Welcome to our most
frequently asked questions
WHAT IS THE ACHWM?
The ACHWM is a self-reported health measure.
WHO IS THE ACHWM FOR?
The ACHWM was created by and for Indigenous children (First Nations, Inuit, and Métis) aged 8-18 years.
Use of the ACHWM is restricted to Indigenous communities (e.g., First Nations, Inuit and Métis) or not-for-profit agencies, whose primary focus is to promote the health and well-being of Indigenous children.
WHAT IS THE PURPOSE OF THE ACHWM?
The purpose of the ACHWM is to provide Indigenous communities or organizations with an overview of the health and well-being status of the children and youth in their communities.
The ACHWM is "wholistic" and is based in the medicine wheel, as it gauges the spiritual, emotional, physical and mental health of Indigenous children and youth.
The ACHWM can be used in 3 different ways.
For Community Health Assessment: To provide Indigenous communities or organizations with an overview of the health and well-being of children in the community.
As a Program Evaluation Tool: Results obtained from the ACHWM can help guide local program and service planning in Indigenous communities or organizations.
Clinical Practice: The results obtained from the ACHWM can also play a role in mental health screening by connecting children and youth to local supports, serving as a catalyst for open and honest conversation. However, it is important to recognize that the ACHWM is not a diagnostic tool.
As the ACHWM is acknowledged by the Chiefs of Ontario, results obtained may also be used to advocate for funding.
WHAT ARE THE CRITERIA FOR A COMMUNITY OR ORGANIZATION TO USE THE ACHWM?
There are two key criteria for use of the ACHWM:
The community must intend to promote better child health and well-being.
The community must have resources in place to support children’s health needs that may be identified through the ACHWM. In addition, a mental health worker or clinician must be available to meet with children immediately after they complete the ACHWM.
WHY WAS THE ACHWM DEVELOPED?
The idea behind the ACHWM emerged from previous research, whereby our team was required to assess a number of Western health measures. We conducted a thorough review of the literature on existing measures and current practices but were unable to identify a measure of health that reflects Indigenous perspectives. Spiritual health is an important component of Indigenous health and well-being that was absent from the Western measures appraised.
It was intended to empower Indigenous children by giving them a voice in their own health assessment.
HOW WAS THE ACHWM DEVELOPED?
The content of the ACHWM was developed through a series of full-day focus groups with First Nations children in Wiikwemkoong Unceded Territory. The ACHWM was then refined based on consultations with Elders, teachers, mental health clinicians, and the recommendations of many children. The final question set was approved by children who participated in the original focus groups.
The ACHWM development process is detailed in an article published in the Canadian Journal of Public Health in 2013, titled: Aboriginal Children’s Perspectives on their Health and Well-Being. (Volume 104, issue 2, pages e136-e141).
The ACHWM was assessed to determine its fit within other Indigenous communities in 2014 and 2015 – including other First Nations, Métis and Inuit populations. After pilot surveys were completed with these populations, a stable and consistent version of the measure was established.
HOW MANY QUESTIONS MAKE UP THE ACHWM?
The ACHWM is comprised of 62 multiple choice questions and 3 open ended questions where children can input their thoughts.
Communities are allowed to add additional questions, keeping in mind that as they add more questions the survey becomes longer.
CAN OUR COMMUNITY CHANGE ANY OF THE QUESTIONS ON THE ACHWM?
We do not recommend changing any of the questions in the ACHWM. However, some of the wording of the questions can be modified to meet the needs and preferences of your community. In addition, there is an option to add new questions to the survey, as well as open ended questions at the end of the survey.
HOW IS THE ACHWM ADMINISTERED?
The ACHWM is administered to children on a Samsung (Android) tablet and takes between 10-15 min to complete.
The ACHWM can be administered at a community health centre, a community event, or within a school or clinical setting.
It is important that the group administering the ACHWM includes a mental health worker that is capable of conducting brief individual assessments on children who may have concerning scores or responses suggesting that further assessment/support is required.
WHAT IS THE IMPLEMENTATION PROCESS FOR THE ACHWM?
Please see the [ACHWM Flow Chart](https://drive.google.com/file/d/1GKvmvg46mg-HmgmRsP7vFytje_rnm5HO/view?usp=sharing) for more information regarding the process of implementation.
ACHWM training is delivered to facilitate the understanding of the ACHWM and how to use it in practice.
DO CHILDREN GET TO SEE THEIR RESULTS?
Yes, the children who complete the survey are given the option to see their results in the form of a medicine wheel we call a BALANCE wheel. This is a complimentary component to the ACHWM app. This was created to help provide a visualization of the results instead of scores. This further enhances the ACHWM by enabling a more holistic conversation by focusing on wellness over illness and talking about the balance of health and how everything is interconnected.
No one beyond the mental health worker and ACHWM facilitator will see individual children’s results, unless the child or parent gives permission do so. If a child’s results are shared with a teacher or parent (without the child’s consent), trusting relationships may be fractured.
For ACHWM results to be accurate, children must provide truthful and unbiased answers. Promising children that their results will remain confidential (unless their clinician would like to share their results with another health care practitioner in the child’s circle of care) is imperative to ensuring that children feel comfortable and safe in providing valid and reliable results.
WHY ARE CHILDREN ASKED TO SPEAK TO A MENTAL HEALTH WORKER AFTER COMPLETING THE ACHWM?
A child’s answers may suggest that additional supports would be helpful to promote their health and well-being. If this is the case, it is in the process and is our responsibility to ensure that the child is connected with someone who can support them in accessing these supports (e.g. referral to a psychologist, community healing circle, etc.)
The ACHWM process requires a brief individual assessment (which must be provided by a mental health worker or health care clinician) following the survey.
In some communities only the children who answer the sensitive questions in a concerning way are asked to speak with a mental health worker, and this is due to the mental health worker resources. Note: If some children are asked to speak with a mental health worker and others are not, there could be assumptions made in relation to the mental health status of those selected. This could exacerbate the stigma surrounding mental health among Indigenous children. Thus, all children are encouraged to speak to a mental health worker regardless of their score or responses on the ACHWM.
WHO WILL PROVIDE ONGOING SUPPORT FOR CHILDREN THAT NEED SUPPORT?
Follow-up support for children must be provided by a local health organization/agency.
Accordingly, a review of local clinician supports is conducted to assess the fit of the ACHWM for implementation within a particular community. This is done to ensure that children in the community are able to access the services/supports needed to improve their overall health and well-being.
I WOULD PREFER THAT MY CHILD NOT SPEAK TO A MENTAL HEALTH WORKER. WHY IS THIS NECESSARY?
We understand that some families may not be interested in having their children meet with a mental health worker. However, this step is mandatory and essential to ensure the safety of the children who complete the ACHWM.
Mental health workers review survey results with children to ensure that they understood the questions. They also seek their feedback on the administration process. If children are upset by the process in any way, we need to know so that we can modify the survey. We do not want to upset children or families.
Mental health workers are also able to provide individual assessments and notify families if any potential health concerns are identified.
WHO CAN ACT AS THE MENTAL HEALTH WORKER TO FOLLOW UP WITH CHILDREN AFTER THE IMPLEMENTATION OF THE ACHWM?
The process of implementing the ACHWM measure with children and youth involves a brief follow up following the survey to identify if the youth is in the need of further support. The following list provides examples of who might be best to do those brief follow-ups
Ø Local Mental Health Worker
Ø School counselors
Ø Guidance counselors
**Note that these individuals will need to have the skills and abilities to talk with children and youth to validate if there is further support needed based on the survey results, and to take the next steps to assist the youth if needed (example refers to local health services, connecting with parents etc.).
HOW IS THE CHILD’S SURVEY/DATA STORED (ONCE COLLECTED FROM THE TABLET)?
The manner in which the data is stored depends on the type of User Agreement signed by the participating community and the ACHWM team. Participating communities are given the option to select one of the following agreement types:
Research Agreement: The Collaborative Research Agreement states that: “data, results and reports from the ACHWM are the shared property of your community or agency, Wiikwemkoong Unceded Territory (WUT) and Laurentian University (LU), and will be stored electronically on a secure server at LU. The data is uploaded from the tablet and saved to the REDCap server at LU.” Collaborative research requires ethics approval from LU and the completion of consent forms. These consent forms contain individual names and will be stored in a secure location within your community or agency. Consent forms will not be accessible to WUT or LU. Results from Collaborative Research are intended to inform the development of publications for submission to academic journals (a process that will involve collaboration between the community and members of the ACHWM team).
Independent Agreement: The Independent User Agreement states that: “data, results and reports from the ACHWM shall remain the "User's" property. Data are saved directly to the table and are stored in your community.” For an Independent Agreement, ethics approval and consent forms may not be required (this is dependent on local policies). In the interest of improving the ACHWM, the "User" will be invited to share data, results, and reports with the ACHWM team, subject to the removal of confidential information (e.g. any information that could identify participants).
Collaborative Agreement: The Collaborative Practice Agreement states that: “data, results and reports from the ACHWM shall remain the "User's" property. Data may be stored in your community or on the LU Redcap server.” For a Collaborative Agreement, ethics approval and consent forms may not be required (this is dependent on local policies). In the interest of improving the ACHWM, the "User" will be invited to share data, results, and reports with the ACHWM team, subject to the removal of confidential information.
WHAT INFORMATION WILL MY COMMUNITY GET BACK?
The community will receive:
Individual level information in the form of the ACHWM Report with scores and flags.
Collaborative and research: A summary report will be provided back to the community. A report can be generated and printed off of the ACHWM website by using your personal ACHWM login. If you do not know your login and/or passcode, please contact one of the ACHWM team members.
Independent: Analytical tools provided in the form of an Excel spreadsheet and used by the community to create graphs and reports.
Note: The amount of detail in the report will depend on the number of children who complete the survey.
The ACHWM team will not look into a community’s individual data unless the community requests specific data or a report from us. When a request is made, the ACHWM team will then forward the data to the community.
HOW MUCH DOES THE ACHWM COST?
The ACHWM App itself is free of charge. There is no licence fee for the measure.
Staff time: To administer the survey, analyze the data, produce reports, and provide mental health support for children.
Equipment: Android Tablets (preferably Samsung), protective cases (i.e. OtterBox). Contact ACHWM staff for hardware details.
Training Travel Costs: To send staff to training in Sudbury or to bring the ACHWM team to your community to administer training onsite.
IMPORTANT NOTE: Remote training is also available; the ACHWM team has developed training videos which are accessible on our website when you log in.
HOW CAN MY COMMUNITY GAIN ACCESS TO THE BACK PART OF THE WEBSITE?
To access the back of the ACHWM website, your community must sign an ACHWM agreement. The community can decide which agreement is best for them. Once this is signed and the online ACHWM implementation survey is filled out, your community will be provided with a User ID and passcode. With these items, a community will be able to access the back part of our website and view our implementation documents, report templates, and training videos. You will also be able to generate an automated report that is specific to your community.
IMPORTANT NOTE: The automated report feature is not available if your community selects the ACHWM Independent User Agreement.
HOW CAN MY COMMUNITY GET STARTED IN USING THE ACHWM?
The first step in the process is to contact one of the ACHWM team members through our [website](/contact). Send us an email or complete our Inquiry Survey to help us learn more about your community.
If you are interested in using the measure, the ACHWM team will connect with you and others you would like to invite to access the resources available to support children’s health, and answer any of the questions you may have.
Implementation plans are unique to each community and we will help guide you through this process. Note that follow-up support for children must be a local initiative. Due to this requirement, a review of local clinical supports is part of the assessment of fit for the ACHWM.
Our ultimate goal is to enable communities to collect their own data for their own purposes as part of local best practices.
WHAT HAPPENS IF A CHILD/YOUTH’S RESPONSES TO THE ACHWM SUGGEST URGENT NEEDS? WHAT ARE THE IMPLICATIONS OF THE “DUTY TO REPORT”?
This was absolutely considered with some of the questions the children wanted included in the survey, and is the reason why the mental health follow-up is embedded in the process of using the ACHWM.
When the child completes the ACHWM, the tablet will "flag" the concerning responses (highlighted in a short report when the survey is complete). The first thing that the mental health worker does is confirm that the answers provided are valid and true. It cannot be assumed that the child is being abused or neglected due to the nature of the questions. For example: A child answering “Always” to the “I don't feel safe at home” question could possibly stem from worries about a spider in the child’s room rather than abuse or neglect from a parent, guardian, or caregiver.
The mental health worker would then follow the legal duty to report if needed. In this case, the mental health worker will use their discretion to connect the child or youth to the proper supports.
WHAT SUPPORTS ARE OFFERED TO A CHILD/YOUTH WHEN COMPLETING THE ACHWM?
As specified in each participating community’s ACHWM agreement, mental health supports must be available to children and youth immediately after they complete the survey. After an initial session, a mental health worker will determine if additional appointments with them or another health care practitioner would be helpful.
The support provided in each community largely depends on the resources available locally (local mental health workers vs. external services).
The support services that are available are not provided by the ACHWM. They are provided by the local mental health team (local or partnered) in the community.
HOW IS THE ACHWM BEING ADVERTISED TO CHILDREN/YOUTH? ARE INCENTIVES PROVIDED TO ENCOURAGE THEIR PARTICIPATION?
This is different in every community and depends on a particular community’s priorities and preferences (e.g. Use of ACHWM for program evaluation, clinical practice, community assessment, etc.)
Program evaluation and clinical practice are the key areas of focus in Wiikwemkoong Unceded Territory (where the ACHWM was developed).
The ACHWM is incorporated into Wiikwemkoong’s Land-Based Learning Program, and children cannot participate if they do not first complete the survey. This allows the community to capture the health status of all youth that participate in the program and determine whether the program improves their health and well-being (it is administered pre and post program).
In one community, the ACHWM is being incorporated into the back-to-school process. Backpacks for children and iTunes gift cards are offered as incentives for participation.
WHY DO YOU CALL YOURSELVES AANIISH NAA GEGII?
In 2014, the children of Wiikwemkoong gave the ACHWM its Ojibway name: Aaniish Naa Gegii, meaning ‘How are you?’. Many other communities since then have named it in their language.
In January 2020 it was decided that we would change our name from Aboriginal Children’s Health and Well-being Measure (ACHWM) to Aniish Naa Gegii: the Children’s Health and Wellbeing Measure (ACHWM) to capture the origin and roots of where the ACHWM came from.