“No one is going to do it if we don’t.”
This analysis was produced by IFSD to support ongoing research in First Nations child and family services. IFSD's work is undertaken through a contract with the Assembly of First Nations (AFN). The views and analysis do not necessarily reflect the views of the AFN
Dilico Anishinabek Family Care (Dilico) long ago realized that they had to capture their own data to understand and meet client needs. No one else was gathering the data necessary to improve needs-based client supports and services with a focus on their strengths. The focus of Anishinabek people is on the gift and purpose of our people, and not on their deficits. The focus on strengths means being concerned with what has happened to them versus what is wrong with them. Dilico’s approach uses a circle of care of professionals to work with the individual to restore balance in areas of their life that are causing them issues. Gathering information and measuring on terms that support the best interests of the communities served is an approach to improving the alignment of services to needs.
In the 1980s, a group of chiefs from Ontario joined together declaring a problem with the existing child and family services system. They wanted their children back in their communities and they wanted an emphasis on prevention. From that effort, Dilico emerged as a child welfare organization.
Since its establishment, Dilico has changed and grown. When two First Nations-led health and mental health organizations were struggling in the 1990s, Dilico took them over, expanding its mandate. Dilico now has an integrated mandate across child and family services, health, and mental health.
By the numbers
Date of establishment: 1986
Number of First Nations served: 13 (child and family services and mental health), with health services for 9 of the 13 First Nations
Total population served from First Nations served (on-reserve): 4,439
Total population served from First Nations (off-reserve): 9,312
Total population served (Thunder Bay District): 146,862
Total revenues and expenditures (FY 2022-23): $72M
Governance: Board of Directors, with one director appointed from each of the 13 First Nations
Average expenditure per client served by service sector:
Child and Family Services (CFS): approx. $15,000/client
Health services: approx. $1,200/client
Mental health and addictions treatment: approx. $3,700
“No one could ever say we weren’t as good as the mainstream. We do everything they do but in a way that works for people, in a way that gives them what they need.”
Dilico’s approach is premised on addressing the root causes of issues with strengths-based approaches. Fully accredited by Accreditations Canada (with distinctions in various categories), the team works to identify root causes of challenges and supports clients to reclaim their identity, building confidence along the way. Treatment approaches are based on need and link the best of Indigenous and Western techniques. In this model, the focus is on what happened, why, and how can we work through it, rather than Western power approaches that dictate behaviours without understanding why and how they arrived at this circumstance in the first place.
There is a lot of demand for supports and services in Thunder Bay. Most of Dilico’s clients are First Nations or Indigenous peoples that find their way to Thunder Bay through transiency. For instance, some have come to the hospital, having been jailed, released from jail, being excommunicated from their First Nation, do not know how to get home, etc. Addictions are a major challenge (for a sense of scale, there are 13 methadone clinics in Thunder Bay, with a population of approximately 123,000 people).
Dilico offers direct services in communities and supports First Nations in delivering their own services. Most community-led services are addictions related. These services focus on pre-treatment supports, after care, cultural services and land-based services, and community health nurses. To build skills in communities, Dilico offers community-based workers access to their professional training, the same as it offers to its own employees. Supporting this capacity building is job shadowing where community-based workers shadow employees at Dilico’s treatment centre. The on-the-job training supports community-based workers in their service delivery.
Central to Dilico’s approach to service delivery is the individual and relative measure of success. This means that Dilico has a different baseline for every client and works to support and measure against that baseline. There is no universal threshold for success. The approach requires that data is gathered using strength-based tools, mental health measures, and outcomes on an individual basis.
In addictions treatment, for instance, clients are assessed multiple times in their treatment cycle. There are intake and exit assessments that compare changes, strengths-based assessments are done early on so that clients leverage those capacities during treatment. Gathered data is a combination of observational and narrative-based (a mix of quantitative and qualitative) that is leveraged to support individual plans, and aggregated and anonymized to assess overall program outcomes. Working with Dr. Christopher Mushquash (Lakehead University), Dilico analyzes data and makes sense of the changes.
Residential treatment centre
Coming around the bend, you are met with the vastness of Lake Superior on the left and rustling trees on the right. The secluded, quiet location of the treatment centre feels like it could be hundreds of kilometres away from the city centre. A garden of sacred medicines guides your path into the centre and the faint sound of drumming greets you. Asked to wait to respect the privacy and intentions of those in circle, the smell of burning sweet grass fills the space as drumming subsides.
Clean and bright, there are hallways with rooms on either side of the main gathering space that is filled with natural light. The residential treatment facility is home to approximately 20 individuals at a time (plus staff) for 5-6 weeks.
The average cost per client for the full in-care residential program is approximately $13,400. The cost includes:
Clients at the treatment centre vary from those on the streets to professionals, e.g., nurses struggling with addictions. There’s a 90% completion rate of the program with 60% of those that took part continuing on a good path. Success is measured on an individual basis, with no universal indicator of what defines success.
Demand for treatment far outstrips capacity. There were 776 requests for treatment/referrals in fiscal year 2022-2023, with 221 people admitted (squeezing in extra beds to meet demand). Taking the toughest cases is a point of pride for Dilico.
The program is always changing and is adjusted with client feedback, “nothing is ever the same.” There is no cookie cutter approach when the program is designed to meet people’s different needs.
As a central part of the approach, culture is woven into the treatment approach and the physical space it occupies. There are Lodges for sweats and a sacred fire. Walking out onto the healing grounds offerings are laid among the trees with gratitude.
Dilico’s approach to integrated service delivery means that they can integrate problem solving and work to meet people’s unique needs. With expertise and service offerings across child and family services, health, and mental health, Dilico’s employees can “yell down the hall” to build an integrated approach to supporting clients in need.
As an integrated service provider, from the outside, Dilico looks like one large centre. Through a financial lens, Dilico is operating three agencies with funding from different sources. The majority of the agency’s funding comes from the province of Ontario for child and family services, as well as health funding (Figure 1).
The increase in Dilico’s overall revenues is attributable to health services funding (Figure 2), which is awarded based on competition through a request for proposals (RFP) process with Ontario. Often, the RFPs have strict criteria for uses of funds and even dictate parameters of how programs will be delivered by providers, e.g., defining numbers of particular types of employees, maximum salaries, etc. The approach restricts problem solving and the ability to address changing needs by predefining what will be done. In its RFP process, Ontario is procuring for a good rather than a service. If Ontario procured for a desired service, e.g., providing addictions treatment support to Indigenous clients, the service provider could determine how to best deliver by deciding on its staffing complement, salaries, operating needs, etc. Procuring for a service would better align to an integrated mandate.
By contrast, federal funding for Dilico is often received through a block transfer. This means that Dilico can decide on how use the funds in the block to achieve a specific goal. The approach is preferred because it empowers the provider to make decisions in the best interests of the people served, rather than following what can appear to be arbitrary constraints imposed by government.
With most of Dilico’s non-child and family services funding awarded through contracts, the organization often reacts to revenues obtained. This can make long-term planning a challenge. While needs are defined through their own data collection system and changes monitored, the ability for Dilico to align resources and service activities is dependent on contracts and their changes.
Consistent with service-delivery organizations, the majority of Dilico’s expenditures are allocated to salaries, benefits, and training (Figure 3). While child and family services has the highest revenues and expenditures, most costs are attributable to the delivery of the program, e.g., maintenance payments, services for children in care, etc. On a percentage basis, child welfare has the lowest salary, benefits, and training allocation, whereas health and addictions treatment are higher (Figure 4).
For a large, mature, integrated service provider like Dilico, service-based procurement, block transfers, and funding certainty better align to the ever-changing realities and needs for service delivery.
Dilico’s integrated service delivery approach is an example of an Indigenous model that leverages the best of Indigenous and Western practice to meet the needs of the people it serves.
Delivering services in a way that works for people means giving them what they need in a way that suits them. The individual-focused approach means that there’s often no black and white in defining success, “it’s often gray.”
To demonstrate the successes of its approach and outcomes, Dilico gathers and analyzes its own data. Measurement and analysis can be done in a strengths-based Indigenous-led approach to support, sustain, and improve practice.