What a difference a few months make! I have begun to quite assertively self-identify as a senior. Not because my health or functioning has aged particularly, but because I have come to understand that political action is necessary if my future is to unfold as I believe it can and should.
The occasion for the change of mind, which has been gradual, is that I completed the four focus groups on Aging Well in Haliburton County - I was in the midst of them in my last blog - and participated in two 4-hour analysis sessions, where a group of about 20 people who had been involved in one of the focus groups (or more, in the case of myself and staff from the three host agencies) considered the data that had been collected in the groups, facilitated by someone who had not.
It was a fascinating process. The person who facilitated was familiar with the principles of inclusion research; she'd been involved in the Cardiff project focused on young children, and she'd subsequently hired me to do a one-day workshop, which she attended. She had paid good attention, and the process was lean and clean. The quality of the data was also very good, perhaps the best in any inclusion project with which I've been involved, because the intern who was my partner in data collection was a whiz at the keyboard and captured the material almost ver batim, as well as identifying speakers. We were a very dynamic duo, me facilitating and using the charted material to move the group to consider themes and inter-relationships of the specifics offered, and her capturing it all.
The outcome of the Aging Well in Haliburton County analysis process was, I thought, quite exciting in that the people said (as people always do if they are appropriately invited and heard) that they owned their expertise in the process of aging in place, specifically this place, and thought they should be in charge of figuring out how to go forward in making the changes necessary for this place to be age-friendly. And, interestingly, they made remarkable progress in conceptualizing the issue areas as similar Social Determinants of Health, and with interesting differences from the 8 issue areas that had been identified by the World Health Organization in the paper that informed the format of the data-collection instruments.
One of the crucial changes from the WHO conceptualizing was that the Haliburton group specifically decided to exclude 'health and community services', meaning medical systems, out of the mandala they created. The rationale was that if all the other elements were in place, health would result; whereas the existence of medical services did not guarentee that they were indeed accessible when needed, or that they would create health. There was some comment that having medical services be one issue area would lead people to think about aging as a medical process, when in fact it was a normal part of life. We begin to age the moment we are born, maybe even conceived... Having medicine as an issue area would draw attention away from the other areas which would undermine health. Because...medicine becomes important when you aren't healthy, not when you are; medicine is the absence of health, not a condition of health. Doctors do not make you healthy, they treat you when you're unhealthy. No, more than that (me here, not the group), they treat you when they recognize you as ill. And that recognition has more to do with seeing something they can treat that having something that needs treating. More on that another time...
So, fast forward to February 2010, Fay & Associates was again contracted to help the Aging Well Committee to develop an organizational structure that would support them as they moved forward in implementing the findings of the research, which was now completed and in the final stages of being written up for the funder and the other engaged institutions (I'll post it on the website.) During the focus groups, people were cynical that anything would come of this exercise of asking people what they think, because nothing ever did. So there was a specific undertaking that there would be community meetings to feed back the information to the people who contributed to the research process. The challenge facing the Committee -- and the host agency staff -- was how best to manage that process. I was hired to help.
So began a series of meetings with the Aging Well Committee (which I suggested should re-conceptualize itself as a Roundtable, which I think more accurately captures its function and relationship, but it was resisted, primarily I would say by the host agency staff; the committee members didn't really care as long as it got on with business.) The meetings were weekly, and considered a structure and draft terms of reference, identified 8 Issue Committees which were conceptualized as the 'work horses' for implementing action projects to address identified priorities, and planned presentations by the committee members in each of the four communities in which focus groups had been held.
My final piece of work was to suggest resources going forward, as the initial research grant was exhausted. Although the story may not yet be finished, it appears that the host agencies aren't sure that further resources will be needed to support the work of the Aging Well group and/or that they don't have or wish to make available the time necessary to acquire or manage more resources. We'll see what happens going forward.
And now we get to where I started, that this experience has raised my awareness that seniors will need to use the political clout they have or can get to ensure that their rights as citizens are retained as they grow older. I believe that seniors in rural areas are vulnerable. Differently, and perhaps more, than their urban counterparts. It gives me a sense of satisfaction to understand that all the skills and passion that Michael and I, for our entire working lives, have made available to the disadvantaged and marginalized are now needed to protect -- or maybe create -- our own well-being as we age. Us, the class of 'seniors', sub-set: living in rural areas. I am who I am fighting for. Me, and others like me. I am the other. It's the first time in my life that I have felt that.
I've been doing some interesting reading that informs my thinking and will share them -- more regularly, I hope, now that I know why it's important to do so.
Showing posts with label inclusion research. Show all posts
Showing posts with label inclusion research. Show all posts
Sunday, April 11, 2010
Tuesday, July 29, 2008
Women's Charter
The Women's Charter project came out of Count Us In! Inclusion and Homeless Women in Downtown East Toronto (Phase 1). That project (final report is on our website) concluded with a 10-point Charter for Offering Services to Women, that is, 10 things that an agency or service would do that would allow the women it served, in particular marginalized women, to feel included. What was envisioned was a Charter statement that agencies would post as a testament to its intent to serve women well, much as the gay movement has marketed the rainbow sticker which agencies can post to show they are 'gay-friendly'.
The Charter Project took this the next logical step, which was to explore how organizations or agencies could move toward 'qualifying' to post the Charter. Ontario Women's Health Network (OWHN) negotiated for funding from Public Health Agency of Canada. F&A worked with the Asset Mapping Research Project (AMRP) of the Toronto Christian Resource Centre, Coordinator Adonica Huggins and Inclusion Researchers Farida Athumani and Marcia Jarman, to engage two agencies located in and serving their neighbourhood, the Regent Park area, in the process of self-evaluating and making changes that would allow them to measure their progress toward practicing selected Charter Items.
The project took place in April through June 2008. Adonica Huggins used her collegial connections among Regent Park service providers to recruit two agencies willing, over a very brief time span, to initiate a process of selecting one or more Charter Items and devising a procedure that would allow them to bench-mark the 'friendliness' of their current practice in relation to the Item, and to measure progress going forward.
The two agencies who volunteered were 614, a small social service program run by the Salvation Army; and the Sherbourne Health Centre (SHC), a large, new and rapidly growing health service offering primary care, a broad spectrum of outreach services, and a brief-stay Infirmary for discharged hospital patients who required follow-up care not available in their usual living circumstances.
We were very pleased that two so very different institutions chose to work with us. Because we had the capacity to work with only two or three agencies, it was important that they represent as much diversity as possible if we were to illuminate the process by which organizations become 'Charter qualified'. We are also pleased that two other agencies have indicated interest, and we are at present working with one of them, a large social services office, to explore what can be done to replicate the process with reduced and pro bono support.
The report has been forwarded to the funder and we are hoping there will be an official launch in the fall. OWHN is anxious to get funding to resource the process with other agencies in the geographic region, working toward an understanding of how a network of agencies and organizations that share serving a disadvantaged population comes to embrace (or resist) a change process.
The work was fascinating. Adonica, in the recruitment phase, stipulated that the organization had to be willing to have all levels of the organization -- i.e., governance, management, staff, volunteers and where possible, service users -- engage in the process. This was challenging from a logistics perspective (particularly given the tight time schedule) -- and very likely, the fact that an agency was able to meet this requirement was an indication that relatively good vertical communication and a positive attitude to the intent already existed. We make no methodological apologies: in any change process, one starts with the willing and goes from there.
Our appreciation of the importance of broad representation in the decision-making process grew with our experience. The interplay of perspectives was invaluable in creating a process that could be implemented within existing resources. Our impression was that the agencies we worked with already had a healthy appreciation for the synergy of different perspectives, but it may be that for some agencies, this experience itself would initiate change within the agency culture.
Both agencies had mechanisms in place for consulting with service users, and both of them made changes to the mechanism in the course of this work. 614 has a long-established practice of recruiting volunteers from among service-users and in some cases hiring them as staff -- a kind of 'career path' for some service users. It decided to initiate a more formal quarterly 'village square' meeting with service users to seek feedback on its service delivery, and furthermore, to look at ways to increase participation beyond the core group of service users. Sherbourne Health Centre, faced with the problem of resourcing data collection among women who might be appropriate users of their Infirmary and from service providers who are likely referrers of women to the service, embraced the concept of using women from among their service population to do this work -- a variation of the Inclusion Research model. Furthermore, the AMRP offered to help select and train these women, in conjunction with SHC staff and volunteers. This plan will be implemented in late summer / fall.
An aspect of the work that I found particularly heart-warming was the enthusiasm with which staff embraced the opportunity to improve their service. It's difficult to work with people who are constantly embattled with seemingly insurmountable problems. It's even more difficult to be seen to be doing a good job. Power-abusing happens. So does bad service. And goodness knows, all institutions breed their own impediments to human exchange over time. But many people in the service system long to do their job differently, more respectfully, more efficiently, more effectively. In many ways, they battle with the same problems that plague their clients, albeit from a different perspective. The conceptualization of this project was based in a belief that people who work with poor people would rather do a good job than a bad job, and had expertise they would make available if given the opportunity. That belief was vindicated by our experience. This is another variation of 'start with the willing'.
I also felt quite validated in my long-held belief about the importance of positive reinforcement as a way to create the conditions under which change takes place. We've always recognized this when it comes to personal counselling - I think the current phrase is 'strength-based intervention', but some variation has been around as long as I've been in the business. But we often think differently when it comes to organizational change. Or we act as if we think differently. We attack, embarrass, make a case. But organizational change, like personal change, comes from a belief and a motivation that better things are possible. And that is nurtured by recognition of progress to date, including trying things that haven't worked or don't any longer work.
In any case, this project included the enjoyment of hearing many innovative and creative things that were being tried to make service users feel more included and accepted. The agencies that volunteered were at what a therapist would call the 'pre-contemplation' phase of the work: they'd already recognized at some level that they wanted to improve their service. The challenge as this project moves forward will be to find efficient ways to move recalcitrant agencies into pre-contemplation phase. I think we'll be looking at collegial networks at work, moving individuals and agencies, one at a time, from "wouldn't it be great if we could..." to "we've got what we need to..."
In this project, we were open to working with agencies and services that dealt with men as well as women, even though the original Count Us In! project was very specifically woman-centric. We believe that implementing a Charter for Offering Services to Women would also improve service to men. But to fine-tune the Charter, to begin the process of rooting it in the service network that serves the Regent Park community, to demonstrate that significant change is possible within existing resources, we needed to start in the middle. Which is what we did: what is more 'middle' than a health centre and a church-based social service?
We'll post the report, or a link to it, as soon as it becomes available. If you're interested in what the Charter Items are, check the Count Us In! report.
The Charter Project took this the next logical step, which was to explore how organizations or agencies could move toward 'qualifying' to post the Charter. Ontario Women's Health Network (OWHN) negotiated for funding from Public Health Agency of Canada. F&A worked with the Asset Mapping Research Project (AMRP) of the Toronto Christian Resource Centre, Coordinator Adonica Huggins and Inclusion Researchers Farida Athumani and Marcia Jarman, to engage two agencies located in and serving their neighbourhood, the Regent Park area, in the process of self-evaluating and making changes that would allow them to measure their progress toward practicing selected Charter Items.
The project took place in April through June 2008. Adonica Huggins used her collegial connections among Regent Park service providers to recruit two agencies willing, over a very brief time span, to initiate a process of selecting one or more Charter Items and devising a procedure that would allow them to bench-mark the 'friendliness' of their current practice in relation to the Item, and to measure progress going forward.
The two agencies who volunteered were 614, a small social service program run by the Salvation Army; and the Sherbourne Health Centre (SHC), a large, new and rapidly growing health service offering primary care, a broad spectrum of outreach services, and a brief-stay Infirmary for discharged hospital patients who required follow-up care not available in their usual living circumstances.
We were very pleased that two so very different institutions chose to work with us. Because we had the capacity to work with only two or three agencies, it was important that they represent as much diversity as possible if we were to illuminate the process by which organizations become 'Charter qualified'. We are also pleased that two other agencies have indicated interest, and we are at present working with one of them, a large social services office, to explore what can be done to replicate the process with reduced and pro bono support.
The report has been forwarded to the funder and we are hoping there will be an official launch in the fall. OWHN is anxious to get funding to resource the process with other agencies in the geographic region, working toward an understanding of how a network of agencies and organizations that share serving a disadvantaged population comes to embrace (or resist) a change process.
The work was fascinating. Adonica, in the recruitment phase, stipulated that the organization had to be willing to have all levels of the organization -- i.e., governance, management, staff, volunteers and where possible, service users -- engage in the process. This was challenging from a logistics perspective (particularly given the tight time schedule) -- and very likely, the fact that an agency was able to meet this requirement was an indication that relatively good vertical communication and a positive attitude to the intent already existed. We make no methodological apologies: in any change process, one starts with the willing and goes from there.
Our appreciation of the importance of broad representation in the decision-making process grew with our experience. The interplay of perspectives was invaluable in creating a process that could be implemented within existing resources. Our impression was that the agencies we worked with already had a healthy appreciation for the synergy of different perspectives, but it may be that for some agencies, this experience itself would initiate change within the agency culture.
Both agencies had mechanisms in place for consulting with service users, and both of them made changes to the mechanism in the course of this work. 614 has a long-established practice of recruiting volunteers from among service-users and in some cases hiring them as staff -- a kind of 'career path' for some service users. It decided to initiate a more formal quarterly 'village square' meeting with service users to seek feedback on its service delivery, and furthermore, to look at ways to increase participation beyond the core group of service users. Sherbourne Health Centre, faced with the problem of resourcing data collection among women who might be appropriate users of their Infirmary and from service providers who are likely referrers of women to the service, embraced the concept of using women from among their service population to do this work -- a variation of the Inclusion Research model. Furthermore, the AMRP offered to help select and train these women, in conjunction with SHC staff and volunteers. This plan will be implemented in late summer / fall.
An aspect of the work that I found particularly heart-warming was the enthusiasm with which staff embraced the opportunity to improve their service. It's difficult to work with people who are constantly embattled with seemingly insurmountable problems. It's even more difficult to be seen to be doing a good job. Power-abusing happens. So does bad service. And goodness knows, all institutions breed their own impediments to human exchange over time. But many people in the service system long to do their job differently, more respectfully, more efficiently, more effectively. In many ways, they battle with the same problems that plague their clients, albeit from a different perspective. The conceptualization of this project was based in a belief that people who work with poor people would rather do a good job than a bad job, and had expertise they would make available if given the opportunity. That belief was vindicated by our experience. This is another variation of 'start with the willing'.
I also felt quite validated in my long-held belief about the importance of positive reinforcement as a way to create the conditions under which change takes place. We've always recognized this when it comes to personal counselling - I think the current phrase is 'strength-based intervention', but some variation has been around as long as I've been in the business. But we often think differently when it comes to organizational change. Or we act as if we think differently. We attack, embarrass, make a case. But organizational change, like personal change, comes from a belief and a motivation that better things are possible. And that is nurtured by recognition of progress to date, including trying things that haven't worked or don't any longer work.
In any case, this project included the enjoyment of hearing many innovative and creative things that were being tried to make service users feel more included and accepted. The agencies that volunteered were at what a therapist would call the 'pre-contemplation' phase of the work: they'd already recognized at some level that they wanted to improve their service. The challenge as this project moves forward will be to find efficient ways to move recalcitrant agencies into pre-contemplation phase. I think we'll be looking at collegial networks at work, moving individuals and agencies, one at a time, from "wouldn't it be great if we could..." to "we've got what we need to..."
In this project, we were open to working with agencies and services that dealt with men as well as women, even though the original Count Us In! project was very specifically woman-centric. We believe that implementing a Charter for Offering Services to Women would also improve service to men. But to fine-tune the Charter, to begin the process of rooting it in the service network that serves the Regent Park community, to demonstrate that significant change is possible within existing resources, we needed to start in the middle. Which is what we did: what is more 'middle' than a health centre and a church-based social service?
We'll post the report, or a link to it, as soon as it becomes available. If you're interested in what the Charter Items are, check the Count Us In! report.
Sunday, March 30, 2008
Keys to Women's Health: Phase 2
Keys to Women's Health: Phase 2 is coming to a close with the end of the government fiscal year. Our role was the preparation of two Manuals, one to support dissemination of the findings of the first phase to participants and service providers, and the second to guide the Inclusion Researchers as they made the transition to facilitating Health Circles in each of the three study sites -- Downtown East Toronto, Sudbury, and Peel. This draft includes modifications introduced during the training of the Inclusion Researchers / Health Circle Facilitators in late January, which F&A designed and delivered.
This is very exciting work that we hope will lead to a third phase in which the methodology is rolled out across the province of Ontario. The first phase had women drawn from among the population under study, disadvantaged or marginalized women, in three different communities -- homeless or under-housed women in Downtown East Toronto, Aboriginal and other women served by a Women's Centre in Sudbury, and recent immigrants from South Asia -- trained as Inclusion Researchers. They organized and ran focus groups to collect data about what the women in their marginalized community knew and wanted to know about preventing stroke. The data was analyzed in conjunction with staff from the host agencies and members of the Provincial Advisory Committee (primarily senior health promotion and research experts), under the direction of Dr. Suzanne Jackson of University of Toronto's Centre for Health Promotion. This Phase was published and launched last spring. (see F&A main page for full report)
The findings gave the clear message that women preferred to learn about health in small discussion groups composed and led by women like themselves, and that they needed and wanted help to address life circumstances that limited their ability to make good health choices. Interestingly, the life circumstances they identified, similarly across all three sites, were what the health promotion world calls the Social Determinants of Health.
The second phase of the work, supported by the same partners, explored whether Inclusion Researchers or women like them, women chosen from among the population under study, could be effective as facilitators of discussion groups that helped participants identify and work together to address a group-selected Determinant of Health that got in the way of making good health decisions. The discussion focussed on stroke, but it is very clear that the methodology could equally well be applied to a number of other chronic conditions or illnesses.
The Inclusion Researchers / Facilitators, in conjunction with staff from their host agencies, first organized at least two events at which they shared the findings of the first Phase and introduced the second Phase. They were then trained by F&A to organize and run Health Circles, to become Facilitators instead of Researchers. F&A wrote and circulated a draft Training Manual before meeting in person for training in late January. The group included agency partners and Inclusion Researchers/ Facilitators from all three sites working together over 1 1/2 hard-working days. They made significant changes to the methodology and left confident that they were ready to set up and facilitate at least two groups in each site. They have subsequently done so, and the energy that has been unleashed is breath-taking. Each site has found its own particular application for the methodology going forward, but all have found it very powerful in engaging and working effectively with marginalized women in their service population. The full report, with independent evaluation, will be published soon -- watch for it here.
The marginalized pose a very serious problem for the health system. They are at increased risk to suffer from chronic illness but are notoriously hard to engage in traditional prevention, early intervention or effective treatment. The health system will continue to waste money and effort unless they find a more effective way of engaging with this population. We think this may be a leading edge approach to doing so.
Furthermore, because the Facilitators themselves are drawn from among the population, the approach quickly builds community capacity and competence. We are just beginning to see the side benefits over time from creating an employment trajectory, a career path, for the Inclusion Researchers / Facilitators. It is becoming evident in their individual lives (as their lives stabilize, they return to education, they get 'regular' employment), in the agencies that shired them (programming is energized, credibility is enhanced, collegial cooperation is strengthened), and in the communities from which they are drawn (a new sense of hope and empowerment). This is Community Based Research at its most potent.
We are very pleased to have been part of this work. We hope the methodology will find broad application.
This is very exciting work that we hope will lead to a third phase in which the methodology is rolled out across the province of Ontario. The first phase had women drawn from among the population under study, disadvantaged or marginalized women, in three different communities -- homeless or under-housed women in Downtown East Toronto, Aboriginal and other women served by a Women's Centre in Sudbury, and recent immigrants from South Asia -- trained as Inclusion Researchers. They organized and ran focus groups to collect data about what the women in their marginalized community knew and wanted to know about preventing stroke. The data was analyzed in conjunction with staff from the host agencies and members of the Provincial Advisory Committee (primarily senior health promotion and research experts), under the direction of Dr. Suzanne Jackson of University of Toronto's Centre for Health Promotion. This Phase was published and launched last spring. (see F&A main page for full report)
The findings gave the clear message that women preferred to learn about health in small discussion groups composed and led by women like themselves, and that they needed and wanted help to address life circumstances that limited their ability to make good health choices. Interestingly, the life circumstances they identified, similarly across all three sites, were what the health promotion world calls the Social Determinants of Health.
The second phase of the work, supported by the same partners, explored whether Inclusion Researchers or women like them, women chosen from among the population under study, could be effective as facilitators of discussion groups that helped participants identify and work together to address a group-selected Determinant of Health that got in the way of making good health decisions. The discussion focussed on stroke, but it is very clear that the methodology could equally well be applied to a number of other chronic conditions or illnesses.
The Inclusion Researchers / Facilitators, in conjunction with staff from their host agencies, first organized at least two events at which they shared the findings of the first Phase and introduced the second Phase. They were then trained by F&A to organize and run Health Circles, to become Facilitators instead of Researchers. F&A wrote and circulated a draft Training Manual before meeting in person for training in late January. The group included agency partners and Inclusion Researchers/ Facilitators from all three sites working together over 1 1/2 hard-working days. They made significant changes to the methodology and left confident that they were ready to set up and facilitate at least two groups in each site. They have subsequently done so, and the energy that has been unleashed is breath-taking. Each site has found its own particular application for the methodology going forward, but all have found it very powerful in engaging and working effectively with marginalized women in their service population. The full report, with independent evaluation, will be published soon -- watch for it here.
The marginalized pose a very serious problem for the health system. They are at increased risk to suffer from chronic illness but are notoriously hard to engage in traditional prevention, early intervention or effective treatment. The health system will continue to waste money and effort unless they find a more effective way of engaging with this population. We think this may be a leading edge approach to doing so.
Furthermore, because the Facilitators themselves are drawn from among the population, the approach quickly builds community capacity and competence. We are just beginning to see the side benefits over time from creating an employment trajectory, a career path, for the Inclusion Researchers / Facilitators. It is becoming evident in their individual lives (as their lives stabilize, they return to education, they get 'regular' employment), in the agencies that shired them (programming is energized, credibility is enhanced, collegial cooperation is strengthened), and in the communities from which they are drawn (a new sense of hope and empowerment). This is Community Based Research at its most potent.
We are very pleased to have been part of this work. We hope the methodology will find broad application.
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