Community Advisory Panels (CAPs)

CAPs Terms of Reference

Aboriginal Health Community Advisory Panel


The Inner City Health Program mandate is to collaborate with community partners towards improving the health of the population by addressing social determinants of health that affect individuals and communities in South East Toronto, as well as pursuing teaching and research partnerships.

In keeping with the Hospital’s mission and core values, the Hospital has established a number of population specific advisory panels, including the Aboriginal Health Community Advisory Panel, to ensure stakeholder input in the planning, delivery and evaluation of services and initiatives.

The terms “Aboriginal” or “Indigenous” will include but is not limited to First Nations (Status or Non-Status), Métis and Inuit communities. “Community” refers to members of the local Aboriginal community as well as Aboriginal and non-Aboriginal people who are involved directly or indirectly in the care of Aboriginal community members, regardless of agency or professional affiliations.

“Cultural Safety” was first introduced by Irihapeti Ramsden, a Maori nurse in Aotearoa (New Zealand) in 1990. Her description of the term explained that cultural safety moves beyond cultural sensitivity and cultural competence (i.e. having knowledge about the culture of “the other”) in that it analyzes power imbalances in society, as well as political ideals of self-determination and de-colonization.

  • Cultural Safety is a better quality of care for people

  • Acknowledges values and norms of the patients may be different form his/her own

  • Health providers engage in self-reflection

  • Involves empathy: the capability to share another being’s emotions and feelings

  • Increases capacity to become collaborator and advocate


As Aboriginal community members working collaboratively with St. Michael's Hospital patients, volunteers, students, clinicians and administrators, the CAP will assist and advise St. Michael’s Hospital to provide culturally aware, sensitive, competent, safe and holistic services for individuals and families within the local Aboriginal community and the broader community.


In partnership with St. Michael’s Hospital and relevant community partners, the CAP will:

  • Assist in needs identification and services planning.

  • Provide input to the setting of goals and priorities related to the clinical, educational and research needs of Aboriginal communities.

  • Contribute to enhancing the knowledge and awareness of staff, physicians and volunteers with respect to the needs of Aboriginal clients. This includes opportunities for an exchange of cultural teachings from various Aboriginal communities and raising awareness within the community about hospital and health system culture.

  • Promote community and hospital partnerships through facilitation of appropriate linkages with the wider health system and Aboriginal community members, networks and agencies.

SCOPE: The Panel will:

  • Receive, review and provide feedback on regular reports from Program staff and physicians with respect to clinical, educational and research initiatives concerning the needs of Aboriginal peoples.

  • Establish sub-committees as needed, to accomplish tasks relevant to the work of the panel and in support of the Program, who will report to the CAP.

  • Receive official and timely responses from the relevant department, director, vice president or president on issues raised by the CAP.

  • Participate in program planning, implementation (as needed) and evaluation.


The CAP will strive to honour Aboriginal principles and working structures when and wherever possible. This can include opening and closing prayers, smudging, invitations to elders, including ceremonial or traditional medicine and healing practices in meetings and processes, talking circles and fostering a culture of mutual respect, inclusiveness and equity.

The CAP will meet a minimum of five times a year with a summer break. Members or their designate are expected to attend at least three of every five meetings per year.


Meetings will be open to all Aboriginal community members; Aboriginal service agency representatives and Hospital staff, physicians, students or volunteers who support the purpose and objectives outlined herein and commit to active participation in accordance with these Terms of Reference.

The CAP will strive to maintain a two-third community, one third hospital mix, especially with regard to decision making.

Community members will be selected by the CAP and appointed by the president and CEO. Factors in the selection of members will be to live or work in the catchment of the hospital or use the hospital services as a patient or agency, group or organization.

Hospital members will be appointed by the Executive Vice President and Chief Medical Officer including key service delivery and administrative personnel involved with the direct care of Aboriginal patients.

Community and Hospital membership will be reviewed annually to ensure effective and appropriate representation to address the needs and concerns of Aboriginal communities.


The chair will be a community representative (non-St. Michael’s representative selected by the CAP at the meeting closest to the Fall Equinox (September). This appointment must be approved by the president and CEO.

In an effort to build community member capacity, CAP members may also choose to elect a co-chair to assist the chair in performing duties and gain leadership experience.

The chair (and co-chair) will for a period of one year until the following Fall Equinox and then be re-affirmed or a new chair (and co-chair) will be elected.

The chair or designate is responsible for providing leadership to the CAP in cooperation with hospital support staff and community members.

The chair will also be responsible for setting the agenda for meetings in consultation with panel members.

The chair or selected designate will represent the CAP on the Community Advisory Committee of the Board of Directors as well as other committees, working groups, planning, implementation and evaluation entities deemed necessary by the CAP.


The Panel will seek to establish consensus on decisions and recommendations. In the absence of consensus, decisions will be by majority vote of a quorum of the Panel. A quorum will consist of 60 per cent of the membership that must reflect the two-thirds community, one-third hospital mix.


The Hospital will provide support with respect to meeting logistics including agenda distribution and minute taking. The Hospital will also cover meeting expenses for non agency affiliated community members, such as parking, interpretation needs, mobility needs and childcare as needed.

Revised draft Approved October 23, 2013

Appendix A

Medicine Wheel Description and CAP Action Wheel

The four directions (east, south, west and north) of the Medicine Wheel symbolize completeness, wholeness, connectedness and strength, and are based on Aboriginal cultural values, tradition and spirituality. They also represent the elements of being that must be in balance in order to achieve wellness and good health – the Physical, the Emotional, the Mental and the Spirit.

By looking at people as whole individuals, we can see that there needs to be supports in place in all areas in order to have that balance. Also connected are the various stages of the lifecycle – Infant, Child/ Youth, Adult, Elder/ Senior – this helps us to see that we must look at individuals as part of a family and community in order to see that balance and harmony.

The Medicine Wheel is a holistic approach that:

  • explains difficult concepts and contributes to better understanding
  • connects the person and community with the rest of Creation, and
  • provides a way of understanding life and the world

In essence, the Medicine Wheel can teach balance and as a result better health and wellness:

  • East represents physical (taking care of the body)
  • South represents emotional (feelings and emotions)
  • West represents spiritual (connection to the Creator, respect and healing the self)
  • North represents mental (gaining wisdom)

The Medicine Wheel has been applied by Aboriginal communities as a guide to living and to explore issues and find solutions – for example, health providers in the Aboriginal community have used the medicine wheel to explore issues and find solutions for their clients; that is, it can be used in creating a vision or plan when working individually with clients and in helping them to deal with larger issues.

The St. Michael’s Hospital Aboriginal Community Advisory Panel chose to adapt the Medicine Wheel into the following Action Wheel as a community based model to define and promote understanding of the CAP within the hospital and broader communities.

St. Michael’s Hospital Aboriginal Community Advisory Panel Action Wheel

(approved June 26, 2013)

  • Click here or on the image below for a larger version of the action wheel (311 kb pdf file)

    St. Michael’s Hospital Aboriginal Community Advisory Panel Action Wheel