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Team profiles :

Conne River Health & Social Services (Miawpukek First Nation)

At a Glance   

Region: Newfoundland and Labrador

Setting: Rural

EAIP program principle(s): 

• Access to specialized healthcare services
• Access to social and community supports

• Access to system navigation and support 

Implementation (new, spread, and/or expand):  

• Expand

Team Profile  

The organization leading this program is Conne River Health and Social Services (CRHSS), a department of Miawpukek First Nation. They will be partnering with other departments of Miawpukek First Nation such as housing, culture and tourism and recreation through this program.  

Community

• This program is in Conne River, Newfoundland located on the south coast of Newfoundland.
• The program serves Miawpukek First Nation, a rural community with a population of less than 1,000 people with many members of the community being Miawpukek Mi'Kamawey Mawi'omi.
• There is a higher incidence of chronic diseases and co-morbidities at younger ages in this community that has encouraged them to provide wellness visits to younger individuals in addition to those 75 and older.

Program Focus 

Program Description  

• CRHSS will expand services to include regular Wellness Visits to community members 65 years old and older. Home visits will be provided at least once a month by a community health nurse (CHN) and will include a general overall assessment including vital signs, medical history, home safety checks, nutrition and other assessments. Referrals will be made by the CHN to other appropriate services based on needs identified during the Wellness visit and clients will be supported to navigate these services. For example, mental health counsellor, nurse practitioner, footcare nurse, housing manager and/or patient navigator/advocate. 

Implementation Approach: 

• Wellness Visit Processes: Develop intake, assessment and referral forms to be used by CHN with clients. Information to be documented and used to support clients in navigating required services.   
• Capacity Building Collaboration: Build a group of representatives from different Miawpukek First Nation departments, Elders and youth from the community and outside partners to take part in an Elder Advisory Committee. The committee will support communication with Elders in the community to ensure they are aware of available programs and services in the community as well as regional and provincial opportunities.
• Programming and Community Awareness: Continuously evaluate and adapt the program based on progress and feedback received from clients, Elder Advisory Committee, staff and community members.