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Making Space project reflections: Improving clinical services for Indigenous people

Approximately 5.9% of the population in British Columbia identify as Indigenous, however data from the BCCDC STI Clinics show that less than 1% of clients identify as Indigenous when accessing services. Making Space is a Quality Improvement project initiated by BCCDC Clinical Prevention Services (CPS) that seeks to improve the appropriateness and accessibility of clinical care for Indigenous people.

Project partnerships between BCCDC CPS and Indigenous groups, including Yúusnewas (YouthCo), the Chee Mamuk Program (BCCDC), and the Provincial Health Services Authority (PHSA) Indigenous Health were formed in February 2019. Clinical services that were reviewed through the Making Spaces project include the Provincial STI and Bute St clinics in Vancouver, Online Sexual Health Services (GetCheckedOnline and SmartSexResouce), and the TB clinics in Vancouver and New Westminster.

Early stages of the project focused on creating a working group, a project plan, a monthly staff education series on cultural safety, baseline surveys for clinic walkthroughs, and a literature review on culturally safe best practices. In summer 2019, the team facilitated interviews and process mapping sessions with staff members to identify barriers within BCCDC’s process, policies, practices, and physical spaces. Indigenous community members were invited to attend clinic walkthroughs where they evaluated BCCDC’s physical and social spaces for accessibility and cultural safety. Project findings were recorded and analyzed, resulting in a final report that identified more than 100 barriers to achieving cultural safety. Some examples include:

  • A clinic space cannot be Indigenous friendly if it is not also family friendly. Clinic spaces should provide basic childcare amenities, such as toys and change tables.
  • Ethnicity questions on clinic intake forms are associated with stigmatization and mistreatment of Indigenous people. As such, these questions need to be carefully and thoughtfully approached with rationale provided to clients explaining why questions are being asked.
  • Visible signage near the clinic location is important to increase accessibility. Lack of directions and poor signage can create unnecessary confusion and frustration.

Making Space will inform a process moving forward for obtaining ongoing feedback from clients and promote more meaningful patient engagement. CPS will also be working to enact changes based on recommendations from the final report.

Acknowledgements: Jillian Arkles Schwandt, STI Services Public Health Manager & Lauren Allan, Clinical Prevention Services Operations Coordinator, BC Centre for Disease Control