Programming Connection

TAHAH: Towards Aboriginal Health and Healing Program 

Vancouver STOP Project
Vancouver, British Columbia
2013

Challenges

  1. The time needed to build relationships. TAHAH clients’ experience of historical and institutional trauma is correlated with their lack of trust of health and social services. Further, many experience instability that prevents them from being able to participate in formalized services. As a result, building relationships takes considerable time— possibly more time than would be needed within other communities.
  2. The transient nature of the population. The realities of client transience and a local housing shortage present challenges to TAHAH service delivery. Clients need stable housing if they are to make regular connections.
  3. Challenges associated with maintaining the therapeutic relationship. It is as challenging to maintain a therapeutic relationship with a TAHAH client as it is to establish it. Staff must stay patient, intentional and assertive while working at the pace set by the client and respecting their priorities. Over time, the client’s and the community workers’ priorities align toward a commitment to accessing services; this alignment evolves naturally as clients feel respected by their workers and as their basic needs for things like housing, food and community are increasingly addressed.
  4. Human resource issues. Hiring and retaining qualified and capable staff is an ongoing challenge. TAHAH’s clients manage multiple issues, and supporting them requires significant human resource hours. As a result, TAHAH maintains a small caseload and restricts its participant intake process to those who are in most need of services.
  5. Ethics of patient autonomy. There is often debate about the ability of patients to make the “right” decisions about their well-being when they have untreated mental illnesses, developmental challenges, acute addictions or combinations thereof. This is an ongoing challenge for staff members trying to understand decisions about refusing treatment and care, especially by clients who are ill and/or dying. In the future, it would be helpful for TAHAH to engage a part-time consultant, on an as-needed basis, who specializes in ethics, cognitive impairments, mental health and/or patient autonomy.
  6. Challenges for peer health advocates. It has been a challenge for all of the peers on staff to transition from solely being participants at the Positive Outlook Program to being valued, peer support workers. For the rest of the TAHAH team, there was a learning curve regarding the amount of supervision and support required (or not required) by the peers and how to recognize former “clients” as employees who now had access to office space and files that previously had been off limits to them. The peer health advocates needed to get accustomed to the responsibilities of their new positions, including self-care and support for one another in their work. Hiring peers as community health advocates requires significant resources in terms of staff support, training and supervision.
  7. Challenges associated with incorporating First Nation culture(s) and healing practices. The inclusion of First Nation culture(s) and healing practices is critical, but not always easy. Although TAHAH is situated on traditional Coast Salish territory, defining what constitutes “Aboriginal” healing practices is a challenge when working with very diverse, urban First Nation peoples, many of whom do not share cultures, histories or languages. Furthermore, “pan-Indian” stereotypes are often applied to all First Nation communities; TAHAH works to deconstruct these beliefs. It is also a challenge for Western practitioners to create and ensure the professional space required for First Nation cultural knowledge and practices.