What is Collective Impact?

Collective Impact is an approach to collaboration that is being used by diverse communities around the world to transform difficult social problems.

Collective Impact isn’t about continuing to do things the way they have been done.

The status quo is giving us exactly the results we have now. If we’re happy with those results: great!

If not, we need to change the system to get the results we want.

To change a system, we need to address the way we think about the system, and how we interact with each other. We need to be prepared to be changed.

Five simple guidelines create the structure of Collective Impact:

  1. A Common Agenda;
  2. Shared Measurement;
  3. Mutually Reinforcing Activities;
  4. Continuous Communication; &
  5. A Backbone Structure.

It is these simple rules that enable the complex work of system transformation.

The model is flexible. Communities focus on what is important at a local level.

For some communities, it’s obesity prevention. For others it’s poverty reduction. Or improving health outcomes for LGBTQ+ community members. Or reducing racial disparities in high school graduation rates. In Bosnia, one town is addressing the ongoing problem they have with feral dogs.

The focus is on whatever leverage point is identified by a community as being most significant to improve the health and well-being of that community as a whole.

In New York, before Collective Impact, 60% of young people in the youth justice system were rearrested within 2 years. After stakeholders came together to align their activities through Collective Impact, youth arrests decreased by 24% and youth in custody declined by 45% …without any increase in crime or risk to public safety.

That’s the kind of change we’re talking about.

The Child & Youth Health Network is working to improve the mental and physical health of young people in the capital region of British Columbia. We aim to do that be aligning people, ideas, organizations, sectors and resources of all kinds behind increasing ‘connectedness‘ for children, youth and families.

More Information

Learn more about Collective Impact at

 

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Healthy Schools

We are busy preparing for the next whole network meeting of Child & Youth Health Network on May 27th at the University of Victoria.

We have an auditorium and 11 break-out rooms booked because we’re expecting a crowd!

Please save the date~.

For the first time, our whole network meeting will be hosted by one of the ‘constellations‘ (working groups) of the network: Healthy Schools.

The first Healthy Schools event took place on May 27th in 2015 and focused on Promoting the Mental Health of our Children & Youth.

Find the background materials from that event here:

The Impacts of Hetero-normativity & Cis-normativity on Youth Mental Health

This week our youth partners presented at the CYMHSU Collaborative Learning Session in Vancouver.

Their presentation was titled The Impacts of Hetero-normativity & Cis-normativity on Youth Mental Health.

First question:

Q: What’s Cis?

A: Identifying as the gender you were assigned at birth.

The youth were speaking from experience. About the impacts of prejudice and discrimination on the mental health of LGBTQ+ youth.

CYMHSU2016

Hetero-normativity & Cis-normativity: What’s the problem?

Here’s what the youth told the doctors, clinicians, practitioners and parents in their workshop:

LGBTQ+ identity doesn’t cause mental health problems, yet LGBTQ+ youth have extraordinarily high rates of depression, anxiety, self-harm, suicide and substance use.

Why?

This video helps to answer that question:

https://vimeo.com/17101589%20

The youth explained that LGBTQ+ youth face increased vulnerability due to:

  • Loss of supports: rejection by family, friends and community;
  • Burden of keeping their a secret identity;
  • Bullying and violence;
  • Discrimination/hetero-normatavity/genderism;
  • The coming out process;
  • Internalized homophobia;
  • Being confused/not knowing how they identify/feeling uncomfortable in their gender; &
  • Pathologization by the medical/psychiatric community.

They shared fresh (2015) statistics from the Canada-wide Transgender Youth Health Survey:

  • Almost half of trans youth reported feeling stressed to the point that they could not do their work or deal with things during the last 30 days;
  • More than half of trans youth reported they had hurt themselves on purpose in the last year; &
  • 65% of trans youth had seriously considered suicide, more than a third had attempted suicide at least once, and nearly 1 in 10 had attempted suicide 4 or more times.

They asked us: Does it make sense that they, as LGBTQ+ youth, face approximately 14 times the risk of suicide and substance abuse than their heterosexual and cisgender peers, when mental health problems, substance use and suicide are not side-effects of having a minority sexual identity or gender orientation?

They are side-effects of prejudice and discrimination.

What’s the Solution?

Our youth partners are saying that it would be really helpful if we could start by making space for who they are.

Sounds like a reasonable request!

They offered an initial strategy:

Start with Language

Youth who have a non-binary gender identity may prefer different pronouns than he or she, but most of us are unfamiliar with gender-neutral pronouns and feel awkward using them.

The youth recommended that we embrace the awkwardness and practice: “because you know what? It’s way more awkward to have people ignore your gender identity. It’s so awkward it causes self-harm and suicide. So really, embracing a little awkwardness while you get used to using some new words is worth it!

They shared some of the pronouns that transgender people may prefer including: They/them; Xe/xir; Ze/Mer; Ve; Ney and Yo.

If that list is overwhelming, they said that most transgender people are fine with ‘they/them’ as gender-neutral pronouns. The key is to ask: “Is there a gender pronoun you prefer?“.

Just ask!

They also offered two tips for pronoun usage:

  1. Never make assumptions about a person’s gender identity; &
  2. If you slip up and use the wrong pronoun, just correct yourself & move on.

Our Bad

Personal Recovery Outcome Measure

Measuring RecoveryLast week Dr Skye Barbic presented on the Personal Recovery Outcome Measure (PROM) at Island Community Mental Health.

The PROM questionnaire is designed for people who are recovering from mental illness. But it can be used by everyone.

The World Health Organization (WHO) defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

Clearly we don’t need to be recovering from a debilitating mental illness to be pursuing improved mental health. In fact, the WHO definition for mental health could be the definition for purpose in life.

How it Works

The questionnaire tells a story of recovery, from the very earliest stages of the process to total wellness.

That’s why all of us can use it: wellness is a goal we all share no matter where we are stating from.

This tool quantifies that which can otherwise feel amorphous. It enables a person to track their progress over time, and also enables comparison between people.

There are 30 multiple-choice questions in PROM and they are sequential.

The metaphor Dr Barbic uses to describe measurement of recovery using PROM is a 30-cm ruler. The whole ruler represents total wellness. For any of us.

Almost no one is at 30. All of us are somewhere on the ruler.

Ruler

Each one of the questions, in order, represents another increment (a centimeter) on the ruler.

By completing the PROM questionnaire we end up with a score. Some number out of the highest possible total of 30.

This score enables you to track changes over time.

If you missed the link earlier in this post,  you can find the questionnaire here.

PROM questionsRecovery

After scoring, the questionnaire enables you to identify areas of strength as well as areas to work on.

Your score also refers you to an intervention opportunity as part of your story of recovery.

So, for example, a score of 16 refers you to statement #16 “I have new interests”.

You could choose to work on something else, but something around 16 might be a good place to start.

Dr Barbic suggested that we look at a range of options, three below and three above our score.

PROM questions 2Implications for Youth

I was curious about whether this questionnaire could be used with youth. Before I could put up my hand to ask, Dr Barbic told us that it can, but that a youth version is currently under development.

One example: Youth don’t care about sleep. But they care very much about intimate relationships. So those statements (#5 & #29) may need to be adjusted in a tool developed for youth.

She’ll have more information in April.

Second Generation Collective Impact

A new article Second Generation Collective Impact from the Stanford Social Innovation Review investigates what separates initiatives that lose momentum from those that are successful in the long term.

Saphira M. Baker & Kelly King Horne identify four elements that are essential to get & keep traction for collective impact:

  1. Results: Align and Deliver;
  2. People: Develop and Share Leadership;
  3. Focus: Keep the Mission Manageable; &
  4. Information: Keep Data Alive.

Read more here.

How Common are Behaviour Disorders?

Mental Health QuarterlyThe winter 2016 edition of the Children’s Mental Health Research Quarterly focuses on children’s conduct difficulties and behaviour problems and notes that “30% to 50% of referrals to children’s mental health services are for behaviour problems”

The following are quotes from this edition:

“According to rigorous epidemiological surveys, approximately 2.4% of children meet criteria for oppositional defiant disorder at any given time. Similarly, a review of nine high-quality surveys found that approximately 2.1% of young people meet diagnostic criteria for conduct disorder at any given time. Extrapolating from BC and Canadian population figures, an estimated 30,000 children and youth in BC and 240,000 in Canada are likely experiencing one or both of these conditions at any given time.”

“Policy-makers, practitioners and members of the public can make a difference for young people by enacting and supporting policies that address socio-economic disadvantage, including overall child poverty levels. For example, evaluations of income-supplement programs have suggested that increasing the incomes of poor families by just $5,000 a year for two or three years could produce large improvements in children’s behaviour. And, given that living in poverty poses multiple risks for child well-being, poverty reduction may also avert other risks. For example, family socio-economic disadvantage has also been linked to children having chronically activated stress pathways, with consequent effects on their immune systems.

The available causal evidence also suggests that practitioners may have an added role to play by directly helping parents — given that parenting appears to be another important modifiable factor in the development of children’s behavioural problems”

Comprehensive Children’s Mental Health Indicators

It’s a wonderful thing when you find a paper that proactively answers your specific research question!

Creating Comprehensive Children’s Mental Health Indicators for British Columbia is a paper like that.

Our Question

What data sources are available and what criteria should we use to select comprehensive indicators to track the mental health of young people in the capital region over time?

This Paper Answers:

The Data Sources used to select indicators for this study can be found on pages 16-18 and the indicators on pages 19-22.

But the whole paper is worth a read. Or two.

Here’s just a little of what this paper offers:

“Mental health—or social and emotional well-being—is fundamental to human development and essential for all children to flourish. Yet at any given time, an estimated 14% of children (or 800,000 in Canada) experience mental disorders causing significant symptoms and impairment, exacerbating matters, clinical treatment services still reach fewer than 25% of these children despite substantial public investments in health care. Meanwhile, there are almost no investments in programs that could address determinants and prevent problems. Consequently, mental disorders unnecessarily persist throughout the lifespan, with adverse outcomes ranging from reduced educational and occupational chances to increased mortality. The associated economic burden is now estimated to exceed $51 billion in Canada annually, urgently underscoring the need to better address mental health starting in childhood. To address children’s mental health adequately, a new comprehensive population health approach is needed—promoting healthy development for all children and preventing disorders in children at risk, in addition to providing effective treatment for children with established problems and disorders.”

“Canada urgently requires a population health approach to children’s mental health—promoting health and preventing disorders, in addition to providing treatment. Underpinning this approach, indicators could enable population monitoring, thereby informing ongoing public investments.”

“Strategically, monitoring could also raise public awareness about the importance of children’s mental health—understanding that ‘what gets counted, counts.'”

“A population health approach for children’s mental health—promoting health and preventing disorders, in addition to providing treatment—requires a correspondingly broad framework encompassing concepts central to the social and emotional well-being of the entire population of children. Therefore we propose a comprehensive framework that covers: major developmental stages; determinants and contexts; mental health status and related developmental domains; and a wide range of intervention approaches.”

Population Health Framework for Children's Mental Health
Gratitude to Charlotte Waddell, Cody A. Shepherd, and Alice Chen from Simon Fraser and Michael H. Boyle from McMaster for all the work that went into this project and for reporting the results so we could learn from them.

Child and Youth Mental Health: BC government recommendations

dad43The all-party Select Standing Committee on Children and Youth has issued its unanimous report on child and youth mental health with 23 recommendations to strengthen child and youth mental health services in British Columbia. The committee’s recommendations are the result of two years of work and public consultations with individuals, experts, and organizations involved in the delivery of child and youth mental health services.

The CBC reported that 140,000 children in the province need some form of mental health intervention, but only 25 to 30 per cent of them receive services from the public system, according to Bev Gutray, CEO of Canadian Mental Health Association’s B.C. chapter.

The report is recommending a new Minister for Mental Health “to provide leadership and accountability and more school- and community-based hubs where mental health professionals work together in child- and youth-friendly settings.”

“Children, youth, and their families are suffering as a result of gaps and weaknesses in services,” added deputy chair Doug Donaldson. “The Committee is recommending a coordinated, integrated system where there are ‘one child, one file’ services for children, youth, and young adults that includes targets where assessments occur within 30 days and treatment within the next 30 days.”

 

Nurturing Early Childhood Development in Times of Austerity

dad16According to a paper titled Nurturing early childhood development in times of austerity in BC, “Canada has the weakest public funding for early childhood development among wealthy countries. The consequences of this lack of investment can be seen in the state of early childhood development in British Columbia.”
This paper describes the findings of  study that identified communities with higher levels of vulnerability on the Early Development Instrument (EDI) that managed to change the trend of vulnerability.

According to this analysis, the following elements enable this change:

  • The federal and provincial government must take a strong leadership role in creating policies and funding for employment, income, housing, parental leave and child care. This sets a well-furnished stage for the work of local agencies and individuals.
  • Initiatives to improve early childhood development outcomes must be broad-based and not simply targeted at low-income or high-risk families. Research shows that vulnerability occurs across all income levels, and that universal approaches are most effective.
  • Government must provide leadership with policies and funding, but must also partner with local agencies and individuals. This type of partnership harnesses the power of active and engaged community members.
  • Local committees that include representatives from all levels of government, schools and community agencies, are an ideal way to support improvements to early childhood development. Communities with this type of committee tend to have lower levels of developmental vulnerability.

Connectedness: defined

beach youthHow do we define connectedness?

Carmina McGuire, graduate student in Public Health who is working with us to developing an Index of Connectedness, is conducting a literature review and has started with reviewing definitions of connectedness. The following, from Connectedness & suicide prevention in college settings is the best definition she has found so far:

We define connectedness as a psychological state of belonging in which individuals perceive that they are valued, cared for, trusted, and respected by the individuals and communities with whom they are in regular contact (e.g., peers, family, romantic relationships, groups) or in which they are socially or geographically embedded (such as a university, college, or fraternal community).

We suggest that connectedness is best understood as a psychological state of being which reflects a sense of closeness, embeddedness, and visibility to individuals and collections of individuals (e.g., groups or institutions) and as a relationship system through which perceptions are generated and norms are transmitted.”