Virtual Indigenous Health and Substance Use Service

You mention continuity of care and the pre-reading article discusses relationality challenges of virtual care. The goal of this program is to link virtual care while in prison with community care upon release. How can you ensure that trust is maintained during this transition while the counsellor or addictions support with Corrections is a different person than the support provided by FNHA’s Virtual Substance Use & Psychiatry Service?

Great answer relating continuity of care to the process and not the individual provider, which is not realistic. Also, she stated sharing care plans that are culturally inclusive and not just clinical. She stated “it’s about not having the individual re-telling their story,” which I believe captures the concern of continuity really well and succinct. She mentioned linking care with elders from the band when able, which meets my other concerns about not generalizing all Indigenous care and relating to specific cultural traditions, languages, etc.

Thorough identification of possible challenges and barriers of both virtual care and in this population and environment. Some of the challenges are built into the implementation – i.e. installing secure telehealth pods to address the physical environment and risk for breech of privacy and training staff and Indigenous navigators to ensure sustainability through including Indigenous people in the implementation.

1. • How will you address rural broadband and equipment gaps? Considering the intersectionality of social determinants on the individuals released from prison – Indigenous, mental health/substance use disorders, poverty, unemployed, these gaps will potentially be large and could result in failure of patients to be followed by the supports post-release.
   • You mention training and preparing staff to support virtual care in custody. How will you ensure that you can gain corrections staff buy in? Change management is difficult, and I imagine it would be particularly difficult with corrections staff considering the environment and occupational difficulties they experience. Some details on building cultural safety and how this education could look would be beneficial to ensure that the program is successfully initiated.

• Virtual care with elders – consider band-specific supports. Find elders with the same traditions, language, and culture as those who are imprisoned.
• How will the transition of support be logistically accessible upon release from corrections? Appointment may be arranged before release. Recruit a community local to the individual where a liaison can assist with connectivity, private environment, etc.
• Geography? Connect someone local with them virtually and have hybrid model. Virtual support can be offered in prison, and peer support, local counsellors, or elders assist with the transition.