PROMISING PRACTICES
A Podcast about Mental Health and Addictions

Episode 13: British Columbia

Episode 13: Designing and Delivering Effective Online Services (BC)

June 16, 2021 – This podcast shines a light on two innovative programs in British Columbia: the First Nations Health Authority’s Doctor of the Day program, and Foundry Virtual, a comprehensive mental health and wellness resource for youth. These programs demonstrate what is possible when services are designed by and for the people they serve. Both programs are actively removing barriers to care by building better relationships between clients and their care providers and embracing digital innovation in service delivery.

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Episode Notes:

Indigenous-specific resources

  • KUU-US Crisis Response Services – call 1-800-588-8717 for culturally-aware crisis support for Indigenous peoples in BC
  • Métis Crisis Line – call 1-833-638-4722
  • First Nations and Inuit Hope for Wellness Help Line and Online Counselling Services – call 1-855-242-3310 or visit hopeforwellness.ca
  • Indian Residential School Survivors Society – call 1-800-721-0066

Other resources

  • 310Mental Health Support – call 310-6789 in BC for emotional support, information and resources specific to mental health
  • Virtual supports during COVID-19 – visit bc.ca/Covid19MentalHealthSupports

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Loretta O’Connor: Welcome to the 13th and final episode of the Promising Practices Podcast. This podcast is an initiative of Canada’s Premiers. The focus of the series is to share the promising practices that are underway in each province and territory. In each episode, we introduce you to experts in the field and tell you about innovative practices and programs. The Premiers’ goal with this podcast is to reduce the stigma associated with mental illness and addiction issues, and to foster a more focused and collaborative approach among provinces and territories.

Today, we are in beautiful British Columbia. Canada’s western-most province is home to a diverse landscape, from the Rocky Mountains and old growth rainforests to six national parks and almost 26,000 kilometres of rich coastlines bordering the Pacific Ocean. BC is internationally renowned for its stunning natural beauty, natural resource and tourism-based economy, diverse cultures, and thriving arts community. BC has a population of over five million people. There are 203 First Nations, 38 Metis Chartered communities, and a large urban Indigenous population.

BC is also considered to be ground zero for Canada’s opioid poisoning crisis, a situation that has only been exacerbated by the COVID-19 pandemic. Since 2011, more than 9,000 British Columbians have died as a result of overdose, and in April 2016, it was declared a public health emergency.

In 2017, BC announced the creation of the Ministry of Mental Health and Addictions, the first of its kind in Canada, and it is through their work to create an accessible, cohesive, and culturally safe system of care that we are able to speak with you today about two exciting new programs aimed at delivering virtual mental health and substance use services to all corners of the province.

I will now turn it over to John Horgan, the Premier of British Columbia.

Premier John Horgan: Greetings everyone. It’s Premier John Horgan here in British Columbia talking to you from the traditional territory of the Lekwungen speaking people, the Esquimalt and Songhees First Nation. I'm delighted to participate in this Council of the Federation podcast to talk about the experiences here in British Columbia, addressing public health challenges and of course, dealing with mental health issues.

Before the pandemic hit, British Columbia had been making progress. We were the first province in the country to appoint a Minister responsible for Mental Health and Addictions, and we had seen a decline in deaths month after month as a result of a toxic drug supply, not just here in British Columbia, but indeed, around the world. When the COVID-19 pandemic hit in the spring of 2020, BC was already four years into a different public health emergency, the opioid crisis. At the time, we were making headway on reducing opioid-related fatalities. The number of opioid overdose deaths had decreased month after month, and we were saving lives.

But tragically, the pandemic interrupted that progress. Measures like physical distancing, and closing BC’s borders, were essential to protecting people from the virus, but they also had a terrible unintended consequence: the illegal drug supply on the streets became more toxic than ever before, and virtually overnight, the progress we had made was reversed. Provincial overdose numbers began to spike again, and Indigenous peoples were disproportionately affected. Today, far too many families are grieving the loss of a loved one as the result of an overdose.

The need is clear. That is why we are redoubling our efforts to address this crisis, to save lives, and get people the help that they need. A little more than a year into the pandemic, we were seeing the tide begin to turn again. There were positive changes underway. The pandemic has required new ways of delivering mental health and substance services. For example, virtual and telehealth care are providing more options for people in rural and remote communities to get the services they need.

In April, we took another big step forward; we're making the largest investment in mental health and addictions in BC’s history – nearly a half a billion new dollars put into the budget to make sure we're providing the services people need in their communities. Funding will directly support our 10-year plan, A Pathway to Hope. This is a roadmap to creating a better, more accessible and culturally safe system of care for mental health and substance abuse. These funds will accelerate the response to the overdose crisis, while building the mental health system that British Columbia's most important vulnerable populations need, and of course, deserve.

Today, I'm joined by my friend and colleague Sheila Malcolmson, the Minister of Mental Health and Addictions here in BC. Sheila stepped into this role last October, just as the second wave of the pandemic was surging here in British Columbia. The impact of COVID-19 on people's mental health has become crystal clear since then, and Sheila is a true advocate and champion for mental wellness and substance use care. I know we both are inspired by what we've heard from people in BC, and from people around Canada. It's great to be part of this podcast to learn from one another, and to share what's working here in BC.

Minister Sheila Malcolmson: Thank you Premier. I'm Sheila Malcolmson, British Columbia's Minister of Mental Health and Addictions. Our province was hit early and hard by the overdose crisis. Premier Horgan knew how important it was to have a single point of accountability for coordinating mental health and substance use care. When the Premier created this ministry in 2017 it was a Canadian-first, built on the principle that mental health should be treated with the same urgency, care and resources as physical health.

Just like the two programs we're featuring today on the podcast, our Ministry has been a catalyst for changing a fragmented and inaccessible system, changing the way we view mental illness and addiction, and changing the way we treat vulnerable people and communities in our province. There is no one-size-fits-all solution to mental health and addictions. That's why so much of our work is focused on creating access points to connect people to the services they need. We understand that what works for one person may not work for another, so options are key.

Like so many Canadians living outside urban centres, British Columbians in rural, remote and Indigenous communities have unique challenges accessing culturally safe mental health and addiction services. One of the many ways we're working to address these barriers is by investing in innovative technology to provide people with free, user-friendly access to reliable information-screening tools and psychological supports.

Today, we're focusing on two key partnerships, and how their services have evolved to fill the virtual space, meeting people where they're at. Our Ministry continues to be a leader and changemaker in the landscape of Canadian mental health care. Let's shine a light on two innovative, first-of-their-kind BC programs: the First Nations Health Authority’s Doctor of the Day program, and Foundry Virtual, a comprehensive mental health substance use and wellness resource for youth ages 12 to 24 and their caregiver.

Strong Indigenous partnerships and Indigenous-led solutions are central to how we approach policy planning and operations in our Ministry. Our relationship with the First Nations Health Authority is integral to that. The way they're creating culturally safe spaces for Indigenous people in BC to access informed care is innovative and inspiring. And just as the First Nations Health Authority has found success in an Indigenous-centric approach to care, Foundry is youth-centric.

Foundry is creating a thriving province-wide network of hubs offering accessible supports, services and programs that cater to the unique needs of young adults and youth in BC. By supporting young people to get the help they need early on, we can prevent small problems from turning into something more serious down the road, ultimately lessening pressure on the system long-term. I'm honored to share with you the incredible work being done through these two organizations and the life-changing, often life-saving, impact they have on British Columbians every day.

Matthew Kinch: Thank you to the Premier and Minister for that introduction. My name is Matthew Kinch, and I'm the Senior Director for Indigenous Partnerships and Wellness with the Ministry of Mental Health and Addictions, and I'll be hosting this podcast today. Before we get going, we want to acknowledge that, after the recording of this podcast, we received the tragic news of the discovery of 215 children found buried on the grounds at the former Kamloops Indian Residential School. This is a reminder of the continued impacts of colonization on Indigenous peoples, their families, and communities.

While we're talking today about two mental health and wellness programs, if you or a loved one are in need of immediate supports as a result of this news, there are resources available to you. There are dedicated resources for Indigenous peoples to provide culturally safe support during this difficult time, and resources and information for non-Indigenous peoples needing some support, all of which we've linked to in the podcast notes.

To start this podcast, we are joined by the First Nations Health Authority. For the past decade, First Nations in BC have led a process to reclaim their decision-making and authority over health and wellness. Through a series of political and legal agreements, the province of British Columbia is working with BC First Nations and the Government of Canada to eliminate inequities in health care. In 2013, this work culminated in the transfer of federal health programs and services to First Nations control through a new First Nations Health Authority.

The First Nations Health Authority is the first and only province-wide health authority of its kind in Canada. This arrangement recognizes that First Nations communities in BC are in the best position to make decisions about the health and wellness of their people. The First Nations Health Authority’s new, virtual Doctor of the Day program enables First Nations people with limited or no access to their own doctors to make virtual appointments. The intent of this program is to enable more First Nations people, and their family members, to access primary health care closer to home.

This program now includes the First Nations virtual substance use and psychiatry service, that provides individuals with access to specialists and addictions medicine and psychiatry, as well as mental health and wellness care coordinators. Today, I'm joined by two people from the First Nations Health Authority who have been leaders in this space. First, Dr. Terri Aldred, who is the Medical Director for Primary Care, and second, Megan Hunt, who is the Acting Executive Director of Primary Care and e-Health. Thank you so much for joining me today.

So, Dr. Aldred, we talk a lot about the health system, and really how it's not necessarily served Indigenous peoples all that well. And I don't necessarily want to start with a deficit-based discussion. But for those that are less familiar, can you talk about some of the unique challenges and barriers that First Nations people are likely to encounter when accessing primary health care services?

Dr. Terri Aldred: Yes, thank you. So, for First Nations, or really all Indigenous people, there is a legacy with colonization and colonialism that has built up a significant mistrust for First Nations populations when accessing care. And that's due to the legacies of the residential schools and the nutritional experiments that went on in those institutions, TB hospitals and other Indian hospitals that also had experimentations, including vaccine experiments in them, as well as forced and coerced sterilization of Indigenous women. And this has led people to fear going into places like hospitals or other institutions, because historically they were not institutions that conferred healing for Indigenous people, but in fact, were places of essentially cultural genocide and actual genocide, as well as trauma, and a lot of people do experience re-traumatization when they access care. And, so that's the kind of historical context. And so, as people are coming to access care, when they're feeling already that lack of trust, and they may already be feeling triggered or traumatized, then they encounter the fact that colonialism is ongoing, and they suffer from systemic and interpersonal racism, and other biases. They often enter spaces that don't feel culturally safe to them and receive care that doesn't incorporate Indigenous ways of knowing and being, traditional healing practices, or use of holistic healing lens. And so due to that, oftentimes, encounters continue to be traumatizing or don't meet the needs for Indigenous or First Nations people.

Matthew Kinch: And you talked a bit about Indigenous ways of knowing and being, and I'm wondering if you can talk about the First Nations perspective on health and wellness and why that's so important in the design of primary care programs.

Dr. Terri Aldred: Yeah, so thank you. Designing primary care programs that are designed to incorporate and include culture as part of the healing practices are really important, a) for comfort, to design spaces that are culturally safe to train staff, develop cultural awareness and humility so that they can provide more culturally safe care is really important, but it's also really important to incorporate culture as in incorporating elders, traditional knowledge keepers and healers, into the care team. As those individuals often understand the historical context, oftentimes the community have familial context, to be able to help provide a more holistic style of care that really looks to address the physical, spiritual and emotional well-being of our patients. In the more Western constructs, we usually focus a lot just on the physical manifestations of disease, but in our traditional ways of knowing and being, we know that oftentimes, the physical aspects of disease are kind of the late stage or the end stage. And oftentimes, there are spiritual and emotional factors underneath that also need to be nurtured and healed in order to have a really good outcome. And with a more holistic lens, it's really important to think of care in terms of a community, and having a community of care providers, to really be able to provide wraparound care and services that are not just culturally safe, but also trauma-informed, given the significant impacts of intergenerational as well as personal trauma histories that could really impact their health and well-being.

Matthew Kinch: And Megan, you know, we're hearing a lot about the context in which clients are interacting with the healthcare system, and I'm just thinking about when someone is ready to pick up the phone, or they go online to access this service. Can you tell us about what makes the First Nations virtual Doctor of the Day and the virtual substance use and psychiatry service so unique?

Megan Hunt: Absolutely and thank you for that question. You know, the First Nations virtual Doctor of the Day program and the virtual substance use and psychiatry program are unique. One, because it's been designed and operated by and with First Nations across BC, but also because of the way in which the program can be accessed. And so, we use the Zoom platform. It's easily used from the comfort of an individual's home or their health centre, or other area that they feel comfortable in. We are staffed with Medical Office Assistants who meet the patients virtually to gather information and set the stage for their comfort and their appointment. It's very patient-centered, we take a holistic approach, and we ensure that there's enough time for patients and providers to really interact in a way that meets the patient's needs. And so, there isn't a restraint or a constraint in terms of the length of time for appointments. We have a focus on principles and practices of cultural safety and humility. The program runs seven days a week, including holidays, and so it makes it really simple and accessible for community members to access. We take a wraparound or a team-based approach with both of the programs, and so we look at the individual as a whole and look to be able to wrap around other services, including traditional wellness services as well to support a patient across their continuum or their journey of health and wellness. We work with local, and community supports and practitioners.

We have a selection and screening process that was developed to ensure cultural safety of practitioners in the program. Roughly 40% of the physicians and specialists in our program are of Indigenous descent. Many of our doctors are already working with communities on the ground and have a connection not only to the community, but to the local and regional pathways of service. And so, it makes it a really appropriate and community and First Nations-driven program that makes community members feel at ease when they're accessing the program. We have an evaluation framework, and we've also created with Dr. Aldred, a safe space framework so that individuals can provide us with feedback, whether that's through complaints, or whether that's through compliments, so that we can continue to improve the program.

Matthew Kinch: So, picking up on that last comment about evaluation and complaints and compliments, and I know this is a relatively new service in the province. But can you tell us more about what the data is telling us as far as who is accessing these services?

Megan Hunt: Yeah, absolutely, and that's a great question. The program's been running now for just over a year, and so it’s given us the ability to really look at and understand the landscape of access: who's accessing the program, what parts of the program are being accessed at the highest, and the different areas or regions that are accessing – age, gender, those kinds of things.

And so, in the First Nations virtual Doctor of the Day program, for example, we've seen over 7,000 individuals within the program, with folks really spending more than 20 to 40 minutes with our practitioners engaged in conversations that are really focused on one, developing a relationship, and then from there, understanding all of the different components of what brings an individual to the Doctor of the Day program, and what other services may be important to them. We see many of our status and non-status First Nations community members accessing the program, along with their family members, who may not be First Nations but are attached to an Indigenous family. We're also seeing many of our other Indigenous groups, Métis individuals, that are also accessing the program. We see that our most remote communities, but also our very urban-centered individuals are accessing the programs at very high rates. And so, what we're recognizing is that, although remote often has significant access barriers to service, we're also seeing that in very urban centres as well. And so, there's a nice compliment between our rural and remote or isolated communities, and our urban centres.

And when we think about the addiction medicine and psychiatry program, we've seen over 2,000 patients since that program started as well. And that program really spends a tremendous amount of time with individuals that are usually around an hour to an hour and a half of time with our practitioners, but also supported by care coordinators that help to then link individuals back into other services that really wrap around a holistic approach to supporting community members, and then linking between the First Nations virtual Doctor of the Day program, as well as the Substance Use Program, so that there's continuity of care, but also coordination and supports to other health and wellness services. And then that communication plan, or that communication approach back to different primary care homes, or health and wellness support services that an individual is also connected into.

Matthew Kinch: And Megan, just building on that, and I think acknowledging the unique role that the First Nations Health Authority has within the provincial system, can you just talk about how the First Nations Health Authority is working with communities to innovate in primary care and mental health and wellness services more broadly?

Megan Hunt: Yeah, absolutely. You know, it's such exciting times, because the foundation that First Nations have really built over the last several years, to be in a space now where really maximizing on the opportunities, although COVID has been a really challenging time. The footprint that First Nations have created has really created an opportunity to advance very quickly a number of primary care and mental health and wellness areas, to support our First Nations communities. And so, things like what's called the real time virtual support pathways, which works alongside the Doctor of the Day and the Addiction Medicine Psychiatry Program from a provincial perspective, that creates peer to peer supports. So, physicians, nurses, nurse practitioners and other allied health professionals can access advanced support services from other disciplines to help support patients and community, especially if they're critical or waiting for transportation out of community for higher levels of care.

We also have regional and community and nation-based approaches to really understand and support those unique developments of models of team-based health and wellness services that build upon the strengths of the culture and the richness of community, that is very different or can be different from other areas within the province, or Western approaches to health and wellness. And then of course, more recently, the 15 First Nations-led primary care centres that the First Nations Health Authority is in partnership with the Ministry of Health on across the province that will then integrate, but also network with the primary care networks across the province, as well as other primary and specialized care from an integration, collaboration and coordination perspective to better support First Nations people on their journey and in their pathways of care, but also to ensure that there's stronger embedment, or alignment of culturally safe practices, within each of those entry points across an individual's journey.

Matthew Kinch: So, Megan, in designing this program, we talk about the importance of bringing community voice into this process. Can you talk about the community of practice and what that means for communities, and I think what that means for embedding cultural safety and humility into the program more broadly?

Megan Hunt: Absolutely. You know, one of the things that was really important to us as we built the virtual pathways for both the First Nations Doctor of the Day, but also the addiction medicine and psychiatry pathway, was to really bring a community of practice together that brought that very local-level community voice, the regional-level voice, and then of course, that provincial-level voice together with the ability to build capacity to do knowledge exchange, to create an environment of education and training, and planning and advancement of both pathways.

And so that includes folks that are traditional wellness providers and healers, maybe Health Directors, or mental health and wellness staff, physicians, as well as the psychiatrists, and so, blending the richness of the different areas of knowledge and experience to really help to shape and advance the pathways that are at play now, but also to be able to do future planning, and also to upscale or increase the capacity and skills that each of the different disciplines, or staff or individuals who are supporting health and wellness at the community level, have the opportunity to share those experiences and their skills and build capacity together, because we know that it takes different approaches, and that each community has different levels of capacity, and this is one way to really strengthen capacity through leveraging and using a community of practice approach.

Matthew Kinch: Dr. Aldred, do you want to build on that?

Dr. Terri Aldred: Thank you, and thanks for that Megan. So, other ways that we have built in the cultural safety and humility into our program is through work with the physicians including incorporating into our selection process, screening physicians who demonstrate cultural safety and humility in various ways, who have had experience with Indigenous communities, and other such factors that we felt would make them a good fit to work in our communities. In addition to that, we also provide ongoing knowledge translation and continuing medical education (CME) opportunities for the physicians to help build their skills around anti-racism, cultural safety and humility, as well as communication skills and other skills to help them in the work that they do with our patients, and we really aim to incorporate that community voice. And we do have regular provider meetings, and in that we have invited elders and other knowledge keepers as well, to help come in hold that space as equal partners in this work, and I think some of the exciting initiatives we're looking at moving into the future is to widening our care team in the virtual pathways to include traditional healers and/or elders, as well as clinical counselors and things like that. And so, there's a number of ways that we try to incorporate it from the selection process, but also building on the skills over time, realizing that cultural safety or developing those awareness and humility takes time, and it's a journey that we're all on.

Matthew Kinch: And Dr. Aldred, I'm thinking about where you go with this program from here. And I know we're all looking forward to that post-pandemic future, and you've built such as solid foundation through this new service. And I know looking at health and wellness outcomes is a long-term endeavor, but can you tell us more about what this program means in terms of supporting a shift in health and wellness outcomes for First Nations people in BC?

Dr. Terri Aldred: Yeah, thanks so much. I think one of the things that I've noticed is that when people access our virtual pathways, for example, we've been getting a lot of feedback, both for surveys that we send out, but also people writing in or responding on social media around both, you know, a lot of compliments, and even people giving us constructive feedback on how we can get better. And I think one of the reasons is that people see this as a program designed by First Nations for First Nations, and it fills people with a level of trust, but also, that they are empowered to help to give feedback to share their experiences, where they may not feel that same empowerment in other care settings.

I think, in addition to that, it has really helped to improve access where there hasn't been, or for people who maybe are unattached to a primary care provider, or who have lost attachment. And so, I think we're seeing people who haven't had much primary care recently, or for quite a long time, starting to access care and to follow up regularly, which I think is a promising trend.

You know, as far as health outcomes go, for sure, it's going to take time. And I think from my clinical work, when we're going into communities that haven't had regular primary care providers and things like that, is that generally speaking, because so much disease or illness may have gone undetected or undiagnosed, sometimes it's almost seen as an increase when really, you're just discovering what has been there already. And I think in this time of the In Plain Sight report, where we're finally acknowledging the level of racism that people experience, that is a significant barrier, as well as the importance of developing cultural awareness and cultural humility in our providers, developing culturally safe spaces that are inclusive of Indigenous people and their voices.

You know, I think we're gonna see a huge increase in people accessing, and hopefully accessing and having better experiences and better health outcomes, which I think is really promising. But it's definitely going to take time, and we're in a period where we've never been before, where instead of having to convince people that there there's a huge need here, and to convince people about the experiences that First Nations people have, that we're finally into a safe, where we're going to be like, where we're working on how we can make it better, on addressing the underlying causes.

And so, I think it's a really exciting time, but I do think that we still have a long way to go. But having those key partnerships with First Nations organizations, communities, and people, and embedding a two-eyed seeing approach with Indigenous ways of knowing and being and culture embedded into primary care services, and really probably all services, is really vital to ensuring that we head off in the right direction.

Matthew Kinch: And I think that's an excellent place to close. And I just want to thank both Dr. Aldred and Megan Hunt for joining us today. And if you want to learn more about the Doctor of the Day, or the virtual substance use and psychiatry service, I would encourage you to go to www.fnha.ca. Thank you so much.

We'll be joined next by Foundry. Foundry is a network of centres and online supports that offer young people ages 12 to 24 integrated health and wellness resources, services and supports. Each Foundry centre offers primary care, mental health and substance use services, peer and family support, and other social services, making it easier for youth to get help when they need it.

Foundry is an important partner to the province, and we are working together to expand Foundry centres across the province. At Foundry, young people can easily access services by walking into a local Foundry centre, exploring online tools and resources at foundrybc.ca, or connecting virtually through our new Foundry BC app.

Today, I'm interviewing three people from the Foundry team. Steve Mathias is the Executive Director of Foundry, Suhail Nanji is the Foundry Virtual BC Operations Lead, and Alicia Raimundo is a Business Analyst with Foundry’s Provincial Virtual Services. Thanks so much for joining me today. I wanted to start off, Steve, by asking you a question. We often talk about the challenges that youth and their families encounter when seeking out mental health supports. Can you tell us a little bit about how the Foundry model addresses some of these challenges?

Steve Mathias: Hi, Matthew, and thank you for that question and introduction. I'm a psychiatrist, and I've been working with young people now for over 20 years, and I think that when we first started to really try to understand why young people were struggling to access services, what we found was that there was often an abundance of services in communities that were available to young people, but that they were really behind individual doors, they were all in in places that were sort of scrambled across the community. And it was really difficult for young people to know where they needed to go.

Further, it often required them to self-diagnose before they actually could get the help that they needed. So, they had to know whether or not they had moderate or severe mental ill health versus mild to moderate. They had to sometimes know whether or not they had anxiety or depression. They often had to know whether or not their substance use was problematic or not. And the reason that was, was that they would often show up at a door and a service and be told that they that they really didn't meet the criteria for the service that was there. So, they were being turned away quite a bit.

We also knew that young people were struggling to access family practice or primary care, often because their family doctors had either retired or were so aged that they really couldn't provide the service that the young people were looking for. So, what we decided to do was really change the model that existed and ask young people what they felt they needed, and really what came out of those conversations was that they wanted one place that they could go to that they could trust, where all those services could be offered under one roof. And that's really where the Foundry idea came to be.

So, imagine a co-op of services in some communities, as many as 15-20 organizations working together in providing care. And not only focused on mental health and substance use, but on most of the key services, either in health or social services, that young people need during that key period of time between the ages of 12 to 24. And so, all our centres offer mental health, substance use, primary care and social services, particularly supportive employment. And now we've been really, really happy to see peer support workers in all our centres: young people with lived experience, trained and giving back, working with other young people coming through the door, so that they can help navigate and support their journey as they come in for help.

So, it's been really a unique journey for us. And the addition of virtual services has really started to address the issue that we've always known, which is that a lot of our bricks and mortar services may not be readily accessible to young people, either because they're too far away, and that might be as little as 10 kilometers away, and it's just too far for them to come. Or because the hours don't work for them, or because they're not comfortable being in a public setting. And so, with COVID, we really saw the opportunity to add virtual care and virtual services. And that's really been an area that we've seen blossom over the course of the last year, and we've had really good feedback on those services.

Matthew Kinch: And I'm wondering, Steve and Al, can you talk about where the idea for virtual Foundry services originated from?

Steve Mathias: I think what I'll start with, was saying that this was something that we had seen emerging in Australia, out of what's called the Headspace model, which is not unlike Foundry, in that these are dedicated bricks and mortar centres for young people, but predominantly focused on the provision of mental health. And Headspace had developed e-Headspace, which was a virtual service that was extremely popular with young people in Australia.

And we had been consulting with them for several years on the idea of providing virtual care, knowing that we have a fairly large rural and remote community population in this province, and that the centres, given that they can take sometimes two, three years to get off the ground, would be likely not in place during their times in need. So, this is something that we started five, six years ago, as a conversation, and COVID really forced us, but I think in a good way to move in this direction. Al, what would you add to that?

Alicia Raimundo: So, something that was really important to me, and kind of my own personal journey was creating the things that I needed to use when I was growing up and being the person that I needed, when I was going through a really hard time when I was younger. And for me, having really, really awesome online supports that are accessible are really important, especially for a lot of young people who feel like their community doesn't really have their back or they're confused about how to access services in their community, or they're struggling with their gender identity or their sexuality, and it's hard to reach out in a small community with those issues, when you know, your best friend's mom might run the local youth centre.

And so, for me, I've always wanted to build something really awesome that was online. That's where my people are, and that's where I have the most passion. And it was also really important that we could offer really amazing services online and in an app that's easy to use and beautiful. And I think there's been other places that have tried, and other apps that have tried, to do similar things. And I think why we ended up being as successful as we have been in having so many users in a short amount of time is that we co-created this app with an amazing group of young people from all over the province who really wanted a service like that in their community, and we really focused on young people from rural and remote areas of the province to understand what would make the Foundry BC app something that they would want to use, something that would bring, be useful for them in their communities and their friends and in their lives. And that's how we ended up with what we have today. And it was an amazing experience just working with young people and working with family members just to build something that meets their needs, and that has features in it that they really want to use. And so that was a really awesome experience. And it really allows me to build something that will work for the young people of today, but also kind of meet my own personal goal of being who I needed when I was younger, and making those services exist. So, the young people today have a have an easier journey than I did.

Matthew Kinch: Building on that last comment, we're just going to cut to a quick clip with Sidney Spence, who is a Youth Advisor to Foundry, who’ll talk more about that.

Sidney Spence: So, speaking as someone in an isolated community, we have so little resources here. And the frustrating thing about the ones that we do is they are primarily open during school hours, which is something I have a lot of students saying to me. I've had the honor of sharing this app with two kids since our public launch, who desperately need it. And it was amazing to see their faces light up. And one of my 13-year old’s, a 13-year-old girl that I shared this with, said “this is so genius.” And I think that about sums it up for me what this app is going to do for communities like mine.

Matthew Kinch: And I'm wondering, thinking about some of the ideas that you touched upon, and I'm wondering if we could go back to March and April of last year, Steve, when the COVID-19 pandemic began. So, all the Foundry centres are having to close their doors because of the public health restrictions. And quite quickly Foundry has to look ahead and start thinking about how those services can be provided virtually. What was your first thought?

Steve Mathias: I think our first thought was: holy cow, like this, this could completely sideline us for months. And this group of centres, so at that time, we had 11 centres, we had just opened our 11th. And they were seeing literally hundreds of people, young people, coming through their doors. I think last year, 2019, we had seen close to 10,000 young people. And we were very quickly overwhelmed by the thought of having all these young people who needed Foundry services not being able to access them.

And unbeknownst to us, our centres rapidly shifted to start providing online services through their own mechanisms. Whether it was through Microsoft Teams or Zoom, they all pivoted within about one to two weeks to provide that care. But what we saw was that there was still a drop-off in the amount of services that young people could actually access, and that we also were aware, obviously, that young people who weren't in the communities where the centres were, were struggling. And a lot of the clinics that weren't Foundry clinics were closing, so public health clinics were closing.

So, we called a meeting of our centre leads and that meeting happened in late March. And we asked folks whether or not there was an opportunity to basically bring all of the resources that they had together, the counseling resources that we had, and could we effectively jerry rig a response so that young people around the province could get the help they needed. And it was an overwhelming response. And it was quite a moment for us because we'd never done this before as a network. But within two weeks, we had created a schedule, a Monday to Friday schedule where counselors were available for young people around the province, we had a 1-833 number, and young people started calling in from communities from where they'd never received Foundry services before. So, it was quite remarkable. And it was from there that we were able to hire up our own clinical staff in June and start to provide the service that you see today.

Matthew Kinch: Linking to that last comment, we're going to turn to a clip from Christine Harris, who's a family peer support worker with Foundry, to learn more about her experience.

Christine Harris: Well, I can just speak to working with one mom that's in the middle of nowhere, literally. I've had one single mom and another family that are in a very remote area, and they have no one, like no one. Without Foundry virtual, they would be getting no help. They actually were going to drive to either Vancouver or Kelowna, and I think it's like a 10-hour drive to either one of them, to try to get help for their, their loved one, the one family. So, the fact that they now can both just be in their own rooms on their phones reaching out and getting the same type of services through the Foundry virtual, it's just amazing.

Matthew Kinch: And I'm wondering too, maybe I’ll turn it to Al and Suhail to comment on this is, you know, knowing that a key objective for Foundry is creating equitable access to care for young people. When you started to deliver services virtually, can you talk about how you addressed some of the technology challenges that folks may have had? I’m thinking specifically, how did you address technology with young folks who may or may not have had access to their own phone or computer?

Alicia Raimundo: Yeah, that's a great question, and I think co-designing this with an amazing group of 20 young people from across the province, with a focus in rural and remote communities, meant that we kind of, were talking to a lot of people who didn't have the best Wi-Fi access, or what we kind of found in talking to young people is that they would have a device of some sort, but it would be old, it might be a family device, and if it was a phone, like a smartphone, then they would maybe not actually have data on that phone.

And so, it was really awesome that we had that Youth Council who can kind of give us a really clear picture into what does their access look like. And because of that, we made sure that the app is something that you can access with very little Wi-Fi, if you have a not super strong Wi-Fi connection, you can access the services. And when you go into an appointment, you have the ability to do video, audio messaging, or a phone call. And, usually, young people find one of those things accessible.

I would also say that one of the things that we continue to work on is, while young people have technology, they don't always have a safe space to be able to take a call. And so, in those situations, we're seeing a lot more messaging appointments that happen, because they don't have any space where they feel like they could talk freely in their home. And so, that's kind of one of the areas we've seen it, but we really did focus on making this app as light as possible, takes as little data and as little Wi-Fi as possible just to get it up and running. And, if technology is a huge barrier to folks, and they can't go to the web version of the app or go download the app, then we have another way of getting them into an appointment. And it's just been awesome to be able to create all of these choices for people to kind of match the situation that they're in.

Matthew Kinch: And Suhail, do you want to add to that, maybe talking about what difference this has made for clients that may be accessing services in rural or remote regions of the province.

Suhail Nanji: Yeah, absolutely. Thanks for that question, Matthew. So, in terms of the data, we're really excited to see that we are reaching young people and caregivers across the province, whether it be Prince Rupert, Duncan, urban areas like Vancouver and Surrey, all the way down to Revelstoke. And what's pretty exciting as well, in terms of getting some client base, client survey data, we know that 32% of our clients who access our services, say they would have gone nowhere if our services didn't exist.

Matthew Kinch: We can turn it to Al now, and Al maybe you could just talk a bit about, you know, given that this service is only a year old: what would you do differently if you knew what you know now?

Alicia Raimundo: I think if I was recreating the service today with all the information I've had for the last year, I think I would be really wanting to make sure that we continue to strive for a program that's accessible to young people across BC, that we know that we can deliver really amazing services online that young people want. One of the cool things that happened during COVID, which is weird to say, is I had been working in e-mental health for 10 years, and I was having the same conversations every single day with service providers who didn't believe you could do good services online. And it was cool with COVID because everyone kind of figured it out and was super-innovative and didn't want to stop offering services. So, they figured out how to do it online and, and I'm really glad and I hope we can keep that energy going forward.

Matthew Kinch: And maybe Steve, as we all look ahead to the post-pandemic future, I'm wondering if you can talk about how the pandemic has really accelerated the adoption of technology, and what are your plans for the future when it comes to these services?

Steve Mathias: Well, I don't know that there's ever been a time, at least in my generation, that we can really look to the old saying that “necessity is the mother of invention,” more so than what we've really seen during the pandemic. I think that we have witnessed significantly, or historically slow government bodies move with incredible speed, to help with partners, such as Foundry, to really accelerate the adoption of new technology, and to even develop new technology.

And it's been really exciting, because we've seen barriers that have been historically in place, kind of break down, and allowed us to move forward. Obviously, there's some checks and balances that are required, but there's been relatively little harm done by us doing this work. So, we're quite excited about where we've gotten to. I think we've had to pivot because with COVID, we had to really focus on virtual care. So, the delivery of virtual service. Now what we want to do is really look at how can an app, a technology that we have, be incorporated into everyday practice in our bricks and mortar centres, so that it can be used to augment already existing in-person services. And so that a young person can really, fully explore their preferences. And that may not be just virtual or just in person, but it may allow them to do both, and shift from one to the other depending on their day, depending on their availability, depending on the week, and what may be going on in their lives. So, what we know is that the more convenient services can be for young people, the more likely they are to access them.

And so, that's really the future for us, is to try to make our technology and virtual care really incorporated into the bricks and mortar services that have existed, keeping in mind that we really want to make sure that we're reaching those young people in rural and remote communities who may not be able to access any service right now, so that's, probably mostly virtual. But that, we also want to make sure that the young people who need to come in for more face-to-face meetings, because they're isolated, are coming in. And so, it's that balance that we will strike eventually. And I think that really is the future of health care for us here, and service provision for young people.

Matthew Kinch: Thanks, Steve. I think that's a great place to close, and I just want to thank all three of you for being part of this podcast today, and for really pioneering services for young people in BC. And for those that are listening and want to learn more, you can explore online tools and resources at foundrybc.ca. Or you can find the new Foundry BC app on all major platforms. Thanks so much.

Loretta O’Connor: Thank you to Matthew Kinch and all the experts and participants he engaged with today, including Dr. Terri Aldred, Megan Hunt, Steve Mathias, Alicia Raimundo, Sidney Spence, Christine Harris and Suhail Nanji.  We appreciate you sharing your views and experiences with us today.

We’ve certainly enjoyed learning more about the First Nations virtual Doctor of the Day program in British Columbia, as well as Foundry Virtual, a comprehensive mental health and wellness resource for BC youth. Both programs demonstrate British Columbia’s leadership in the field of mental health and addictions, and both are excellent models for other jurisdictions to consider.

With this episode, we conclude the Promising Practices podcast series brought to you by Canada’s Premiers. The Premiers’ goal with this podcast has been to reduce the stigma associated with mental illness and addictions, and to tell you about innovative practices and programs underway in each province and territory. I hope we have made some headway in achieving these goals. Special thanks go to Saskatchewan Premier Scott Moe and Yukon Premier Sandy Silver for spearheading this initiative.

Once again, thank you for listening. For more information, we encourage you to check out our website at canadaspremiers.ca.

 

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