Being Least Intrusive emerges from the frontline challenges of practice in responding to situations of abuse, neglect and self-neglect of vulnerable First Nation adults living in on-reserve First Nation communities. It is a hybrid approach, which draws on indigenous knowledge, key concepts from critical social work theory and first-hand accounts of response and prevention initiatives within First Nation communities across Canada. It has been developed to assist front-line service providers (primarily non-aboriginal) in orientating themselves to respond to situations of abuse, neglect and self-neglect of vulnerable First Nation / Aboriginal adults in a way that:
Being Least Intrusive presents a fundamentally different approach to health care service delivery. It challenges front-line clinicians to:
Being Least Intrusive was developed within the socio-legal context of British Columbia’s provincial adult guardianship legislation. However, we believe that the concepts and principles underlying this approach to practice and process of engagement are applicable across jurisdiction and geographical regions.
The following principles and concepts form the foundation of the Being Least Intrusive tool. Responding to situations of abuse and neglect of vulnerable adults is a complex endeavor. In the context of vulnerable First Nation adults, this work presents additional challenges. Integrating knowledge and awareness of the following principles and concepts is critical in assisting clinicians to develop a way of being in practice that facilitates encounters and experiences that reduces risk and vulnerability and protects the dignity of the client.
Embedded in the BC Adult Guardianship Legislation are guiding principles intended to assist clinicians balance the responsibility to intervene, support and protect vulnerable adults with the often competing ethical responsibility to respect and protect an adult’s rights of autonomy and self-determination. Two critical principles are:
Cultural safety, a term first used in New Zealand in reference to health care service with the indigenous Maori people, is an outcome reflected in the qualitative experience of the client. The client determines whether s/he has felt that her/his cultural identity, values and preferences have been respected and taken into account in the care provided and decisions made.
Cultural Safety is predicated on:
Issues of vulnerability and capability are at the heart of adult abuse and neglect investigations and central in adult guardianship and substitute decision-making legislation. They are complex individual and interconnected concepts:
Attention to an adult’s social environment and the factors that contribute to vulnerability is critical in giving meaning to the notion of capability and informing responses that are least intrusive and most effective.
The aboriginal understanding of health and wellness stands in stark contrast to the definition of health in mainstream healthcare. Central to aboriginal worldview is the belief in the interconnectedness of all things in existence; and, reverence for the intrinsic wholeness, sacredness and value of self and others.
Health and well-being is understood holistically across multiple and interconnected dimensions. It is inclusive of and determined by the
connection and balance between and within:
The concepts that define and determine one’s experience of health and well-being include: wholeness, balance, connection or relationships, harmony, healing, learning and growth.
Meaning centered practice is
Inquisitive: clinician engages as ‘humble knower’, curious about the client’s worldview, meanings and lived experience.
Collaborative: engages in a reciprocal process of sharing knowledge and exploring meaning.
Respectful: honours diverse ways of knowing and being; creates space for voice, wisdom and experience of the client to emerge, be heard, be valued and understood.
Critical: clinician engages in critical self-reflection —cultivating an awareness of how social and cultural identity and experience shape knowledge, awareness and interactions.
Being Least Intrusive is a concrete tool that front-line clinicians can use to guide them through a process of critical preparation, assessment and reflection. It is divided into three sections, each with a series of questions that will assist clinicians to develop a critical self-awareness, gather information that will inform a more holistic assessment, and engage with clients, families and communities in ways that are culturally safe and appropriate.
When: : before case work begins
When: prior to engagement with client/family/community
When: over the course of multiple interactions with client and involved family, caregivers, and service providers.
1. How does the client experience his/her own Physical, Mental, Emotional and Spiritual Health?
2. What is the client’s experience of connection and belonging to:
When: after as much information as possible/relevant is gathered
1. What are the specific factors in the following wholistic dimensions that contribute to the client’s strength and vulnerability?
2. How will I distinguish my understanding of health and well-being from those of the client, family, and community?
3. How will I distinguish my values regarding standards of care, family relationships, and physical surroundings from those of the client, family, and community?
When: after intervention; happens over time
1. Was I least intrusive/most effective in my intervention? (e.g. was the client’s autonomy and self-determination respected and balanced against the need for support and assistance?)
2. Was my involvement experienced by the client as culturally safe? (was the client’s cultural identity, values and preferences taken into account in the service encounter; was the client engaged in the encounter; was the client involved in developing a respectful and appropriate support and assistance plan; did the client welcome my involvement; was I invited back?)
3. What did I learn about myself (were my values and assumptions about the situation, client, culture challenged?)
4. What has the feedback been that I have received from the client, family, community, colleagues about the process?
5. How could my practice improve?
Ball, J. (2008). Cultural Safety in practice with children, families and communities. Early Childhood Development Intercultural Partnerships, University of Victoria. Victoria, BC.
Being Least Intrusive
Background to approach in: Struthers, A., L. Neufeld. (2010). Being Least Intrusive: an orientation to practice in responding to situations of abuse, neglect and self-neglect of vulnerable First Nation adults (Working Paper)
Vulnerability & Capability
(2009). Provincial Strategy Document: Vulnerability and Capability Issues in British Columbia. BC Adult Abuse / Neglect Prevention Collaborative. Vancouver, BC.
Adopting a social determinants of health lens, the Assembly of First Nations (AFN) developed a wholistic policy and planning model to highlight gaps in First Nation well-being and identify broader explanatory factors to assist in developing actions and responses to more effectively address and improve the health of First Nation people. Underpinning this model is a cultural framework, based on indigenous knowledge, values and beliefs, that defines health and wellbeing as a integration of ‘total health’, ‘total person’ and ‘total environment’.
Reading, Jeffrey L.; Andrew Kmetic, Valerie Gideon. (2007). First Nations Wholistic Policy and Planning Model: Discussion Paper for the World Health Organization Commission on Social Determinants of Health. Assembly of First Nations, Ottawa, Ont.
Meaning Centered Practice
Janet Clark offers a research based approach to co-creating meaning across cultures. Clark, J. (2006). Listening for Meaning: A Research Based Integrative Model for Attending to Spirituality, Culture and Worldview in social work practice. Critical Social Work, Vol. 7, No. 1.
Abuse & Neglect Tools
Flowchart of Intervention: a graphic mapping of tools and resources within a process of response in situations of abuse and neglect within on-reserve First Nation communities. The process of response itself can be helpful in guiding front-line service providers in their response to concerns of abuse and neglect, as well as assist communities build capacity, identify strengths, resources and service needs, and develop a coordinated, community based response.
In: Promising Approaches for Addressing / Preventing Abuse of Older Adults in First Nations Communities. Available at:
First Nation Re:Act: Assessment and reporting information/ process for investigating reports of adult abuse and neglect, adapted for use with First Nation’s individuals and communities across Canada
The development of this orientation to practice would not have been possible without the direct learning that has emerged from frontline work and the wisdom and knowledge that has been shared by our First Nation colleagues, community leaders and engaged individuals through dialogue and example, in practice and in partnership. We are grateful for the support, guidance, feedback and joint exploration that have come from the following:
While the tool is specifically directed towards non-aboriginal clinicians providing services to vulnerable adults in on-reserve First Nation communities, we have received feedback from a variety of service providers, community agencies and involved community members who are interested in using the tool to enhance practice, build capacity and more effectively and safely engage with individuals, families and communities in their service environments; including: