Providing health promotion case management to Indigenous peoples in Vancouver
2017
Overview
The Health Promotion Case Management (HCPM) program provides short-term (less than six months), outreach-based case management to individuals at ongoing high risk for HIV infection who could use support to remain HIV negative. The program works with clients to decrease their vulnerability to HIV by providing case management to clients to help them develop the self-efficacy and personal skills that strengthen their resiliency. Case managers support clients to make the changes they want to their behaviour, lifestyle, relationships, and emotional and mental health. Case managers also address structural barriers to wellness that impact people at ongoing high risk for HIV, including support to access social assistance, housing and healthcare, and referrals to community, immigration and legal services.
The program provides support to at-risk individuals from the following groups:
- Indigenous peoples
- HIV-negative partners in serodiscordant couples
- Women
- Newcomers, immigrantsand refugees
- Gay, bisexual and other men who have sex with men (MSM)
The objective of HPCM is to improve clients’ self-management skills and, through a care plan, to develop a network of service providers that helps clients remain HIV negative in the long term. Through strong community partnerships, HPCM reduces silos and improves integrated healthcare for people at ongoing high risk for HIV infection.
This program element complements a case study and another program element that describe the Health Promotion Case Management program. For more information about the work of the health promotion case managers in general, see the HPCM case study. For more information on the work of the case manager who works with gay, bisexual and other MSM, see the program element on the work of the case manager who serves Fraser Health Authority.
One case manager works with Indigenous peoples in Vancouver who are at ongoing high risk for HIV infection. This case manager works primarily at AIDS Vancouver, but has also spent time working onsite at an Indigenous-serving organization in Vancouver’s Downtown Eastside. This organization is housed in a building that includes many other Indigenous agencies and services and was chosen because it is already known to Indigenous clients, is close to other Indigenous-serving organizations, and is close to where many Indigenous people live. Connections continue to be built with other Vancouver organizations that primarily serve Indigenous people with the possibility that the case manager may offer drop-in hours or other onsite availability from these locations in the future.
Providing culturally safe services to Indigenous peoples
Indigenous clients may have a deep mistrust of the health and social service system because it may not have traditionally served them well. Because of this mistrust, the case manager typically focuses on building trusting and respectful relationships with clients as a bridge to building better relationships between clients and the wider health and social service system.
The case manager aims to be reliable and dependable and demonstrates this to clients by being trustworthy and doing what they say they will. The case manager also intentionally discloses their own identity as an Indigenous person as a way to build trusting relationships with clients. A shared identity as Indigenous peoples can help build trust by acknowledging shared experiences.
The case manager works through Indigenous frameworks to offer culturally competent and culturally safe support to clients. One of the first things the case manager does with clients is gauge their level of comfort and familiarity with Indigenous culture, understanding that the history of colonization and the legacy of residential schools have had an impact on the ability of many Indigenous peoples to remain connected to their culture. Using this information, the case manager can discuss with the client how involved they would like elders, Indigenous peers and Indigenous-serving organizations to be in their support system. Depending on their familiarity with Indigenous practices, the case manager also uses the medicine wheel to talk about holistic health and wellness.
Meeting the needs of Indigenous peoples
With most clients, the first goals are to get identification such as Indian status cards, apply for social assistance and housing, and connect them to Indigenous-serving organizations, Indigenous peers and local elders. The case manager acts as an advocate for clients and navigates them through the social service system. They help clients seek health and social service providers with experience working with Indigenous peoples, and who understand the historical trauma, violence and legacy of residential schools.
Once these structural issues have been addressed, the trusting relationship the client and case manager have developed allows them to work on issues clients may have been hesitant to discuss, such as trauma and substance use. It also allows the case manager to have conversations about sex, drug use, HIV, and HIV prevention that may not have been possible at the beginning of their relationship. If healthcare and HIV services were not identified as immediate needs then, once trust is built, the case manager supports the client to access health services, which can include an HIV test.
Building a network of service providers to support Indigenous peoples
Connecting to the wider network of service providers who work with Indigenous peoples in Vancouver is one of the key ways that the case manager serves their clients. The case manager attends local events and gatherings with other Indigenous service providers. They also often access the drop-in times of local Indigenous-serving organizations to build and maintain connection with their staff and community members. The case manager has also worked to increase support for two-spirit clients by fostering relationships with two-spirit organizations and people in the community who are willing to work with two-spirit clients as peers. Building relationships with other service providers not only improves the case manager’s comfort referring clients to them, but it has also increased referrals to the HPCM program from these organizations.
Ultimately, the case manager uses relationships with other service providers to connect clients to services in a sustainable way so that once clients transition from the HPCM program, they can connect to a variety of service providers who can support them to maintain the positive health and wellness changes they made while working with the case manager.