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Welcome to HC Link's blog! Our blog will provide you with useful information on healthy community topics, news, and resources, as well as information on HC Link’s events, activities, and resources. Our bloggers include HC Link staff and consultants, as well as our partnering organizations, clients, and experts in the health promotion field.

Please note: opinions in posts are those of the author and are not necessarily the opinions of HC Link or our funder.

We look forward to engaging in thought-provoking conversation with you!

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Theories, models and frameworks used in capacity building: an excellent article from our colleagues at PHO

HC Link has been helping build the capacity of people, groups and communities working to build healthy communities for eight years. The three organizations that now make up HC Link – Health Nexus, Parent Actions on Drugs, and Ontario Healthy Communities Coalition- have been involved in capacity building for decades. The term “capacity building” is often seen as jargon — as nebulous as the terms “health promotion” or “healthy communities”.  What does it really mean to build capacity? How important is capacity building in health promotion and healthy communities work? Does it really make a difference? These are questions we often get— and that we often ask ourselves. Answering them has not always been easy.

My long-time colleague, Kim Bergeron, and her colleagues at Public Health Ontario (PHO) have recently published an excellent article on this very topic. The article summarizes a systematic review that PHO conducted to identify the underlying theories, models and frameworks that inform capacity building interventions in the published literature.

What does it really mean to build capacity?

The WHO defines capacity building as the development of knowledge, skills, commitment, structures, systems, and leadership to enable effective health promotion. In other words, we are building all of the components necessary for health promotion to affect the health of our communities. To do this effectively, we need to work at three levels: individual, organizational and community. Importantly, like with many things, there is no “silver bullet” in capacity building; no one thing that will build capacity on its own. A range of approaches is needed across a number of dimensions. Typically, services that build capacity include consultations, webinars, training workshops, and knowledge products and resources (precisely the services that HC Link provides). 

Theories, Models and Frameworks for Capacity Building

The purpose of the systematic review conducted by PHO was to identify underlying theories, models and frameworks used to support capacity building interventions relevant to public health practice. Twenty-eight different theories, models and frameworks were identified. Of this number, five were most frequently cited:

  • Two were theories: Diffusion of Innovations and Transformational Learning;
  • Two were models: Ecological and Interactive Systems Framework for Dissemination and Implementation; and
  • One was a framework: Bloom’s Taxonomy of Learning.

How important is capacity building in health promotion and healthy communities work?

Well, that’s a good question. Clearly, HC Link believes this is critical work! We are not the only ones, however: the Bangkok Charter for Health Promotion, Canada’s past Chief Public Health Officer Dr David Butler Jones, and Ontario’s strategic plan “Make No Little Plans” all refer to the importance of capacity building. In the late 1990s, the Ontario Government established a system of capacity building resource centers. That system, the Ontario Health Promotion Resource System (OHPRS), developed a framework to show the relationship between the services that its 22 members provided and the health of Ontarians. By building the capacity of health promoters, the framework proposes, the quality of health promotion programs will be enhanced, which will ultimately improve health outcomes at the individual and community level.

Does it really make a difference?

It has often been a struggle to show tangible outcomes from capacity building interventions, beyond satisfaction and short-term change. In 2004, the OHPRS conducted a literature review to establish the link between health promotion capacity building and positive health outcomes at the population level. While a causal pathway (below) was inferred from the literature review and research conducted, direct evidence to support the link between capacity building amongst health promoters and positive health outcomes is difficult.

CB causal pathway

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tina Sahay, 2004. A Review of the Literature on the Links between Health Promotion Capacity Building and Health Outcomes

Conclusions and Implications for Practice

That is why the work that Public Health Ontario has undertaken is so important. The article concludes that there is a need for the use of theories, models and frameworks to be intentionally used to develop capacity building interventions, and importantly, to be explicitly referenced.

The findings presented in the article can be used to better design capacity building interventions (e.g., consultation, technical assistance, training, coaching, web-based and/or facilitated learning opportunities, knowledge products and resources). They can also help to guide implementation practice by encouraging practitioners to consider, explicitly identify, and clearly define which theories, models and frameworks were used during various stages of the capacity building process.

I’d highly encourage you to read this article- and wait impatiently for Kim and her colleague’s next published work on this topic. 
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Conference Workshop : Engaging Young People from Diverse Backgrounds

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by Aly Tropea 

Working with Young People means actually having to listen.

Do you ever think “Why ask me for advice if you’re just going to ignore it?”. Whether it be a colleague asking for your input on a group project, a friend planning a trip somewhere you’ve been many times before, or a spouse asking for your opinion on redecorating the house, it happens to us all at some point that you get asked for help but that advice you take the time to give back gets ignored. It can be frustrating when people seek you out purposefully for your input, only to completely disregard it in the end. 

I attended the workshop Actionable Knowledge & Helpful Tools for Engaging Young People from Diverse Backgrounds on the morning of day 2 of our conference and this was a theme that I think many people did not consider before. When working with youth, YATI presenters Garett and Leila explained that youth should be included in decisions, and not in a tokenism kind of way. For example, you want to include a young person on your board but don’t want to give them a vote? Unfair. What’s even more unfair is when you assume that that 1 young person can represent an entire community of young people. Integrating youth into more of your planning will make for better outreach. That doesn’t mean having to give them carte blanche, though. The role of the adult is still one of authority and security, but by giving them more time and guidance to develop their own process to problem solve ways to uphold community efforts, you may just be surprised by the outcome. 

To young people, they should feel like the sky’s the limit in their ability to grow their potential and excel in this world. So maybe you can provide them with a creative outlet to express themselves. Setting goals of achievement are important and adults can be consulted for direction on how to achieve goals, but youth should be able to come to the conclusion on what those achievements are by themselves. If in your diverse community, you want to instill a sense of ownership and responsibility among your teens, ask them to take charge in planning an activity or event that children will partake in and that the teens will have to plan from beginning to end. By offering leadership and guidance, but by also providing a safe space for creativity and ideas to flow freely, young people will become less apprehensive to breach more important subjects such as substance abuse or family issues with you later on. 

We explored Roger Hart’s ladder of participation (see below):

roger harts ladder of participation

We took a look at how adult influence in youth activities can range from manipulation to equality. Our goals should not and cannot always be to have to achieve youth engagement at the rung 8 level, but implementing the uses of a mixture of the top 5 rungs, young people should begin to feel a sense of confidence in their work and be able to take on more responsibility and autonomy. 

By allowing them this autonomy, they will begin to take charge and excel in new ways that you may not have thought up in your initial planning. Although certain barriers may seem to exist currently, such as the need to have set plans and timelines, a more effective strategy of engaging youth even in the planning process will reap better rewards. This may mean having to rework your planning and scheduling to accomodate more inclusive conversation around upcoming programs. It is sometimes hard to ask for several people's input on program development simply because of the "too many cooks in the kitchen" idealogy. But, the reality is that if programs are being developed for youth, they should be developed with youth in mind right from the planning stages -- and that means having to ask them. Once a new timeline and scheduling system is in place and youth are feeling more confident that they are being heard, programming for youth should come more naturally and you may find that having more hands on deck might actually be a great thing! 

 

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Linking for Healthy Communities: Day Two Reflections

It’s the day after our Linking For Healthy Communities: With everyone, for everyone conference. Aside from feeling exhausted, I’m thrilled that conference participants were engaged and excited throughout the conference.

Day Two began with two sessions of four workshops. I heard many people say that it was difficult to choose which workshop to attend as they all sounded wonderful!

day two sessions

Following the workshops and (yet another) magnificent meal (featuring the BMO Institute’s famous and unbelievably delicious) bread pudding, it was time for something a little different. When we first started planning this conference, and selected the theme of diversity, inclusion and working across difference, we wanted to provide an opportunity for small group conversations for conference participants to cultivate empathy, think from other people’s perspectives and co-learn. We came up with the idea to merge together a Living Library format with a World Café, where we would have table facilitators from a variety of life and lived experience work with small groups to deepen conversation and reflection. HC Link was very fortunate to work with consultant Sara Mohammed, who created an incredible “collection” of “Living Books” to help conference participants explore successes and barriers in this work. Throughout the Living Library Café, conference participants were engaged, open, and reflective.

living library

We closed our conference with something even more unique. Branch Out Theatre joined us to interpret our conference experiences through participatory theatre, music and movement. It was a wonderful way to digest the past two days and close the conference.

theatre

 

This was our third- and last- Linking for Healthy Communities conference. We have been thrilled to have hundreds of people join us over the years, to work with you, learn with you and celebrate. 

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Conference Workshop: Working with the Priorities of People Living in Poverty

There are a lot of workshops at this year’s Linking for Healthy Communities conference that I was excited about. But I think the one I was looking forward to most was Jason Hartwick and Gillian Kranias’ workshop Working with the Priorities of People Living in Poverty. The workshop provided a lot of open space for us to reflect on our own work and experiences, for us to discuss the values and principles of community development work, and for us to hear about Jason’s work and experiences (which frankly, I could have listened to all day). What I loved the most about the workshop was the opportunity to reflect on my own experiences and what I've personally learned. 

jason 3

One of the key messages from the workshop was about the assumptions and biases made about people who live in poverty. Societal reaction to those living in poverty is that “they” are handed everything that they need (eg social assistance), that they are responsible for their own conditions, and that they should “pull themselves up by the bootstraps”. But, as Josephine Gray says, “they” do not have boots. The reality is much more complex.

jason 1

People who live in poverty are often treated as if they have no value: the only thing expected of them is to live on social assistance and accomplish nothing. One workshop participant recommends using as asset-based approach: to recognize that communities have something inherently good and precious about them. Jason talked about the importance of pride, that communities who live in poverty rarely feel like they have something to be proud of.

Another take-away for me is how those of us who work in agencies come to the work with the agendas of our agencies: our mandates, our visions, our programs, our timelines. It’s important to keep those agendas slightly behind us (rather than pushing them in front of us) and use an open approach with communities. Rather than walking in and talking about he wonderful program that we have, we need to take the time to ask: what do you need? What do you want? Jason says communities do not have to own the problem, but they can be a part of creating the solutions.

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Built to Last: Sustainability Does Wonders!

(Or, "You’re taking away our hotdogs? This is supposed to be a democracy!”)

In the afternoon on the first day of our HC Link conference, the Local Project Managers for the Healthy Kids Community Challenge communities had a private session to chat and learn about sustainability. Between online and in-person participants, we had LPMs from about 2/3 of the projects present, which was a terrific turn-out!

LPMs arranged the content for the session – Cyndi (from KFLA), Fenicia (from Toronto) and Luke (from Sault Ste Marie) led the presentation. Naomi Giuliano shared a story about the Healthy Kids charter in the Superior North Greenstone HKCC region. HC Link provided space in the conference agenda, as well as the online connection.

LPM session photo

Key questions in the open discussion were:

  1. How has your HKCC operational structure supported the Program to be sustainable? What are some of the advantages or disadvantages?
  2. Are your key stakeholders committed to continuing the Program? If not, what's required for them to do so?
  3. What opportunities do you see? Are there any challenges?

Discussion flowed both online and in the room – sharing stories and challenges; making connections; and just enjoying the chance to be in the same space. LPMs can find the slides and continue the discussion in their private space on The Source.

Thanks for a great session, LPMs!

 

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