Prepared by Chloe Straw
Rural & Remote Division of Family Practice
The findings described in this report were collected through a series of in-person interviews that were conducted with clinicians, practitioners and community service providers during the summer of 2015. The following organizations and individuals were consulted:
❖ The Gabriola Health Care Foundation
❖ Gabriola Emergency Social Services
❖ The Gabriola Medical Clinic
❖The Gabriola Health Centre
❖ Gabriola Health Care Auxiliary for Island Health
❖Seniors Outreach Resources Team (IH)
❖ Mental Health Intake Nurse (IH)
❖Community Social Worker
❖ Home & Community Care Program (IH)
❖People for a Healthy Community
❖ The Hope Centre
❖ The Gabriola Arts Council
❖ Gabriola Recreation Society
❖ BC Ambulance
❖ Gabriola Elementary School
❖ Gabriola Midwife
❖ Companions Through Grief Support Group
❖ Gabriola Housing Society
Interview questions were prepared using an appreciative inquiry approach and a S.O.A.R. (Strengths, Opportunities, Aspirations, Results) analysis was used to prepare the following summary of findings. The Community Strengths section describes the community’s greatest assets, as reported by those working in the field. The Opportunities section outlines areas where immediate action can be taken with the resources currently available. The Aspirations section outlines work that is needed that is beyond the scope of current community projects and services. The Results section describes indicators that will act as measures of the community’s success in achieving desired results.
The following is a snapshot of the strengths, opportunities, aspirations, and desired results as reported by those interviewed.
❖ Diversity & quality of on-island services.
❖ Improved access & continuity of care
❖ Commitment to improved communication & relationshipbuilding
❖ Community participation
❖ Ability to innovate
❖ More collaboration & partnerships
❖ Connecting more Gabriolans to resources and services available on-island.
❖ Identifying vulnerable/isolated people through more community outreach
❖ Enhancing Emergency & Crisis Response
❖ Continuing to innovate
❖ Increase access & affordability of services
❖ Develop appropriate, implementable & sustainable housing solutions
❖ Inspire more government participation & support
❖ Facilitate social connection for vulnerable & isolated people
❖ Promote an integrated community care approach to health and wellness
❖ Develop more programs for youth & families
❖ A communication system that seamlessly enables people to connect with the services they need
❖ Social safety net where no one is left out
❖ Suicide rate below the national norm
❖ All those requiring counselling services have access
❖ Access to services for low-income people
❖ Adequate housing for all
❖ Formation of a Health & Wellness Collaborative dedicated to setting and accessing funding for community health priorities.
❖ Safe community for seniors to age in place
Community Strengths in Promoting Health & Wellness
“We are very fortunate to be served by such excellent practitioners—people visiting the island comment on it if they have received treatment here. We regularly host medical/dentistry students who are blown away by the diversity, quality and integration of services offered on Gabriola." -Verna Gregson, Owner/Operator of Gabriola Health Centre
1. Excellent quality and diversity of services available
o The island is served by excellent physicians, three of whom have taken advanced training in Emergency Medical Response,
o Exceptional team-based care that includes GPs, home care nurses and other specialist supports (plastic surgeon, psychiatrist, etc.),
o A wealth of talented practitioners offering everything from Reiki and Feldenkrais therapy to shamanic coaching and medicine horse therapy. There is also a cultural preference towards a holistic approach to wellness, rather than labeling these types of therapies as "alternative."
o Overall, the island boasts excellent emergency response. From the neighbourhood preparedness awareness, training and organization provided by Gabriola Emergency Social Services; to the first responders and paramedics who offer public assists when someone has fallen and can’t get up; to the community built and managed urgent treatment centre and physicians who are on-call for emergencies, Gabriolans are well cared for.
o The island is also served by a variety of private home care workers offering a range of skills for hire.
o The food bank is well run and the school hot lunch program is exemplary in terms of the level of local and nutritious food being served. There is a high level of participation in community gardens and fresh local produce is available for sale year round.
2. Improved access and continuity of care
o Everybody who wants a physician on Gabriola has one.
o More continuity of service in the publicly funded home care support workers and nurses serving the island. Patients now know whom they’re going to see on a regular basis, which has resulted in better patient care,
o The new Community Social Worker is helping more Gabriolans to navigate the broader health and social service systems. Patients now have greater access to health and wellness services and supports through the Island Health sponsored Mental Health Intake Nurse who visits the island once a week.
3. Commitment to improved Communication & Relationship-Building
“We are seeing continued improvement in our relationship with the health system through a focus on structural program collaboration (e.g. social worker being augmented to mental health worker, support for Mental Health First Aid course, etc.). The challenge is to appropriately support each partner, so that our interagency efforts are successful." -Brenda Fowler, Executive Director of People for a Healthy Community
o There have been marked improvements in this area, as exemplified in the excellent interdisciplinary team-based care being provided at both the Gabriola Medical Clinic on Church St. and the Gabriola Health Centre on North Rd. Where appropriate, when a patient is being seen by multiple practitioners there is a dedicated effort for practitioners to consult with one another, resulting in better patient outcomes.
o Home & Community Care workers from Island Health love working with the Gabriola physicians. They have developed great communication, respect and a commitment to working together for the best treatment possible for Gabriolans.
o New informational resources like the FETCH Gabriola website1 will help to promote the wealth of services available on the island.
4. Community Participation
o One of Gabriola’s biggest assets is the wealth of skilled and hardworking volunteers who live on the island.
o There is also excellent leadership within the medical community.
o A strong citizen initiative exists to promote mental wellbeing and respond to mental health and substance use concerns.
o The entrepreneurial spirit of the community seems to be contagious, with leading edge initiatives springing up in just about every part of community life—from solar energy demonstration projects, to multi-generational cooperative farms, social enterprises and recycling centres, artist collectives, and more sustainability projects than can be listed within the breadth of this report. This is a community that designed, planned, fundraised and built its own state of the art medical clinic.
1. More Collaboration & Partnerships
o A push towards more new community partnerships and joint efforts amongst those serving Gabriola will allow for better identification of those being underserved by local health care and social support systems. One example is a partnership between People for a Healthy Community (Gabriola’s only social service agency) and the grassroots Gabriola Housing Society, which is allowing the two groups to share resources in order to support more Gabriolans in securing appropriate housing. At the same time, they are collecting the necessary data to help push policy in this area.
o Ensuring that anyone working in health care and/or social services on Gabriola knows and contributes to new community informational resources like the FETCH Gabriola website will enable the community to keep these resources current. !
o Both items mentioned above will result in better coordination of services on the island, thereby avoiding any unnecessary duplication of services and wasting of resources. Across the board, there is a shared spirit of frugality and of "doing more with less"; no one likes to see resources being underutilized in the community.
o Through a new partnership with the Integrated Health Network, more personal development programs related to stress, food and sleep management will be offered.
2. Identifying vulnerable & isolated people through more community outreach
o Coordinating an effort to identify and support isolated people on Gabriola is a priority for the community. In addition to having an older population,(2) there is also a high incidence of seniors living alone (26.6%)(3) on the island.
o There are different levels of isolation on Gabriola: those with mobility issues who don’t get out much; those who don’t generally leave their homes, but who have regular support come to them (friendly visits, Meals on Wheels, Home Care Nurse, etc.), and then those who have no regular contact with anyone and are complete shut-ins. New strategies are needed to identify and support individuals at every level of this continuum.
o There is no form of adult day care on the island. A study to assess the need for such a program is recommended.
o More low-cost community based programs that support the wellness of all Gabriolans—and especially those who are isolated—are needed.
o Increased transportation support is also needed for those facing mobility issues. A joint effort between People for a Healthy Community and GERTIE, the community bus team, is working to target and better serve isolated people on Gabriola through offering door-to-door bus service to get people to community events and programs.
o Several volunteer initiatives to support those with mobility or transportation challenges (Drivers to Doctors, Seniors Link, Transportation Tuesdays) also exist, but could be better utilized. Improved communication networks across organizations and new community tools such as the Fetch Gabriola website will help to target isolated community members in order to connect them with these services.
3. Connecting more Gabriolans to resources and services available on-island
o By ensuring that all those working in health and social services on Gabriola have access to a comprehensive listing of the services available, we expect to see more people accessing the excellent on-island practitioners and support workers that exist.
o New ways of providing low-cost options must be explored so that low-income people can receive the supports they need without local service providers and professionals having to offer their services at a discounted rate.
4. Enhancing Emergency & Crisis Response
o The increased threat of forest fires in the summer of 2015 caused many residents to question their own level of emergency preparedness and disaster resiliency. The island is well served by excellent emergency response personnel, but personal responsibility and self-sufficiency are also paramount. More training and awareness raising will help more Gabriolans to take this important step. There are several groups, such as the Gabriola Agricultural Society, The Commons, and the Gabriola Grows campaign that are working to increase the amount of food produced on Gabriola. This is an area of opportunity for more community collaboration and support.
o In terms of crisis response, because there are limited mental health
resources available on the island, the local paramedics and first responders often end up on the front lines of mental health-related crisis. Though more mental health training has been offered to the local crews, it is clear that more professional and community supports are needed as this is beyond the scope of their jobs. During a recent Mental Health First Aid workshop, a list was taken of community members willing to form a mental health community response team. With some coordination and leadership, this group could be activated.
o There is a demonstrated need for low-cost and/or free crisis counseling that is offered on-island.
5. Continuing to Innovate
o As mentioned above, Gabriolans aspire to—and are demonstrably good at— innovating. Gabriolans want to and will innovate; however, even with tremendous volunteer commitment, new projects require start-up capital. As such, there is a real risk of “fundraising our community to death,” as one interviewee put it. Gabriola is both the poorest and the most educated of the Gulf Islands, according to the average annual income and average educational attainments listed by Stats Canada.(4) Gabriola does not have its own local governing body and only a handful of groups on the island have non-profit status. As such, conventional funding streams can be hard to reach and new sources of funding must be explored.
1. Increase Access & Affordability of Services
o The cost of private services is a barrier for a broad portion of Gabriola’s population. Both practitioners (psychologists, counsellors, RMTs, etc.) and the Mental Health Intake Nurse spoke to the frustration of having so many qualified practitioners on the island, but of those requiring their services (especially counselling) not being able to afford them. Practitioners are left in a difficult position where they must choose between offering a sliding scale of fees for service or turning clients away. Added to this, many of the free or low-cost services that are available in Nanaimo require significant travel (i.e. not walkable). New strategies are needed to allow Gabriolans who are low income to access Gabriola-based services that will support their health and wellness.
o Ferry wait times present a recurring complication for clinicians coming from off-island to support and treat Gabriolans. It was suggested that a petition of support be available at both medical clinics on Gabriola to ask community members whether they would support giving priority boarding for clinicians and support workers coming to serve Gabriola.
2. Developing Appropriate, Implementable and Sustainable Housing Solutions
“The largest gap, in my opinion, is our inability to deal with the housing issue, both for those who own their own homes and who are moving in to their senior years without family support and those who are currently under-housed. Our inability to solve the housing issue is huge. Municipalities within our country have stepped up to the plate to address their communities' housing issues, we have not done that." -Brenda Fowler, Executive Director of People for a Healthy Community
o Many Gabriolans, committees and community organizations have flagged housing as the most pressing matter facing the Gabriola community. "It’s a governance issue," said one interviewee, "the Islands Trust, as a governing body, needs to decide to tackle the housing issue on every island. It needs to put programs and policies in place that are intergovernmental and supportive of local island communities." Having recently elected two new trustees to represent Gabriola on the Islands Trust, Gabriolans are hoping for progressive new policies and strategies in this area.
o There is no assisted living facility available on Gabriola. With such a large senior population, it is recommended that options for developing such a facility be explored.
3. Inspire more Government Participation
o Many community members find the role of the Islands Trust and Regional District of Nanaimo (of which Gabriola is a part) as the main local governing bodies to be fairly limited. There is an opportunity to work with the Regional District and Islands Trust to engage them in participating in building new supports for Gabriola.
o Several high profile consultants who live on the island have taken it upon themselves to undertake research and analysis to address the local information deficit and support efforts to advocate for more governmental support.
4. Facilitate Social Connection for Vulnerable & Isolated People
o There has been great success with grassroots, community-based initiatives like the Companions Through Grief, Caregivers Support, Cancer Support, and Compassionate Connections groups in providing a safe space for people to connect with peers in their community. Some have expressed concerns that the waters are sometimes muddied in terms of when a clinical referral is needed and where liabilities lie in offering this more informal type of support to people who may be high risk. More awareness raising, through seminars and trainings like the Mental Health First Aid course, would be highly beneficial.
o The work of Village Vision, a multi-year community project to develop a new plan for the village core, is exploring how physical infrastructures in the Gabriola village could be re-designed to facilitate more social interaction.
5. Promoting an Integrated Community Care Approach to Health and Wellness
o The Rural & Remote Division of Family Practice has established the Gabriola Chapter with the primary goal of improving primary health care on the island. Within a short span of time, this initiative has resulted in important new supports for Gabriola including a community social worker and an opportunity to host a new community collaboration for health and wellness to set priorities and coordinate collective action.
o There is a strong desire for the community to move towards integrated community care, with many practitioners enacting this approach in their own private practices. Broader education and support for this approach paired with meaningful new collaborations built through the Community Collaboration, will allow for the creation of a new norm for how the local Gabriola health care system operates.
o More resources are needed to help support this shift, but the potential to ensure better health outcomes for community members is undeniable. Several new community resources have been proposed in this vein, including a monthly support/education group for people living with diabetes and a rehabilitation centre, where community members could go to do their rehabilitation exercises and receive support from a physiotherapist, occupational therapist or chiropractor.
6. Supports for Families
o There seems to be an insufficient supply of affordable childcare on the island, partly due to the inability of local service providers to predict the level of demand. The resident midwife reported that she sees many pregnant mothers who struggle to maintain good health during their pregnancies because they do not have adequate support in caring for their other children.
o Approximately 1/3 of participants at the local Food Bank are low-income families and they tend to be long-term and repeat participants. This summer, children were in attendance of every soup social hosted by People for a Healthy Community.
o Many of those interviewed expressed a desire to see the community move towards being more “family friendly.” Due to the older median age on Gabriola, the particular needs of families can sometimes go overlooked. Small measures such as offering childcare (by donation) at community meetings and events or planning events earlier in the evening could go a long way to making them more inclusive to families. There also seems to be more room— and a lot of support—for intergenerational programs like the Comfort on Computers program that brings local youth and seniors together for technology help.
o There is a further desire to provide more programs and places that are supportive of teenagers, however, with teens making up a relatively small percentage of the population, it is difficult to acquire the funding necessary to develop and run programs and facilities.
“A healthy community has young families that stay to raise their children. This is becoming harder and harder on Gabriola. Improved supports for parents, including child care and employment opportunities would make things easier. ” -Tamara Cowan, Registered Midwife on Gabriola
The following 7 priorities emerged as main themes from one-on-one discussions with clinicians, practitioners and community service providers on Gabriola. They are intended as a jumping off point for further discussion for groups, like the Community Collaboration for Health & Wellness, so that a comprehensive set of community priorities can be established.
1. Formation of a Health & Wellness Collaborative dedicated to setting and accessing funding for community health priorities.
Through the GP For Me program, Gabriola has the opportunity to host a new community collaboration to coordinate a unified effort towards improving primary health care services and supports available on the island. This will address an important gap on Gabriola where there are many dedicated groups doing good work in isolation. Every organization and practitioner interviewed spoke to the importance of such a group for Gabriola. As such, it is expected that the collaboration will boast healthy representation from those groups working in health and wellness across the island towards a robust approach to responding to the needs and opportunities addressed in this report.
2. A communication system that seamlessly enables people to connect with the services they need.
An important function of the Community Health & Wellness Collaboration will be to act as the convener and communication infrastructure for all groups and individuals working in health and wellness on Gabriola. This role will involve developing, promoting and maintaining new communication tools like the Fetch Gabriola website so that practitioners and residents alike know where to go to find up-to-date information about services available.
3. Social safety net where no one is left out.
Through the coordinating function that the Health & Wellness Collaboration will perform, island-based organizations will be able to support one another and share information towards targeting vulnerable and isolated people. This improved communication will serve to extend, evaluate and strengthen the social safety net that currently exists on Gabriola.
4. Suicide rate below the national norm.
The Rural & Remote Division of Family Practice, Island Health and the many dedicated health and social service providers of Gabriola have provided crucial support in identifying the root causes of the community's staggeringly high suicide rate.(5) Building on these supports, the Community Health & Wellness Collaboration will be able to leverage the research and outreach that has begun in order to set concrete next steps in promoting mental health and wellness and effective crisis response for all Gabriolans.
5. All those requiring counselling services have access.
By working with the provincial health authority and local service providers, the Community Health & Wellness Collaboration can also explore ways of addressing the barrier of cost for counselling services to ensure access for all Gabriolans.
6. Adequate housing for all.
Organizations like People for a Healthy Community and the Gabriola Housing Society have contributed important research and advocacy in this area and have succeeded in placing the issue as a top priority for the community and for the Islands Trust. These and other groups will continue to work towards achieving suitable and sustainable housing options that “cost no more than 30% of a household's gross income in rental and/or maintenance fees” for those households with incomes “at or below 60% of the median household income for Gabriola.”(6)
7. Safe community for seniors to age in place.
The benefits of aging in place are well documented. With the necessary age-friendly provisions in place (assisted living, adult day care, appropriate and affordable home and health care supports, etc.), more residents will choose to live out their final years on Gabriola.
1 Fetch Gabriola is an online directory of health and social services available on Gabriola.
2 The median age on Gabriola is 57.3 compared to the provincial average of 42 (Statistics Canada,
3 From “Gabriola Island Community Backgrounder” prepared by Wave Consulting Ltd., June 25, 2015.
4 Statistics Canada, 2011 Census.
5 There have been 8 reported suicides on Gabriola since 2012.
6 Gabriola Official Community Plan, section 1.4.
See the PDF document for the formatted appendix including a table that lists the resources that exist currently, as well as those that are needed in order to address the health and wellness needs of the residents of Gabriola.