GUIDE TO CTD. Connecting the Dots: A Handbook for Chronic Disease Prevention through Community Engagement

Transcription

1 GUIDE TO CTD Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement

2 ACKNOWLEDGEMENTS We thank the cmmunities, rganizatins and individuals wh participated in Cnnecting the Dts (CTD) t date, as well as the key infrmants wh helped t evaluate CTD. Their input was essential in creating this handbk. Mantreh Atashband Health Prmter, Rexdale Cmmunity Health Centre Sarah Blackwd Manager, Wellness Prgrams, Cmmunity Care East Yrk Jean-Marc Bisvenue, directeur général Réseau franc-santé du Sud de l Ontari Dnna Cheung Rehab and Cmmunity Re-engagement Crdinatr, Suth East Trnt Strke Netwrk Christiane Fntaine Executive Directr, RIFSSSO : Regrupement des Intervenants en Santé et services sciaux Jcelyne McKellar Strke Rehab & Cmmunity Re-engagement Crdinatr, Trnt West Strke Netwrk Sandra Melchirre Reginal Strke Acute Care Advanced Practice Nurse, Strke Strategy: Sutheastern Ontari Sabrina Merali, RN, BScN Public Health Nurse, Cancer Preventin & Heart Health Team, Regin f Peel Marilyn Mrley Plicy Analyst, Ontari Federatin f Indian Friendship Centres Mary Slmn District Strke Crdinatr, Grey Bruce District Strke Centre Sue Saulnier, RN, BNSc, MEd, GNC(C) Reginal Strke Educatin Crdinatr, Reginal Strke Strategy fr Sutheastern Ontari Susan Swartzack, MPA, BScN, RN Senir Lead, Health System Develpment, Mississauga Haltn LHIN Sharn Trttman Cmmunity and Lng-Term Care Strke Specialist, West GTA Strke Netwrk This handbk was prduced by the Prevent Strke team at Health Nexus and is funded by the Ontari Ministry f Health Prmtin. Prject Lead Shaylyn Streatch The fllwing staff cntributed t this handbk: Suzanne Schwenger, Subha Sankaran, Rbyn Kalda, Peggy Schultz, and Kusar Khan. Citatin Health Nexus. (2009). Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement. Trnt: Health Nexus. Health Nexus is Ontari s lngest standing health prmtin rganizatin. Fr mre infrmatin abut Health Nexus, visit Health Nexus 180 Dundas Street West, Suite 1900 Trnt, Ontari M5G 1Z8 (416) inf@healthnexus.ca The infrmatin herein reflects the views f the authrs and is nt fficially endrsed by the Ontari Ministry f Health Prmtin. This wrk is licensed under the Creative Cmmns Attributin-Nncmmercial-Share Alike 2.5 Canada License. T view a cpy f this license, visit Because ur resurces are designed t supprt lcal health prmtin initiatives, we wuld appreciate knwing hw this resurce has supprted r has been integrated int yur wrk (inf@healthnexus.ca). Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 1

3 TABLE OF CONTENTS Acknwledgements 1 Intrductin 3 Purpse and Scpe f Handbk 3 Cnnecting the Dts Overview 4 Ratinale fr Cnnecting the Dts 5 Guide t Cnnecting the Dts 8 Cnnecting the Dts At-A-Glance 8 Getting Started 10 Step 1. Identificatin/Inclusin f Cmmunity and Planning Cmmittee Partners 10 Planning Tgether 12 Step 2. Netwrking and Relatinship-Building by the Planning Cmmittee 13 Step 3. Cnsideratin f Brad Planning Questins fr the Cmmunity 14 Step 4. Preparing fr the Cnnecting the Dts Event (Wrkshp, Frum r Cnference) 15 The Event 20 Step 5. Cnnecting the Dts Wrkshp, Frum r Cnference 20 Evaluatin 22 Step 6. Evaluatin and Reprting 23 Sustaining Mmentum 25 Step 7. Fllw-up 26 The Facilitatr s Rle 27 Netwrk Analysis and Develpment 28 Related Resurces 30 Appendix A Backgrund n Cnnecting the Dts 31 Appendix B Cnnecting the Dts with Urban Abriginal Cmmunities in Ontari: A Review f Cntext and Fundamental Principles 34 Appendix C Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts 40 Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 2

4 INTRODUCTION INTRODUCTION Purpse and Scpe f Handbk This handbk is fr health prfessinals, health prmters/ educatrs, and cmmunity grups/rganizatins wh want t wrk acrss sectrs and with multiple levels t leverage their jint ptential t prevent chrnic disease in their cmmunities. T be effective, chrnic disease preventin requires a cmprehensive apprach that ges beynd the traditinal health care sectr. The Canadian Best Practices Prtal fr Health Prmtin and Chrnic Disease Preventin identifies cllabratin acrss sectrs and levels 1 as a key element in a ppulatin-health apprach. This cllabratin requires "shared respnsibility fr health utcmes with multiple sectrs and levels whse activities directly r indirectly impact health." 2 Since 2004, the Prevent Strke team f Health Nexus has wrked with 15 cmmunities acrss Ontari t cnnect the dts. Each Cnnecting the Dts (CTD) prcess was cmmunity-led and participant-driven. As a netwrk develper, facilitatr, and brker f the CTD prcess, Health Nexus wrked with these cmmunities t engage a wide crss-sectin f stakehlders. See Appendix A fr backgrund infrmatin n hw CTD started and fr a list f CTDs t date. The 2009 Evaluatin Reprt n CTD cncluded: The CTD mdel f cmmunity engagement has successfully cnnected and engaged a range f service prviders acrss the cntinuum f care, facilitating new partnerships and ways f wrking lcally t address strke and chrnic disease. CTD prvided an imprtant mechanism t help peple learn abut physical risk factrs and scial risk cnditins in their wn cmmunity, link the scial determinants f health with chrnic disease preventin, and gain a better understanding f the brad range f rganizatins and individuals wh need t wrk tgether t create change. Fr many, the CTD experience was an eye-pening intrductin t the fabric f their wn cmmunity; fr thers it was an affirmatin f their apprach and wrk. Fr mst, it was an exciting pprtunity that led t new infrmatin, partnerships and enhanced service delivery/planning. This handbk utlines a practical mdel f cmmunity engagement. The guide t CTD includes key questins t cnsider and key actins. Helpful tips and suggestins are included thrughut. 1, 2 Public Health Agency f Canada. (2009). Key Element 6: Cllabrate Sectrs and Levels. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 3

5 INTRODUCTION Cnnecting the Dts (CTD) Overview CTD is a dynamic, multi-sectral cmmunity engagement mdel. It helps cmmunities wrk tgether differently fr better chrnic disease utcmes and imprved health fr all. CTD brings tgether a wide crss-sectin f stakehlders wh wuld nt therwise typically meet. They learn tgether and address cmplex prblems in a new and innvative way. Thrugh this engagement, CTD helps t strengthen capacity, share knwledge, and build netwrks fr health prmtin and chrnic disease preventin acrss a gegraphic cmmunity r a cmmunity f interest. Cnnecting the Dts: Increases knwledge Increases cnnectins Creates a greater readiness fr cllabratin Fsters new and strengthened partnerships CTD is cmmunity-led and participant driven. The tpic r theme (e.g. besity, pediatric strke preventin, pririty ppulatins) f a CTD reflects the individual cmmunity cntext, including needs, pprtunities, demgraphics, assets and histry f cllabratin. The CTD prcess includes a multi-sectral planning cmmittee, an event, and fllw-up. But CTD is mre than just planning fr and delivering an event; it s abut the cntinuus prcess f maintaining cnnectins, generating new partnerships and cllabratins, and learning frm each ther. CTD creates a climate fr creative change and sets the stage fr further cllabrative wrk in the cmmunity. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 4

6 INTRODUCTION Ratinale fr CTD We find at least fur key ingredients that are essential t success in preventing chrnic diseases and achieving health equity. The first ingredient is a lcal investment in cmmunities... A secnd key ingredient is prviding a venue fr lcal cmmunities t learn abut effective strategies, particularly thse related t plicy and envirnmental and systems changes.. The third ingredient is mbilizing netwrks fr change... Finally, cmmunities need tls t assist them as they mbilize t achieve health equity and prevent chrnic diseases. 3 Cmmunity Engagement as Health Prmtin CTD is a cmmunity engagement mdel t build capacity fr chrnic disease preventin. It builds a cmmunity s capacity thrugh the sharing f knwledge, best practices, and perspectives t address issues n ne sectr can achieve n its wn. Cmmunity engagement is peple wrking cllabratively, thrugh inspired actin and learning, t create and realize bld visins fr their cmmn future. 4 Cmmunity engagement is a fundamental health prmtin strategy and CTD is grunded in the values and features f health prmtin. It addresses scial, ecnmic, and envirnmental causes f health and wellness; it fcuses n assets and strengths f individuals and cmmunities; and it applies participatry appraches that build the capacity f individuals and cmmunities t address their health cncerns. CTD creates the cnditins fr cllabratin and fsters the fllwing health prmtin actins: strengthen cmmunity actins, rerient health services, create supprtive envirnments, and build healthy public plicy 5. Tamarack, an Ontari-based institute fr cmmunity engagement, cncluded frm a literature review that cmmunity engagement: Infrms plicy-making at the lcal level HEALTH PROMOTION VALUES Hlistic view f health Scial justice and equity Pwer sharing and respect Scial inclusin Empwerment Evidence-based practice Cllabratin FEATURES OF HEALTH PROMOTION Enable cntrl Use participatry appraches Fcus n determinants f health Fcus n strengths and assets Fcus n gals rather than prblems Use multiple strategies in multiple settings Acknwledge the imprtance f cntext Imprves the targeting and effectiveness f services Helps t measure hw agencies and partnerships are perfrming Helps t build cmmunity wnership. 6 One way t strengthen cmmunity engagement is t strengthen netwrks. The imprtance f supprting netwrks is clearly stated by Plastrik and Taylr: Given the cmplexity and enrmity f scial prblems, the unrelenting pressure t reduce the cst f creating and implementing slutins, and the recent prliferatin f small nnprfit rganizatins, netwrks ffer a way t weave tgether r create capacities that get better leverage, perfrmance, and results. 7 3 Giles, W. H., Hlmes-Chavez, A., & Cllins, J. L. (2009). Cultivating healthy cmmunities: The CDC perspective. Health Prmtin Practice, 10: 86S-87S Ottawa Charter fr Health Prmtin Plastrik, P. & Taylr, M. (2006). Net Gains: A Handbk fr Netwrk Builders Seeking Scial Change. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 5

7 INTRODUCTION Netwrks: Enhance the flw f infrmatin Imprve cmmunicatin and interactins Open new resurces Build and enhance leadership Encurage cllabratin and innvatin Build bridges acrss traditinal divides 8 CTD helps cmmunities build and engage netwrks fr chrnic disease preventin. Integrated Chrnic Disease Preventin This handbk builds n the cmmunity engagement wrk dne in the strke field. Its applicability and suitability t chrnic disease preventin has been bradly recgnized by participants, planning cmmittee members, key infrmants and thers in the cmmunity. Furthermre, this applicatin is supprted by the call fr integrated chrnic disease preventin and cllabratin. 9 The Ontari Chrnic Disease Preventin Alliance reprt f 2006, entitled Chrnic Disease in Ontari and Canada: Determinants, Risk Factrs and Preventin Pririties, recmmends a cmprehensive strategy fr chrnic disease preventin that links multiple levels f risk factrs, multiple stakehlders, and multiple strategies. Abut ne in three Ontarians f all ages have ne r mre chrnic diseases. Of thse ver the age f 65, almst fur ut f five have ne chrnic disease, and f thse, abut 70 percent suffer frm tw r mre. Ontari Health Equity Cuncil. (2007). A Reprt n Ontari s Health Care System. Risk factrs fr chrnic diseases are genetic, behaviural and envirnmental. If we lk at behaviural risk factrs, strke shares risk factrs in cmmn with ther chrnic diseases. The figure belw shws this. 8 Hlley, J. (2005). Why Netwrks? 9 Public Health Agency f Canada. (2009). Key Element 6: Cllabrate Sectrs and Levels Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 6

8 INTRODUCTION The CTD mdel brings tgether all thse wh need t be wrking tgether t address chrnic disease, including thse frm the different disease sectrs. This is in line with Ontari s Chrnic Disease Preventin and Management framewrk. Additinally, the CTD mdel brings tgether peple frm different sectrs wh are nt usually invlved in health issues and interventins. If we lk at the envirnmental factrs, pverty and scial determinants play a majr rle. See the figure belw. These scial determinants f health are ften verlked when addressing the risk factrs fr chrnic disease because they fcus n systemic and structural features rather than n individual behaviurs. Fr example, smking is a risk factr fr strke. Hwever, the data shws that the tendency t smke is higher amng lwer incme grups. 10 Therefre, we need t fcus n the causes f the causes. While the prximate cause f strke may be high bld pressure r besity, the causes f causes are the scial determinants f health. Interventins must fcus n hw t shift these scial determinants f health, 11 in additin t shifting individual behaviur. This can nly happen when we wrk acrss sectrs and cnnect the dts. At least 60 percent f Ontari s health-care csts are due t chrnic diseases. Ontari Health Equity Cuncil. (2007). A Reprt n Ontari s Health Care System. Wrld Health Organizatin research puts the cst f medical treatment fr chrnic diseases, and the lst prductivity they cause, at $80 billin annually in Canada. Ontari Health Equity Cuncil. (2008) Reprt n Ontari s Health Care System Check ut ur Primer t Actin resurce fr mre backgrund research n the scial determinants f health. This electrnic resurce helps us t understand and influence hw the scial determinants f health impact chrnic disease. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 7

9 GUIDE TO CTD GUIDE TO CTD CTD At-A-Glance With deliberate, sustained facilitatin and sensitivity t each cmmunity s lcal cntext and needs, each CTD prcess sets the stage fr creative change and further cllabratin. Cnnecting the Dts: A Cmmunity Engagement Mdel t Build Capacity fr Chrnic Disease Preventin Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 8

10 GUIDE TO CTD CTD takes 6 r mre mnths and fllws a 7 step prcess: Getting Started Step 1 Identificatin/Inclusin f Cmmunity and Planning Cmmittee Partners Planning Tgether Step 2 Netwrking and Relatinship-Building by the Planning Cmmittee Step 3 Cnsideratin f Brad Planning Questins fr the Cmmunity Step 4 Preparatin fr the CTD Event (Wrkshp, Frum r Cnference) The Event Step 5 CTD Wrkshp, Frum r Cnference Evaluatin Step 6 Evaluatin and Reprting Sustaining Mmentum Step 7 Fllw-up Each CTD is cmmunity-led and participant-driven. Fr specific guidelines regarding the applicatin f CTD within an abriginal cmmunity, see Appendix B CTD with Urban Abriginal Cmmunities in Ontari: A Review f Cntext and Fundamental Principles. Appendix C Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts describes hw CTD was applied within a rural cmmunity (Grey Bruce), an urban cmmunity (Suth East Trnt), and a pririty ppulatin (Suth Asian). These reflective case studies detail the CTD prcess in each f the selected cmmunities and include the utcme and impact, as well as the key learnings and recmmendatins frm each. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 9

11 GUIDE TO CTD Getting Started Partnerships and cllabratin d nt happen withut the deliberate allcatin f resurces and supprts. Remember, it takes time t build relatinships and t explre areas f cmmn interest. It can als be very exciting t begin t share learning and insights and t think mre strategically abut what is needed in yur cmmunity. Find ut hw the Grey Bruce, Suth East Trnt, and Suth Asian CTDs gt started. Step 1 Identificatin/Inclusin f Cmmunity and Planning Cmmittee Partners The first step in the CTD prcess is t identify and include cmmunity stakehlders. Key Questins t Cnsider Wh are yur key partners? Wh wuld yu like t partner with that yu have nt befre? Wh might share a cmmn interest in the issue? Wh is wrking in the area f chrnic disease preventin? Whse wrk indirectly impacts chrnic disease? Review the determinants f health Wh are the influencers? Wh is affected by the issue? T help yu think thrugh ptential stakehlders, here is a list f sectrs, rganizatins, and levels yu may want t engage. Sectr Business Educatin Envirnment Health Prmtin Health Services acute care rehabilitatin lng-term care cmmunity re-integratin Husing Recreatin Settlement Scial Services Organizatin Chrnic Disease Netwrks Cmmunity Health Centres Cmmunity Services Faith-Based General Public Gvernment Hspitals Lcal Calitins Lcal Health Integratin Netwrks Nn-Gvernment Organizatins Public Health Units Schls Scial Planning Cuncils Level Frnt-Line Service Delivery Management Planning Plicy-makers Lcal Prvincial General Public senirs patients/survivrs family/friends specific cmmunities and sub-ppulatins within the larger gegraphic cmmunity Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 10

12 GUIDE TO CTD Key Actins Identificatin Review yur cntact lists Netwrk with peple yu knw and new peple yu meet t determine interest and wh s wh. Yu need t find the right cntact persn in the rganizatin. Cntact related calitins r netwrks Health Nexus has created a list f Ontari Health Prmtin Calitins and Netwrks by Lcal Health Integratin Netwrk (LHIN) Check ut 211Ontari.ca fr easy access t cmmunity, scial, health and related gvernment services in Ontari Link with yur lcal Family Health Team (FHT) Use the Internet t search fr ptential stakehlders and t find cntact infrmatin Cnsult Health Nexus Key Actins Inclusin Start talking abut Cnnecting the Dts in yur cmmunity! Netwrk, netwrk, netwrk Invite ptential stakehlders t an initial meeting Use Internet-based cmmunicatin methds such as , yur rganizatin s website, and scial netwrking tls, but d nt underestimate the value f telephne and face-t-face cnversatins Cnsider framing the initial meeting as a brad stakehlder meeting with tw bjectives: t hear frm the cmmunity and t frm a planning cmmittee f attendees wh are interested and/r able TIP Sme f the peple yu cntact (and thse wh attend the initial brad stakehlder meeting, if applicable) will nt be interested and/r be able t participate in the planning cmmittee. Recrd their name, psitin, rganizatin, and cntact infrmatin. Maintain a running list f ptential participants fr the event. When it cmes time t send ut event invitatins yu will already have a list started! Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 11

13 GUIDE TO CTD Planning Tgether Planning tgether supprts the prcess f mving tward a mre integrated and cmprehensive apprach t chrnic disease preventin and management. Yet, the interdependence required fr CTD des nt arise spntaneusly. CTD participants may cme frm different sectrs, rganizatins, and levels and may have different strengths, experiences, and needs. Ultimately, this diversity enriches the prcess as different perspectives wrk t cnnect the dts and t crdinate effrts. Learning t wrk tgether is an nging prcess! Find ut hw the Grey Bruce, Suth East Trnt, and Suth Asian CTD planning cmmittees planned tgether. 12 In the early stages, the netwrk lead, crdinatr r facilitatr must develp an agenda 13 fr each planning meeting. They need t think thrugh the purpse f the sessin and they need t design the sessin s that members get t knw mre abut each ther s wrk and rganizatins (Step 2). At the same time, peple wh are just getting t knw each ther are als charged with planning an event (Step 3 and Step 4). Tw deliberate actins supprt cllabratin: ensuring gals and activities that reflect the reasn fr wrking and planning tgether AND fcusing n hw the grup itself will functin. A cllabrative leader will pay attentin t the functining f the grup itself while building n capacities and interests s that members may see the part they want t play. 12 Health Nexus has used this building partnerships mdel in training sessins and in a resurce fr Ontari s Family Health Teams. 13 See Frm the Grup Up: An Organizing Handbk fr Healthy Cmmunities, sectin 2, page 12, fr tips n hw t plan and execute effective meetings and hw t develp effective meeting agendas. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 12

14 GUIDE TO CTD Cllabratin is supprted by a shared understanding f the CTD purpse and visin. Building cnsensus des nt necessarily mean that everyne will agree. If there is a cmmitment t listening t each persn and t valuing their pinin, then the questin may be: Are we tgether enugh t g frward? Trust is built ver time. The CTD prcess cmbines active participatin (e.g. planning and develping a CTD event) while creating an envirnment f cllabratin s that future intersectral actins can spring frm this wrk. Step 2 Netwrking and Relatinship-Building by the Planning Cmmittee Fr mst cmmunities, this is a netwrk develpment pprtunity fr the planning cmmittee members themselves as they share ideas and infrmatin abut their rles and begin t build relatinships tgether. Keep in mind that many f the planning cmmittee members will nt have wrked tgether befre. It is essential t bth acknwledge the imprtance f relatinship-building and t allw time t fster relatinships. Taking time t cnnect will prvide wider access t infrmatin, resurces, and netwrking pprtunities, as well as c-learning and reflectin t build capacity fr chrnic disease preventin. Key Actins Incrprate structured pprtunities t cnnect with and understand each ther and learn mre abut each ther s wrk These netwrking activities are variatins f appraches that have been used in CTDs in rder fr cmmittee members t get t knw each ther in a different way. CTD emphasizes cllabrative wrk n chrnic disease. It creates the pprtunity t wrk tgether differently. Tuch and G (a versin f speed dating ) This activity helps the frming grup t cnnect with each ther. Everyne breaks ff int dyads and asks each ther questins abut cmmn wrk interests. There can be 3 g-arunds and each ne lasts 10 minutes. In first g-arund, find ut mre abut each ther s wrk. In the secnd g-arund with a new persn, discuss new cllabratins that are pssible. In the third g-arund, try t find ut abut the cmmnalities and differences. Take time t debrief and see if there is sme sense f attractin, that is, a new pprtunity r linkage! I m Here, Yu re There, We re It: Mapping ur Netwrks During a regular planning meeting, each participant can take time t cnsider his/her wn netwrks and cnnectins. Each participant is asked t use paper and markers t draw a map f cnnectins (self/rganizatin in the centre) that reflect the varius ways in which each separate rganizatin cnnects in its wn sphere. Each participant is asked t place peple/rganizatins n their map. Sme cues t get yu started: Think f grups yu might turn t fr advice r invlvement in yur current wrk. Think f the cllabratins yur rganizatin is currently invlved in Think f grups that yu culd re-cnnect with. Afterwards, everyne can d a walkarund. This helps participants t see the depth f the netwrks! Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 13

15 GUIDE TO CTD Our Gifts f Cllabratin Ask participants t think abut this questin: What gift f cllabratin d I bring t this grup? Each persn is asked t select ne f their belngings r an bject in the rm t symblize this gift. Share the meaning f this symbl with anther persn. Then, ask everyne in the grup t intrduce themselves. If yu are nt using a symblic bject, ask each participant t intrduce her/himself with 3 r 4 wrds that describe the gift (talent, skill, capacity, resurce, cntributin) that s/he brings t a cllabratin. Identify individual and mutual expectatins and bligatins Each member f the planning cmmittee will have different mtivatins fr being a part f the cmmittee that derive frm their wn wrk mandates. Each persn will als have different resurces (e.g. skills, time, funding) that they are able t cntribute. Therefre, it is imprtant t clarify expectatins and rles in the early planning prcess. Encurage further brainstrming and the inclusin f planning cmmittee members Initial cmmittee members may suggest I knw smene wh wrks in X wh wuld be a great asset t the cmmittee Be aware f grup dynamics Ask peple what they need t feel supprted in the planning prcess. Cultures f cllabratin are based n a paradigm f each persn s experience having equal status and peple wrking tgether t cme t an agreement thrugh interactin and mutual accuntability. Encurage and supprt each ther in jintly feeling respnsible fr making the planning prductive. If smething is nt wrking, take time t understand what is happening. Explre differences between cmpeting ideas. Cmmunicate penly and frequently Step 3 Cnsideratin f Brad Planning Questins fr the Cmmunity Once the planning cmmittee has begun t build relatinships and t share infrmatin and netwrks, members can begin t identify pririty areas f fcus fr the cmmunity. This may be based n demgraphic and epidemilgical data which fcus n the incidence f disease, a specific risk factr (e.g. besity), r a pririty grup (e.g. Suth Asian ppulatin). Key Questins t Cnsider Infrmatin D we have access t ppulatin-based data t identify pririties fr preventin? What gaps, needs, and assets d we have in ur health/scial services? Hw des health prmtin fit within the structure f chrnic disease preventin and the range f health prmtin prgrams within the cmmunity? Has ur cmmunity identified any best practices t address the determinants f chrnic diseases? Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 14

16 GUIDE TO CTD Key Questins t Cnsider Cmmunity Engagement and Cllabratin Experience What cllabrative initiatives exist t prevent disease and prmte health? What is the range f public participatin and engagement t date? What is the prir use f multiple engagement and educatin strategies? Are there pprtunities fr cmmunity develpment and mbilizatin arund cncurrent health issues/campaigns that can create and prmte supprtive envirnments? Key Questins t Cnsider Pririty Ppulatins D we want t fcus n the ppulatin as a whle r n pririty ppulatins within ur cmmunity? What risk factrs are prevalent in ur cmmunity? (Include bth physical risk factrs and scial risk cnditins such as pverty) Key Actins Cnsider the questins listed abve with yur grup. Fr additinal guiding principles, please refer t the Cmmunity Health Prmtin Checklist in Prescribing Preventin: Health Prmtin and Strke Preventin If there are unanswered questins, suggest that the grup gather infrmatin by inviting smene frm the cmmunity t act as a resurce, r by accessing lcal needs assessments and research reprts. The grup may als wish t supplement their knwledge f cmmunity resurces thrugh netwrk analysis. Step 4 Preparing fr the CTD Event (Wrkshp, Frum, r Cnference) Once yu have addressed these brad planning questins abut yur cmmunity, it s time t begin planning yur CTD event. Key Questins t Cnsider What is the purpse f the CTD event? What bjectives d yu want t achieve? Wh d yu want t engage? What type f event will help yu t achieve the purpse and bjectives that yu have decided upn? What type f event will engage the audience: A wrkshp? A frum? A cnference? Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 15

17 GUIDE TO CTD Key Actins Six Mnths r Mre Befre Yur CTD Event Determine bjectives CTD is a cllabrative, cmmunity-led and participant-driven prcess. Using participant methdlgies means that each CTD planning cmmittee develps bjectives apprpriate t cmmunity circumstances. Thus, bjectives may vary. The bjectives stated here reflect the cre bjectives fund in each CTD prcess; supplemental bjectives may cmplement these. Increase knwledge abut health prmtin, chrnic disease preventin, and scial determinants f health, as well as individual mdifiable risk factrs, with a specific fcus n resurces (e.g. tls, peple, rganizatins), interventins, and evidence Cntribute t imprved planning fr chrnic disease preventin at all levels Fster greater intersectral cllabratin thrugh existing and new netwrks Key Actins Six Mnths Befre Yur CTD Event Determine the date and time fr yur event Cnsider yur audience and ther events that they may be attending Find ut abut ther events in the brader cmmunity that may cnflict with the CTD TIP Try t hst a full-day event with lunch and breaks t ensure maximum netwrking pprtunities (e.g. 9:00 a.m. t 3:00 p.m. r 10:00 a.m. t 4:00 p.m.). Develp a budget Try t arrange fr as many in-kind cntributins as pssible frm the planning grup. (e.g. printing, dr prizes) Basic expenses will include facility rental, catering, and hnraria Additinal expenses culd include items fr participants such as printed lunch bag, r pedmeters Yu may wish t seek spnsrship fr yur event Chse a venue and catering Past CTD events have included between 20 t 120 participants. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 16

18 GUIDE TO CTD Venue: When chsing a venue, cnsider the fllwing: Budget The lcatin culd be anther in-kind dnatin (e.g. Public Health Unit space) r the event culd be held at a htel r a cnference centre Prximity t cmmuter rail r public transit Wheelchair accessibility Adequate space fr anticipated number f participants as well as display area Rm layut (apprpriate fr use f PwerPint; wall space fr flip chart display) Technlgical requirements (e.g. audi-visual equipment, micrphnes, Internet access). Catering: Find ut if yu can bring in yur wn caterer r wrk with venue staff t ensure healthy breakfast, lunch and snacks, depending n yur itinerary Cnsidering ffering vegetarian-nly ptins Plan the agenda Identify ptential speakers frm the cmmunity (e.g. public health staff, chrnic disease prfessinals, thse living with disease r challenges). It is imprtant t identify speakers early n in rder t ensure their availability. Review the agenda fr the Grey Bruce,Suth East Trnt, and Suth Asian CTD events. Develp and circulate a PwerPint template fr all presenters t use. Be sure t include a spt fr their rganizatin s lg. Als, ensure that the template applies apprpriate fnt sizes and clrs schemes s that the audience can read the text. This will create cnsistency between presentatins and be f help t the presenters as they will nt have t create their wn. Ensure that there are many pprtunities fr netwrking and interactivity. Include small grup discussins, icebreakers, and breaks int the agenda. Cnsider a theme and a title fr the event. The title culd simply be Cnnecting the Dts in X Cmmunity r it culd specifically refer t the fcus, such as Mving and Eating Well t Cmbat Obesity. Assign rles t the planning grup Delegate tasks t planning grup members. This helps t divide up the many rganizatinal respnsibilities, save resurces and prmte engagement. The planning grup can be a wnderful surce f in-kind cntributins. Fr example, a public health clleague can help find smene t lead a fitness r activity break. Pre-event rles fr planning cmmittee members include cntacting speakers, creating the event brchure and arranging fr gifts/hnraria. On the day f the event, planning grup members greet participants, deliver wrkshps and facilitate small grup discussins. TIP The engagement f the planning cmmittee is the key t the success f the CTD event. Regular meetings by phne and/r in persn will help members t stay cnnected and engaged thrughut the planning prcess. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 17

19 GUIDE TO CTD Create an invitatin list Planning cmmittee members will brainstrm a brad range f ptential participants Ptential invitees will draw frm the brad cmmunity f thse wrking acrss the cntinuum f care in chrnic disease, cmmunity service prviders, as well as many representatives f lcal and reginal netwrks and calitins. It is imprtant t include als thse individuals with lived experience, including strke survivrs, peple living with diabetes, and family caregivers. Brainstrming tgether n ptential invitees will help yu t make new and different cnnectins which include: Interprfessinal links acrss disciplines f the chrnic disease cntinuum (e.g. health prmtin, public health, hspitals, cmmunity health centres, lng-term care, and cmmunity services) Intersectral links between healthcare, scial services, educatin, husing, recreatin, etc. TIP Think abut inviting many different sectrs and levels f the cmmunity, frm frnt line wrkers t gvernment plicy-makers. Send ut a save-the date message Invite individuals t save the date and let them knw abut the event theme and title. Send this initial invitatin t the varius s and listservs that have been gathered. Reminder s will fllw clser t the event. Key Actins Three mnths Befre yur CTD Event Create a registratin prcess Set up a registratin prcess (e.g. nline, fax, ) t track numbers Include pre-evaluatin questins t cmpare t pst-evaluatin data Ask whether participants require any physical r dietary accmmdatins Set up a system t stp registratins nce they have reached capacity Create a prmtinal brchure The brchure shuld include the fllwing infrmatin: Intended audience Objectives Agenda List f speakers (with bis ptinal) Lcatin and time Registratin (include a link t nline registratin, r include a registratin frm t be returned by fax r ) Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 18

20 GUIDE TO CTD Prmte event Send ut the invitatin with the brchure t expanded yur list and listserv grup Fllw up with reminders tw mnths, ne mnth and tw weeks prir t the event (reminders will depend n registratin activity) Request displays frm key stakehlders Displays are a wnderful way t prmte many key prgrams and netwrks in yur cmmunity The planning grup will identify grups and prgrams that may wish t prvide displays such as public health, Heart and Strke, diabetes educatin prgrams, and lcal initiatives such as cmmunity gardens Create a pre/pst set f evaluatin questins See evaluatin sectin fr suggestins regarding evaluatin Key Actins One Mnth Befre Yur CTD Event Cntinue t mnitr registratins Clse the registratin prcess nce full r cntinue t prmte the event with reminder s as required Review all tasks fr the planning grup Ensure that everyne knws what is required f them bth befre and during the CTD Fllw an internal agenda that identifies each 15 minute segment f the day, materials required and persn respnsible Gather all materials fr the event, including any dr prizes Crdinate all materials fr registratin package Agenda, nametags, PwerPint handuts, pre-evaluatin frm, release frm fr phtgraphs Key Actins The Week f Yur CTD Event Cmmunicate final review f agenda and rles with the planning grup Cnfirm final attendance with caterers Finalize all materials: Prepare any signs yu might need fr yur CTD event Pack all materials fr registratin table Prepare thank-yu cards r gifts fr the vlunteers Purchase supplies needed fr the event (e.g. nametags, clured dts fr nametags) Find ut hw the Grey Bruce, Suth East Trnt, and Suth Asian CTD events were prmted. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 19

21 GUIDE TO CTD The Event A CTD event serves many purpses: knwledge exchange, netwrking, and cnnectivity within the cmmunity. Whether yu chse the frmat f a frum, cnference, extended wrkshp, r netwrking day, planning a CTD event can be a creative and energizing prcess. Yu will find that yu will begin t cnnect the dts thrughut the event planning stage as the planning cmmittee cntinues t build relatinships and cnnectins. These cnnectins will be enhanced, and new nes fstered, the day f the CTD event. Step 5 CTD Wrkshp, Frum, r Cnference The agenda f yur CTD event will vary depending upn the cmmunity and decisins f the CTD planning cmmittee. Make sure that yur event is interactive, with pprtunities fr small grup wrk as well as plenary sessins and keynte speakers. It is recmmended that yu bk a full day CTD event, e.g. frm 9:00 a.m. t 3:00 p.m. r frm 10:00 a.m. t 4:00 p.m. Find ut what the Grey Bruce, Suth East Trnt, and Suth Asian CTD events were like. Cntent CTD events may include a mix f the fllwing: An epidemilgical snapsht f the cmmunity, its envirnmental and scial risk cnditins/ factrs, and lcal health status data An verview f the Ontari Strke Strategy and hw it wrks An intrductin t health prmtin and the scial determinants f health Case studies that demnstrate the applicatin f health prmtin cncepts, practice, and cllabratin; the case studies shw hw grups culd wrk tgether mre ften and mre effectively Stries tld by strke survivrs and thse with lived experience Sme means t demnstrate the varius health prmting and preventin cntributins f varius sectrs, prfessins, and rganizatins Prcess Activities fr a CTD event may include: Icebreakers Small grup discussins with assigned facilitatrs Cnversatin cafés Keynte speakers Lts f discussin and netwrking! TIP Speed Netwrking is an easy and fun icebreaker. Yu have 5 minutes t find smene in the rm, intrduce yurselves, and learn smething new! Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 20

22 GUIDE TO CTD Speakers Pssible speakers may include: Members f the planning cmmittee Experts in the area f chrnic disease Epidemilgists r medical fficers f health Representatives frm gvernment r lcal planning rganizatin (e.g. LHIN) Peple with lived experience such as strke survivrs and their families Dn t frget t include a gift r hnrarium fr yur speakers when yu plan yur budget Rm Set-Up Try t chse a rm with adequate light and blank wall space t display ntes frm flip charts. Rund tables are ideal fr small grup discussin. If yu are including display tables, try t bk enugh space s that displays can be visited during break time withut vercrwding the rm. Key Actins The Day f Yur CTD Event Crdinate all venue lgistics (e.g. rm set up, a/v equipment, fd, signage) Set up a registratin table t greet participants as they arrive Greet presenters, speakers, and thse handling displays Take phtgraphs Key Actins After the CTD Event Uplad presentatin slides (with apprval frm the presenters) t yur website(s) Analyze, interpret, and reprt evaluatin results Check ut the website cverage fr the Suth Asian CTD event. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 21

23 GUIDE TO CTD Evaluatin Evaluatin, reflectin and building nging learning are essential parts f gd cmmunity engagement. Funders increasingly require evidence-infrmed r evidence-based practice. By taking a systematic apprach t evaluatin, yu will be generating evidence abut cmmunity engagement that can be f use t yu, yur partners and many thers. Evaluatin can yield imprtant infrmatin abut the nature and quality f cmmunity engagement. It can shw whether bjectives were met, hw well they were met, and als the intended and unintended utcmes f the engagement prcess. Evaluating cmmunity engagement is nt easy. It des nt ften yield hard data such as numbers f hspitalized patients r emplyment numbers. Yu may need multiple evaluatin methds. Think abut evaluatin as yu begin t plan yur CTD event. Cnsider the evaluatin questins, the data gathering tls, the actual data gathering prcess, the analysis and interpretatin f findings, and hw all f this infrmatin will feed back int further actin steps. Yu might want t think abut the pssible utcmes f yur CTD event. These may include enhanced service crdinatin resulting in better service fr clients, dialgue generated amng unlikely r uncnventinal partners, r the fstering f new partnerships. All f the pssible utcmes may result in imprved health fr peple. It can als have an impact at the plicy level as yu will be better prepared t address questins that require a plicy level respnse. All f these factrs will infrm yur apprach t evaluatin. There are many excellent guides t assist yu with the evaluatin prcess. Here are links t sme f them: Evaluating Cmmunity Engagement by Department f Cmmunities, Queensland Gvernment Prgram Evaluatin Tl Kit by Public Health Agency f Canada Ten Steps t Evaluating a Health Prmtin Prgram by The Health Cmmunicatin Unit Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 22

24 GUIDE TO CTD Step 6 Evaluatin and Reprting Althugh this handbk dentes Step 6 as Evaluatin and Reprting, evaluatin crsses all steps. It is included as Step 6 because this is where the analysis and reprting f results takes place. As mentined abve, it is imprtant t incrprate the develpment f a cmprehensive evaluatin plan during the planning prcess. Key Questins t Cnsider What is the purpse f yur evaluatin? This will prvide the cntext fr yur evaluatin and a framewrk within which ther questins will fit. What are yu evaluating? Are yu evaluating utcmes (what yu did and hw well yu did it), prcess (hw yu did it), r bth? When evaluating cmmunity engagement, remember that many f these prcesses build ver time. They may nt have immediate, tangible results that can be shwn t funders r turned int tables and charts. They may be hidden in the successes f ther initiatives that they spawn. In additin, nt all f the factrs that influence the utcme may be in yur hands. What d yu want t knw abut what yu are ding? This will help yu t craft the evaluatin questins that yu want t ask. This is why it s helpful t think abut evaluatin during the early planning stages. Fr example, if yu rganize the CTD event in rder t increase knwledge, then yu will want t find ut if knwledge was in fact increased, by hw much, fr hw many, abut what, etc. Hw will yu knw this? What indicatrs will yu use? Yu may want t define this in terms f yur situatin. One f the CTD series n besity asked participants if they were aware f mtivatinal strategies fr clients and hw cnfident they felt in using these strategies. These were measured befre and after the event. Hw will yu gather this data? Build the evaluatin questins int the tls that yu will use during the CTD event (e.g. registratin frms, evaluatin frms, fcus grups). The evaluatin questins will relate t the purpse r bjectives f the CTD event. Fr example, when rganizing a CTD event n pediatric strke, ask participants if they learned mre abut pediatric strke and if they can identify the stakehlders wh are invlved in this issue. One ptin is t use a pre/pst test t measure participants level f knwledge befre and after the event, and then cmpare the results. Yu can use varius nline evaluatin tls such as SurveyMnkey.cm. Use varius methds t gather and analyze data. Quantitative data prvides an verview r a snapsht, while qualitative data can help t tell a stry by fleshing ut the bare bne details f a quantitative picture. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 23

25 GUIDE TO CTD Since each CTD event is tailred t the cmmunity, questins n evaluatin tls will differ. Here are sme things that yu might want t include in yur evaluatin tls: Demgraphics (e.g. wh was engaged, the number f participants, the sectrs/rganizatins/ levels represented) Participant feedback n cntent. Was the event meaningful t participants? What did they gain frm the event? Is the event relevant t their wrk? Participant feedback n prcess. Was the prcess participatry and interactive? Was the prcess accessible and equitable? Overall participant satisfactin with the event Shrt-term, medium-term, and lng-term utcmes. Frame the pssible utcmes in reference t the bjectives identified at the start f yur prcess. Fr example: Increase infrmatin, specific knwledge, skills Enhance netwrking Enhance capacity in general Find ut the utcmes frm the Grey Bruce, Suth East Trnt and Suth Asian CTDs. Key Actins Identify the bjectives f yur CTD event. Identify smene wh will take the lead n evaluatin. This may be the same persn(s) wh will lead the CTD event. Develp an evaluatin framewrk at the start f the planning prcess s that yu can cntinually cllect data. If yu plan t use pre/pst questins, build the pre questins int the registratin frm. It is easy t set up and cllate these questins by using nline evaluatin tls such as Survey Mnkey. Engage the whle planning cmmittee in the evaluatin as apprpriate and needed. Discuss evaluatin at planning meetings, have a separate meeting, r cmmunicate by . Send ut draft questins and get feedback s that yu can create an evaluatin frm that peple will feel is useful. Build time int the event s agenda s that peple d nt leave withut cmpleting their evaluatin frms. Include the evaluatin frms in the participant s package. Or, ask participants t fill ut the evaluatin frms nline a day r tw after the event. Yu will likely receive mre respnses this way. Data analysis can take time. Frame yur questins s that the respnses can be easily cllated and interpreted. Ask the planning cmmittee t interpret the data. Grup discussins ffer great insights. Send the draft evaluatin reprt t the planning cmmittee fr cmment. Incrprate the cmments and finalize yur reprt. Share this reprt with yur funders, partners, and ther interested parties. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 24

26 GUIDE TO CTD Sustaining Mmentum S, yu rganized a very successful event that had fabulus participatin frm many sectrs. Yu met all f yur splendid bjectives and participants gained infrmatin, knwledge, skills, and cnnectins. Nw, hw d yu maintain the interest and enthusiasm and build n this fundatin? Peple and rganizatins ften face this dilemma after an event. Sustaining the mmentum requires cmmitment and effrt n everybdy s part, especially frm the leaders. By nw, yu will have cllabrated with yur planning cmmittee and clleagues fr sme mnths, learned mre abut yur clleagues wrk and their rganizatins, and built relatinships that are necessary fr deeper cllabratin. Many writers have discussed these challenges. In The Dance f Change: The Challenges t Sustaining Mmentum in Learning Organizatins, Senge et al., 14 discuss hw t: Enhance persnal results ( because it matters ) Develp netwrks f cmmitted peple ( because my clleagues take it seriusly ) Imprve business results ( because it wrks ). The key is t identify why peple shuld cntinue t maintain their cnnectins. As a leader, yu d nt have t d everything, but yu shuld fcus n maintaining cnnectins. D nt expect everyne t be as cmmitted as yu. That is perfectly all right and t be expected. Start small and keep ging. Krebs and Hlley, 15 frm Netwrk Weaving, identify fur steps that yu can take t maintain yur netwrk: Identify pprtunities Identify assets Invite ther peple t jin yur netwrk Begin with a small activity. 14 Senge et al. (1999). The Dance f Change: The Challenges t Sustaining Mmentum in Learning Organizatins. 15 Krebs, V. & Hlley, J. (2004). Weaving Smart Netwrks. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 25

27 GUIDE TO CTD Step 7 Fllw-up There are tw types f fllw-up that ccur after a CTD event: fllw-up initiated by the planning cmmittee and fllw-up initiated by the peple wh made cnnectins at the CTD event. The latter may include using new resurces in their wrk (e.g. referring clients t a new service/supprt, applying new tls/knwledge); changing the way they wrk (e.g. thinking f cllabrating n existing r new initiatives and with a wider stakehlder grup); and/r fllwing up n a new partnership pprtunity. Find ut the impact t date frm the Grey Bruce,Suth East Trnt and Suth Asian CTDs. Key Actins Invite the planning cmmittee t a debriefing sessin sn after the CTD event. Fcus n successes and assets. Learn frm what yu culd have dne better. Celebrate! Send a reprt t the planning cmmittee. Fllw-up n yur cmmitments t the participants. Once yu have finished writing the reprt, rganize a meeting r telecnference call. Give participants smething new t fcus n after the CTD event. Inviting new peple t jin. Identify new initiatives that yu wrk n tgether. Peple need a reasn t stay cnnected when there is a fit with their wn rganizatinal mandate and agenda. Send ut infrmatin that might interest the grup. Stay in tuch via r a listserv. This allws everyne t set their wn level f participatin. Yu may learn f an initiative that yu can share with thers. Sme CTD prcesses have resulted in service crdinatin between sme participants; sme have resulted in learning netwrks; and sme have taken n issues f cncern in the cmmunity. Apply fr funding t help address gaps that have been identified. Cnnect with thers wh may be ding similar wrk. Organize a learning day t share infrmatin r research with thers in yur grup. TIP Use yur imaginatin, respnd t real situatins, bring yur passin and leadership. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 26

28 THE FACILITATOR S ROLE THE FACILITATOR S ROLE Facilitatin is integral t the success f CTD events and t sustainability. In rder fr the CTD prcess t be successful, at least ne individual must take n the rle f CTD facilitatr in an external r a cnsulting capacity. This individual will participate in the planning cmmittee, supprt netwrk develpment and relatinships, and supprt cnditins fr cllabratin. This rle is smetimes referred t as a Netwrk Weaver, a term cined by June Hlley, an American researcher. The rle f the Netwrk Weaver in a CTD grup is t help t bring tgether peple frm acrss the cmmunity and t help the grwing grup f individuals t mve frward. Accrding t Hlley and Krebs, 16 this rle includes the fllwing functins r activities: Identify needs, assets, and existing netwrks Share knwledge and ideas Make individual cnnectins Cnvene diverse grups t stimulate new thinking and cnnectivity Cnnect netwrk members t ptential resurces. By acting in the rle f catalyst fr the CTD grup, the facilitatr can cntinue t help nurture and sustain activity and eventually mve the grup t actin. As Hlley says, the key t sustainability is when everyne starts saying I see smething that can make a difference. I knw wh t wrk with and where t get resurces. Review the key learnings and recmmendatins frm the Grey Bruce,Suth East Trnt and Suth Asian CTDs. 16 Krebs, V. & Hlley, J. (2004). Weaving Smart Netwrks. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 27

29 NETWORK ANALYSIS AND DEVELOPMENT NETWORK ANALYSIS AND DEVELOPMENT Netwrk analysis is a useful tl fr visualizing and interpreting the cnnectins within a grup s that the grup itself, and therefre its wrk and effectiveness, may be strengthened. Netwrk maps help an intersectral/interprfessinal netwrk such as thse resulting frm CTD prcesses t clearly see where bridges t ther parts f the netwrk exist. Netwrk maps can als help t create and strengthen new links within the netwrk. Befre yu can imprve yur netwrk, yu need t knw where yu are (i.e. the as is picture). A netwrk map shws the ndes and links in the netwrk. Ndes can be peple, grups, r rganizatins. Links can shw relatinships, flws, r transactins. A link can be directinal. A netwrk map is an excellent tl fr visually tracking yur ties and designing strategies t create new cnnectins. Netwrk maps are als excellent talking dcuments, that is, visual representatins that supprt cnversatins abut pssibilities. 17 Over time, netwrk analysis helps a grup t demnstrate its grwth, develpment, and functinal effectiveness. Befre and after maps fr example, a map frm the very beginning f a CTD prcess and a map frm the end f the prcess many mnths later- can shw dramatic imprvements in a grup s cnnectedness and their ability t cllabrate and slve prblems. Fr example, in Figure 1 (see belw) the first image depicts a netwrk befre the initial CTD prcess. Each clured square (nde) represents a persn, and the arrws represent cnnectins between peple (links). Nte that many peple in this first map have n cnnectins. The secnd image shws the same netwrk five years after they participated in CTD. Nte the significant increased density f cnnectins and the much lwer number f peple wh are nt cnnected. It effectively demnstrates the dramatic change in the relatinships and infrmatin flw that ccurred ver the five years. Figure 1: Befre-and-after maps f ne netwrk. 17 Krebs, V. & Hlley, J. (2002). Building Smart Cmmunities thrugh Netwrk Weaving. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 28

30 NETWORK ANALYSIS AND DEVELOPMENT Netwrk analysis can als help a grup t adapt t new develpments r t changing envirnments. Cnnectins, strengths, and weaknesses are visible, and they prvide data which cntribute t evidence-based practice within the netwrk. Mnitring yur netwrk using scial netwrk analysis can help yu [t] see where yur netwrk needs t shift cnnectins [in rder] t match the current envirnment. 18 The netwrk analysis prcess begins by discussing what the netwrk needs r wants t knw abut itself. What kinds f infrmatin abut each netwrk member is imprtant? What types f cnnectins des the netwrk wish t examine? Netwrk members are surveyed based n the answers t these questins. Fllwing the survey, netwrk analysis sftware is used t prduce a series f maps and numeric tables. The mapper, alng with the netwrk, analyzes the maps and tables and develps a strategy t strengthen the netwrk and its wrk. These maps and the related numeric tables can help t answer these key questins in the cmmunity building prcess: Are the right cnnectins in place? Are any key cnnectins missing? Wh are play playing leadership rles in the cmmunity? Wh is nt, but shuld be? Wh are the experts in prcess, planning, and practice? Wh are the mentrs that thers seek ut fr advice? Wh are the innvatrs? Are ideas shared and acted upn? 19 Once these questins are answered, it is pssible t identify and implement strategic next steps t strengthen netwrks. After this strategy has been in place fr sme time, netwrk members are surveyed nce again and the netwrk is re-mapped. This may pssibly lead t anther strategy t imprve the netwrk. This prcess can be repeated any number f times. Health Nexus plans t ffer netwrk analysis as ne f ur services. Please cntact us fr mre infrmatin. 18, 19 Krebs, V. & Hlley, J. (2002). Building Smart Cmmunities thrugh Netwrk Weaving. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 29

31 RELATED RESOURCES RELATED RESOURCES Tlkits/Manuals/Handbks Cllabratin Handbk: Creating, Sustaining, and Enjying the Jurney by Michael Winer and Karen Ray Cmmunity Engagement and Cmmunicatin: The Health Planners Tlkit by the Ontari Ministry f Health and Lng-Term Care Frm the Grund Up: An Organizing Handbk fr Healthy Cmmunities by the Ontari Healthy Cmmunities Calitin Heart Healthy & Strke Free by the U.S. Department f Health and Human Services and Centers fr Disease Cntrl and Preventin Intersectral Actin Tlkit: The Clverleaf Mdel fr Success by Health Canada Net Gains: A Handbk fr Netwrk Builders Seeking Scial Change by Peter Plastrik and Madeleine Taylr Online Health Prgram Planner by The Health Cmmunicatin Unit Primer t Actin: Scial Determinants f Health by Health Nexus and Ontari Chrnic Disease Preventin Alliance The Cmmunity Develpment Handbk: A Tl t Build Cmmunity Capacity by Fl Frank and Anne Smith, Human Resurces Develpment Canada The Partnership Handbk by Fl Frank and Anne Smith, Human Resurces Develpment Canada Twards Whle f Cmmunity Engagement: A Practical Tlkit by H. J. Aslin, and V. A. Brwn., Murray-Darling Basin Cmmissin Websites Canadian Best Practices Prtal fr Health Prmtin and Chrnic Disease Preventin Cmmunity Tl Bx (als check ut Grup Facilitatin and Prblem Slving) EPIC Engaging Peple. Imprving Care A Cmmunity Engagement Resurce fr Ontari s Health Care System Engagement Methds and Tls by Queensland Gvernment Health Nexus Santé NHS Centre fr Invlvement Tamarack An Institute fr Cmmunity Engagement The Health Cmmunicatin Unit Urban Research Tlkit VOICE (Vluntary Organizatins Invlved in Cllabrative Engagement) in Health Plicy Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 30

32 APPENDIX A APPENDIX A BACKGROUND ON CTD In 2001, the Ministry f Health and Lng-Term Care (MOHLTC) asked Health Nexus (then the Ontari Preventin Clearinghuse) t help build capacity t prevent strke and chrnic diseases as a cmpnent f the Ontari Strke Strategy and System (OSS). Health Nexus fulfilled this mandate by develping the Prevent Strke prgram: a) Netwrk building t imprve lcal cllabratin, t enhance referrals, and t supprt the crdinatin f services acrss the cntinuum f strke preventin and care (e.g. health care prviders, health prmters, cmmunity-based scial service staff); b) Training, supprted by print and electrnic resurces, t enhance learning abut strke and chrnic disease preventin, the scial determinants f health, and ther related tpics; c) A website and searchable database that prvides infrmatin abut lcal resurces fr client referral ( In 2001, the newly established reginal strke netwrks and centres were inward lking. They fcused n establishing new infrastructure and patient interventins within hspitals. Our early wrk fcused n needs assessment; finding entry pints fr health prmtin and disease preventin; building trust; starting educatinal initiatives; and supprting the wrk f the Ontari Heart Health Netwrk as it integrated chrnic diseases. As the OSS grew and matured, strke specialists became mre willing t learn hw health prmtin culd cntribute t their effectiveness and t wrk acrss disciplines and sectrs t address ppulatin health, including the scial determinants f health. Health care prviders want cmmunity partners t mve upstream in rder t address the rt causes f strke and ther chrnic diseases at a ppulatin level. At the same time, health prmters are mre invlved in chrnic disease preventin. Our evaluatin suggests that this change has resulted, in part, due t interventins develped by Health Nexus. The figure belw shws hw health prmtin is bth a cmpnent f and integral t the cntinuum identified by the OSS. 20 Figure 1. Strke Preventin and Management Cntinuum 20 Prevent Strke prepared this figure. It is based n the strke cntinuum f care as identified by the OSS. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 31

33 APPENDIX A Several years int the OSS, the MOHLTC undertk a research and cnsultatin prcess t develp the Ontari Chrnic Disease Preventin and Management (OCDPM) Framewrk. 21 Health Nexus, alng with ther members f the Ontari Chrnic Disease Preventin Alliance, encuraged the MOHLTC t integrate health prmtin strategies. The Framewrk emphasizes the building f partnerships between cmmunities, patients, and prviders. It als helps t develp netwrks, knwledge, and skills and t increase cllabrative wrk acrss the cntinuum f care. Figure 2. Ontari s Chrnic Disease Preventin and Management Framewrk T meet this emerging partnership need, we cnsulted with reginal strke netwrks/centres, cmmunity rganizatins, and calitins. We drew upn ur extensive experience in supprting cmmunity engagement 22 and assessed engagement appraches t strengthen cmmunity capacity. Health Nexus s CTD apprach has evlved t meet the grwing cmmunity engagement needs f the Ontari Strke System at the reginal and district levels. Since 2004, the Prevent Strke prject has cllabrated with mre than 1,000 participants in 15 CTD cmmunity engagement prcesses in mst regins f the prvince in English and in French. (See table f CTD cmmunities belw.) CTD cnvened key partners wh had nt yet met and taught them basic cncepts. Mre recently, in respnse t changes in chrnic disease preventin, and depending n each lcal/reginal situatin, CTD cntinues t fcus n a whle-ppulatin perspective, emphasizing pririty ppulatins (e.g. Suth Asian and Abriginal), and addressing specific tpics (e.g. pediatric strke, besity) as needed. CTD has been designed and implemented as part f OSS. As such, its primary fcus is strke preventin. Health Nexus was an early prpnent f integrated chrnic disease preventin. We understd that the majrity f individuals cmmitted t reducing the incidence f strke recgnize the cmmn risk factrs (e.g. scial cnditins, individual behaviurs) that cntribute t strke, heart disease, cancer, diabetes, and ther chrnic diseases and cnditins. Fr this reasn, when we designed CTD with ur strke partners, we set strke preventin within the framewrk f chrnic disease preventin. As we wind dwn the current Prevent Strke prgram, we cntinue t explre ways in which CTD may benefit integrated chrnic disease preventin and ther chrnic diseases. 21 Frm Presentatin at GTA Rehab Netwrk Best Practices Day, Meera Jain, MOHLTC March 2, Retrieved June 8, Fr instance, during the 1990s, Health Nexus (then the Ontari Preventin Clearinghuse) supprted the demnstratin cmmunities in Better Beginnings Better Futures, Best Start, and the Healthy Lifestyles prgrams. Health Nexus helped t shape emerging netwrks, rganizatins, and initiatives such as Brighter Futures, Ontari Healthy Cmmunities Calitin, and Vices fr Children. Health Nexus als supprted netwrk, partner, and service reach enhancement initiatives by the Public Health Agency f Canada, Freign Affairs Canada, and health prmtin partners in Ontari. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 32

34 APPENDIX A CTD Cmmunities Strke Centre/ LENGTH OF FORUM # OF LOCATION PROCESS DATE PARTICIPANTS KEY THEMES 1. Suthwestern Ontari Strke Making cnnectins Netwrk Grey Bruce (Owen Sund) 6 mnths May, acrss the cntinuum. 2. Nrthwestern Ontari Strke Netwrk (Thunder Bay) 6 mnths Feb., Abriginal strke risk factrs 3. Suthwestern Ontari Strke Enhanced partnerships Netwrk Windsr-Essex (Windsr) 6 mnths Feb., between District Strke Centre and Public Health 4. Suthwestern Ontari Strke 6 mnths May, Fcus n pverty Netwrk Chatham-Kent (Chatham) 5. Sutheastern Ontari Strke Netwrk Strke and bld Hastings-Prince Edward (Belleville) 6 mnths June pressure reductin 6. Suthwestern Ontari Strke Strke in the brader Netwrk Hurn-Perth (Stratfrd) 6 mnths Mar cntext f chrnic disease 7. West GTA Strke Netwrk 12 mnths May Making cnnectins acrss (Peel-Mississauga) + fllw up the cntinuum, including educatin and diversity netwrks 8. Nrtheastern Ontari Strke Making cnnectins Netwrk (Sudbury, Nrth Bay 6 mnths Sept via vide technlgy acrss and Sturgen Falls) the cntinuum. 8. Trnt West Strke 12 mnths Oct Links acrss the cntinuum, Netwrk (Trnt) + fllw-up including utreach t newly created Lcal Health Integratin Netwrk (LHIN) 10. Suth East Trnt Strke 24 mnths Mar Strengthening cnnectins Netwrk (Trnt) + fllw up thrugh fcused infrmatin nging & resurce sharing 11. Sutheastern Ontari Strke 12 mnths Mar Obesity # 1 - knwledge Netwrk (Kingstn) + fllw up building n behaviural change nging fr risk factr management 12. Sutheastern Ontari (Belleville) 12 mnths Oct Obesity #2 - knwledge + fllw up building n behaviural change nging fr risk factr management. Obesity catalgue enchanced. 13. Sutheastern Ontari 12 mnths March Obesity #3 - Determinants (Brckville) + fllw up f besity and new partnerships nging fr plicy change. 14. Trnt West Strke 12 mnths Nv Develpment f a brand Netwrk (Trnt) + fllw up new crss-sectral netwrk n nging children and yuth strke. 15. West GTA Strke Netwrk (Peel) 12 mnths March Suth Asians & Strke + fllw up nging TOTAL CTDs: 15 TOTAL PARTICIPANTS: 891 Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 33

35 APPENDIX B APPENDIX B CTD WITH URBAN ABORIGINAL COMMUNITIES IN ONTARIO: A REVIEW OF CONTEXT AND FUNDAMENTAL PRINCIPLES Adapted frm wrk by Marilyn Mrley, Health Prmtin Cnsultant, Health Nexus Intrductin In January 2009, Prevent Strke at Health Nexus requested a general review f the Cnnecting the Dts (CTD) mdel f cmmunity engagement fr chrnic disease preventin t evaluate the cmmnalities and strengths in the mdel and recmmendatins fr adaptatin f/r re-develpment f the tlkit twards an inclusive apprach t engaging the Abriginal cmmunity twards preventing chrnic disease and prmting the health and well-being f urban Abriginal cmmunities thrughut Ontari. This general review f fundamental principles is intended t serve nly as a reflectin f the cultural and hlistic health diversity f urban Abriginal peple living in Ontari. Each Abriginal individual and cmmunity living in Ontari has individualized and diverse cultural teachings, values, and beliefs. Abriginal Cultural Cntext In rder t begin t effectively cllabrate with Abriginal cmmunities t address the preventin f chrnic disease, it is necessary t understand Abriginal peple s cultural wrldview. While each Abriginal cmmunity has its wn distinct characteristics, cultural diversity, individualized needs, and languages, there are fundamental traditinal and cultural cncepts that are cmmn t each grup. It is imprtant t accept and respect these beliefs, values, custms, and languages when develping health prmtin and preventin prgrams. Perspectives n Health and Wellness Abriginal peple s perspectives n health and wellness are hlistic. They include the emtinal, physical, emtinal, and spiritual aspects f life. When these aspects are balanced, there exists wellness and harmny in the cntinuum f life. Abriginal wrldview includes a cncept f cnnectiveness which cntributes t the understanding f health and wellness rather than illness. Abriginal individuals, families, cmmunities, natins, and the spirit wrld are cnnected. Emtinal, physical, mental, and spiritual imbalance affects everyne. Abriginal Cnnectiveness Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 34

36 APPENDIX B Abriginal peples value the Medicine Wheel as a hlistic and sacred symbl that was given t them by The Creatr. The Medicine Wheel is t be used with great respect and reverence. The Medicine Wheel revlves endlessly in a clckwise directin. The Medicine Wheel teaches us that we must strive fr balance and maintain a healthy mind, bdy, and spirit. Illness is cnsidered t be the result f imbalance in ne r mre f these areas. The Medicine Wheel represents the universal cycles f life such as: THE STAGES OF LIFE birth t death CHANGING OF THE SEASONS spring, summer, fall, winter ELEMENTS OF THE EARTH water, air, earth, fire The Medicine Wheel HUMAN PERSONALITY physical, mental, emtinal, spiritual THE RACES OF THE WORLD yellw, red, black, white HEALING MEDICINES tbacc, cedar, sage, and sweetgrass. Abriginal peple are deeply cnnected t Mther Earth. They use all f the resurces that the earth prvides as a cnduit fr expressin. Abriginal peple use the natural medicines that Mther Earth ffers, such as tbacc, cedar, sage, and sweetgrass, fr wellness and balance. These cncepts f wellness als include traditinal Abriginal healing practices based n traditinal medicines and ceremnies, and the supprt f traditinal healers, Elders, midwives, and cunsellrs. Self-determinatin is a fundamental cncept fr Abriginal cmmunities. Abriginal peple must have full invlvement and chice in all aspects f health prmtin strategies and prgrams, including research, planning and develpment, implementatin, and evaluatin. This supprtive, cmmunity-driven cncept f Abriginal health prmtin must always encmpass the needs f the individual, the family, and the cmmunity in a safe, cultural, and hlistic apprach. These cncepts f health empwerment are supprted by definitins in the Ottawa Charter fr Health Prmtin (1986). The Ottawa Charter fr Health Prmtin defines health prmtin as the prcess f enabling peple t increase cntrl ver, and t imprve their health. T reach a state f cmplete physical, mental and scial well-being, an individual r grup must be able t identify and t realize aspiratins, t satisfy needs, and t change r cpe with the envirnment. This includes a secure fundatin in a supprtive envirnment, access t infrmatin, life skills, and pprtunities fr making healthy chices. Peple cannt achieve their full ptential unless they are able t take cntrl f thse things which determine their health. Health prmtin strategies and prgrams shuld be adapted t lcal needs and shuld take int accunt differing scial, cultural, and ecnmic cnditins. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 35

37 APPENDIX B Understanding the Histry f Abriginal Peples in Canada Health intermediaries require knwledge f Canada s histry f clnizatin and assimilatin practices that have created a legacy f pr health status, chrnic diseases, and adverse sci-ecnmic utcmes amng Abriginal peple. The impact f this histry f vilence, ppressin and discriminatin, health inequities, and sci-ecnmic prblems are clearly demnstrated by the alarming verrepresentatin f the Abriginal ppulatin in the justice system, by the multi-generatinal effects f vilence, especially against Abriginal wmen, by pverty and hmelessness, by health disparities, by alarming suicide rates, and by pr mental health and chrnic diseases. Majr Histrical Impacts Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 36

38 APPENDIX B Applicatin f the CTD Mdel The Cnnecting the Dts mdel f cmmunity engagement fr chrnic disease preventin brings tgether cmmunities and health intermediaries. It creates a fundatin fr the preventin f chrnic diseases and fr the prmtin f health and well-being. Health prmtin activities have enabled a cmmunity f diverse health intermediaries t cnnect with each ther and t share infrmatin, resurces, and ideas n chrnic disease preventin. This cnnectin between individuals, grups, and cmmunities ffers diverse appraches and cmmunity-driven practices fr prmting health and fr preventing chrnic disease. A CTD prcess fcused n urban Abriginal cmmunities shuld reflect the fundamental Abriginal cncept f self-determinatin. Health prmtin activities shuld be cmmunity-driven and develped by, fr, and with Abriginal cmmunities. Six Fundamental Principles and Recmmendatins that Organizatins Shuld Review Befre Cnnecting with Abriginal Cmmunities in a CTD Prcess: 1. Allw time t include Abriginal cultural sensitivity training as a preliminary stage t cmmunity engagement activities with Abriginal individuals and cmmunities. 2. Develp an understanding f histrical clnizatin and its impacts n the health, wellness, and spirituality f Abriginal peple, in the cntext f chrnic disease. 3. Recgnize the fundamental cncepts f Abriginal self-determinatin and health empwerment. Fster the need fr the develpment and prmtin f Abriginal cmmunity-driven health prmtin prgrams and services. 4. Create a knwledge base f Abriginal culturally-based health services, prgrams, and resurces in Ontari and key barriers t equitable health access fr Abriginal peple. 5. Establish and nurture respectful relatinships with Abriginal cmmunities. Develp a cmmunitydriven, culturally-apprpriate CTD prcess. 6. Advcate fr specific funding and intersectral appraches t develp an Abriginal CTD and specific urban Abriginal health prmtin activities t effectively address the preventin f strke and chrnic disease in urban Abriginal cmmunities. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 37

39 APPENDIX B Additinal Resurces n Abriginal Health and Chrnic Disease, including Diabetes 1. The Nrthern Ontari Abriginal Diabetes Initiative published resurce lists fr bth primary and secndary diabetes preventin 2. Dietitians f Canada Feeding Mind, Bdy and Spirit: Rle Paper f the Dietitians f Canada Abriginal Nutritin Netwrk 2005, 33 pages. This paper is intended fr thse that have little t n understanding f the rle f a registered dietitian, specifically within Abriginal cmmunities. Adpting a hlistic and cultural cntinuity apprach in nutritin educatin is key t vercming barriers t health. The impact f nutritin n health and well-being is captured thrugh discussins n health prmtin, traditinal fds, fd security, and varius stages f nutritin thrugh the life span. The paper presents nutritin as the crnerstne in chrnic disease management, fcusing n diabetes, cardivascular disease, besity, cancer, and substance abuse. The paper cncludes with suggestins n hw t build and sustain nutritin capacity within Abriginal cmmunities. 3. Windig First Natin Cuncil has a number f diabetes resurces: Pamphlet and 87-page diabetes resurce guide. Bth f these resurces are aimed at cnsumers, nt practitiners. 4. The Natinal Abriginal Health Organizatin has psted their presentatin t a Senate cmmittee. It briefly cvers First Natins, Inuit, and Métis statistics cmpared t the general Canadian ppulatin. It als includes sme abriginal-specific determinants f health. (17 slides). They als prduced a Traditinal Knwledge tlkit fr use in health cntexts. 5. The Natinal Abriginal Diabetes Assciatin als prduced the Pathway t Wellness handbks fr cmmunity wrkers and peple with diabetes. See: It includes prvincially-based lists f abriginal diabetes initiatives. See: The list f initiatives in Ontari, published in 2006), is a 30 page PDF. 6. Ontari Abriginal Diabetes Strategy The intrductin is in five languages Abriginal Healing and Wellness Strategy Draft Guidelines fr Traditinal Healing 8. Vancuver Castal Health has put tgether an excellent verview f diverse abriginal perspectives n health and wellness: nd Internatinal Diabetes in Indigenus Peples Frum in Nvember Includes presentatins n a cmmunity learning centre fr health educatin mdel, the Diabetes and My Natin mdel, and an verview f a large US prgram. Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 38

40 APPENDIX B 10. Hw d I knw if I have diabetes? Factsheet Canadian Abriginal Diabetes Initiative by Health Canada Fr an Inuktitut versin f this dcument, see: There are ther fact sheets as well: The Manitba Divisin f the Canadian Cancer Sciety prduced a best practices dcument n Effective Chrnic Disease Preventin Interventins fr Abriginal Ppulatins Fr infrmatin n mderate-strength interventins, see: Infrmatin%20packages.aspx?sc_lang=en#ab 12. A Pilt Schl-Based Healthy Eating and Physical Activity Interventin Imprves Diet, Fd Knwledge, and Self-Efficacy fr Native Canadian Children The gal f the schl-based prgram was t demnstrate that after 1 y, a culturally apprpriate schl-based interventin wuld increase the students knwledge, skills, and self-efficacy and psitively change behavirs related t diet and physical activity. This paper describes the effect f the interventin n the knwledge and psychscial factrs related t healthy eating and the effect f the interventin n dietary fiber intake and the percentage f energy frm dietary fat. 13. Activity Implementatin as a Reflectin f Living in Balance: The Kahnawake Schls Diabetes Preventin Prject Eating Well with Canada s Fd Guide First Natins, Inuit and Métis A ready-t-use presentatin is available fr all educatrs invlved in prmting healthy eating: Active Cmmunities BC This resurce includes many cmmunity-driven mdels fr increasing physical activity amng Abriginals in British Clumbia. 16. Heartbeat Of The Anishnawbe Natin This DVD mvie is designed t educate Canada s Abriginal ppulatin abut cerebrvascular disease, including strke, and bld pressure management. Prduced by the Nrthwestern Ontari Reginal Strke Centre in Thunder Bay. 17. Suthern Ontari Abriginal Diabetes Initiative Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 39

41 APPENDIX C APPENDIX C Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Cnnecting the Dts: A Handbk fr Chrnic Disease Preventin thrugh Cmmunity Engagement 40

42 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Intrductin Cnnecting the Dts (CTD) CTD is a dynamic, multi-sectral, cmmunity engagement 1 mdel that helps cmmunities wrk tgether differently fr better chrnic disease utcmes and imprved health fr all. Health Nexus wrks with cmmunities t bring tgether a wide crss-sectin f cmmunity leaders t address cmplex prblems in a new and innvative way. Key features: Creates a climate fr creative change and sets the stage fr further cllabrative wrk in the cmmunity. Builds capacity thrugh increased knwledge f resurces (including peple and rganizatins), as well as specific knwledge abut a health-related issue. Bridges peple frm acrss the chrnic disease cntinuum health prmtin, public health, hspitals, cmmunity services, and lng-term care and frm sectrs such as scial services, educatin, husing, and recreatin. Each CTD is cmmunity-driven. Mst include a multi-sectral planning cmmittee, a cmmunity frum, and fllw-up. But the CTD mdel is mre than just an event; it s abut the cntinuus prcess f maintaining cnnectins, generating new partnerships and cllabratins, and learning frm each ther. Reflective Case Studies 2 The CTD mdel began as an initiative f the Prevent Strke prgram at Health Nexus. Since 2004, Health Nexus has wrked with 15 cmmunities acrss Ontari t cnnect the dts. Tpics have included strke preventin, pediatric strke, besity, and pririty ppulatins. These CTDs have ranged frm partial and full-day frums, t twn-hall meetings, t a French videcnference amng three cmmunities in Nrtheast Ontari. The fllwing reflective case studies describe hw three cmmunities cnnected the dts, including the utcme and impact in each cmmunity, as well as the key learnings and recmmendatins. Grey Bruce CTD Rural cmmunity and first CTD Suth East Trnt CTD Urban cmmunity Suth Asian CTD Pririty ppulatin CTD t me is like cmpleting ne f thse children s drawing activities where yu jin tgether the dts t make a picture, except this time the dts represent the factrs that cntribute t an individual s jurney with strke (r any cnditin) including health prmtin, public health, hspitals, lng-term care and cmmunity: the WHOLE picture. Jining tgether the dts is like building capacity fr actin. Mary Slmn, District Strke Crdinatr, Grey Bruce District Stke Centre CTD is a multi-phase prcess that plants seeds fr ther cllabrative initiatives. Beth Ward, Health Prmtin Manager, Health Nexus 1 Cmmunity engagement: peple wrking cllabratively, thrugh inspired actin and learning, t create and realize bld visins fr their cmmn future. 2 This reprt was prepared by Shaylyn Streatch, Health Prmtin Student Intern, winter 2009, based n key infrmant interviews as well as dcumentatin and participant evaluatins frm each CTD.

43 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Grey Bruce CTD The Cmmunity Cntext Getting Started Planning the Frum Prmting the Frum The Frum Outcme Impact t Date Key Learnings and Recmmendatins Grey Bruce was a natural lcatin t try a Cnnecting the Dts mdel fr the first time. This cmmunity has a strng histry f cllabratin. Suzanne Schwenger, Health Prmtin Cnsultant, Health Nexus Nte: Thank yu t case study key infrmants Mary Slmn and Dnna Mitchell The Cmmunity Lcated in Suth West Ontari, Grey Bruce is a large rural area with numerus small cmmunities. Map f Suthern Ontari divided by Health Units 3 3

44 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Cntext In additin t sme f the inherent challenges that exist in prviding quality health care t residents dispersed ver a large rural area, in 2003 there was a grwing recgnitin f the challenges presented by the significant senir ppulatin in Grey Bruce. In terms f chrnic disease, Grey Bruce had a high incidence f cardivascular disease and diabetes. Additinally, health prfessinals and the cmmunity were cncerned abut the number f residents wh were verweight, heavy cnsumers f alchl, and physically inactive. Grwing Interest in Cllabrative Wrk t Prevent Disease In 2003 the Ontari Strke System 4 was in its third year f the initial implementatin phase by the Ministry f Health and Lng-Term Care. Each strke centre was at a different stage in implementing the clinical guidelines and emergency prtcls, and als varied in terms f their readiness t address health prmtin. Nevertheless, the need fr cmprehensive and integrated strke preventin and care acrss the cntinuum was being emphasized by the Ontari Strke System. At the brader cmmunity level, chrnic disease preventin was just emerging. The Grey Bruce Health Unit was ding mre preventinrelated wrk, but it was nt well-linked t ther areas f the cntinuum. Heart health calitins were nt yet linked t strke, cancer r diabetes netwrks. Multi-sectral cllabratin was ccurring in pckets, but mstly at the upper administrative level (e.g. hspital restructuring and thrugh directin f the District Health Cuncils); mst frnt-line wrkers were nt engaged in cllabratin. Grey Bruce Partners in Health (the lcal Heart Health Calitin) had the beginnings f a great netwrk, but there were ther sectrs that needed t be included (e.g. rehabilitatin units and families). Knwn fr their innvative and cllabrative appraches, Grey Bruce residents are als highly independent. Furthermre, thugh it wuld seem that relatinships have always existed between health-related agencies, identifying areas fr cllabratin had ften been verlked due t the mandates f each unit and rganizatin. Part f the success had t d with timing. Yu can have a great idea but it needs t be the right time; Fr example, the cmmunity wuldn t have been ready fr CTD when ur hspitals were being restructured. CTD drpped n fertile grund when it happened. Mary Slmn, District Strke Crdinatr, Grey Bruce District Stke Centre 4 The Ontari Strke System is a client-centered, cllabrative netwrk that leads, plans, crdinates and delivers strke preventin and care acrss the age-life cntinuum and acrss the cntinuum f strke care. Thrugh dynamic relatinships amng individuals, rganizatins, and gvernments, the Ontari Strke System wrks acrss the cntinuum f strke care t cntinuusly imprve strke preventin, care, recvery and re-integratin. [Implemented by 11 Reginal Strke Netwrks], the OSS includes 9 Reginal Strke Centres, 18 District Strke Centres/Enhanced District Strke Centres, 24 Secndary Preventin Clinics, cmmunity hspitals, and many reginal partners pdf Fr mre backgrund infrmatin n the Ontari Strke System see

45 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Getting Started At a Suthwestern Ontari Strke Strategy meeting, the Prevent Strke Team f Health Nexus (frmerly Ontari Preventin Clearinghuse) prpsed it wuld like t wrk with the District Strke Centres and ther cmmunity partners t advance the gal f a cmprehensive and integrated strke cntinuum. The Prevent Strke Team lked frward t the pprtunity t cntribute knwledge f, and experience in, cmmunity engagement strategies t fster increased awareness and cllabratin within cmmunities. The Grey Bruce District Strke Centre Crdinatr was very interested in the idea. She immediately saw the ptential benefit in wrking with Health Nexus and hw cmmunity engagement fit int her rganizatinal pririties. In , hspital-based Strke Centres were unfamiliar with what ther health sectrs (e.g. rehabilitatin units and public health) and cmmunity agencies had t d with strke. Additinally, the District Stke Crdinatr was pen t the pssibility f pilt prjects and was new t her psitin s was lking t establish cntacts. After the Strke Strategy meeting, the District Stke Crdinatr and a member f the Prevent Strke Team at Health Nexus planned t tuch base by phne abut wrking tgether n a prject. During that fllw-up phne call, they talked abut rganizing a health prmtin netwrking wrkshp r frum that wuld bring tgether peple frm acrss the cntinuum f strke management t learn abut wh des what. The name Cnnecting the Dts (CTD) was brn. As a next step they apprached Grey Bruce Partners in Health (the lcal Heart Health Calitin at the Grey Bruce Health Unit). This prvided the prcess with sme much-needed netwrks and expertise. Althugh Grey Bruce Partners in Health were nt able t participate in all f the planning meetings, their input was vital in helping t think bradly abut wh t invite t the frum itself. As the first CTD planning cmmittee, this cmmittee had the challenge and the pprtunity f creating the visin fr CTD. I lved wrking with Health Nexus. Nt cming frm a health prmtin backgrund myself, their expertise and energy played a crucial rle. They mdeled what cllabratin is all abut: We were able t penly discuss all f the details (which is nt the case with every cmmittee) and yu knew if yu prpsed an idea it wuld get acknwledged and rlled int the discussin. They appreciated that every place has its wn culture and were adaptable t Grey Bruce. Never a dubt we wuld pull this ff. They were cmmitted and have always been there if I need advice r supprt. Mary Slmn, District Strke Crdinatr, Grey Bruce District Stke Centre Planning the Frum Planning Cmmittee Members District Strke Crdinatr, Grey Bruce District Strke Centre Crdinatr, Grey Bruce Partners in Health Manager, Prevent Strke, Health Nexus Health Prmtin Cnsultant, Health Nexus

46 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Planning the Frum cntinued Planning Meetings Started meeting apprximately six mnths prir t the frum Scheduled mnthly telecnference meetings and then held three meetings clse t the frum Minutes f every meeting were recrded and distributed Decisins were made by cnsensus Brainstrmed and determined the purpse f the frum, taking int cnsideratin the fllwing: what else was ging n in Grey Bruce wh ideally shuld cme t the frum hw the frum culd be framed s that it wuld attract thse peple expectatins fr what wuld happen after the frum The purpse became: The purpse f the meeting is t bring tgether representatives frm rganizatins in Grey and Bruce t discuss cmmunity-wide strke preventin and health prmtin acrss the cntinuum f strke management. This meeting is an pprtunity t nurture relatinships, t build n the excellent cllabratins that exist in Grey Bruce and t discuss the interactins needed by the different sectrs in supprt f health prmtin fr strke. Actin plans will be generated. We were aware that everyne is s busy and wuld be wary f the cmmitment required after the wrkshp. We decided t frame it as an pprtunity fr netwrking. Ultimately, we didn t see it becming the CTD cmmittee. We just wanted everyne t think mre bradly in their everyday wrk and t recgnize that increasing awareness and building relatinships are key t imprving the health f ur cmmunity. Mary Slmn, District Strke Crdinatr, Grey Bruce District Stke Centre Decided t schedule the frum t fllw a previusly arranged Grey Bruce Partners in Health meeting set fr the mrning f May 12, 2004 Reserved a meeting rm at the Grey Bruce Public Health Unit fr 12-3pm Planned the agenda Apprached and cnfirmed speakers Prmted the frum Bked catering

47 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Prmting the Frum The planning cmmittee generated a list f ptential participants by cnsidering the jurney smene wh experiences a strke wuld g thrugh. An initial invite was sent t all ptential participants by the District Stke Crdinatr. Additinally, the frum invitatin was sent t the Grey Bruce Partners in Health netwrk. This initial invitatin asked participants t RSVP by April 26, 2004, and indicated mre infrmatin wuld be sent sn. A frmal invitatin and meeting package was then mailed t the ptential participants. Pstal service was used because was still in the prcess f becming the nrm. The Frum Title: Cnnecting the Dts in Grey Bruce fr Cmmunity-Wide Strke Preventin! Date: Wednesday, May 12, 2004, 12:00-3:00 p.m., including lunch Lcatin: Grey Bruce Health Unit, 3 rd Flr Meeting Rm, st Ave. West, Owen Sund, Ontari Agenda: 12:00 p.m. Registratin and cnnecting the dts! Lunch fllwed by trails walk (bring cmfrtable shes!) 1:00 p.m. Welcme and purpse f afternn Dnna Mitchell, Prevent Strke Manager, Health Nexus 1:10 p.m. Jint welcme Dr. Hazel Lynn, Medical Officer f Health, Grey Bruce Health Unit 1:20 p.m. A snapsht f strke in Grey Bruce Alanna Leffley, Epidemilgist, Grey Bruce Health Unit 1:35 p.m. Chrnic Disease Preventin - what s the big picture? Dnna Mitchell, Prevent Stke Manager, Health Nexus 1:45 p.m. Small grup activity: Learning abut, and supprting ur wrk 2:15 p.m. Plenary: themes and patterns 2:25 p.m. Health prmtin and the brader determinants f health 2:35 p.m. Mving t actin. What s next? 3:00 p.m. Evaluatin and Adjurn Particularly given the small twn nature f Grey Bruce, I was surprised hw many peple either didn t knw each ther r did, but weren t familiar with each ther s wrk: Lts f peple cnnected that day. The atmsphere was ne f We are cmmunity. We have issues. Hw can WE make this a healthier cmmunity? I gt the sense that the majrity felt there was an pprtunity fr increased cllabratin. Dnna Mitchell, frmer Manager, Prevent Strke, Health Nexus

48 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts The Frum cntinued 20 Participants by Practice Setting Outcme Participants felt they made useful cnnectins and sme participants identified specific peple and/r rganizatins they intended t fllwup with. There was a strng expressin f interest in cntinuing the prcess they started that afternn. The fllwing themes were highlighted by participants when they were asked t identify what they learned that afternn that might influence the wrk they d, including a strnger knwledge and understanding f: epidemilgical data specific t Grey Bruce, including risk factrs fr strke and chrnic disease the existence f an Ontari Strke System ambulance respnse infrmatin fr strke in their cmmunity resurces and strategies Participants als identified additinal benefits frm the frum which might influence they way they wrk, including: new cntacts an understanding f pprtunities that exist fr cllabratin and netwrking grwing awareness f a rle fr health prmtin CTD bradens participants perspectives and fsters an attitude f cllabratin: When they return t nging prjects r get invlved in new nes they will cnsider wh else shuld be invlved? and find ut if anyne else is ding smething similar. It s nt just abut learning wh is ut there, but hw that fits int yur mandate. CTD can prevent duplicatin f services/initiatives and enhance the wrk we d! Mary Slmn, District Strke Crdinatr, Grey Bruce District Stke Centre

49 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Impact t Date Tw weeks after the frum, the planning cmmittee ed the participants a ne-page summary f the wrkshp. Participants were asked if they wuld like t use the list as a way t share infrmatin, hear abut annuncements, and stay cnnected. Fllwing psitive feedback, the District Stke Crdinatr began sending a mnthly bulletin and cntinued t add new cntacts t the distributin list. This distributin list was used fr three years until ther calitins started and thse distributin lists (which included mst f the riginal participants) became the primary link. The fllwing is an excerpt frm 2005 article 5 Still cnnecting dts in Grey-Bruce: An interview with Mary Slmn, District Stke Crdinatr Grey Bruce Health Services, Owen Sund: Right away, we had a brad-based cnnectin electrnically and began t send infrmatin t the grup anything that wuld be f interest sent n behalf f Cnnecting the Dts I think that this infrmatin-sharing has increased ur lcal netwrking. Sme f the participants have frmed sme neat partnerships with sme f the public health agencies such as Falls Preventin and FOCUS, the antidrug calitin. On the rehabilitatin side f things, they have started t think seriusly abut the chrnic disease mdel. The ther exciting thing that s happening is that sme f the rganizatins are starting t think abut health prmtin in terms f their staff and hw t create a healthy wrkplace. Cnnecting the Dts has meant that ther events planned since last May have had a brader reach. An example f this was ur besity wrkshp: Healthy Weights, Healthy Lives, spearheaded by the Obesity Preventin Cmmittee and the Wmen, Heart Disease and Strke Cmmittee. After Cnnecting the Dts, we submitted a prpsal fr Best Practice funding frm the Heart Health Resurce Centre and we were selected! We hpe that it will be a tw-part prcess. Part ne invlves an inventry f prgrams, but we want t als include nn-traditinal netwrks, including thse ffered thrugh the municipality and Chamber f Cmmerce. We want t identify sme gaps, and evaluate the prgramming fr best practices. Part tw will help us mve sme f thse best practices ut int the cmmunity, including nntraditinal netwrks. We ve als dne three r fur letters frm the Cnnecting the Dts grup t supprt research prpsals as partners in the cmmunity. Fr example, recently there was a grant prpsal submitted n hypertensin, and the meeting t discuss the prpsal was a very cnnected grup, including public health, rehabilitatin and ur strke centre. This als happened fr the Falls Preventin prgram when they realized that we shuld be part f their discussins. Thse cnnectins are very exciting and they weren t happening befre. Peple will ften leave an event nw and say, mre dts cnnected! Mary Slmn, District Strke Crdinatr, Grey Bruce District Stke Centre Peple are lking upstream and cnsidering hw ccurrences are cnnected; Fr example, there is increased recgnitin that if we can prevent falls, we can reduce the number f emergency visits. Maybe thrugh events like CTD the varius sectrs have learned each ther s language and each ther s culture and understand hw t actually wrk tgether. Mary Slmn, District Strke Crdinatr, Grey Bruce District Stke Centre 5

50 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Impact t Date cntinued CTD set the tne fr lking beynd ne s wn part f the cntinuum. As nted in the article excerpt n the previus page, events that have ccurred and cmmittees that have been established since May 2004 have been much brader in scpe. While attributin is cmplicated, it has been suggested that CTD cntributed t the brad membership f cllabrative cmmunity grups related t: falls preventin anti-alchl aging at hme besity healthy living senir fitness chrnic disease In terms f cntributing t strke and chrnic disease preventin, the cllabrative prcess fstered by the riginal CTD frum has increased the cmmunity s capacity thrugh the sharing f knwledge, practice, and perspectives t address issues that n ne sectr culd achieve when acting n its wn. Nw five years since the initial CTD frum, Health Nexus is wrking with the District Stke Crdinatr, the riginal CTD participants, and new individuals wh are nw invlved in the ever-grwing cllabrative wrk in Grey Bruce t pilt an innvative evaluatin and mapping tl fr netwrk analysis and develpment. The CTD mindset is ging t be invaluable as we mve n t address the scial determinants f health. Mary Slmn, District Strke Crdinatr, Grey Bruce District Stke Centre

51 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Key Learnings and Recmmendatins The Planning Prcess The Frum Timing: the cmmunity must be ready Gals and bjectives fr the frum need t be clear Stay fcused n the gals Recrd and distribute meeting ntes s that decisins can be reviewed and built upn Peple wanted t talk! Incrprating time t netwrk is imprtant The rm was just the right size: everyne was cmfrtable and it was small enugh that it encuraged participatin Sme peple in attendance did already knw each ther and this helped facilitate new cnnectins The activity that prtrayed the cntinuum prvided an effective demnstratin f CTD placed 40 centimetre diameter dts (ne each fr health prmtin/primary preventin, secndary preventin, acute care, rehabilitatin, cmmunity re-integratin, and cmmunity services) arund the rm and had participants stand by their respective practice setting Participants valued the epidemilgical data that was presented n their regin The afternn wrkshp was t rushed; aim fr a full day frum Braden further the number and variety f participants Keeping the Dts Cnnected and Cnnecting New Dts Cntinually add new names t the distributin list After the successful CTD in Grey Bruce, the Prevent Strke Manager and the District Stke Crdinatr made a presentatin at ne f the Suth West Reginal Strke Netwrk meetings. This helped spread the wrd abut CTD and gt ther Crdinatrs interested. Since the riginal CTD in Grey Bruce, the CTD initiative has evlved int a dynamic, multisectral, cmmunity engagement mdel that helps cmmunities wrk tgether differently fr better chrnic disease utcmes and imprved health fr all. Health Nexus has nw wrked with 15 cmmunities acrss Ontari t cnnect the dts. In subsequent CTDs we have encuraged cmmunities t braden the membership f their planning cmmittee as well. This has strengthened the prcess. Dnna Mitchell, frmer Manager, Prevent Strke, Health Nexus If I were t d it nw, I wuld lk at sme f the technlgies that wuld make netwrking easier, such as scial netwrking web-based technlgies. Als, Grey Bruce nw has a health line that distributes resurces and a newsletter. I wuld tap int it instead f creating an independent distributin list. Mary Slmn, District Strke Crdinatr, Grey Bruce District Stke Centre

52 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Suth East Trnt CTD The Cmmunity Cntext Getting Started Planning the Cnference Prmting the Cnference The Cnference Outcme Impact t Date Key Learnings and Recmmendatins Nte: Thank yu t case study key infrmants Dnna Cheung and Sarah Blackwd The Cmmunity Lcated dwntwn Trnt, Ontari, Suth East Trnt includes the area east f Ynge Street t Ruge River, nrth t Eglintn Avenue and suth t Lake Ontari. One strand f grass can be weak and easily brken but when a basket is weaved tgether with these fine grasses it becmes strng and beautiful. This can be parallel t the strength we have as a grup as we cnnect and weave tgether we becme strng and cnnected as ne. Frm A Tapestry in the Making panel presentatin, CTD March 4, 2008 Marilyn Mrley, frmer Health Advcacy Develper, Ontari Abriginal Health Advcacy Initiative Map f Suthern Ontari divided by Health Units

53 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Cntext Suth East Trnt is a densely ppulated area with ethn-racial and linguistic diversity. Sci-ecnmic status varies dramatically frm sme f the wealthiest husehlds t the mst deprived and hmeless. This area includes sme f the lwest incme husehlds in Canada and has a higher burden f illness than the City f Trnt as a whle. Grwing Interest in Cllabrative Wrk t Prevent Disease In Octber 2006, Health Nexus shared the CTD mdel at the Heart and Strke Fundatin f Ontari s 9 th annual Strke Cllabrative sympsium. At that time, ten CTDs had been rganized 6 acrss Ontari. Health Nexus partner rganizatin fr the majrity f the CTDs had been a District Strke Centre r a Reginal Strke Netwrk. When planning began fr the Suth East Trnt CTD, the CTD prcess was already underway in the Trnt West Regin with a frum planned fr Octber 25, The Suth East Trnt Strke Netwrk is ne f 11 reginal netwrks established acrss the prvince f Ontari t implement the Ontari Strke System. Based at St. Michael s Hspital, its primary bjective is t supprt innvatin, knwledge translatin, and practice imprvements acrss the Suth East Trnt Regin, with the gal f prmting equitable access and imprved utcmes fr strke survivrs and their families. This netwrk represents a cllabratin f reginal partners in strke care delivery that spans the areas f preventin, health prmtin, acute care, rehabilitatin, lng-term care facilities and cmmunity prviders. When the Netwrk was established in 2002, there was an emphasis n acute care (e.g. recgnitin f the signs f strke and apprpriate triage fr strke patients) and ensuring health care prviders were prviding prper care while wrking twards a mre cllabrative apprach and imprved integratin. In 2006, the Suth East Trnt Strke Netwrk was lking t braden its fcus and wrk with partners in ther parts f the strke cntinuum. T help accmplish this, the Netwrk hired a Rehab and Cmmunity Re-engagement Crdinatr. In additin t the effrts being made by the Suth East Trnt Strke Netwrk, St. Michael s Hspital itself had been invlved with varius multi-sectral cllabratins, such as the hmelessness cmmittee and Inner City Health prgram. There was als an increasing call fr cllabrative wrk that was initiated acrss the system by the newly created Lcal Health Integratin Netwrk. Health Nexus apprached the Suth East Trnt Strke Netwrk befre my psitin was created, but the Netwrk was nt ready t cllabrate n CTD. We cmmenced the CTD prcess when we did because f the maturity f ur netwrk: We were ready t mve frward and nt just wrk with rganizatins individually. It was part f ur strategic plan t get them talking t each ther. Dnna Cheung, Rehab and Cmmunity Re-engagement Crdinatr, Suth East Trnt Strke Netwrk 6 As yu read this case study yu will ntice hw the CTD prcess evlved frm the first CTD in Grey Bruce t the CTD prcess in Suth East Trnt. Take nte, fr example, f the variety f rganizatins represented n the planning cmmittee, the netwrking activities that were incrprated frm the beginning, and the size f the cnference.

54 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Getting Started In the fall f 2006, the Rehab and Cmmunity Re-engagement Crdinatr fr the Suth East Trnt Strke Netwrk cntacted Health Nexus abut rganizing a CTD. The Crdinatr became aware f CTD thrugh her clleagues and the presentatin made by Health Nexus at the Heart and Strke Fundatin f Ontari s 9 th annual Strke Cllabrative sympsium. Preliminary brainstrming meetings were held between the Rehab and Cmmunity Reengagement Crdinatr, Educatin Crdinatr, and Health Nexus early The first planning meeting fr the Suth East Trnt CTD was held April Prir t the first planning meeting, the Rehab and Cmmunity Reengagement Crdinatr had the pprtunity t attend the Trnt West Regin CTD frum: Strke and Chrnic Disease Preventin Making the Cnnectin One Dt at a Time. Additinally, she did a lt f netwrking. This netwrking ccurred during her frmal and infrmal meetings with rganizatinal partners, cnnectins she made as she met with newly engaged individuals and facilities, and thrugh her wrk f raising strke best practices, preventin, and awareness. A frmal invitatin was ed t interested individuals abut jining a CTD cmmittee with the purpse f planning a ne day cnference. The ne day cnference fcussed n bringing tgether a wide range f individuals frm acrss the cntinuum t lk at ways f wrking mre cllabratively with ne anther t enhance strke care. Planning the Cnference It requires a lt f effrt t get and keep peple engaged. At first they may be interested, but then they ften have t be given the g-ahead t attend the meetings and recgnize hw it ties int their wrk pririties. We are still in a system where ften individuals are fcused n meeting their mandate, nt t mentin verladed. It takes time t change this sil-based mindset t ne f: CTD will help me get my wrk dne easier with better utcmes. Dnna Cheung, Rehab and Cmmunity Re-engagement Crdinatr, Suth East Trnt Strke Netwrk Planning Cmmittee Members Case Manager, St. Michael s Hspital Registered Nurse, Strke Preventin Clinic, Trnt East General Hspital Adult Day Prgram Supervisr/Wellness Crdinatr, Cmmunity Care East Yrk Divisin Crdinatr and Cmmunity Engagement, City f Trnt, Parks Frestry and Recreatin Prfessinal Practice Leader and Cmmunicatins Cnsultant, Prvidence Healthcare Case Manager, Trnt Cmmunity Care Access Centre Rehab and Cmmunity Re-engagement Crdinatr, Suth East Trnt Strke Netwrk Occupatinal Therapist, Rugh Valley Hspital Centenary Patient Care Manager, Bridgepint Health Clinical Leader, Prvidence Healthcare Cnsultant, Physical Activity Resurce Centre

55 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Planning the Cnference cntinued Registered Nurse Vlunteer, Cmmunity Strke Preventin, Suth East Trnt Strke Netwrk Cmmunity Recreatin Crdinatr f Adapted and Integrated Services, City f Trnt, Parks Frestry and Recreatin Educatin and Health Prmtin Crdinatr, Ontari March f Dimes Cmmunity Missin Specialist, Heart and Strke Fundatin f Ontari Scial Wrker, Trnt Grace Hspital Public Health Nurse, Trnt Public Health ABI Practice Leader, COTA Health Prject Crdinatr, Ontari Wmen s Health Netwrk Reginal Prgram Manager, Suth East Trnt Strke Netwrk Health Advcacy Develper, Ontari Abriginal Health Advcacy Initiative Registered Dietician, Sherburne Health Centre Health Prmtin Cnsultants, Health Nexus Reginal Educatin Crdinatr, Suth East Trnt Strke Netwrk Registered Nurse, VHA Hme Healthcare Manager, Wdgreen Cmmunity Services Chinese Outreach Wrker, Suth Riverdale Cmmunity Health Planning Meetings Started meeting apprximately ne year prir t the cnference Scheduled fur 2-hur meetings (catered lunch t fllw fr additinal netwrking): April, June, September, and December 2007 Additinal meetings t debrief and plan ccurred between Suth East Trnt Stke Netwrk and Health Nexus in between full planning cmmittee meetings, as well as between December 2007 and the March 2008 cnference The first hur f each meeting incrprated a presentatin, fr example Overview f Ontari Strke System Organizing fr Impact Prcess and Cntent Issues that Cntribute t and Enhance Successful Cllabrative Effrts Trends in Strke Care This was my favurite cmmittee! Meetings were s participatry. Decisins were made based n discussin and feedback. Everyne was given the pprtunity t vice what was imprtant t their rganizatin/sectr/ clients. We tk all f the steps tgether as a grup, frm deciding what the event wuld lk like t wh wuld be there: It was determined by the cmmunity. Sarah Blackwd, Manager, Wellness Prgrams, Cmmunity Care East Yrk

56 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Planning the Cnference cntinued and a structured netwrking activity that prvided an pprtunity fr the cmmittee members t get t knw each ther, fr example Cnnecting the Dts thrugh Dialgue Tuch and G I m here, Yu re there, We re it: Mapping ur Netwrks Determining ur Needs, Understanding ur Cllabratins The secnd hur f each meeting invlved brainstrming and planning fr the March 2008 frum Cnference bjectives became: T infrm and educate participants abut the Ontari Strke System, scial determinants f health, strke best practices, and the jurney f a strke survivr Highlight the activities f the Suth East Trnt Strke Netwrk Prmte the value f netwrking and reflect n innvative ways t create imprved strke services T create an pprtunity fr prfessinals t netwrk and establish cllabratins within the strke netwrk frm different areas f the cntinuum f care T gain greater understanding f cmmunity services and resurces Decisins were made by cnsensus Minutes f every meeting were recrded and distributed where apprpriate Planned the agenda Apprached and cnfirmed speakers Bked the Chestnut Residence and Cnference Centre fr March 4, 2008 Brainstrmed, apprached, and cnfirmed rganizatins t set up exhibits at the cnference Prmted the cnference Ordered lunch based n number f registrants Cmpiled materials fr the participant packages and dr prizes The tw health prmtin cnsultants frm Health Nexus n the planning cmmittee had a lt f experience in cmmunity engagement and it shwed. They were very mindful f the planning prcess and making sure everyne was n bard. Overall, they cntributed exceptinal facilitatin skills and a wealth f health prmtin knwledge. It was refreshing t wrk with them. Sarah Blackwd, Manager, Wellness Prgrams, Cmmunity Care East Yrk

57 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Prmting the Cnference The Rehab and Cmmunity Re-engagement Crdinatr, Suth East Trnt Strke Netwrk, began prmting the cnference thrugh purpseful netwrking frm the nset. Newly created and existing cntacts were invited t jin the CTD planning cmmittee and/r attend the cnference. Ptential participants were identified based n their capacity t affect change in their rganizatin and their interest in cllabratin. Sme f the participants were already engaged with the Suth East Trnt Strke Netwrk. A frmal invitatin was ed t a large cntact list. This invitatin included a detailed brchure with a descriptin f CTD, the cnference bjectives, exhibits, the agenda, planning cmmittee members, lcatin, and registratin frm (t be returned by fax r ). Recipients were asked t frward the invitatin n t anyne they thught might be interested in attending. The Cnference Title: Cnnecting the Dts... By Cnnecting the Champins Date: Tuesday, March 4, 2008, 8:00 a.m. - 4:00 p.m. Lcatin: Chestnut Residence and Cnference Centre, University f Trnt, 89 Chestnut Street, Trnt, Ontari Agenda: 8:00 a.m. Registratin, Netwrking and Breakfast 8:45 a.m. Welcme and Opening Remarks Dnna Cheung, Rehabilitatin and Cmmunity Reengagement Crdinatr, Suth East Trnt Strke Netwrk 9:00 a.m. Transfrming the System thrugh Cllabratin and Integratin Rse Ck, Senir Integratin Cnsultant, Trnt Central Lcal Health Integratin Netwrk 9:30 p.m. Neighburhd Envirnments and Resurces fr Healthy Living: A Fcus n Diabetes and Cardivascular Disease in Trnt Dr Rick Glazier, MD, MPH, CCDP, FCFP, Senir Scientist, Institute fr Clinical Evaluative Sciences Scientist, Centre fr Research n Inner City Health, St. Michael s Hspital Assciate Prfessr, Family and Cmmunity Medicine, University f Trnt 10:30 a.m. Nutritin Break and Netwrking Our wrld changes as netwrks and relatinships frm amng peple as they discver that they share a cmmn cause and visin f what is pssible. Thrugh CTD ur wrk is t fster critical cnnectins s that separate, lcal effrts cnnect with each ther and divergent wrld views cme int relatinship arund imprved strke services. Change ccurs as lcal actins spring up in many different areas AND when thse actins becme cnnected they emerge with influence! Peggy Schultz, Health Prmtin Cnsultant, Health Nexus

58 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts The Cnference cntinued 11:00 a.m. A Tapestry in the Making Presented by 7 f the Cnnecting the Dts Cmmittee Members 12:00 p.m. My Strke: A Secnd Chance at Life Patrick McCarthy, Strke Survivr 12:30 p.m. Lunch and Netwrking 1:30 p.m. Cgnitive Changes and Recvery frm Strke Debbie Hebert BSc(OT), MS(Kin), PhD candidate, Clinical Educatr and Crprate Prfessinal Leader (OT), Trnt Rehab Instructinal Clinical Assciate, University f Trnt 2:30 p.m. Strke: Opening Drs Peter Silverman, MA, PhD, Ombudsman, CityNews & Silverman Helps 3:30 p.m. Wrap up, Dr Prizes, and Evaluatins 120 Participants by Practice Settings Sng Lyrics t the tune f He s Gt the Whle Wrld in His Hands We've gt the whle cmmunity in ur hands, We've gt the whle cmmunity in ur hands, We've gt the whle cmmunity in ur hands. We've gt the cmmunity in ur hands. We will netwrk with each ther, it's in ur hands, We will netwrk with each ther, it's in ur hands, We will netwrk with each ther, it's in ur hands. The Netwrk is in ur hands. We make the cntacts, fr seamless care, Refer & fllw up, it's because we care, Let's be infrmed & aware, Netwrks equal seamless care. Netwrks equal seamless care. Netwrks equal seamless care. Frm A Tapestry in the Making panel presentatin, CTD March 4, 2008 Written and presented (with crwd singing and clapping alng) by Sarah Blackwd, Manager, Wellness Prgrams, Cmmunity Care East Yrk

59 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts The Cnference cntinued Exhibits Cmmunity Care East Yrk COTA Health Health Nexus Ontari March f Dimes, Strke Recvery Netwrk Ontari Wmen s Health Netwrk Suth East Trnt Strke Netwrk Outcme Suth Riverdale Cmmunity Health Centre Trnt East General Hspital Trnt Parks, Frestry and Recreatin Trnt Public Health VHA Hme Healthcare Wdgreen Cmmunity Services The CTD cnference successfully served as a venue fr netwrking and learning abut strke best practices, resurces, and infrmatin. It created an pprtunity fr the 120 participants t see hw cnnectins can happen and t cnnect with peple utside f their usual clleagues. The event enhanced service knwledge twards seamless care thrugh infrmatin sharing abut services and resurces. Furthermre, it allwed fr the ball t start rlling n hw t wrk tgether t prevent strke and prvide better utcmes. Overall, participants fund the presentatins and discussins infrmative, relevant, and inspiring. I had a lt f peple cme up t me the day f the frum and in the mnths that fllwed wh said it was really great because I met a, b, and c, and nw we are lking at ding x tgether. Peple are slwly cming t understand that we can t wrk in sils if we want t psitively impact strke preventin and management. Dnna Cheung, Rehab and Cmmunity Re-engagement Crdinatr, Suth East Trnt Strke Netwrk Impact t Date The Suth East Trnt Regin is still cnnecting the dts. After the cnference, all planning cmmittee members were invited t a wrapup sessin t discuss evaluatins. Everyne was invited t cntinue with the grup and a discussin fcussed n the purpse f future meetings. A few members did nt cntinue, while new members have since jined. The cmmittee meets every fur mnths frm 10amnn, fllwed by a lunch prvided by the Suth East Trnt Strke Netwrk. Apprximately 25 peple participate in each sessin. Health Nexus helps t shape the agenda which stems frm tpics f interest expressed by participants, and als includes presentatins t cntinue t raise awareness f the initiatives f the strke netwrk and its partner rganizatins. Netwrking activities during the meetings facilitate cllabratins amng the cmmittee members. The purpse is t cntinue t share strke related infrmatin and awareness, build linkages amng service prviders, educatrs, planners, etc. frm acrss the strke cntinuum and build n lessns learned fr chrnic disease preventin and health prmtin. In between meetings participants are encuraged t fllw-up n the cntacts they have made and the knwledge they have gained, as well as t use the

60 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Impact t Date cntinued grup distributin list and the Suth East Trnt Strke Netwrk t facilitate cllabratin. Belw are a few examples f cnnectins that participants have made as a result f the Cnnecting the Dts By Cnnecting the Champins planning meetings, the cnference, and/r the pst-cnference meetings: the Ontari Abriginal Health Advcacy Initiative (OAHAI) delivered cultural sensitivity training t St. Michael s Hspital, the Ontari Hspital Assciatin, and the Heart and Stke Fundatin f Ontari. OAHAI als presented n the tpic Wrking with Abriginal Cmmunities at the 10 th annual Strke Cllabrative sympsium. This type f cnnecting has led t bld pressure clinics in Abriginal cmmunities, prvincial netwrking, and strke research and health prmtin activities. the Manager fr Wellness Prgrams at Cmmunity Care East Yrk made a cnnectin with a vlunteer fr the Ontari Wmen's Health Netwrk wh then shared resurces n wmen's health circles and linked her with a wealth f resurces abut starting self-help r mutual aid grups, facilitatin, and evaluatin. She als learned abut the YWCA f Greater Trnt which prvided supprt grup develpment infrmatin and best practices. An utcme has been that Cmmunity Care East Yrk has develped a Wmen's Well Being Supprt Grup. the Patient Care Manager fr Cmplex Neurlgical Care and Activatin at Bridgepint Health, wh was nly vaguely familiar with Strke Recvery Canada befre CTD, learned abut the prgram and its resurces thrugh face t face talks at the meetings and a presentatin t the grup. After this the Patient Care Manager shared the materials with the Neurlgy Department Scial Wrker. The Scial Wrker has since prvided a Strke Survivrs package t apprximately 75 patients and their families. Overall, it s been a very psitive cnnectin and benefits peple mre than we can even appreciate. a strke preventin nurse is nw referring clients t a smking cessatin prgram prvided by the Centre fr Addictin and Mental Health as a result f learning abut this prgram during a special presentatin at the January 2009 meeting. a Manager frm Central Neighburhd Huse cnnected with the Registered Nurse vlunteer fr the Suth East Trnt Strke Netwrk mbile strke clinics. They are currently planning t hld an educatin sessin fr the clients wh attend the cmmunity centre, as well as rganize a strke sessin and bld pressure clinic fr the staff. CTD has prvided me with infrmatin and resurces that have enhanced my knwledge f supprt services in the cmmunity. It has als helped Cmmunity Care East Yrk t enhance prgrams and learn abut best practices, as well as prvide seamless care and infrmatin t clleagues, clients, and caregivers. It has pened up a new wrld f preventin and infrmatin. Sarah Blackwd, Manager, Wellness Prgrams, Cmmunity Care East Yrk

61 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Key Learnings and Recmmendatins The Planning Prcess incrprating structured netwrking activities int planning meetings enhanced the CTD prcess prviding lunch after the meeting is bth an incentive fr peple t attend and an additinal pprtunity fr netwrking it is imprtant t engage decisin makers, in additin t frntline wrkers, because they are the nes wh can mre directly affect rganizatin-based change it is imprtant t netwrk frmally and infrmally cntinuusly, during and utside f meetings, events, scial gatherings, etc. The Cnference participants became aware f resurces they were unfamiliar with and made cnnectins they therwise might nt have made the A Tapestry in the Making panel presentatin by seven cmmittee members was an excellent way t shwcase hw being part f the planning cmmittee had imprved the services they prvide and reflect n hw the CTD prcess had changed their practice the exhibits facilitated netwrking sme participants identified that they wuld have appreciated mre structured netwrking activities in small grups t help them cnnect Keeping the Dts Cnnected and Cnnecting New Dts the Suth East Trnt Strke Netwrk has cntinued t rganize a 2-hur Cnnecting the Dts By Cnnecting the Champins meeting, plus lunch, three times per year that is pen t new members at the beginning f each meeting the Rehab and Cmmunity Re-engagement Crdinatr reviews the purpse f CTD fllwed by everyne in attendance intrducing themselves and what they d it is helpful t knw wh is cming, what their interests are, and what is happening in the health prmtin and care envirnments s that yu can create a relevant and purpseful agenda successin planning by participants is very imprtant (e.g. a few participants have mved n t ther psitins but ensured that their replacements were aware f this cmmittee) I had taken a scial netwrking curse befre initiating Cnnecting the Dts By Cnnecting the Champins in the Suth East Trnt Strke Netwrk. I fund the knwledge I gained abut netwrks and netwrk weaving frm the curse very helpful thrughut this CTD prcess. Dnna Cheung, Rehab and Cmmunity Re-engagement Crdinatr, Suth East Trnt Strke Netwrk

62 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Key Learnings and Recmmendatins cntinued it is difficult t get peple invlved wh wrk further away and sme rganizatins d nt have tele-cnferencing r videcnferencing abilities, which even if they did it wuld lessen their ability t cnnect with thers present at the meeting have been meeting fr 2 years and there are still lts f linkages that need t be made. Sme f these cnnectins include: Trnt Cmmunity Husing Meals n Wheels Cmmunity Health Centres Mental Health rganizatins need t cntinue t prmte the benefit f cnnecting the dts CTD has prvided I wuld like t see me with infrmatin the CTD mdel applied and resurces that t ther health-related have enhanced my tpics; fr example, knwledge f supprt this prcess wuld be services in the beneficial fr all cmmunity. It has chrnic disease als helped preventin and Cmmunity Care East management. It is Yrk t enhance abut creating prgrams and learn crdinated initiatives abut best practices, and services that as well as prvide functin like a seamless care and seamless channel in infrmatin t the cmmunity. clleagues, clients, and Sarah caregivers. Blackwd, Manager, It has Wellness Prgrams, pened up a new Cmmunity Care East Yrk wrld f preventin and infrmatin. Sarah Blackwd, Manager, Wellness Prgrams, Cmmunity Care East Yrk

63 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Suth Asian CTD The Cmmunity Cntext Getting Started Planning the Frum Prmting the Frum The Frum Outcme Impact t Date Key Learnings and Recmmendatins Nte: Thank yu t case study key infrmants Sharn Trttman, Mantreh Atashband, and Subha Sankaran The Cmmunity This CTD frum fcussed n Suth Asian cmmunities and was held in the Regin f Peel, Ontari, where the majrity f Suth Asians in Ontari reside. The CTD intentinally went beynd the gegraphic bundaries f the West GTA Strke Netwrk unlike the ther CTDs, t invlve and invite all thse wh might be stakehlders in the issue. As a result, planning cmmittee members and participants were drawn frm acrss the Greater Trnt Area. Suth Asian cmmunities are diverse; the peple vary by their cuntry f rigin (including nt just the cuntries f Suth Asia, but ther regins such as Africa r the Caribbean), religin, language, immigratin status and histry (refugees, new immigrants, secnd/third/etc. generatin Canadians), sci-ecnmic status, educatin, and ther factrs. The term Suth Asian is based n self identificatin, and is an identity f slidarity. Mst Suth Asians have nt thught f themselves as Suth Asian until cming t Canada. Suth Asians are Canada s largest and fastest grwing visible minrity 7. In 2006, Suth Asians accunted fr 23.6 percent (273,760 persns) f the ppulatin f the Regin f Peel and 6.6 percent f the ppulatin f Ontari (2006 Census, Statistics Canada). Peel itself is a very large gegraphic area, and the ppulatin f the regin was 1.16 millin in If ne takes the whle Census Metrplitan Area f Trnt, the number f Suth Asians was 684,100 in Engaging the relevant players in this CTD was n small task.. Suth Asian cmmunities face large inequities in access t health care and in terms f health utcmes. Wrking twards health equity is an imprtant gal and is ne f ur strategic pririties. CTD prvided a gd pprtunity fr us t wrk with diverse health prfessinals and rganizatins. This indirectly increased ur knwledge f health related tpics and enhanced ur ability t advcate fr health. Neethan Shan, Executive Directr, Cuncil f Agencies Serving Suth Asians 7 Based n existing Census classificatins.

64 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts The Cmmunity cntinued Map f Suthern Ontari divided by Health Units Health Nexus has significant prvincewide netwrks. Within ur wrk we are s islated by ur gegraphical bundaries; fr example, I wuld nt have knwn abut the Cuncil f Agencies Service Suth Asians if it weren t fr Health Nexus and the CTD prcess. Planning Cmmittee Member

65 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Cntext Suth Asians are amng a number f ethn-racial cmmunities at high risk fr strke. They are three times mre likely t have high bld pressure than ther Canadians 8, have higher rates f diabetes and chlesterl, and are a pririty ppulatin fr strke preventin: Suth Asians have a three-t five-fld increase in the risk fr a heart attack and death frm heart disease and strke. 9 Furthermre, with the Suth Asian ppulatin grwing rapidly, it is likely that we will see mre cases f strke in the cmmunity. Grwing Interest in Cllabrative Wrk t Prevent Disease, including Suth Asian Specific Initiatives In May 2006, a CTD frum was held in Peel: Strke Preventin: Cnnecting the Dts Tgether in Peel. This event was led by the West GTA Strke Netwrk alng with Health Nexus and a small multisectral planning cmmittee. Apprximately 50 individuals frm acrss the cntinuum f strke attended this frum. Participants identified the netwrking and knwledge exchange (tpics included available services and resurces, strke and strke preventin, scial determinants f health, demgraphics f Peel) that ccurred that day as valuable. A unique feature f that CTD frum was the participatin f HeartMbile frm Peel Public Health. The request fr fllw-up, future pprtunities t netwrk, and similar seminars was a theme that emerged frm participant evaluatins the day f the frum. Furthermre, lts f partnerships were nurtured during the 2006 Peel CTD prcess that cntributed t such initiatives as the strke survivr netwrks, the Key t Wmen s Health prject, and the Suth Asian CTD. Given the significant Suth Asian ppulatin in the Regin f Peel, the West GTA Strke Netwrk and partners rganized a cmmunity educatin event Suth Asian Strke Preventin in June 2008 strke mnth. Suth Asian cmmunity members were invited t attend this afternn wrkshp that included varius exhibits and presentatins by a family physician, a Suth Asian strke survivr, a clinical pharmacist, and a public health nutritinist. The Heart and Stke Fundatin is making a significant cntributin t health prmtin and preventin effrts related t Suth Asian cmmunities; they have prduced a variety f resurces (including brchures, vides, and stries) in varius Suth Asian languages. In additin, they prmte healthy lifestyles and distribute resurces at cmmunity events. All these are dne in partnership with ther rganizatins. Suth Asian cmmunities are als an area f fcus fr the Heart and Strke Fundatin Cmmunity Missin Specialist fr Peel Regin. Being invlved with Being invlved with the 2006 CTD prcess the 2006 CTD prcess in Peel increased my in Peel increased my cnnectins with cnnectins with many new cmmunity many new cmmunity partners. Fr example, partners. Fr example, am cllabrating I am cllabrating with Parks and with Parks and Recreatin t ffer Recreatin t ffer cmmunity strke cmmunity strke exercise prgrams in exercise prgrams in ur regin, accessing ur regin, accessing cmmunity strke cmmunity strke care prfessinals t care prfessinals t deliver lng-term care deliver lng-term care strke educatin strke educatin mdules, and mdules, and partnering with Public partnering with Public Health t deliver Health t deliver nging strke risk nging strke risk factr preventin factr preventin prjects in the prjects in the cmmunity. CTD is cmmunity. CTD is a great way t meet great way t meet pssible partners and pssible partners and learn hw yu can learn hw yu can wrk tgether t reach wrk tgether t reach cmmn gals. cmmn gals. Sharn Trttman, Cmmunity Sharn Trttman, and Lng-Term Care Cmmunity Strke and Specialist, Lng-Term West GTA Care Strke Netwrk Specialist, West GTA Strke Netwrk Cntext cntinued D85B2D02EE71%7D/HSFO_AR08.PDF?src=abutus

66 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts There has als been actin frm within the Suth Asian cmmunities themselves. The Cuncil f Agencies Serving Suth Asians (CASSA) is a scial justice umbrella rganizatin wrking with Ontari s diverse Suth Asian cmmunities. 10 In its current strategic plan, CASSA identifies the crdinatin f access t health and wellness, including the prmtin f health equity, as ne f its strategic directins. In Octber 2008, CASSA held a frum n chrnic disease preventin, mental health, sexual/reprductive health, and health care services. Punjabi Cmmunity Health Services began as a health prmtin prject in Since 1995, this cmmunity-based agency has been serving the Peel cmmunity thrugh cmmunity develpment, culturally apprpriate service delivery, partnership with ther rganizatins, research and asset inventries, develping resurces and vlunteers frm within the cmmunity, cnsulting and prmting diversity, and thrugh cmmunity utreach. 11 Therefre the Suth Asian CTD built n mmentum already created by wrk being dne by a range f partners. These cmmunity leaders were engaged in the prcess f the 2009 CTD as partners n the planning cmmittee. What new ideas, thughts, r infrmatin are yu taking away frm tday s frum? The amazing number f cmmunity resurces there are in the GTA. Participant, CTD March 4, 2009, Evaluatin Frm 10 CASSA s missin is t facilitate the ecnmic, scial, plitical and cultural empwerment f Suth Asians by serving as a resurce fr infrmatin, research, mbilizatin, crdinatin and leadership n scial justice issues affecting ur cmmunities. Create scial change by building alliances and wrking cllabratively with thse wh share a visin f empwering all cmmunities t participate in defining Canada's future

67 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Getting Started In spring 2008, Health Nexus (with a supprt letter frm the West GTA Strke Netwrk 12 ) respnded t the Ministry f Health Prmtin s call fr prpsals related t pririty ppulatins and strke preventin. As part f verall funding fr its Prevent Strke prject, Health Nexus was granted funding t help rganize a CTD prcess and frum specific t Suth Asians and strke. This prcess cmmenced August In cllabratin with the Cmmunity and Lng-Term Care Strke Specialist, West GTA Strke Netwrk, Health Nexus began by talking t stakehlders frm the strke preventin/care cntinuum and Suth Asian cmmunities abut the idea f hlding a full-day frum in March The gal was t engage a wide range f stakehlders frm the nset. With this gal in mind, at the beginning f September 2008 an invitatin t attend the first planning meeting was sent t stakehlders within health prmtin, public health, hspitals, cmmunity health centres, lng-term care, cmmunity services and Suth Asian rganizatins. Asked t RSVP by September 12, 2008, 22 stakehlders attended the first planning meeting n September 29, During this initial stakehlder meeting, the strke netwrk was explained and the CTD prcess was utlined. Fllwing this intrductin, everyne brainstrmed tgether abut the frum: What shuld the purpse be? What tpics shuld be cvered? Wh shuld be there? At the end f the stakehlder meeting, individuals wh were interested in becming part f a smaller planning cmmittee put frth their names. The brader grup decided that the next full stakehlder meeting wuld be January With six planning cmmittee members cnfirmed frm the initial stakehlder meeting, several ther individuals were apprached t ensure multi-sectral representatin and engagement. The result was a diverse planning cmmittee f 13 peple wh brught preventin and health prmtin, acute care, and cmmunity perspectives t the cmmittee. Planning cmmittee member participatin in meetings was very high, and everyne n the cmmittee undertk tasks in the many mnths prir t the frum, and n the day f the frum itself. The fact that the Suth Asian cmmunities are ne f the pririty ppulatins identified by the Ontari Stke System gave us an pprtunity t wrk in a way that is different frm previus CTDs. The reference grups we were lking at were thse invlved in strke, thse wrking with Suth Asian cmmunities, which are a pririty ppulatin als fr diabetes. In additin, we went beynd the catchment f the West GTA strke netwrk t that f the ther GTA strke netwrks. We had participatin frm as far away as Windsr precisely because f the cmmunity fcus. Subha Sankaran, Health Prmtin Cnsultant, Health Nexus 12 The West GTA Strke Netwrk was a lgical partner fr this CTD because f the significant Suth Asian ppulatin in the Regin f Peel, the Ontari Strke System s interest in Suth Asians as a pririty ppulatin fr strke preventin, and the Peel CTD prcess that was led by the West GTA Strke Netwrk in 2006.

68 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Planning the Frum Planning Cmmittee Members Cmmunity and Lng-Term Care Strke Specialist, West GTA Strke Netwrk Executive Directr, Cuncil f Agencies Serving Suth Asians Executive Directr, Punjabi Cmmunity Health Services Lng-Term Care Cunselr, India Rainbw Cmmunity Services f Peel Cmmunity Missin Specialist fr Peel Regin and Suth Asian Cmmunities, Heart and Strke Fundatin f Ontari Health Prmter, Rexdale Cmmunity Health Centre Vlunteer, Canadian Assciatin f Multicultural Peple Senir Lead, Health System Develpment, Mississauga Haltn Lcal Health Integratin Netwrk 13 Public Health Nurse, Regin f Peel, Public Health Educatin and Health Prmter, Peer Supprt Services, Ontari March f Dimes Patient Navigatr, Diversity Services, William Osler Health Centre Recreatin Prgrammer, Hurn Park Pl Health Prmtin Cnsultant, Health Nexus Planning Meetings Held initial stakehlder meeting September 29, 2008 Planning cmmittee met fur times Fall 2008, and began meeting every tw weeks starting January 2009 Rtated cmmittee meeting lcatins, giving each cmmittee member an pprtunity t hst a meeting (telecnference ptin was available fr members wh culd nt attend in persn) Decisins were made by cnsensus Recrded and distributed minutes fr every meeting ( cntact was maintained with thse wh attended the initial stakehlder meeting) Finalized the purpse f the frum by building n the brainstrming dne at the initial stakehlder meeting The Cuncil f Agencies Serving Suth Asians jined the planning cmmittee fr this CTD because there is a discnnect between health care, chrnic disease preventin prgrams, and the cmmunity: We wanted t help address this discnnect. Neethan Shan, Executive Directr, Cuncil f Agencies Serving Suth Asians 13 This was the first CTD planning cmmittee t include representatin frm a Lcal Health Integratin Netwrk.

69 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Planning the Frum cntinued Frum bjectives became: Enhance understanding f strke and Suth Asian cmmunities Increase knwledge abut availability f services and supprts Help imprve planning fr strke and chrnic disease preventin at all levels Prmte greater intersectral cllabratin thrugh existing and new netwrks Brainstrmed agenda tpics (these were then cmpiled and rganized int a draft agenda) Invited stakehlders t a fllw-up stakehlder meeting January 28, 2009, t review the wrk dne s far by the planning cmmittee and tgether cmpleted a netwrking activity called drawing ur netwrks t generate a list f ptential participants Apprached and cnfirmed speakers One f the day s presentatins was pre-recrded and played n DVD at the frum. This ccurred because the speaker was nt available n the day, but was interested in being part f the frum as a Suth Asian herself, and generusly made herself available fr the recrding. The recrding itself was carried ut as an in-kind cntributin by ne f the planning cmmittee members Finalized the agenda Explred varius lcatin ptins fr the frum, decided n the Burnhamthrpe Cmmunity Centre because f its availability, affrdability, accessibility, as well as its adequate space and technlgical accmmdatins Brainstrmed, apprached, and cnfirmed rganizatins t set up exhibits at the frum Arranged fr phtgraphy and videgraphy f the frum Assigned prmtin tasks t all cmmittee members Cmpiled materials fr the participant packages and dr prizes Arranged fr healthy catering by an Indian restaurant Assigned participants t tables prir t the frum t ensure a mix f participants frm acrss the cntinuum at each table The planning prcess fr the Suth Asian CTD was much mre cmplex cmpared t the 2006 CTD and was directed at specific cmmunity rganisatins bth frm a medical and sci-ecnmic perspective. The expected number f participants grew frm 50 t 100, the cmmittee members frm 5 t 13, and the bjectives als expanded. These features made it mre cmplex t incrprate all f the tpics int the agenda and als t cme t cnsensus. Hwever, the diversity f the planning cmmittee brught a diversity f passins, strengths, and experience which ultimately enhanced the richness f the prcess and the frum. Sharn Trttman, Cmmunity and Lng-Term Care Strke Specialist, West GTA Strke Netwrk

70 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts Prmting the Frum A brad grup f stakehlders was infrmed abut the March 2009 frum and invited t the initial planning meeting in September A running list f sectrs that shuld be represented at the frum was created at that initial meeting. The planning cmmittee sent a save the date invitatin 3 mnths prir t the frum. Incrprating ptential participants identified by the planning cmmittee, a frmal invitatin was ed the end f January The invitatin was als psted t the Scial Determinants f Health listserv, Click4HP listserv, and Health Equity Cuncil listserv. The invitatin included an electrnic versin f the flyer with a link t the nline registratin frm n the Health Nexus website. Recipients were encuraged t frward the electrnic invitatin t anyne wh might be interested. The website address fr registratin was included n the print versin f the flyer that planning cmmittee members distributed. A final invitatin including the detailed agenda and a reminder t register was sent the middle f February Additinal prmtin ccurred via netwrking and wrd-f-muth. The Frum Title: Frm Risk t Resilience: Cnnecting the Dts n Suth Asians and Strke Date: Wednesday, March 4, 2009, 8:30 a.m. - 4:30 p.m. Lcatin: Burnhamthrpe Cmmunity Centre, 1500 Guelleden Drive, Mississauga, Ontari Agenda: 8:30 a.m. Registratin and Breakfast 9:00 a.m. Welcme and Intrductins 9:15 a.m. Getting n the Same Page Backgrund t the Cnnecting the Dts Prcess Subha Sankaran, Health Prmtin Cnsultant, Health Nexus What is the Ontari Strke System? Sharn Trttman, Cmmunity and Lng-Term Care Strke Specialist, West GTA Strke Netwrk Strke Overview Dr. Manu Mehdiratta, Neurlgist, Trillium Health Centre

71 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts The Frum cntinued 10:00 p.m. Panel Discussin I 10:45 a.m. Break Fcus n the Suth Asian Cmmunities and Immigrant Health Scial Determinants f Immigrant Health Farah N. Mawani, Traveling Faculty, Internatinal Hnrs Prgram Understanding Suth Asian Health Issues in Peel Regin Amandeep Kaur, Punjabi Cmmunity Health Services Wh Are the Suth Asian Cmmunities? Neethan Shan, Cuncil f Agencies Serving Suth Asians 11:00 a.m. Getting the Big Picture Identifying the Dts Facilitated Sessin 11:20 a.m. Panel Discussin I Understanding the Strke Cntinuum Cnnecting the Dts A Strke Survivr Speaks A Panel f Speakers frm Different Parts f the Cntinuum 12:30 p.m. Lunch (fllwed by Bllywd Energizer) 1:25 p.m. Cnnecting the Dts Small Grup Discussin 2:20 p.m. Understanding Cultural Cmpetencies in Health A Suth Asian Perspective Baldev Mutta, Panjabi Cmmunity Health Services 2:50 p.m. Engaging with the Planners Dr. David Mwat, MOH, Regin f Peel, Public Health Pegeen Walsh, Directr, Chrnic Disease Preventin and Health Prmtin, Ministry f Health Prmtin Evelyn Myrie, Directr, Peel Newcmer Strategy Grup In cnversatin with Cnnie Clement, Executive Directr, Health Nexus 4:00 p.m. Clsing Remarks, Evaluatin and Adjurn The mst valuable was learning abut strke and Suth Asians. Als, it helped us t cnnect with ther peple and learn abut imprtant resurces. Participant, CTD March 4, 2009, Evaluatin Frm

72 Reflective Case Studies: Hw Three Cmmunities Cnnected the Dts The Frum cntinued 115 Participants by Practice Settings Lts f dts were cnnected bth hrizntally acrss sectrs and vertically between planners and frnt-line wrkers.. Subha Sankaran, Health Prmtin Cnsultant, Health Nexus Exhibits Cuncil f Agencies Serving Suth Asians Canadian Diabetes Assciatin, Diversity Health Nexus Heart and Strke Fundatin f Ontari India Rainbw Cmmunity Services f Peel March f Dimes Ministry f Health Prmtin Mississauga Haltn LHIN Parks and Recreatin, Mississauga Peel Newcmer Strategy Grup Peel Public Health Punjabi Cmmunity Health Services Rexdale Cmmunity Health Centre Telecare Distress Centre West GTA Strke Netwrk