary to the community mental health team, and Tikinagan Child and Family Services,

• follow-up with the community mental health team within 24 hours.

  1. Nurses working in the Pikangikum Nursing Station should receive specialized training and education with respect to assessing those at risk for suicide, including when patients should be referred for emergent psychiatric inpatient treatment in a Schedule 1 facility. This could be achieved by the nurses obtaining certification in mental health.
  2. AMDOCS, the principal physician service provider to Pikangikum should develop an educational module for its physicians with regard to suicide prevention and treatment. This program should discuss:

• The high rate of mental health disorders in youth that kill themselves.

• The utilization of treatment strategies in youth including the use of antidepressants such as selective serotonin re-uptake inhibitors.

• The need to effectively treat children suffering with major psychiatric illnesses such as psychotic disorders.

• The association of substance abuse disorders and suicide.

  1. The Pikangikum Health Authority, the North West LHIN and the Pikangikum Nursing Station should develop an agreement with paediatric and adolescent psychiatric service providers whereby prompt consultation for youth presenting with suicidal ideation and/or risk factors can access this psychiatric expertise via telehealth video linkages.
Crisis Telephone Line: North West and North East LHIN

See recommendation 19.

Mental Health Crisis Response Teams
  1. The Pikangikum Health Authority should develop a Mental Health Crisis Response Team through its Mental Health and Addictions Programs for those identified as suffering with parasuicidal ideation. This service should have the capacity to mobilize counsellors to respond to youth in crisis 24/7.
Solvent and Substance Abuse Treatment
  1. The Pikangikum First Nation, and the Pikangikum Health and Pikangikum Education Authority should seek to identify all children and youth <19 years of age involved in solvent abuse. This could be facilitated through screening programs in the school, and with the assistance of the OPP and the Nursing Station. All youth and children identified as suffering with solvent abuse, who are age appropriate based on the criteria of the Child and Family Services Act, should be referred to Tikinagan Child and Family Services. All youth, regardless of age should also be referred to the Solvent Abuse Worker.
  2. The Pikangikum Education Authority should augment the school’s current curriculum on solvent abuse to ensure that education begins in kindergarten with developmentally appropriate modules throughout elementary school.
  3. The Pikangikum Health Authority, with the assistance of Health Canada, Youth Solvent Abuse Program (YSAP), Tikinagan Child and Family Services, the Ministries of Children and Youth Services and Health and Long-Term Care, and the Local Health Integration Network should develop a comprehensive in-community Solvent Abuse Program. Medical expertise on solvent abuse should be retained for this exercise. This program should incorporate support of the children before and after treatment in residential solvent abuse programs, adopting holistic approaches to treatment, including aftercare programs delivered in the community.
  4. The Pikangikum Health Authority, Health Canada, First Nations and Inuit Health Branch, Youth Solvent Abuse Program (YSAP), Tikinagan Child and Family Services and Health and Long-Term Care and the Local Health Integration Network, in developing the comprehensive in-community Solvent Abuse Program, should liaise with residential solvent abuse providers such as White Buffalo Youth Inhalant Treatment Centre (WBYITC) to develop comprehensive after-care and follow-up to residential treatment programs. This should include outreach programs delivered at Pikangikum whereby a provider such as WBYITC delivers a community intervention including such items as identifying protective factors in the community such as the school system, community support groups, and connecting with elders.
  5. Pikangikum First Nation should develop a Healing Treatment Centre with funding provided by Health Canada, Inuit and First Nations Health Branch. The Centre could house multiple providers of health services under one roof including Tikinagan Child and Family Services, the community mental health workers, NNADAP workers and the solvent abuse workers. In addition, children who are apprehended by police for solvent intoxication would not lodged in police cells overnight, but rather, would be brought to a safe sheltered environment in the centre to be monitored by peace keepers until they are no longer intoxicated. The comprehensive in-community Solvent Abuse Program after-care program could be delivered in this location.
  6. Social workers, mental health workers and solvent abuse workers will need to proactively reach out to involved families of solvent abusing children and youth, and should consider adopting models of home visits to ensure confidentiality and diminish the stigma attached to help-seeking which has emerged in the community.
  7. The Pikangikum First Nation and Health Authority should liaise with Health Canada, First Nations and Inuit Health Branch and the Government of Canada to explore the feasibility of introducing Opal fuel in their community, a type of gasoline that will not make users intoxicated when sniffed.
Postvention: The Pikangikum First Nation Health Authority
  1. The Pikangikum First Nation Health Authority, as a component of its Community Suicide Prevention Program should develop a postvention program directed at the youth of the community.
  2. The postvention program should be developed for delivery both in the school, and in the community. School engagement is a protective factor for preventing suicide and as such, the program should specifically consider addressing the isolated community of solvent abusers, who make up the largest percentage of suicide victims.
  3. The components of the postvention program might include, but not be limited to, the following elements:

• Mobilization of a Crisis Response Team.

• The victim’s family should be contacted, empathy and support provided, and an inventory of those who are most likely to be affected by the death developed.

• A determination of what information is appropriate for release. This should ensure that the victim is neither glorified nor vilified.

• Identify those who are most likely affected by the death, including those who discovered the decedent.

• The Crisis Response Team should seek to meet all those who have been identified individually, providing support and counselling.

• Drop-in counselling centres following the suicide should be established to allow those who are experiencing distress to gain ready access to mental health services.

  1. The Pikangikum First Nation should establish an appropriate and culturally sensitive approach to funereal and memorial activities. Of paramount importance, is that the activities do not “…romanticize or sensationalize the death.” Youth “…should not view suicide as a way to obtain incredible amounts of attention”.
  2. The Pikangikum First Nation should consider developing a community cemetery. In this way, permanent physical memorials are placed in an appropriate locale, away from residential areas to avoid the constant recognition and reminder of suicidal deaths.

Theme: Education

Pikangikum First Nation and the Pikangikum Education Authority (PEA)
  1. The Pikangikum First Nation, Education Authority and educators from the school should convene a meeting to meaningfully discuss the fundamental role of education as delivered in the community. This might include a discussion of the mission, vision and values of the Pikangikum Education Authority. Central to this discussion is the creation of a statement of understanding about what outcomes are expected or anticipated for the children and youth attending the school that will assist them in creating viable futures for themselves. Consideration should be given to employing a facilitator for the meeting from outside the community, with expertise in the provision of First Nations education.
  2. The Pikangikum First Nation, Chief and Council should pass a Band Council Resolution requiring that an accurate census be taken of all the children in the community who are of school age.
  3. The Pikangikum First Nation, Chief and Council and the Pikangikum Education Authority should pass a Band Council Resolution requiring children to attend school until 18 years of age. This reflects the reality that children and youth with good school and social connectedness are more likely to have positive educational outcomes and less likely to be involved in health risk behaviours and experience subsequent mental health issues. Examples of health risk behaviours and mental health issues include gasoline sniffing, depression and suicide.
  4. Secondary school education at Pikangikum School should improve to a level so that its graduates will be capable and willing to face the challenges of post-secondary education at the trades, college or university level. The PEA should develop options so that children who might have the potential and interest to achieve higher levels of post-secondary education can do so comfortably in Pikangikum or in First Nations’ operated schools off-reserve in areas such as Pelican Falls and Thunder Bay should this be in the best interests of the student.
  5. The Pikangikum Education Authority retaining expertise available from the provincial Ministry of Education, should consider developing an e-learning program at the secondary school level. The community may also wish to utilize the expertise of the Keewaytinook Internet High School in developing an e-learning program.
  6. The Pikangikum Education Authority should liaise with the Pikangikum Health Authority for the purposes of providing a public health nurse in the school to assist with such issues as solvent abuse and sexual and reproductive health. The public health nurse should be readily available to the youth and deliver the services through offices in the school. Funding may be available for this via a community health nurse provided by the Health Canada, Community Primary Care.
  7. The Pikangikum Education Authority should consider developing a Day Nursery attached to the school and complying with the requirements of the Day Nurseries Act, R.S.O 1990 in providing for child care services to the community and for students of the school.
  8. The Pikangikum Education Authority should consider developing and implementing a full-day kindergarten program.
  9. Given the extraordinary level of solvent abuse and its consequent neurocognitive damage and the probable high presence of Foetal Alcohol Spectrum Disorder (FASD) in the community, the Pikangikum Education Authority should aggressively pursue funding and the development of programs for special education needs. In particular, screening for FASD and testing for solvent abusing children and youth should be conducted for those “at risk”.
  10. Remuneration for teachers at the Pikangikum School should follow the provincial salary grids. A pension plan should also be made available to the teachers. If possible, this should occur through the Ontario Teacher’s Pension Plan. Professional development support should be identified and accessioned for the teachers, through the provincial Ministry of Education.
Federal Government, Indian and Northern Affairs Canada (INAC)
  1. Funding for First Nations education should be provided by INAC at a level comparable to that provided to other children and youth being educated in the province of Ontario.
  2. INAC should fulfill its commitment to build a new school in Pikangikum as soon as possible. The school should be built to;

• accommodate all children currently of school age and projected into the future,

• include children’s playgrounds, soccer fields, baseball diamonds, and basketball courts,

• include an auditorium where community members can gather for traditional and cultural community events, and

• include a daycare facility.

  1. INAC should fund:

• A public health nurse in the school at Pikangikum.

• A Day Nursery attached to the school to provide early childhood education.

• The special education needs of the children and youth of Pikangikum. This should include general screening for Foetal Alcohol Spectrum Disorder (FASD), with plans to support both these needy children and those suffering with solvent abuse in their educational pursuits. This presents a potential link with the Foetal Alcohol Spectrum Disorder Initiative offered by Health Canada, First Nations and Inuit Health Branch.

Federal Government, Province of Ontario, and the Chiefs of Ontario
  1. The federal government, Indian and Northern Affairs Canada, the Chiefs of Ontario and political First Nations organizations such as the Nishnawbe Aski Nation, and the Province of Ontario, Ministry of Education, Aboriginal Education Office should convene a meeting to begin a dialogue about the transfer of the delivery of education to First Nations children and youth living on-reserve residing in Ontario from federal to provincial jurisdiction. This in no way should be construed as an effort to negate the constitutional and treaty obligations of the federal government with respect to funding First Nations education, but rather, using the estabilished resources and expertise of the provincial government, redirects the focus on planning, execution, delivery and outcomes for First Nations youth residing in Ontario, in essence, the quality of education provided to First Nations children and youth in the province.
Nishnawbe Aski Nation
  1. The First Nations communities in the Nishnawbe Aski Nation should consider developing a First Nation School Board for the North. This might be created by liaising with NAN and other stakeholders such as Northern Nishnawbe Education Council (NNEC), the provincial Ministry of Education, and ensuring First Nation representation by inviting elected membership from each of the Tribal Councils. The Board might wish to set as some of its many goals, enhanced student achievement, models for the effective stewardship of resources, and delivery of education uniquely First Nations respecting culture and tradition.

Theme: Policing

Pikangikum First Nation, Chief and Council
  1. The Pikangikum First Nation should consider developing a Pikangikum Police Board, to interface between the police service and the community. The Board should be comprised of elders and community appointees, with the Chief as Chair.
  2. When developing its terms of reference, the Board should ensure that the elected members of the local First Nation, such as the Council have representation on the Board through the Chief, and:

• Do not attempt to influence or interfere with the expertise of the police in carrying out their day-to-day policing duties,

• Develop a process whereby community members can voice their concerns to the Board, who would then investigate and attempt to resolve the matter.

Theme: Child Welfare

Tikinagan Child and Family Services
  1. The Tikinagan Child and Family Services should establish, as one of its priorities, the recruitment, training and retention of qualified staff (frontline, administrative and management) to assist in the provision of services, compliance with provincial standards and the protection of children within its catchment area, particularly in Pikangikum.
  2. The Tikinagan Child and Family Services should be supported by the Ministry of Children and Youth Services (MCYS) in its attempts to recruit, train and retain qualified staff to perform child protection duties.
  3. The child welfare capacities of staff should be enhanced through orientation, ongoing training and supervision. Benchmarks should be established for caseloads, required documentation and timelines, and audited for compliance.
  4. Staff of Tikinagan Child and Family Services in Pikangikum should have access to an office, telephones and computers, including the software and capabilities required to complete standardized child protection documentation when working in Pikangikum and like remote communities.
  5. In addition to basic child protection training, staff members should be offered specific training in topics such as Foetal Alcohol Spectrum Disorder, Suicide Prevention, Solvent Abuse and Engaging Families and Communities.
  6. Tikinagan and Nodin Child and Family Intervention Services should be stakeholders in the development of Pikangikum’s Community Suicide Prevention Program.
  7. Tikinagan has identified that in some cases, more intrusive action is required and its own recommendation is supported: “… Pikangikum First Nation Chief and Council should pledge to support Tikinagan’s protection mandate by recognizing that removing children from their families and community may save children’s lives.” Ways and means of addressing the financial hardship arising from the loss of the Child Tax Credit for children no longer in the care of the family should be considered and addressed to ensure that the best interests of the child are being met.
  8. Tikinagan should endeavour to maximally utilize its membership in the Ontario Association of Children’s Aid Societies (OACAS) to allow its staff access to the resources and training provided by the OACAS.
Ministry of Children and Youth Services
  1. It is recommended that the Ministry of Children and Youth Services establish a fund for the documentation, development and implementation of Anishnabek child welfare laws, similar to the fund established by a previous Minister in 2007, and that the fund be made available through the office of the Chiefs of Ontario.
  2. The Ministry of Children and Youth Services should implement the recommendations contained in the Northern Remoteness Study on behalf of Tikinagan, Payukotayno and other northern agencies. In the alternative, if the MCYS can not endorse and comply with the recommendations of the Northern Remoteness Study, it should undertake its own review of the costs associated with the provision of child welfare services in the north of Ontario. This review could be undertaken as a component of the current Commission to Promote Sustainable Child Welfare. It should accurately reflect upon the cost of providing service to remote and fly-in First Nations communities, and the significant and substantive challenges that providing child welfare services to First Nations encompasses. It should ensure that children’s aid societies providing service to First Nations communities have unique and adequate funding to provide that service to provincial standards, or as closely approximating the level of service provided in other jurisdictions in Ontario as is reasonably possible.
  3. The Ministry of Children and Youth Services should establish for each region an extraordinary cost fund and guidelines for distribution of those funds.

Theme: Social Determinants of Health

Pikangikum First Nation
  1. The Pikangikum First Nation should develop a housing authority.
  2. The Pikangikum Housing Authority should conduct a study of existing homes and repair needs, as well as completing a housing status strategic study to understand the community’s projected needs for the future, based on population growth. An external consultant to assist with the study should be retained.
Indian and Northern Affairs Canada (INAC)
  1. INAC and the Pikangikum First Nation should complete its earlier project to connect the First Nation to the hydro grid. Funding for this initiative should be provided by INAC.
  2. INAC and the Pikangikum First Nation should review the current water treatment system and identify the need for any upgrades to ensure that Pikangikum has access to safe healthy potable water, immediately and in the future. Funding for the projected improvements to the water treatment system should be provided by INAC.
  3. INAC should be a stakeholder in the housing status strategic study (see recommendation #89) and plan for the building and upgrading of sufficient housing units to address the critical housing shortage and overcrowding that exists in the Pikangikum First Nation. It is the belief of the current Chief and Council that to effectively alleviate overcrowding, 50 new homes are required.
  4. INAC and the Pikangikum First Nation should review the sewage disposal system and identify the needs for any upgrades to ensure that Pikangikum has a safe healthy sewage disposal system in the future; one which will not compromise the First Nations drinking water supply. Funding for the projected improvements to the sewage disposal system should be provided by INAC.
  5. INAC and the Pikangikum Housing Authority should ensure that all homes built in the future are connected to water for indoor plumbing, and the sewage disposal lagoon. In addition, the Pikangikum Housing Authority should study and determine which homes could be retrofitted to allow for indoor plumbing and sewage. Funding for the projected improvements to the homes which could be retrofitted for indoor plumbing and sewage disposal should be provided by INAC.
Federal Government
  1. The Federal Government, Indian and Northern Affairs Canada should develop an antipoverty strategy for Aboriginal people, particularly focusing on those living in remote and isolated First Nations reserves such as Pikangikum. This strategy could be modelled after provincial strategies such as Ontario’s Poverty Reduction Act, 2009 or Nova Scotia’s Poverty Reduction Strategy.
  2. The Government of Canada, Indian and Northern Affairs Canada should support the Pikangikum First Nation’s Whitefeather Forestry Project.
Pikangikum First Nation
  1. The Pikangikum First Nation should undertake a review of its electoral policy and practices and consider adopting an electoral process whereby elected officials retain office for a sustained period of time to allow for the growth of political expertise, stability, and to allow for momentum to be obtained with respect to projects directed toward enhancing community infrastructure. The First Nation might benefit from formalizing, in writing, and communicating its electoral process to its constituents. The First Nation could retain expertise for assistance from political organizations such as the Nishnawbe Aski Nation who would be aware of “best practices” with respect to First Nations’ governance. Consultation and assistance from the National Centre For First Nations Governance Institute should be obtained.
  2. The Pikangikum Housing Authority should clearly identify its future land needs as a product of its study (see recommendation #89) and with the assistance of Indian and Northern Affairs Canada, obtain reserve lands to allow for sustained population growth in its membership.
Government of Ontario and Federal Government
  1. A Committee should be struck called the Pikangikum Steering Committee:

• Joint chairs should be named from a Provincial Ministry and the Federal Health Canada, First Nations and Inuit Health Branch.

• The Province of Ontario should have inter-ministerial representation at the Assistant Deputy Minister level from the Ministries of Health and Long-Term Care, Aboriginal Affairs, Children and Youth Services, Community Safety and Correctional Service, Health Promotion and Sport, and Education.

• The Pikangikum First Nation should be represented on the Committee by the Chief, Deputy Chief, a youth leader and an Elder.

• Federal Government representatives on the Committee should include Indian and Northern Affairs Canada, and Health Canada, First Nations and Inuit Health Branch.

• Invited members might include the North West Local Health Integration Network, the Sioux Lookout and First Nations Health Authority, the Nishnawbe Aski Nation the Sioux Lookout Meno-Ya-Win Health Centre, Nodin Child and Family Intervention Services, Tikinagan Child and Family Services, the Ontario Provincial Police; the Ontario Child and Youth Telepsychiatry Program, and a paediatric and adolescent psychiatrist providing services in the North West of Ontario.

• The purpose of the Pikangikum Steering Committee would be to advance the recommendations included in this report.

  1. The context for change in Pikangikum should include:

• A dialogue with Elders, Chief and Band Council members, and selected community members about any recommendations stemming from the Report.

• Elders, Chief and Band Council members and selected community members should lead any initiative to encourage and facilitate change in Pikangikum First Nation.

• Mechanisms to support and bolster leadership in the change initiative need to be put in place.

Given the historical and current context, the Pikangikum community, government, and all other involved parties should anticipate a long-standing change process. The duration of the intervention, in order to maximize outcomes, needs to span a decade.