Using Data (for measurement and intervention)

Shared Measurement is at the heart of Collective Impact.

According to Jeff Raderstrong in his recent blog post at Living Cities, “Without continuously tracking and managing progress with data, it is highly unlikely that a collective impact initiative, or any large-scale change initiative, can achieve its goals.”

Measurement only one of the reasons we are developing an Index of Connectedness through the Child & Youth Health Network. We also intend to use data as a core element of our intervention strategy.

In an earlier post, Jeff outlined five steps to using data in Collective Impact:

Step 1: Agree on the Data

This is what we are currently doing as we build the Index of Connectedness with a panel of experts in the area of measurement from around British Columbia.

Step 2: Find the Data

The Index will use existing data sources, such as the EDI and the Adolescent Health Survey, but we know that there may be data gaps that we will also need to fill in order to create a truly useful index.

Step 3: Present the Data

We are currently working with data science students to create data visualization for the index so that it will be easy for everyone (not just data geeks!) to interpret. Data visualization will also aid comparison between communities and over time.

Step 4: Discuss the Data

Once the index is complete (we are planning to launch the Index in 2017, it will provide information that we hope will provoke discussion at multiple system levels throughout our region.

Step 5: Change Behavior and Share Responsibility

The Index of Connectedness will be at the core of our shared measurement system, but it is also intended to function as an intervention for change. Through the index we hope to:

  1. Mobilize knowledge, to help everyone in our communities understand that increased connectedness for children and youth improves their health, as well as their academic performance, future productivity, and future parenting capacity.  Increased connectedness for children and youth results in improved overall community health in the long-term.
  2. Support all community members in seeing that they have a role, and helping them to  take steps to increase connectedness for children and youth in their families, schools and communities.

The Wellness Wheel

Wellness WheelThe Child & Youth Health Network has customized a variation of the Wellness Wheel to portray the 8 domains of development for young people.

These domains are reflected in our goal, and will form the structure around which we are now building our shared measurement system.

This post shares a brief history of the origin of the Wellness Wheel. But first our goal:

Our Goal

Our goal as a network is to optimize the health and wellness of children and youth in the following domains: Cognitive, Physical, Emotional, Spiritual, Cultural, Environmental, Social, and Financial/Occupational.

A brief history of Wellness

Traditionally, societies have always been concerned with wellness. Preventative, holistic health systems are the foundation of Ancient Wisdom Teachings from around the world, many of which are still practiced today, including Ayurveda, Traditional Chinese Medicine, Yoga and Indigenous shamanic practices. But ‘Wellness’ is a relatively new concept for the Eurowestern worldview. The World Health Organization, without actually using the word ‘wellness’, first defined it as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity” in 1948. The first mention of ‘wellness’ in research literature was in 1959, in a visionary paper by Halbert Dunn, who wrote, “the state of being well is not a relatively flat, uninteresting area of ‘unsickness’ but is rather a fascinating and ever-changing panorama of life itself, inviting exploration of its every dimension.” Halbert proposed a health grid which considered health and environment, creating four quadrants that reflected the complex  nature of wellness. The Health Grid The health axis included “an area of good health at present largely uncharted and undifferentiated, toward a goal as yet but dimly perceived which is indicated as peak wellness.” (Excitingly, 55 years after Halbert published this paper, we still don’t know what the outer limits of ‘peak wellness’ are).

Domains Of Wellness

6DimensionsDiagram_finalThe idea of wellness spread in the 2nd half of the 20th century, until the first ‘Wellness Wheel’ (called the Six Dimensions of Wellness), was developed by Bill Hettler in 1976. You can find his definitions for these six domains here. Variations on this model abound, as many people want to tease out and make explicit other domains of wellness, including cultural, creative, financial, sexual, and/or environmental. The Child & Youth Health Network, we selected 8 domains of wellness for young people (see below).

Next Steps

Currently, the shared measurement and evaluation constellation is working to create definitions for each of those domains to bring to the stewardship committee for critique on July 10th. Throughout the summer, we will be working to develop recommendations for outcomes, targets and indicators for each domain. Once developed, these will be shared widely with the community and refined through consultation. Once this process is complete, these 8 domains, with associated outcomes and targets and a set of 15-20 high-leverage indicators, will form the measurement system for the network~. Wellness Wheel

Ecological Determinants of Health

The Canadian Public Health Association has just released a discussion paper on the Ecological Determinants of Health. Find it here.

Wellness WheelThis document relates to the current work of the Shared Measurement constellation of the Child & Youth Health Network. Partners in the Shared Measurement constellation are currently defining each of the 8 domains identified as core to our Common Agenda.

We have wondered about about whether we should include any ecological measures in the ‘environment’ domain.

Though ecological systems are not our target (social systems are) if we really want to ensure that children & youth thrive in the long term, we cannot pretend that ‘ecological determinants of health’ are not going to be increasingly relevant to young people’s well-being.

Not only their future well-being, as ecological impacts became more pervasive, but their current well-being: if young people see adults committing to improving the health of our ecological systems, they may experience less nihilism about the state of the world they are inheriting.

Including an ecological measure in the Child & Youth Health Network would also be a way to engage all of the people in our community, including those who are passionate about the environment.

But at the same time, if it is not a system we are targeting, is appropriate for us to try to measure it?

Though this document doesn’t provide example indicators, it advocates for their development (the following excerpt is from p. 26):

The Public Health Agency of Canada, the Canadian Institutes for Health Information, and Statistics Canada should develop and test a set of indicators of the ecological determinants of health to be used to monitor and report on these issues across all four orders of government (i.e., federal, provincial, municipal and First Nations) and to guide more comprehensive impact assessments of the ecological, social, health and economic impacts of major public policies and private sector developments.

Specifically, to:

  • Identify health indicators for conditions plausibly related to ecological change for use within impact assessments and as early-warning or sentinel conditions to be monitored;
  • Revise the core set of indicators of health used in Canada to include indicators to measure key ecological determinants of health, the socio-ecological system and sentinel health conditions associated with ecological change;
  • Ensure that public health reports at all levels include indicators of ecological determinants of health in routine reports, and report specifically on them on a regular basis, reflecting local, regional, provincial, national, indigenous and global contexts; and
  • Assure that as much effort and profile are applied to the collection and publication of data on the state of the environment as on the state of the economy.

Shared Measurement

One of the next big tasks for the Child & Youth Health Network is creating a shared measurement system.The following is an excerpt from an article published by the US-based childtrends.org and addresses some of the challenges to establishing a shared measurement system. Find the original article here.

Linking Data

The barriers to linking data across multiple electronic storage systems are rarely technical, it turns out; instead, they tend to reflect traditional issues of turf, leadership, and organizational culture.

Data linked across multiple systems has long been heralded as an obvious extension of the digital information age. Connecting the data silos, so the thinking goes, is essential for gaining a better understanding of how well people are served by various public systems (schools, child care, income/work support, and so on).

To fully realize the potential of indicator data to drive change in practice (and outcomes) often requires bringing together information from multiple sources and platforms, and across traditional administrative boundaries. This is certainly not a new idea, yet several recent reports shed light on some of the challenges that still stand in the way of data integration.

An example: School & Community Data

The interface between school data and a variety of other community data on child well-being has become another familiar ground for data linking/integration efforts. The growth in place-based initiatives, such as Promise Neighborhoods and the Strive Network, has provided added impetus to this work, but also made some persistent areas of difficulty more prominent.

Into this space, a recent report from Strive Together and the Data Quality Campaign casts some helpful light. In Data Drives School-Community Collaboration: Seven Principles for Effective Data Sharing, the authors identify some essential lessons, and debunk a few common myths.

A sampling:

  • “Decision-makers, not data people, get information moving—and they do it when it’s in their own best interest.”
  • “The first rule of data systems is to never begin by talking about data systems.”
  • “One good question is worth a dozen data points.”
  • “Data stewardship needs to be part of [school] districts’ and partners’ organizational DNA.”
  • “When it is in the students’ best interest, very little legitimate data-sharing between schools and communities is prohibited by FERPA [the federal Family Educational Rights and Privacy Act] or the array of state and federal laws that extend it.”

An Interactive Logic Model

Logic models depict the theory of change for a program.

This interactive logic model depicts an initiative that may be compatible with the Child & Youth Health Network in some respects. It focuses on early childhood, an excellent & high leverage intervention point. We might include a prenatal, middle childhood, youth & early adulthood area.

Find the interactive version here (It’s interactive! Hover your mouse over almost any field to drill down & find more detail).

The following are screen shots of the fields from the system level into the family level:

Theory of Action
The System

In the area of Capacity Development on the main page, we can access more detail in the Family Assets field:

Theory of Action_family assets

In the area of Outcomes on the main page, we first find a goal for Family Well-being when we click on that outcome area:

Theory of Action_family well-being

Then indicators for each timeframe (short, medium & long). Here are the Long-term Outcomes & Indicators:

Theory of Action_family well-being outcomes & indicators

Social Determinants of Health: Indicators

Social Determinants of HealthWe’re working on our Common Agenda, including fine-tuning long-term outcomes, setting targets & selecting indicators for our Collective Impact Initiative.

To engage in shared measurement, we need to adopt shared indicators that can be measured by each service-delivery partner in the initiative, so we can track our collective progress toward our goals.

We know much of this work has already been done, and can be adapted to our purposes.

For example, here’s a list of indicators for monitoring the social determinants of health (SDH) found on the Action:SDH website (find the full list here). The following relate directly to young people in a Canadian context:

  • Proportion of young people not in school or employment, by age and sex;
  • Literacy rate;
  • Completion of primary/secondary education by ethnic/ “race” group in a country;
  • Newborns with low birth weight (% by mother’s education);
  • Children aged <5 years with moderately or extremely low values for weight and height;
  • Prevalence of obesity (by wealth quintiles).

Applying the Social Determinants of Health

Sam Bradd graphically documented strategic-level dialogue around the Social Determinants of Health by the the First Nations Health Authority, First Nations Health Directors Association, and First Nations Health Council in BC in October 2013. Find the graphics he created based on that dialogue here.

Upstream is a Saskatchewan-based organization devoted to using the Social Determinants of Health to leverage social change. According to Upstream: “Upstream interventions start at home. When everyone has access to adequate housing, nutritious food, and support for early childhood development, we are thinking and acting upstream.”

Measuring the Social Determinants of Health

As for using the Social Determinants of Health for measurement, the Action: SDH site notes that “Effective action on social determinants requires monitoring and measurement to inform policy-making, evaluate implementation, and build accountability. Inequities in health outcomes, social determinants, and the impact of policies must be monitored. Key requirements are collecting and monitoring indicators of social determinants from different sectors, linking with health outcomes, and monitoring inequities; establishing whole-of-society targets towards the reduction of health inequities; and disaggregating data to better understand baseline levels and potential impacts of policies.

Indicators selected for monitoring policies aimed at reducing health inequities need to be clearly understood by policy-makers across the different sectors that influence the social determinants as well as by communities. Thus simpler measures may be more transparent and easier to interpret than complex summary measures.”