Sunday, April 11, 2010

More thoughts on aging

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.

Friday, October 23, 2009

on gendered aging

I'm 3 focus groups into a set of 4 facilitating discussion of what it means to age well in Haliburton County, part of a larger research project being conducted by our local Health Unit and Family Health Team. A Trent student, through U-Links, is collating the data from a survey done over the summer that was well publicized and elicited a good response.

The focus group participants are 'seniors', as, of course, am I, although I do not self-identify as that. Which interests me. Does it imply that I feel the word, the category, is denigrating?

Yeah, I think I do. In subtle ways. The first thing that bothers me is the looseness of the term: it is used to describe a 50-year span, from age 50 to when you die, which could be 100.

Secondly, because it is used so loosely, the logic goes all to hell. The presumptions are not made clear, and the subsequent discussion has a good chance of not being about the same thing.

Age is one presumption; others are about the process of aging. Which, as I and those around me grow older (is there an alternative?), I find much more variable than, say, the process of adolescence, of becoming an adult. I know I am not the only person who has a start of surprise when I see myself reflected in a shop window and wonder who the grey-haired woman is: I don't feel the age I look. I know this perspective is shared by others. I'm told I don't look or act the age I am. Michael, on the other hand, since his go-round with cancer 15 or so years ago, is physically older than me even though he is two years younger.

When I was working with adolescents in the child care system, I would rail about the injustice of aging them legally: at 16 they could not be required to live where placed - they could leave 'home' or, alternately, be kicked out if they didn't meet expectations. At 18 they were legally adult and could no longer be cared for by their state parents. And so forth. Is it different at the other end of the adult spectrum?

Not yet. We're protected by the fact that we are votors who can register our dissatisfaction with legalizing us wrongly or unnecessarily (e.g., the debate about mandatory retirement at 65). And by the demography of our country, with its bulge of Boomers, which gives us (although I'm older than David Foot's definition of Boomer, although that designation, as well, is used very loosely) a numerical advantage.

But I think we're in danger. The basic paper developed by the federal government on managing the greying of the demography is, to my reading, founded on the fear that we older people are going to scupper the economy unless a way is discovered to have us age more cheaply. The Problem is that we are old longer - we don't have the good grace to die when we cease to be productive. I recall seeing an 'art film' when I was in undergraduate studies where an old woman who was Eskimo (as we said in those days) or maybe Japanese, voluntarily left the village and went into the wild to die. It's entwined in my memory with the idea of going into the great beyond on an ice pan. Our culture doesn't have the stomach to look the issue in the eye quite that boldly.

Another Problem is that we hog health services as we age, and to what (economic) avail? Heart surgery on a 40-year-old who has 20 more years to contribute his taxes is one thing; what about the person who has left the work force? My greatest fear, on the contrary, is that the health system will insist on prolonging my life beyond what I would wish. And that it medicalizes the aging process. I recall being 'encouraged' to take Hormone Replacement Therapy as the responsible thing to do for my loved ones and my country: to refuse (as I did) was to willingly expose society to the cost of my self-chosen, it would seem, decripitude. I did not (quite in those words) say I Told You So when HRT had its sudden and dramatic fall from grace.

But I am presently harassed to be treated for osteoporesis, which I am diagnosed with having by the results of annual bone scans that were routinely put in place when I turned 55, I think, some magic number, maybe 60. I am hugely sceptical about the norming of bone scan results. Almost every woman I speak to says she, like I, was told she had 'the hips of a 90-year-old' on her first assessment, and since then gets graphed on the osteoporesis bell curve. My questions about how these results have been normed have never been answered to my satisfaction, and I do not know why I continue to undergo these annual tests. In fact, I have decided I will discontinue them, because I know that I will not take treatment for the condition they purport to diagnose.

Both HRT and medicine's love affair with osteoporesis are examples of gendered medicalization of normal physical processes. My husband, using any of the predictors of osteoporesis, is very much more at risk than I, but has he ever been sent to have a bone scan? No. Why? Because he's the wrong gender: osteoporesis is conceptualized as a post-menopausal condition which, inadvertently or otherwise, pretty much leaves males out of consideration. I wonder when men being under-diagnosed for osteoporesis will be as much of an issue as women being under-diagnosed for heart conditions.

My time is up; thus endeth the rant for today

Tuesday, July 29, 2008

Business Planning with Women

Over the past year, we've been working with a local business woman who needed to change her business to accommodate changes in life circumstances. We've subsequently been approached by two other women in similar situations, although different lines of business, to do similar work with them. In all cases, the women felt that the usual business planning resources available were not a good fit. They were choosing to struggle on their own to think their way through the dilemma facing them rather than 'take advantage of' the usual resources. This was tantamount to their being disqualified from publicly funded services, without the services being held accountable -- or even knowing about -- the way in which these business women were excluded as clients.

It strikes me, as I write, that this is similar to the situation we are involved with in the Women's Charter project: clients are excluded because of how the institution does business but the clients are 'at fault' because they don't take advantage of what is available to them. Helping an institution find a way to dialogue with people who could be but are not their clients is a difficult assignment -- as the Sherbourne Health Centre is finding in the Women's Charter project -- that only the highly motivated will undertake. We don't have a pre-contemplation situation here, at least not at present.

Therefore the work comes from the other perspective, the disentitled client -- although none of the women who have approached us would likely describe themselves in that way. They are established and respected members of the community -- but perhaps not established and respected in the business community. Not disrespected; more likely 'under the radar'.

The woman with whom we've been working for a year has a successful massage therapy business. Over 12 years, it has become steady throughout the year (always a factor in our community, which is 'cottage country' with a 4-fold, or more, increase in population over the summer months) and as much work as our client could manage. Because the business is 'piece work' and the pricing structure is largely established by professional bodies, there is a natural revenue ceiling. It is also physically demanding work, and as our client aged, she was not able to manage as many clients a day as she had in earlier days. And she was less willing to sacrifice family life to work evenings or weekends. But she wanted and needed to increase her income.

She had introduced a number of changes by the time she began to work with us. In fact, the first order of business was us recommending that she apply for a grant from 'the usual resources' in order to hire us to work with her. We wrote the proposal for her signature on spec. She was given the grant with very little discussion. The granters were mildly surprised that she planned to work with us, as they hadn't thought this was our line of business. They 'knew' Michael as a writer and volunteer and me as a government-funded social service type, none of which said 'business' to them. However, each of us has a strong local reputation as people who make things happen, so they were willing to take a chance. We are now on their 'accepted' list of consultants.

Our client had already attempted to engage a second massage therapist to share her business and space and had had limited success. She wanted to develop a clearer framework for sharing her business. And to make money out of her physical space, which had untapped potential, not all of which would be absorbed by the addition of another massage therapist. We helped identify the negotiating elements: what kind of skill set, what financial arrangements, what work arrangements, how important is personal chemistry, how to protect and enhance her 'brand' (and what was that brand), etc..

We developed a generic contract for sharing space and support services to help her clarify and quantify these elements in her decision making. This was mostly useful in increasing her comfort with doing 'hard-nosed business' in what she saw primarily as sharing her 'baby', her business and physical space, with a new partner. Balancing head and heart: the usual woman's dilemma! But not one that many business planners are comfortable with working through.

We also developed a mechanism for our client to analyze rigorously her core clientele. She is analytical by nature, but wasn't confident in her conclusions. We developed a data collection instrument from which she gleaned non-identifying information from active files of her core clientele over 12 years of business, a full-population study of considerable size. This was time-consuming for her to do and took quite a while to complete. She found the process itself interesting and useful. The analysis was a lot of fun (for me). It ratifies the rationale for the decisions she has already taken and should give her confidence going forward -- both in her plans and in her capacity to correctly analyze her situation.

We also developed a simple survey questionnaire for her clients to complete in the waiting room, asking what auxiliary services they would like to see in the community, perhaps as an addition to her business. This, too, was merely confirming the validity of data collection she has always done informally. She took it the next step by organizing and hosting (in her beautiful space) a meeting of other massage therapists in the community (pointedly not including those who called themselves massage therapists but who were not qualified professionals) to share information about the services available and to strengthen referral patterns.

Before we began working together, our client had entered an informal apprenticeship as a travel agent as a potential second business that was compatible with her massage therapy business and had the capacity to increase her earnings. During the time we worked together, she 'graduated' herself from her mentor and registered independently as a travel agent with a new firm. She applied for a skill-development grant to take the required training and offset the substantial fee (and received something, although less than she was hoping for, as the training fee was interpreted as a purchase of franchise). She also applied for and received an interest-free loan to get broad-band internet access at her home, so that she could do more of her travel agent work at home.

The final piece of work that remains is to write The Business Plan, which is a deliverable of the grant. The template that the granter provides is not a good fit with the work we have done: it's all about head and nothing about heart. I see that as an indicator of the process of how business women (or some, at least) are excluded and need to figure a way to reflect this to the granting agency without alienating them.

This is particularly important because two other local women have indicated interest in hiring us to work with them in very similar ways. One of them approached us to help her make the application for a business plan. She, too, has one successful business that cannot grow to meet her financial requirements, and the desire to develop a second business that turns a 'hobby' about which she is passionate into a source of income, which will involve asking people to pay for something that she has always made available for the sheer love of it.

However, this woman found the granting organization to be challenging to work with as she went through the application process. Although she was eventually given the grant, she refused it - without explanation - rather than allow them to be involved in her progress going forward. She insisted on paying me for my role in the application process, which began with bringing its availability to her attention, hearing her plans at length and translating them into the grant proposal. My belief is that my listening and translation was all she needed to affirm her intention and capability to launch her new business. Ironically, the granters may have been correct when they questioned why she wanted to hire F&A when she was already an acknowledged expert on the business she was proposing to develop. In her head she is; in her heart, she wasn't sure. But now she is. I plan to purchase her new product from her this fall.

The third woman who has indicated interest in working with F&A to do a business plan is, once again, involved in a successful business but wants to modify it to accommodate life stage and circumstances. Unlike the other two women, she is very aware of the granting agency and very comfortable with applying for a grant. The impediment for her was that she wasn't aware of anyone that she wanted to do the work with -- until she affirmed that we did this kind of work and were acceptable to the granter. It will be interesting to see how the granter deals with her application when the time comes... and how she deals with what they do.

It seems to me that by making ourselves available to do business planning locally, we have inadvertently drawn attention to how the business world works by posing an alternative. F&A itself was the recipient of a business planning grant, at the point when we were preparing for me to leave paid employment and become a principal partner in F&A. We hired a woman who worked for a sister organization to our granting agency. She did a good business plan, based on our input at the time. Ironically, we've never used the resources she provided. It assumed that we would grow the business by marketing ourselves to take advantage of the credentials and interests I brought. But in fact, the market network in health promotion that Michael established has welcomed me as well, and my network in the community has claimed my skills in ways I did not anticipate.

Again, it seems that F&A's business planning process spoke to the head and ignored the heart. My perception of myself in the business world was clearly not in line with the business world's perception of me. Actually, in retrospect I think I did not have a perception of myself as a business person. I saw myself as an experienced and skilled manager of people, an administrator with proven capacity to get and manage funds, someone able to conceptualize, resource, implement and disseminate community-based research (a combination of skills that I think is not captured by saying I am a researcher). And maybe some other things. But they didn't add up to what my business should be. I think if our business planning partner had had the skills and interest to listen to me as much as I have listened to the the women we've worked with, we might have derived a more useful document. Or perhaps the business plan document is not in itself important, but only evidence of a process that is more or less helpful.

I don't want to downplay or disregard Michael's role in this business-planning part of our business. Although I take the lead in these local contracts, he is the lead in developing strategies for funding for our social inclusion projects. He has an intuition for positioning and describing work in a way that joins together partners who didn't realize they had a confluence of interests. He sells well. I listen well. Together we're a great team!

And now I need to decide how to write The Business Plan... for women, by women... in a men's world... I thought we were past that!!!!! Not!

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.

Sunday, March 30, 2008

Haliburton Highlands Land Trust Organizational Development

F&A has been working with this local Land Conservancy agency for almost a year, helping with a number of aspects of organizational development.

HHLT, like many community organizations, was catapulted into existence by serendipty -- they were offered the gift of a large island with ecological significance, exactly what Land Trusts pray for. They build the organization around the specifics of the legacy, and as it became neatly tucked in for posterity, with management plans and funding strategies in place, they realized that the infrastructure of the organization was not well equipped to move forward. They successfully applied for an Ontario Trillium Foundation grant to strengthen the organization, in particular by developing its capacity to engage and effectively use volunteers. They felt particularly unprepared to do fund-raising of the scope necessary to move forward -- it costs money to locate, assess and acquire land!

F&A started by developing a Power Point Presentation suitable for HHLT to use to do community education, orient volunteers and support fund-raising activities. We developed an e-bulletin to update members and others on a quarterly basis, and edited the first two editions. We recommended a protocol for recruiting, training and maintaining volunteers. We did an environmental scan to recommend a fund-raising event with capacity to become their 'signature' annual fund-raiser -- a spring Gala with auction of donated 'green' art and recreation (Haliburton's primary economic resources) as the primary revenue source. We prepared a data base of potential grant sources. We supported HHLT to take advantage of an offer from the provincial umbrella body, Ontario Land Trust Association, to participate -- for free -- in a strategic planning procedure that OLTA was piloting as a resource to its members.

As we near the end of our contract, our time is focussed on modelling how to plan and run a fund-raising Gala scheduled for May 31, 2008. HHLT needs to learn how to use the planning and the event to raise their profile in the community and to recruit new volunteers -- as well as reaching their earning target. This is a many-faceted undertaking, and we will leave HHLT with a How To Run a Gala Manual to guide them in future iterations. We have also created, in the course of the work, a number of specialized data bases that pull together contact information and other details about groups that share particular interests. For example, a local 'green business' data base supports effeciently contacting businesses in the area to buy ads in the Gala Programme.

We were interested to learn that while almost all the contact information you need can be found fairly easily on the internet, there is a distinct shortage of lists. The internet has White Pages, but not Yellow Pages. We pulled together a few Excel spreadsheets to organize information in a way that increases efficiency in making contact in several ways (telephone, snail mail, internet), and as a repository for anecdotal facts in a form that can be shared and build on over time. It can be adapted to support team work -- for example, I recorded advertising agreements on the green business spread-sheet and send it to the Treasurer so that he could track received and outstanding invoices to support the final Gala financial report. The Board could strengthen the connections by easily sending an e-mail (or for those few not on the 'net, make phone calls) to thank the advertisers and tell them about the success of the Gala. Whoever sells ads in next year's Gala Program can start with that list and build on it.

We will also give the Board assistance as needed to take the findings of the OLTA Strategic Planning exercise, when it become available, to develop a three-year development plan. This will include a workshop in grantsmanship.

One of the unanticipated outcomes of our work with HHLT was the creation of an environmental collaborative. In response to a potential funding opportunity that required collaboration among environmental groups, we organized a meeting of representatives from the dozen or so environmental organizations in our County. To our amazement, this group had never before met for the purpose of exploring the potential for collaborative work. The funding opportunity that was the raison d'etre for the meeting turned out not to be appropriate, but we convened a second meeting of the group at which the Haliburton Environmental Collaborative was birthed. It continues to meet monthly with great enthusiasm and optimism about its future value to all members.

F&A are not environmentalists -- we certainly learned a great deal about Species at Risk, environmental significance, and other biological and geological minutiae in the course of working with HHLT. However, we were well equipped to help the organization to position itself more centrally in the community, which is the secret to expanding membership and volunteerism, as well as spreading fund-raising across a broader population. Preaching to the choir isn't a good organizational technique. Organizations that grow know how to find common interests and speak a common language.

This was also our first local contract. It has been interesting to watch our friends and neighbours watch us put yet another hat on our heads in local interactions. As volunteers, our community knows Michael as a playwright and vigorous organizer / developer of the arts. Fay is seen as a not-for-profit administrator and advocate on social and children's issues. We are both recognized as creative in finding resources, both financial and human. All of these enriched our work with HHLT. Working with HHLT broadened our profile in the community. It's been a win/win -- as long as the Gala goes off smoothly!

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.