Outcomes from a collaborative project developing and evaluating a community rehabilitation worker program for Northwestern Ontario First Nations

Introduction: Major inequities exist in levels of health and wellbeing, availability, and access to health care services between seniors of Indigenous and non-Indigenous background in Ontario. First Nation (FN) elders are 45-55% more frail than the average senior in Ontario. Additionally, needed rehabilitation services are not easily accessible or available in the first language of most FN elders within their home community. A literature review showed community-based rehabilitation assistant models had been successfully developed and implemented in regions facing similar equity and access challenges. Building on these findings, a needs assessment was conducted to capture unique needs and requirements in Northwestern Ontario (NWO) relating to rehabilitation among FN elders.
Methods: The needs assessment resulted in four FNs, three Indigenous health organizations, three rehabilitation health organizations, and two academic institutions iteratively developing and evaluating curriculum for a Community Rehabilitation Worker (CRW) program in treaty territories 5, 9, and Robinson-Superior. The goal of the program is to train local CRWs, familiar with local languages and cultures, to provide rehabilitative services that support ageing in place, health, wellbeing, and quality of life for FN elders. The study employed a community participatory action research approach aligning with the OCAP® framework for working with Indigenous populations. Seventeen community partners were active participants in the program development, evaluation, and adaptation of the CRW curriculum.  Feedback was received through advisory committee (AC) meetings, surveys, and individual and group interviews.
Results: All 101 participants agreed, across all curriculum modules, that: 1. the time allotment was realistic; 2. instructional materials, activities, and resources were appropriate and easy to understand; 3. evaluation activities accurately measured learning; and 4. respondents identifying as Indigenous felt Indigenous culture was adequately reflected. The qualitative findings highlighted the importance of incorporating culture, spirituality, traditions, local language use, and re-integration of elders into traditional activities and community activities for both the CRW curriculum and rehabilitation efforts. The need for locally available elder-focused mental health support, transportation options, and gathering spaces such as those commonly seen in urban areas were also highlighted.
Conclusion: The process of iteratively developing and evaluating a CRW program resulted in a NWO college welcoming the first cohort of students to the CRW program in March 2022. The program is co-facilitated with a FN Elder and includes components of local culture, language, and the reintegration of elders into community as part of the rehabilitation efforts. In addition, to appropriately support the quality of life, health, and wellbeing of FN elders, the project team called upon provincial and federal governments to work with First Nations to make available dedicated funding to address inequities in resources available to elders in NWO urban and FN remote communities including elder-focused transportation options, mental health services, and gathering places. The program implementation will be evaluated with the first cohort of CRWs for further adaptations considering potential scale and spread. As such the project and findings may also represent a resource for others wishing to pursue similar development using participatory approaches in rural and remote communities both nationally and internationally