Archives - Profiles





(photo by Rishia's son Alex)

May 2004: Profile of Rishia Burke, community researcher and evaluator, Burlington, Ontario, Canada

current work focus
I do a variety of contract work - mainly evaluation and community-based research - the majority with CHCs [Community Health Centres]. I also taught health promotion at Brock University in the fall.

definition of "best practices"
My definition of best practices has probably become more basic and practical over time - "making the best decisions you can with the best evidence available to you, and constantly making improvements to that."

involvement with best practices approaches
At AOHC [Association of Ontario Health Centres] we developed a best practices approach for interdisciplinary teams - to bring all staff together, to work as a team to develop best practice for anything from diabetes to food security. While at AOHC, Susan Arai and I also wrote a paper called "Unpacking the Evidence in Health Promotion" which considered the variety of sources of evidence in health promotion.

I was a member of the Best Practices Work Group at the Centre for Health Promotion [University of Toronto]. The IDM informed the best practices work we did at the AOHC, particularly the principles piece.

In my volunteer work I try to be that quiet voice, to raise people's awareness about why they make decisions, about best practices, and about evaluation.

Susan and I also completed a project on mapping the effectiveness of the CHC model of care. More recently we have been working on a framework for health promotion outcomes that assists with the development of process and outcome objectives. People often jump straight to outcomes but so much of health promotion is about process. Is capacity building an outcome or a process? It can be both. The framework lays out a process for people to talk this through.

impact of a best practices approach on work
I don't necessarily use the term best practices in my current work but it's embedded in the process of research and evaluation as well as developing information used for decision-making, it informs everything I do. For example I am currently developing an environmental scan and making sure I collect information from a variety of sources - focus groups, on-line survey, questionnaires, statistics, and information from relevant literature. Ensuring that I am respectful of health promotion principles, developing sound methodology to collect information and providing information in a format that people can use are all important.

comments on using a best practices approach
You have to be constantly aware of the realities on the front line - there isn't extra money for evaluation, it's an add on for many organisations. Staff are usually aware of the importance of a best practices approach but they just don't always have the time to dedicate to it. Making small steps is ok, getting people to say "let's do an evaluation" or "how can we make the best decision."

life outside of work and best practices
I have a 2 year old and 4 year old. Being a Mom is like being a full time health promoter on its own! I love spending time with my guys. I like sports and have started running again. We inherited a great garden in our new house, I enjoy guessing which flowers are coming up, and I am getting ready to plant tomatoes. My husband and I work with grade 7 and 8 kids at the kids' club at our church. That's lots of fun and keeps you on your toes!

This profile is based on an interview with website co-editor Barbara Kahan.

Click here to read a reflection by Rishia Burke.


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June 2004: Profile of Irv Rootman, researcher, Vancouver, BC, Canada

current work focus
I am very excited about a community research training program I am involved in, with Jim Frankish and Allan Best. I am co-convening the "vulnerable populations" cluster, which consists of about 15 academics, graduate students, and practitioners, sometimes called "community learners." The topics are literacy in health, youth at risk, and food security. It is very interactive. It gives me a chance to work with practitioners and graduate students, to pass on what I've learned over the years about working with communities and research.

I am also working a lot in the area of literacy and health, with people in BC and across the country. I am principal investigator for a national research program on literacy and health, and am doing something similar in BC but in more depth.

Other projects include developing new measures of health literacy, the impact of technology on health information use, an evaluation of the BC HealthGuide program, and the impact of the physical environment in schools on health.

I'm very busy - it's been great.

definition of "best practices"
I usually refer to the IDM definition if I'm asked to define best practices - I think that's a well thought out definition, it captures what we have to be looking at regarding best practices, especially for health promotion.

involvement with best practices approaches
I was involved in the IDM best practices project at the beginning. [note: Irv, when he was Director of the Centre for Health Promotion, University of Toronto, provided the support needed to get the Best Practices Project going and thriving.] Later I wasn't as involved as I would have liked to be, but I followed its development with interest and promote it any opportunity I have.

I was also involved in a project for Cancer Care Ontario which looked at the issue of best practices in terms of community nutrition. We used a more traditional approach than the IDM; basically, we looked at the literature to try and assess what research had been done and the quality of the research, and made conclusions based on the research. This was used by Cancer Care Ontario to develop a provincial program in cancer prevention.

impact of a best practices approach on work
I always think about the values that underlie any work I'm doing. The [IDM] Model is in there somewhere, it comes out in what I'm doing - but I don't formally apply the Model. And, of course, I try to apply best practices in research. However, I am not involved too much in policy or practice, where best practices can be most useful.

comments on using a best practices approach
It's important to use that kind of approach particularly in program and policy development - it is important in terms of giving work credibility and in maximizing the effectiveness of what you're doing. There is no point in repeating mistakes of the past. A best practices approach is one way to build on knowledge of the past and continuously improve what we're doing.

life outside of work and best practices
I am enjoying living in Vancouver, although I miss people in Toronto. Now that summer is here I'm enjoying getting out and cycling, we live near Granville Island where there is a bicycle path that goes by False Creek and Stanley Park. That's about all I've got time for outside of work. Work is pretty demanding and time consuming.

This profile is based on an interview with website co-editor Barbara Kahan.



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July 2004: Profile of Joy Emmanuel, consultant, researcher & writer, Grand Pré, Nova Scotia, Canada

current work focus
I have been working on different research contracts, for example an anti-racism project, and an evaluation of a program for children with special needs. I also teach sociology courses at Saint Mary's University in Halifax - Introductory Sociology, Research Methods, Critical Issues.

I am most engaged right now with transformational work - which in another way is best practices - where I am combining writing and research to look at how people are using the raw materials of life and transforming them. I am very excited about this - it's a new horizon, a new way of meeting people and learning. Everybody has a story and everybody has wisdom. It is exciting to see people, individually and collectively, manifesting tools for building a more loving, just world. I look forward to tapping that energy of transformation. I get inspired when I talk to people about what's going on in their lives. Stories have included a woman who does solidarity work with people in Guatemala, an 18 year old who sailed around the world on a ship, and, on a collective level, an organization called Peace Makers which does alternative dispute resolution - mediation work, new ways of facilitating and working with groups, personal development in dealing with conflict.

definition of "best practices"
For me, best practices comes down to taking a holistic approach. One part requires drawing on a wide array of perspectives and materials to think through various angles of an issue. Another part is drawing on the best information available, whether this is existing research, expertise, or first hand knowledge. A third component is looking at the project or problem in a larger context, not in isolation - looking at how it is located in terms of sociological issues, resource issues, finances, emotions, different players, etc. Another component is using critical questions - questions that help us move beyond surface appearances, such as questions around values and assumptions, thinking about what's missing, where is this information coming from, what are the consequences - questions that can help us look at the complexity.

involvement with best practices approaches
I helped develop the
Nova Scotia Framework for best practices. For this we drew on the IDM model as one of the models of best practices out there.

impact of a best practices approach on work
It was a very satisfying opportunity to work on developing that holistic approach. Many times when we work on a project we're working on a small piece, we don't have the opportunity to look at it from beginning to end, to look at the larger context. Having the opportunity to work through the Nova Scotia Framework has been beneficial in bringing more - a new or larger perspective - to the other work I do.

comments on using a best practices approach
Best practices frameworks are really tools for transformation. For myself it was a wonderful opportunity to take up those tools, to look at what is possible when you have a framework that guides you through a holistic, larger approach when working on a project.

Being holistic and larger is also a draw back. Often in the way that funding happens - time, resources, etc. - we just don't have the right positioning and all the resources available to do it. Living in the reality of our day to day work, we are more likely to do piece meal work.

But in those situations, having a framework at least gives you a larger context in which to think about the issue and the steps one is working on. Just having a framework is beneficial even if we can't use it to its fullest extent. Even if we only use it for one part of the work, it still helps us go deeper and take a broader perspective on that part of the work.

life outside of work and best practices
I am soon going on a trip to Europe with my daughter who is graduating from high school, then I am moving to the west coast where my son lives. My daughter will also re-locate to the West Coast. I am looking forward to the change, to the next step in our lives. I am looking at the coming year as a sabbatical year, a time to do something different.

This profile is based on an interview with website co-editor Barbara Kahan.


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August 2004 Profile of David Rosenbluth

David Rosenbluth is Director of Research and Evaluation, Department of Community Resources and Employment, Regina, Saskatchewan, Canada.

current work focus and relationship to health
Because the Department covers so many areas I have a range of research and social policy topics I can work on, which I like. The areas we deal with are all determinants of health. We deal with income inequality, with poverty - that's a big determinant - with housing, early childhood, family stability. We don't deal with health in the sense of primary care but all these things go into what makes people healthy.

One project we want to do is a study of families involved in child protection and child welfare and how they view their situation. Everything we know about the families comes from workers, their assessments and their biases too. We've never talked to families themselves, to ask "what do you think got you here," "what do you think is necessary to get you out of the system." More and more we realize the answers are going to be quite different than the perceptions we get as seen through the eyes of workers. That's one project that excites me.

The other thing I'm interested in is the number of new programs we're putting in place that have evaluation built in early - there's now a realization among program directors that the evaluation starts before you implement the program. This will make the work more interesting; you're not doing after-the-fact evaluations, you have the chance to develop real measures of change. It's doing things the right way.

definition of "best practices"
Best practices are those things that have an empirical base that link them to outcomes of interest, and that also have a values base consonant with the delivery structure that you're working in.

involvement with best practices approaches
My involvement started when I was looking at what was helpful in moving people off welfare and the Department started experimenting with educational upgrading programs, training, employment support or job creation. Government posed the question: "Was one better than the other?" That's where I started looking at the literature for how you determine which results are most credible, and understanding the context in which different programs have been implemented and therefore how applicable the results would be to Saskatchewan. And then I carried on that type of analysis to other areas of social policy.

One of the things I've done for several years is a workshop on measuring results for the Canadian Evaluation Society. To me that workshop is about how you assess evidence, how you separate out the good and the bad, the credible and the not credible, the useful and the not useful.

impact of a best practices approach on work
I don't think that the way I go about my work has changed because of best practices. In the social services, people now often use terms like "what works" or "evidence-based decision-making" which are pretty similar to a best practices approach. In recent years, because of these ideas, the organizational environment has changed to be more receptive to the type of research and evaluation I do. A lot of the emphasis on performance measures and outcomes and developing an evidence base for policy is a reflection of a changing organizational climate that is related to best practices. Relatively speaking these are good times to be a researcher or evaluator compared to 10 years or so ago. There's a receptiveness of the organization to having information that's based on transparent replicable methods and that's what research is all about.

life outside of work and best practices
I enjoy doing things outdoors, bicycling and running and camping. I'm teaching myself photography - I'm having fun doing that.

This profile is based on an interview with website co-editor Barbara Kahan.


Click here to read a reflection by David.


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September 2004 Profile of Anne Lessio

Anne Lessio is Manager of the Heart Health Resource Centre, Ontario Public Health Association, Toronto, Canada.

current work focus
At Ontario's Heart Health Resource Centre (HHRC), we provide a comprehensive mix of activities to meet our mandate of increasing the capacity of the community partnerships involved in the Ontario Heart Health Program: Taking Action for Healthy Living. To do this, we offer a number of different services including training, consultation and coaching, educational material development, list serves and peer-to-peer networking.

definition of "best practices"
My conceptualization of best practices incorporates the contextual nature of community-based interventions along with a notion of using information currently available rather than waiting for the "best" information available. Last year while on secondment with Health Canada and working on the National Best Practices Consortium, I came across the following definition of best practices and have adopted it: "Best available practice or policy based on available evidence for a specific group under specific circumstances to achieve an identified aim".

involvement with best practices approaches
In my role at the HHRC, I have commissioned two international scans of best practices in chronic disease prevention by the Health Behaviour Research Group (HBRG) of the University of Waterloo. These have been very exciting projects and as part of the Advisory Committee I have been involved in refining the assessment criteria and then reviewed some of the practices identified by the HBRG's Best Practices Team through a massive literature review and international key informant scan. The criteria identified not only the practices showing scientific evidence but also those that had the potential of showing positive outcomes. I am now seeking funding to support the HHRC's dissemination of these best practices to practitioners involved in community-based chronic disease prevention programming.

Also within the Centre, we have reviewed all of our processes, e.g. training, product development etc., and have incorporated a best practice approach into our revised processes.

comments on best practices
We are all very busy people and none of us have the time or luxury to "reinvent the wheel." A best practice approach allows us to build on the knowledge we already have in the field and improve upon it. This approach has now become a standard way of work within the HHRC as it is embedded in our new work processes.

Equally important with taking a best practice approach in developing a project is sharing our learnings - that is, creating a feedback loop to the field to support continuous learning. I can't say that I do this routinely, but, I am making a more conscious effort to share our experiences from the HHRC with others and to support the community's opportunities for sharing and learning.

Taking a best practice approach in health promotion and chronic disease prevention is important as it increases our probability of using limited resources - human, financial, and material - in the most efficient and effective manner. It also increases the credibility of our field when we can show how we use the best available knowledge and build on it.

life outside of work and best practices
I thoroughly enjoy the outdoors and canoe and camp regularly. I also find quilting a relaxing activity and made my first quilt totally by hand. Needless to say it is not on anyone's lap, it is on display.


Click here to read a reflection by Anne. In addition, Report on the Proceedings from Best Practices At Home and Abroad: making health promotion decisions for the best results contains a presentation by Anne Lessio on best practices.



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October 2004 Profile of Jan Ritchie

Jan Ritchie is Associate Professor, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.

current work focus
My main interests are working with people and helping them to learn, and linking community input through participation with less advantaged people. My publications seem scattered because I am interested in the method of Participatory Action Research (PAR) rather than any particular population - the populations I have worked with range from intravenous drug users to steel workers. It is the process I am interested in - how do you energize people so they feel empowered and move off and do things for themselves? My interest in culture and values has developed through my involvement with PAR.

The projects I am most excited about are those involving PAR. Two of my eight Ph.D. students are working on PAR projects. The first project is with people who have diabetes; all have now made marked improvement in self-management. The second student's project is to evaluate a national peer education program for older people to enhance the quality use of medicine. This is empowerment education, working out how to do it and what they need. This research is the furthest from RCTs that you can get.

I've worked in China and Vietnam as well as the South Pacific, which is my current focus. My desire to work in the South Pacific was strengthened when I was asked to work with the WHO office based in the Philippines to make regional guidelines following the Healthy Cities model. This enhanced my understanding of the challenges and obstacles in working with Pacific people and the importance of offering them culturally appropriate resources. Giving them Canadian or American textbooks doesn't make sense - they are polite but they put them back down and never look at them again.

At the university I have been responsible for the health promotion class for 17 years. When I first arrived there was no teaching of qualitative research in the Masters of Public Health program, so I started a new course teaching that in 1996. Recently I have been holding advanced qualitative reserch seminars for the increasing number of our research students using those emthods in their studies. In addition I have written a chapter on qualitative research for a textbook, Health Research, edited by Catherine Berglund.

definition of "best practices"
Best practices is implementing practice in the way that is best under the circumstances, recognizing that health promotion is contextually bound and always will be. It is conditional on the context.

involvement with best practices approaches
Having been convinced of the worth of the [Interactive Domain] Model, I added it to my resources and took it to the Pacific islands. I had been working with Pacific peoples in upgrading their health promotion skills for the past decade and had workshopped different aspects of these skills innumerable times over this period. Immediately that I started discussing the Model with these Pacific peoples, I realised that if I were going to convince them of its merit, I had to take into account their traditional ways of teaching and learning, while being actively aware of their lower level of educational qualifications and their limited access to appropriate resources.

Thus the IDM has infiltrated our Pacific work, but it is not used as set out for Canadian or other resource-rich countries. Instead of a series of boxes and checks, we use story or narrative to draw attention to those issues we want covered. We make certain we include understanding of the environment; we always consider values and meanings in the underpinnings. I know it has enhanced our Pacific work.

I use stories in different ways. I will use a bit of story when I introduce different concepts, for example I will tell a story about a sea voyage before talking about the Ottawa Charter [for Health Promotion]. If I am wanting to learn about something I ask them to tell me their version, I phrase my question in such a way to allow them to give me their answer in a story format. They then might tell me, for example, about their uncle - the story is concrete, about a real body.

Talking about things like "creating supportive environments" is so up in the air. Rather, I might talk about getting the village on-side, and choosing a night to meet when there's a full moon. The full moon is the spiritual piece, getting the village on-side is the social piece, the meeting place is the physical.

comments on best practices
What bothers me about the evidence-based best practices approaches, where you use expert knowledge to say what defines an issue, is that the individual situation gets left out. It is not just a simple matter of finding out a patient has kidney disease and then telling them what treatment they have to follow. Some things might not be possible for them to do because of their situation. The person's particulars must be in there.

life outside of work and best practices
I like to do bush walking, bird watching, and sailing with my family.


This profile is based on an interview with website co-editor Barbara Kahan and in part on a handout written by Jan Ritchie.


Click here to read a reflection by Jan.


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November 2004 Profile of Delora Parisian

Delora Parisian is Executive Director, Aboriginal Family Services, Regina, Canada.

current work focus
Aboriginal Family Services is a community-based organization whose mandate is to provide family and child centred services to the Aboriginal community. The different components of the agency include the Family Support Program, Foster Care, Come and Learn Head Start pre-school program, and a home visiting program which is part of a larger initiative, KidsFirst Regina.

In addition, we have been training and certifying Life Skill Coaches from across Saskatchewan. Life skills is a best practices model for facilitating healing in individuals and their families and communities. It is a holistic approach. At the recent graduation of the last class - funding, sadly, has ended - graduating participants spoke about the impact the life skills program had on them. It was amazing to hear their stories; they are very powerful. Taking part in the life skills classes was a life changing experience for all of the participants. This approach also guides our agency's hiring practices to those we help. It plays an important role in maintaining relationships and our ability to make a difference in our community.

Foster care is our newest initiative - we are recruiting, training and supporting foster parents. This is a challenge - we are "breaking trail" as they say in our culture, entering new territory. We are not saying that we know better than the government, but that it is a matter of cultural relevance. There are 800 kids in care in Regina, and 80 to 90 percent of these are Aboriginal. It took us five years to get this program in place, but we didn't give up on our dream and vision. We kept meeting with Social Services, sending them letters, putting in proposals. We could have taken the approach that the system has failed us and demanded that the government do something about it, but we didn't. Instead, we negotiated and indicated that we could work together, let us have a chance to try out our approach; this way we can have a win-win situation.

Believe it or not I'm still excited about all our programs. I feel we haven't finished growing yet - we have come a long way and have a long way still to go. This year we want to do more capacity building, for all our programs.


definition of "best practices"
Best practices to me are something that can facilitate positive change and bring about growth, not just growth in numbers, but in individuals -the individuals that work in the organization and the people they're working with.


involvement with best practices approaches
I've worked in community development for 30 years, except for 8 years with what was then the community college in Regina. I've worked with political and non-political Aboriginal organizations where I learned a lot about best practices. I saw what worked and what didn't, and thought someday I would be able to put to use what I was learning.

I started out as a secretary and through training on the job and additional education I eventually got into management. I had a hard time with that because I wanted to be a front line worker, I didn't want to lose touch with the people. But I saw a need in the management area and believed I could make a difference there. I felt that by incorporating best practices, changes could be made and organizations could thrive and individuals could grow. I am blessed to be in a place like Aboriginal Family Services where I can use those best practices.


impact of best practices on work
In almost every situation I think about the holistic piece before making a decision - for example, in a human resources issue, what is best not only for the person but for the job and the team. One single part of our agency affects every other part; even though we have different components we can't compartmentalize. Aboriginal Family Services is this vital, growing, dynamic organization, and all those parts make up the whole. We have to consider what is the best in any situation.

We have developed a lot of policies about how to relate to each other, for example we have a conflict of interest policy and an Aboriginal code of ethics. At every staff meeting there is a Sharing Circle and each staff member's opinions/concerns are encouraged.

Other examples of best practices we follow include being culturally relevant, working as a team, and hiring people who are well on the way in their own healing journey. This is especially important to us as Aboriginal people. We come out of a history of the residential school syndrome, alcohol and drugs, and the sweep in the 1960s when they put many of our kids in foster homes. This is not a very positive history, which resulted in feelings of helplessness and powerlessness; we became our own worst enemies because of that history of oppression. We are only now beginning to identify and realize that because of this we did turn on ourselves, and as we are learning about "lateral violence" we can deal with it. In order to help another person you have to be moving along in your own healing journey, otherwise you cannot be an effective facilitator for someone else. Not paying attention to the lateral violence weakens an organization.

We talk about self care to prevent burnout for front line workers but more than that is needed. Another of my best practices is to have an open door policy for staff so I can be available to them in more than once a month meetings. Staff can come into my office any time. As a result none of our workers have had any major leaves of absence due to stress.

At times, staff wonder whether they are making a difference in the lives of people who continually return to the same negative lifestyle. I say to them, as long as someone is breathing there's hope. Who are we to give up on them? Even if you don't see change, just being there may make all the difference somewhere down the road.

Best practices give you confidence, individually and as an agency. You can see growth, positive change; one of the best indicators is when others are approaching us for partnerships. As I gain my confidence I see staff gaining their confidence. There is a ripple effect.


life outside of work and best practices
We are raising our family with strong Christian values. I have been married for 25 years this year, and as any married person knows, this is quite an accomplishment. We have four children and both of us come from large families, which remain a vital part of our life. We also are lay ministers, my husband and I co-pastor a church. We have been doing that for about 15 years now. I try to keep a balance between that and work and my family. We have two grandkids and two step-grandkids.

I love to travel - I haven't been overseas but have travelled on pleasure and ministering trips in northern Saskatchewan, the rest of Canada, the U.S.

I read everything and I study on various subjects. I'm intending to write a book - I've written children's stories and legends of our people. I even wrote some songs, which my daughter put to music and recorded on a c.d.


This profile is based on an interview with website co-editor Barbara Kahan.


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December 2004 Profile of Lisa Brownstone

Lisa Brownstone has her own consulting business, Brownstone Consulting, in Regina, Canada.

current work focus
I am currently completing a feasibility study, looking at housing for people with FASD (Fetal Alcohol Spectrum Disorder) who are experiencing homelessness. This is funded with a National Homelessness Initiative grant. A partnership of three organizations applied for the funding: Saskatchewan Fetal Alcohol Support Network, a parent driven organization; Regina FASD Community Network which is a combination of community organizations, government, parents; and the Regina Community Clinic, a member driven community health centre.


definition of "best practices"
My best practices definition includes developing programs, developing community, evaluating, research that's done from the bottom up, using available knowledge to build the best models possible.


involvement with best practices approaches
Best practices has always been and always will be an essential part of my work. It is critical to me to look at the community in question, look at other communities, use whatever's out there to build the most appropriate service or research or evaluation for that community or agency or person. One example is the battered women's shelter I started in the mid 1970s where we looked around and saw what the community needed, looked across Canada to see other models - we looked at models in Ontario, Saskatoon and Calgary - then put together an informal group of people representing both funders and CBOs [community based organizations] as well as a number of women who had experienced battering, and developed the delivery model from that. From day one of operation we collected information regarding the women and children that could then be taken and used to build a better understanding of both battered women and their child and whether we were delivering the kind of services they needed.

Another example is the community committee I sit on that advises how funding is to be used for people with disabilities. This committee gives the community input into how money is spent. Having community input is part of best practices.

My third example is the FASD homelessness project. I've had a series of interviews with young adults with FASD and their parents. They've talked about their lives, the barriers that they've run across, and the kinds of supports they think they need to live independently with some quality of life. This information will be a central part of building those supports into the community. I'm also interviewing community organizations and government in terms of what's currently there and what could be available in terms of funding. With this information we can go about building a continuum of care for people with FASD in Regina.

Ninety percent of the people I've interviewed have experienced absolute homelessness - without adequate safe affordable shelter, you can't get anywhere in terms of developing a life that is stable and has much quality. And so the work I'm doing is pretty critical from a best practices standpoint - the willingness of people with FASD and their families to share their life experiences is informing all that comes after in terms of what I'll be recommending in terms of housing and supports that need to be in place.

I'm also interviewing those across Canada who are currently offering housing and supports to people with FASD to find out about the kinds of programs they've set up, the programs' strengths and weaknesses, and what they'd change if they had a chance. In addition I'm reviewing reports and evaluations of those programs. Again, it's using that approach of figuring out what are the best practices in existing services combined with three things - what people with FASD say they need, how local organizations might change their practice to better meet people's needs, and how governments can change funding processes to better meet people's needs.

I have used this same approach as described in these examples to whatever kind of work I've done, whether one on one counselling, as an occupational therapist, or within community development, program development and evaluation and research. I've always believed in learning from other peoples' experiences and using that experience to inform my practice. That has meant I've been able to build networks, that I can call upon people who can also call upon me - and the focus is always on people's needs or organizational needs.

In terms of IDM best practices, I was involved both formally and informally in the initial development - I participated in lots of discussions, I was one of the reviewers for the IDM Evidence Framework.


comments about using a best practices approach
It could be that there's a wonderful practice happening in Vancouver, say, but it might not fit Regina's environment. Just because something is a best practice elsewhere doesn't mean it's a best practice here. You have to assess each situation and how the fit is locally and individually. And, as well, you have to use a combination of qualitative and quantitative methods when looking at anything, not just one or the other. The richness of detail you can get from qualitative methods regarding best practices is really important.

The time that it takes to figure out and implement best practices seems longer, but if you spend time up front putting together best practices you're not going to have to undo - you're always going to have to improve, but you save time by not undoing. And just because something is a best practice now doesn't mean it will be six months down the road. To have continuous quality improvement you have to keep questioning and looking at things - there's never a real best, everything changes.


life outside of work and best practices
My main interests outside of work and best practices are family and friends, travel, getting to know my province more and more - drives out to the Saskatchewan countryside and finding the beautiful hidden places - reading group and music.


This profile is based on an interview with website co-editor Barbara Kahan.



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January 2005 Profile of Dilys Haughton

Dilys Haughton is Executive Coach of Long Term Care at Shalom Village Nursing Home, Hamilton, Canada.

current work focus
I'm responsible for the care provided to the residents of the nursing home. My title of "Executive Coach" rather than the more typical "Director of Nursing" reflects Shalom Village's leadership/coaching philosophy. The two initiatives I am working on at Shalom Village are two of the reasons I decided to work there - developing staff to be leaders, and implementing resident centred care.


putting values into practice
In my experience "patient/resident centred care" is a catch-all kind of phrase; it is often used but truly quite difficult to do. At Shalom Village we are trying hard to be resident focused and are achieving it. We use a lot of dialogue in our work - we talk to the residents, their families, and each other. We not only give traditional change of shift reports on how the residents are doing, we update each other about the details of their past lives and families and talk about what's important in their routine. This kind of process takes time - we talk a lot and have many impromptu meetings, we often gather people together for short meetings, 10 to 15 minutes, to talk about issues that arise.

Our discussions are not always about clinical issues. Sometimes we come up against conflicts between a family member or a resident and staff - in those situations we always come back to what we're here for, which is to make Shalom "home" and a happy place for the residents. That makes decisions clear, usually the resident is right - residents then get what they need and it is not a power struggle anymore. For example, if a resident wants to take their own medication but is not doing it wisely - it's important that they have control and feel good about themselves in their situation. We have to get away from a maternalistic attitude - residents have the right to decide about their own lives. Another example - a resident who has dementia goes out on his own and sometimes gets lost and is brought back by the members of the community. Most nursing homes would lock the doors and not let him out. But we try to balance life and risk. It is more important for him to be autonomous and happy and feel he has some control over his life. A third example - sometimes people are on particular diets such as needing pureed food because they can't chew very well. But sometimes they just want what everyone else is getting. That's a risk, and we weigh that risk, but if for that moment it makes them feel good to have that egg salad sandwich or that chocolate éclair or to have dessert first…that's what we mean by our mission statement "helping people get on with their lives."

An organization's mission and vision are often paper exercises, plaques on the wall - the challenge is to translate that into everyday practice and into language that people use. At Shalom Village our vision statement loosely stated is "helping people get on with their lives." Everyone can understand that - everyone, whether they have dementia or other problems, has a life to get on with. As staff we have the attitude that we work in the residents' home as opposed to the residents living in our workplace. We try to think of the resident not as a patient but as someone whose home we are privileged to be in and someone who we are privileged to support in any way we can. It's very cool.

To do this we have to be incredibly flexible - what's truly important is not that the place be shipshape but that people are happy. Things could be tidier or we could be better organized, but if you put people first those things are secondary. Maintaining priorities and seeing the residents not as people with conditions but as people you care for - that is a best practices approach.

We try to be very inclusive with the staff so that everyone's involved in working on an initiative. For example, in developing the meaning of the "ATHOME©" model, we had focus groups which included everyone from the people who clean the floors to the management team. It's really a special place.

In terms of putting the leadership philosophy into practice, I'm on the nursing units coaching and mentoring and showing rather than sending out memos, it's all about working together as a team.


definition of "best practices"
I define best practices as the best that you can do at the moment, based on the reading that you've done and the evidence that you're able to accumulate. And when there is no evidence, you use your own experience and wisdom from your colleagues to shape your practice. The evidence you use comes from a variety of sources and not always from your own field - for example, if there is a body of literature around nursing leadership and another set of literature about leadership in general, you pick your information from both. You need to look in a variety of places.

Experience plays a fairly important role as well - as you try a number of different approaches you learn what works well in a situation. We often underplay the importance of that aspect. People who are on the leading edge of things are often creating the literature - they use their knowledge and experience and what they learn from other people. For example for the "at home" model at Shalom Village there isn't literature or examples out there -we've had to create the model.

When working at the Willett Hospital [in Paris, Ontario] as part of the IDM best practices pilot testing project I realized how important values-based practice was, it is a part of best practices. During the pilot project that was almost the most important piece of our work - it was the foundation for all the work that we did after that. What are the values that you hold and how do you implement those values - that's the up front piece. You might come across a particular piece of evidence that worked in a particular situation but if your values aren't the same, it doesn't help does it.


involvement with the best practices
Being part of the original IDM pilot project was phenomenal, we learned so much about health promotion. There were a couple of significant impacts of the project. For me personally, I came to understand the value of values-based practice and how important it was for me to find a workplace that is consistent with my personal values and beliefs. Shalom Village lives and breathes its values and beliefs and is a good fit for me.

Second, our IDM work kickstarted the new portfolio of Community Integration, created for the integration of the Willett Hospital with Brant County Hospital. The Willett's work in health promotion was part of the reason this portfolio was created. What the portfolio would look like was completely open, so our work on the IDM Framework shaped it. The new portfolio was based on the Framework's underpinnings that we developed and resulted in business being done in a new way in a hospital setting. It helped us identify how the hospital could work with the community as a partner and how we could work as a system to address health issues. Health promotion became a part of the hospital's core business - that was a big deal for a hospital, hospitals are into surgery and managing waiting lists. "What do you mean doing health promotion, I don't think so."- "Yes, we are!"


comments for others
It was difficult for us in the hospital to find a place on the agenda for what we wanted to do with our new portfolio because of the demands of acute care services, but we persevered because we had done the up front work and knew our goals and values, so we just kept plugging away and building on our successes. Take the plunge, focus on the positives, keep moving forward - health promotion is important and valuable.

One of the key things that is important in every setting is having the vision of a leader. For example the CEO at Shalom Village lives and breathes the philosophy. She tries to bring people together that are like minded. Assembling the team is really important.


main interests outside of work and best practices
I love going to the cottage, I enjoy reading, and I enjoy needlework.


This profile is based on an interview with website editor Barbara Kahan.


note: Report on the Proceedings from Best Practices At Home and Abroad: making health promotion decisions for the best results contains a presentation by Dilys Haughton on her experiences using the IDM approach to best practices.



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February 2005 Profile of Debbie Bang

Debbie Bang is Manager of the Consumer Health Information Service and of Womankind Addiction Service, St. Joseph's Healthcare, Hamilton, Canada.

current work focus
The focus of the Consumer Health Information Service is to help hospital clients, community members, staff, students and others gain access to health information. Since 1992 we've been showing people how to access health information. However people are becoming increasingly comfortable with the internet - the numbers of people on our website have increased and the number of people calling or coming in-person for health information has decreased. Because of this I would like to go back to our roots, look at our vision and mission, and think about what the future holds for us. We will use the IDM as the backbone - a structure - as we sit down and figure out our next direction.

Womankind Addiction Service has been developed to support women with addictions along the road to recovery. They enter into our service as part of their journey from any point in their journey: initial engagement through to stability, aftercare and/or back as a volunteer. We have a chance to help women make a difference in their lives. We are modeling best practices by putting the whole range of services women need all in one place and expecting to see them over a long range of time. This brings about a level of comfort for women that will make a difference in their journey.

We have a drop in program which includes a clothing exchange, showers, a washer and dryer. Some of the women live at Womankind to attend withdrawal management or treatment. We also have a day treatment program for women who have stable housing. The space is shared with a unique program for women with addictions and their children under the age of 6. There is a therapeutic day care programming for children and treatment for the women. The aftercare program is in place to support women when they go out into the community and try to utilize their new skills. One of our goals for the future is to ensure that women can attend treatment with their young children.

It's been quite a process getting it up and running, managing the operations and capital side - what I've learned in that process! I can change core locks and I know all about boilers now. Not sure when I will use the skills again but it is new learning that I'll always have - I'm very grateful to St. Joseph's for letting me lead the project. I didn't do it by myself but was part of a fabulous team.

A very exciting piece is that we have a wonderful database that will allow us to track the women's progress throughout their involvement in any of the services and give knowledge back to the field. The whole service is based on a best practices approach - but remains shifting sand and we are prepared to make changes based on what we are seeing, reading, hearing, learning.


definition of "best practices"
The IDM definition of best practices works well for me. Looking at and emerging from a values base works well for me. We need to value the desire for ongoing improvement so that things are not static. The other part of that is that we're attempting to do what is best for the people we're trying to serve based on a whole variety of knowledge. Knowledge is multi-layered - there is intrinsic or internal knowledge which includes our experiences, there is external knowledge which includes evaluation. In addition we need to be aware of the environment - I can read something (new knowledge) but when I talk to our clients and really listen to what they say, I often know the new knowledge before I read it. That receptivity, that open door, that need to look at what's working and what's not and a need to do it better, that's what helps us achieve a quality approach...and it is so much a part of best practices.


involvement with the best practices
Having learned alongside other members of the Best Practices Work Group [Centre for Health Promotion, University of Toronto] as we defined best practices and all the struggles we went through is one of my big advantages; we pioneered [the IDM], I'm really glad to have been a part of that. There was also the opportunity to present [at a consultation process] in Nova Scotia - you have to understand it in order to teach it. I have played with it, I have practised it. In our current situation I didn't teach my team the IDM but I used it to frame how we went about planning and incorporating best practices into our work - we used the IDM and its Framework to develop an end product, a new addiction program and service for women based on current best practices.


impact of best practices approach on work
Best practices is intrinsic in my approach - I would never think of beginning a process of planning anything without first rooting myself and others in current reality and the values base from which we're developing it. I expect to work in that way, to use best practices in my work with others. I don't make others go through the whole IDM process but I facilitate the approach in my questions in order to ground people in best practices, that's the expertise I can contribute to the group.

The hospital is going through a strategic planning process corporate wide - defining values, what are we here for, who are we here for, what do we want to do. We're in a position to look at the work we do in relation to values and where to place ourselves strategically with the external world - for example who else is doing the same work and can they do a better job than we can. This may mean people and services go but at least this way is respectful, we keep the client in the centre, and hopefully reabsorb people who are displaced - many skills are transferable.


comments for others
Practices, changes, directions that are most successful come from premises pervasive in the IDM - values, theories, understanding our environments such as the corporate culture, what are people's practices, what works, what doesn't. Our best outcomes emerge when we use the IDM at least as the backbone of what it is we're doing - the IDM is a way of being, of thinking, of starting things. If that's the corporate culture people catch on to it, it becomes part of the way of doing things.


main interests outside of work and best practices
A major interest of mine is long distance swimming. I'm a ravenous reader - that desire to learn again - and I'm part of a book club. Then there's my parenting role and trying to do the best I can and help my boys become who they are meant to be - one of the greatest lessons I really learned is transferring the knowledge I learned from the oldest child down to the youngest, they're not the same but at least I don't get burned so much! An outlet for me is training with our dog Jema and new puppy to arrive in February 2005. I also love to scuba dive.


This profile is based on an interview with website editor Barbara Kahan.


note: Report on the Proceedings from Best Practices At Home and Abroad: making health promotion decisions for the best results contains a presentation by Debbie Bang on her experiences using the IDM approach to best practices. Click here to read a reflection by Debbie Bang.


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March 2005 Profile of Lynn Greaves

Lynn Greaves is a health promotion coordinator with Population and Public Health Services, Regina Qu'Appelle Health Region, and Chair of the Advocacy Committee for the Saskatchewan Coalition for Tobacco Reduction, in Canada. She is also author of the Coalition's report Best Practices in Tobacco Control: a Vision for Saskatchewan, a former Resource of the Month for this website.

definition of "best practices"
I define best practices as those strategies which have the greatest positive impact on a population.


current work focus
I spent over a decade working on tobacco control issues like cessation and smoking bylaws. It became apparent there weren't enough resources to address all aspects of tobacco control. With the help of Health Canada funding I did a literature review to find tobacco reduction strategies that work. The five top best practices indicated by the literature are: increased tobacco taxation, smoke free public places, smoke free workplaces, a ban on tobacco advertising and promotion, and counter-advertising including denormalization of tobacco industry activities.

In the last few years we have been promoting best practices in tobacco control to policy makers and the health community. These 'best practices' are also our goals for Saskatchewan. To achieve 'best practices' we are involved in advocacy work as well as educating the public and policy makers. It is also important to counter the misinformation campaigns that invariably come from the tobacco industry and "front groups" which knowingly or unknowingly carry the tobacco industry's agenda.

Currently I'm most excited about carrying the message of best practices to the health community and policy makers. I and the President of the Coalition will be speaking about 'best practices in tobacco control' at the National Conference on Tobacco or Health in Ottawa in June.


impact of best practices approach on work
My involvement with best practices has totally refocused my work. It has made it easier in many ways - I don't spend my time on ineffective strategies. When one knows where one is going one is more apt to get there. We have achieved several of the top five best practices in Saskatchewan since we began focusing on best practices - smoke free public places were put in place January 1 of this year, we have a high level of tobacco taxation, and we also have a retail display ban in place. We are waiting for the next survey report from Health Canada and are hopeful we will see a drop in smoking rates.


comments for others
It's important to always keep your goals in mind - best practices are the quickest way to get to your goals. In Saskatchewan 1,600 people lose their lives every year because of tobacco-related diseases - we can't afford not to use best practices.

Unfortunately using best practices is not always easily accepted by people - a lot of best practices requires advocacy and some people don't feel that comfortable with that. However education and pamphlets aren't going to get us to our goals.


main interests outside of work and best practices
Sleeping! And singing. And driving on the grid roads in Saskatchewan while playing Charlie Major, he has a song about "cruising the back roads."


This profile is based on an interview with website editor Barbara Kahan.


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April 2005 Profile of Hélène Gagné

Hélène Gagné is a senior planner in the Prevention Unit, Division of Preventive Oncology, Cancer Care Ontario (CCO) in Toronto, Canada.

current work focus
I support the work of the Provincial Cancer Prevention and Screening Council - made up of agencies, individuals and groups with an interest in cancer prevention and early detection- to meet the goals and targets in Cancer 2020, an action plan developed by CCO in partnership with CCS [Canadian Cancer Society]. The aim of this plan is to reduce the incidence of cancer by focusing on specific risk factors such as tobacco, physical activity and nutrition - those three contribute to 50 percent of preventable cancers - as well as other risk factors such as sun safety, environmental and occupational contaminants. Specific targets for 2020 include reductions of obesity, tobacco use and related risk factors leading to cancer. There are screening targets too. Early detection - cervical screening, breast screening and colorectal screening - can reduce mortality.

A related project is the development of a regional capacity building strategy, working with regional cancer prevention and screening networks to put the Cancer 2020 action plan into practice. What complicates matters is that there are so many stakeholders, so many organizations - some look at chronic disease prevention, some at cancer, others lung disease. We try to build partnerships so we can all work together towards our targets - especially as they relate to common risk factors such as tobacco, nutrition and physical activity. For instance, if we work on tobacco, this not only reduces cancer but also cardiovascular diseases.

The piece I am most excited about is developing a knowledge exchange system for our Division. When I was at OPC [Ontario Prevention Clearinghouse] I saw the benefits of such a system, which collected information from projects and then fed this back to stakeholders so everyone knew about each other's work. CCO is an advisory body to government on the cancer system. Part of this role involves knowledge production, management and dissemination - now our Division wants to go one step further and hear from stakeholders, to find out if the research findings are useful to their decision making process, to know what impact the research had on their practice, and to find out the stakeholders' needs for information to accomplish their work at the regional and/or provincial level.

When we talk about evidence with the IDM we make a point of saying there are different kinds of evidence. CCO focuses on the traditional medical/scientific approach to evidence - there is a large focus on making evidence based decisions, or at least making sure that the information we disseminate is evidence based according to traditional research protocols. It is interesting to put on the IDM hat to see how we can use an approach where we're all experts in our own fields and all levels of knowledge are used to shape current practice. When you live in both worlds, you see the invaluable contribution of research to the knowledge base as well as the front line knowledge developed by practitioners, and the importance of bridging the gap between the two to inform each other's work. At times, it is difficult to implement but always an interesting challenge to tackle.


definition of "best practices"
The IDM definition of best practices works for me. If I were to paraphrase the IDM definition, I would say that best practices is a set of comprehensive strategies and approaches that have shown the results that we originally anticipated, which also explores all the underlying assumptions of those strategies and approaches.


involvement with best practices
I was a member of the Best Practices Work group from the beginning - it started out with CQI [Continuous Quality Improvement]. Then while still at OPC I led the project along with the Francophone Work Group to see the applicability of the IDM in the Franco-Ontario context. We did a scan, focus groups, presentations and conferences, translated the IDM Manual into French, developed training modules and interactive software based on the IDM, and explored linkages with the Health Promotion 101 on-line course.


impact of best practices approach on work
Sometimes I wonder, do I use the IDM? Then I realize that I do, in the way I look at issues. Having worked to support the IDM and its Framework I now have a tendency in my work to look for what's behind things, what are the underlying assumptions, are we talking about the same things, do we have the same values.


main interests outside of work and best practices
Now that the spring is here, I'll start playing beach volleyball again and I am looking forward to it. I have also joined a dragon boat racing team at work and I am into my second year. I like to explore other forms of physical activity and I very much want to be more involved in Bikram yoga which is done in a hot room, based on the premise that if the room is really warm, it's going to be more therapeutic because muscles are less likely to get injured, the benefits go deeper into the body, it improves circulation, gets rid of toxins. It's really intense. I am not sure what will be the next thing but as a fair weather sport enthusiast, the sun needs to shine and the air needs to be warm…otherwise I am indoors and may consider getting into crossword puzzles!


This profile is based on an interview with website editor Barbara Kahan.


Click here to read a reflection by Hélène Gagné.

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May 2005 Profile of Nora Sellers

Nora Sellers is Administrative and Financial Assistant at the Centre for Health Promotion, University of Toronto (Canada).

current work focus
My duties are wide ranging and varied. As the only admin person in the CHP office I try to maintain an efficient office environment and infrastructure. I write and edit material for the Centre's website and serve as webmaster. I also coordinate production, edit and contribute to all Centre for Health Promotion promotional material, including the annual report, brochure and newsletters, and provide support for student practicum placements.

When I first started here one of my first assignments was to revamp the Centre's website and bring it up to date. I worked with a graphic designer and we produced the new design for the website, and the content was updated. Now I do all the updating of the site. I also provide administrative and financial support to the Health Promotion Summer School and update that website which is connected to ours. Financially I oversee project accounts and do online financial accounting using the University of Toronto system. I'm working for Suzanne [Jackson, Director of the Centre for Health Promotion] so I assist her. I work with Suzanne on project proposals, among other things. We just finished a couple. We have practicum students that are part of the Health Promotion Masters of Health Science program. They're great and I really enjoy having them here. I help to get them settled in, look after their salary requirements and generally support them while they are here. I'm very interested in working with students - one of the reasons I enjoy being at the University. I enjoy getting to know the students and working with them in whatever capacity I do. In my spare time I'm cleaning up our database of names. I also do special events. I also oversee the yearly Healthy U of T Award for campus members, and sit on the selection committee. My co-workers are great and lots of fun - we have regular social events.


definition of "best practices"
My definition is general - some things work better for some people than for others. Best practices are the methods that get the optimum results in the best possible way - whatever produces the best success rate. Success of course is subjective.


involvement with best practices
I helped out with all the work around the best practices event [Best Practices at Home and Abroad, September 2004], I put up the website with the best practices page, and do other things as they come along. This has made me aware that there are these ideas of best practices out there - I think it's really important to share these, that's why things like the session are good, sharing what works.

A good practice for me is taking advantage of the courses at the University of Toronto, that's a nice perk. I've taken some courses for websites - on Dream Weaver, HTML - as well as Continuing Education courses.

I took a certificate in Teaching ESL [English as a Second Language]. Teaching ESL involved best practices. At one time rote learning - repetition - was considered the best way to go, now there is the communicative approach, where you create real-life situations for people. Everyone has different learning styles - some students prefer more repetitive classes. Like any approach to anything it involves what appears to work best.

Because I have worked at a lot of different places - UNICEF, Polish Canadian Society of Music, Art Gallery of Ontario, now the University - I know a little bit about a lot of things. I do know a lot about administration - how to find the information I need and to work things out in as hassle-free a way as possible. I guess it's like best practices, you know how to do something, who to contact, who to speak to, use trial and error. Now I know people around the university, know how to book a room or do this or that, or if I have a question about human resources or finances I can find the answer.

Everything you do involves deciding what's the best way to do it - for example when I first came here and we talked about doing the website I didn't know much about it, so I talked to a friend at the University who said, "Well I talked to so and so." I went and talked to her and together we designed the site, then I took a few courses in web software. Best practices in my work involves talking to other people and getting input that way, continuing education, trial and error, knowing what works best for you - that is, when you're not dependent on someone else. When other people are involved you have to use a consensus approach.


comments about using a best practices approach and being healthy
Theory is one thing and practice is another. The idea of best practices is using the practice that actually works rather than some theory that sounds good on paper but in actual life doesn't fit.

I believe to be healthy you need a mixture, a little bit of everything. I see everyone working way too hard. Balancing work and family is important to me. And having time for other relationships as well - friends, love. That's hard to do sometimes but that's important. I am glad I have the chance to do physical activity, to go to the gym at the University. Nothing extreme. Mental activity is also important, in all my jobs I've worked with really interesting people and learned a lot from them. The University is a good place to work, there are myriad courses to take on all sorts of topics. This is health in the workplace - you're expanding your horizons, plus, if you keep learning you don't stagnate. It's all part of a healthy life.


main interests outside of work and best practices
I like gardening and reading and doing crossword puzzles. I enjoy getting away up north when I can. I enjoy taking courses, seeing friends, spending time with my kids - they are 19 and 21 years old. I'd like to travel more - next year we're going to Alaska, will take the Alaska Marine Highway, the ferry boat - it's an inexpensive way to get there. I was taking botanical drawing - it was really fun so I may take another course in that.


This profile is based on an interview with website editor Barbara Kahan.



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June 2005 Profile of Brian Hyndman

Brian Hyndman is an associate of the Alder Group in Toronto, a health and social policy consulting firm based in Ottawa and Toronto. Up until the end of May 2005 Brian worked with The Health Communication Unit, Centre for Health Promotion, University of Toronto (Canada).

current work focus
Right now I am working on a project for the Ontario Inclusion Learning Network (OILN), I have to map out what an inclusive policy development process would look like. This is a think piece on how to develop policies incorporating the principles and values of inclusion - a policy framework for decision makers to make sure policies in the health sector keep the principles of social inclusion in mind. This is, to the best of my knowledge, the first initiative analyzing public health policies from an inclusion perspective. The principles of inclusion have been widely applied for social justice issues and various forms of oppression, but not much as far as I know in public health. I am hoping in the future to work on a project looking at the relationship between housing and neighbourhood design and social inclusion - which designs lend themselves to an environment which allows for social cohesion? This will give me a chance to do additional work in the field and build on what I have done with OILN.

Another primary area of interest for me is looking at how public health units and community health centres can take action on the determinants of health. I'm doing some work with Sudbury and District Health Unit on this and will be leading a session on this at the Ontario Public Health Association conference in the fall. Hopefully this session will generate some insights about how to make the leap from theory to practice, how to overcome organizational, political and cultural barriers which limit what public health units can do to address the determinants of health. The session will be a collective brainstorming exercise with public health practitioners. In connection with the determinants I have developed two instruments for the Peterborough health unit. One is a planning tool for setting priorities around the social determinants of health, another is an audit checklist to identify the extent to which existing programs address the determinants of health - a gap analysis and planning tool.

In addition, I'm continuing to serve as a Citizen Representative on the Toronto Board of Health. I'm also Vice-Chair of the provincial Local Public Health Capacity Review Committee, which was formed to review the way in which public health programs and services are delivered through health units. I am also doing strategic and operational planning with Parkdale and Riverdale community health centres.


definition of "best practices"
My definition of best practices is the one I used with my
reflection piece - "practices demonstrating the ability to learn from experience (both your own experience and the experiences of others)." This is based on the definition of intelligence that came up in my high school psychology class, I thought it applied to best practices as well. The ability to learn from our experiences requires critical reflection and goes beyond evaluation. It is learning from what we have done, and then making the leap to modifying programs and policies and making whatever changes we need to make.


involvement with best practices
I haven't been involved too much with best practices in a direct way since I was on the [Centre for Health Promotion's assessment of evidence] committee a few years back. I was recently one of the external reviewers for a new practice framework developed by Toronto Public Health, which is going to be a step in the right direction towards best practices. I am interested in developments in the field, particularly in advancing knowledge in the areas of inclusion learning and the determinants of health.

I am primarily a consumer of best practices information. My involvement with best practices has made me become a more informed consumer - I say that as someone who acts in a decision making capacity on the Toronto Board of Health [as a citizen representative]. On the Board we try to make decisions according to the resources available, that meet the needs of people in Toronto, that reflect diversity and the needs of different groups, that impact in a positive way on the determinants of health. Politics, of course, enters into the equation sometimes.

As I continue to stay active in the field of health promotion, working on my areas of interest, the principles of best practices do guide my work. I think I do this in an unconscious way - I don't consciously think "I'm going to take a best practices approach to reviewing this piece."


comments for using a best practices approach
Best practices is a product of carefully thought out planning and ongoing evaluation, which, in turn, informs planning decisions and critical reflection. There are no short cuts to best practices.


main interests outside of work
I will be getting back into middle distance running this summer, I am hoping to get into 5 and 10 kilometre runs. I'm also into cycling, reading, and coin collecting, and am a volunteer [as mentioned above, with the Toronto Board of Health and Vice Chair of the Capacity Review Committee].


This profile is based on an interview with website editor Barbara Kahan.



Click here to read a reflection by Brian Hyndman.


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July 2005 Profile of Joan Roberts

Joan Roberts has her own consulting business, Joan Roberts Consulting, in Toronto (Canada).

current work focus
I'm an independent trainer and consultant. I work across government and non-profit sectors, solving complex health and social issues, by building and sustaining collective processes. My clients range from health promotion coalitions dealing with issues like substance abuse to environmental protection processes to whole government delivery systems such as the policing sector.

Most people are trying to keep up with information overload and are feeling very overwhelmed. I've found things get accomplished because of those same people, so we need to create safe spaces and bring people together to share their knowledge and resources in a way that does not stress them but makes collaboration fun. I don't stress content so much, which is easy to get by bringing those people with technical knowledge to the table - I'm a process person. All processes these days are about building trust; I'm very excited about my work because few people are doing the work I'm doing with multi-stakeholder processes the way I'm doing it. I have a background in governance so I bring topics like power, conflict and accountability into the discussion. That's rarely touched on, so the people I work with really value it.

I'm starting to write another book, the sequel to Alliances, Coalitions and Partnerships, Building Collaborative Organizations [put link], with more details on issues like accountability, power and organizational culture.


best practices and the multi-stakeholder process
When we bring organizations together we create a knowledge transformation process - each member is a knowledge resource, with each organization an expert on whatever they do. Sometimes they don't have specific knowledge on certain areas such as health promotion, but that's what a coordinator would do - bring in content knowledge from the literature or other sources to help in that learning process. That's what we're all doing - as information workers, accessing information and data, transforming it through learning, and making decisions about it.

In my six step model on developing a multi-stakeholder process, best practices come into play in the different stages through literature or best practice reviews. For example, in the first stage, the problem identification step we ask questions like- What have other people done? Have they made recommendations or published learnings around the identified problem set?

In the third stage the membership selection stage, you can use the literature to inform you about who to invite in as partners. As the partners are knowledge resources, the more knowledge you have extracted from best practice literature the more discerning you can be in membership selection. In the next stage visioning, best practice material can be used as a background resource to inform what kind of vision your group will determine is the way to address the complex social problem you have come together to solve.

Once you have your vision, you can use best practices material to inform your project development. The last step is evaluation and certainly best practices material can give you benchmarking data, comparables, and tell you what else is possible.


other comments about using a best practices approach
My approach to helping large groups plan together is to identify outcomes and attach measures to them - a focus on best practices right at the beginning. Also, an understanding of best practices tells me that what I do and the knowledge generated from the groups I work with should be shared with other people so they can learn from it.

I try to write about the work I do, publish and share it. I didn't have that awareness 10 years ago, I didn't think what I did mattered to anyone. But once I realized I'd done something others were interested in I went back and did a masters in organizational development and adult education, with the understanding that learning is the key process, that is our work. Before, I didn't understand that health promoters are knowledge workers and learning is the work that we do. Now I realize that my role is to help people learn and create adaptive responses to their changing environment.

We can make better decisions if we look at what other people have determined is a best practice for them and try to use it in our practice. The quality of our work is in the decisions we make. If we have better quality information from the learnings others have discovered, this can result in better quality decisions for us.


life outside of work and best practices
I'm an Argentine tango dancer. I just have so much fun with it. I've danced in Argentina and other places, and I'm the publicity director for a non-profit tango club in Toronto. (See next month's reflection where Joan Roberts will discuss the relationship between the tango and best practices.)


To read a two-part reflection by Joan Roberts, click here for part 1 and here for part two.


This profile is based on an interview with website editor Barbara Kahan.



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August 2005 Profile of Sean Sunley

Sean Sunley is a student and has his own business, Tidal Software, in Regina (Canada).

current work and life focus
I live in Regina and am currently working for EcoTech Research for a two month term this summer. During winter I'm a student at the University of Regina taking physics. I also do some website design through my home business Tidal Software.

Despite these other interests what really excites me the most is politics. I'm excited and intensely hopeful about the prospects of a website I co-developed -
voteinformed.ca - an effort to get more people educated about our political parties. So far it hasn't been terribly successful but if we get more support from the parties it could be a very successful exercise. A related website I have planned will focus on spreading the idea of a specific form of proportional representation, an attempt to get Canada to change to a better electoral system.

definition of "best practices"
When I see the term best practices I think of efficiency and simplicity of design - any system that does what it needs to do very effectively with very little waste.

nature of involvement with best practices
When I do website design I'm constantly thinking about the most efficient way to present information, to make it pleasant to look at with a good design and non-abrasive colour scheme and a clean interface. So, when I'm doing a new website I incorporate best practices into the design to make it as good as possible with no waste.

When I was designing the IDM Best Practices website I came across a design on another website that I really liked and adapted it to idmbestpractices.ca. What drew me to it was the perfectly clean content on the left, the unobtrusive title at the top, the simple clean floating menu on right - it's very simple, but still visually appealing and easy to find your way around on. I quite liked it for that, it's very neat. Were I to do it again, based on what I've learned since then, I would keep the interface - what the visitor sees - the same, but I would clean up the back end so that managing the site would be simpler.

Best practices is certainly always on my mind. Again, when I'm thinking about a new website design I'm thinking about the best way to deliver content - its impact is everything.

comments on using a best practices approach
I think any time anyone's working with a large project they should be thinking as broadly as possible about how they can improve the efficiency of what they're doing - think about the users, the designers, anyone else who might be impacted by it - the most efficient and clean way of reaching their objective.

Defining "efficiency" depends on the context - in general, I define it broadly as minimal waste - reducing input to achieve your end. I don't agree with the current business sense of efficiency where efficiency means, for example, job cutting without looking at the total system. This is a reductionist approach that usually doesn't work. When it comes to efficiency you have to look at everything involved and then it can only have good results.

life outside of work and best practices
Sepak Takraw is a large part of my life - a cross between volleyball and soccer which started in South East Asia. And of course there's my physics degree.

This profile is based on an interview with website editor Barbara Kahan.



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September 2005 Profile of Maurice B. Mittelmark

Maurice B. Mittelmark is Professor, Research Centre for Health Promotion, University of Bergen (Norway), and President, International Union for Health Promotion and Education (IUHPE).

current work focus
One project I'm very excited about has to do with mapping countries' capacity to engage in health promotion policy, infrastructure and key programs. For the last 10 years in Europe we have been developing an approach to capacity mapping to the point where we have more than 40 countries in the data base. This is an area related to healthy public policy and a country's ability to carry out health promotion.

A more traditional project I am working on is research into the role of the near social environment's influence on people's physical and mental health. We are interested in both the positive and negative aspects - social support and social stress. Most people interested in social stress work from a sociology paradigm which looks at distant as well as close stressors that might affect people, including crowding, unemployment, civil unrest, crime, etc. We're interested in a very special kind of social stress - unresolvable cognitive dissonance in situations close to a person. In theory this kind of social stress should be found in all cultures, all genders, young and old, people in all works of life. We're trying to find out if this is right by looking at people who are adolescents, middle aged and elderly, in Norway, Rumania, Russia and Thailand. Related studies are now underway under way in Sweden and Hungary. It looks like this kind of social stress is relevant to all cultures and backgrounds, based on the results we have published to date.


definition of "best practices"
IUHPE is deeply interested in the issue of best practices in a variety of ways. How do you achieve best practices by using evidence in the best way, and by learning from good practice and practitioners? I do have a little problem with the term best practices - who is to decide what best practices are? They change from time to time, place to place, situation to situation. You can never achieve best practices; it is a theoretical construct. I prefer a continuous quality improvement process - having quality-enhancing systems in place, being reflective, trying to make regular improvement. This is different from setting benchmarks. Benchmarking in health promotion is difficult and maybe impossible. We are not making automobiles or clothing - benchmarking falls apart when you're working with complex things like health promotion.

Contextualization is extremely important. If you're given instructions on how to make a cake you're not engaging in best practices unless you take the ingredients and make them your own - critically evaluate the steps and procedures and modify them based on your own tastes and experiences.


involvement with best practices
In the past I worked with WHO on benchmarking exercises. But the published research shows that this is difficult or impossible to do with health promotion so I have stepped away from benchmarking and moved into activities related to triangulation of practice, evidence and policy - what do we know about turning practice into evidence and evidence into practice, and both of these into policy, and policy into evidence and practice? How do each of these influence each of the others? The future for me will focus on the question, "How do we learn from good practice?"

I am not satisfied with how the field of health promotion is addressing this issue of learning from good practice. It is being done in a rather mechanical way - there is no paradigm about how to identify and learn from it. I am turning to the educational sciences, a field that doesn't inform health promotion very much but where exciting work is going on. For example in the US at Wisconsin and Northwestern universities, education scientists are asking how we identify excellent school leaders, why they are superior, what can we learn about them to transfer to others. I am trying to introduce these paradigms to health promotion.

I am most concerned with the kind of knowledge and wisdom we're not usually paying attention to. Aristotle identified three kinds of knowledge - scientific, technical and wisdom. He put an equal emphasis on all three - he thought you couldn't have a productive person or system without each of them. He called the third kind "phronesis" - wisdom in the sense of a practical, ethical and reflective approach to knowing and to doing. But with the rise of logical positivism, science - and health promotion - has ignored this last kind of knowledge and turned to science and technology as the answers to all important questions.

Health promotion has a serious problem - it is not growing intellectually. It is fed by health education, public health, social psychology and now a little political science, but there is nothing from art, literature, philosophy, educational science, anthropology and so forth. We need desperately to tap into other fields and the innovations that are there. For example, regarding the role of the social environment on functioning, there is brilliant work in the field of literature. Much of what we know about social relationships' meaning for health and wellbeing comes from the world's body of literature, but people in science disdain the use of non-scientific literature as a data source.


impact of best practices on work
It's a good question, whether I follow best practices in my work or not - or whether I do my work with as much reflection as I should or not. I am trying to be more reflective. I spend time writing to myself; I am also writing more editorials and commentaries and fewer scientific articles. I am trying to be thoughtful - if we don't write but just discuss we don't develop ideas in cohesive way. This has been my plan for the last 10 years - before that I didn't do a single commentary or book review or editorial because that detracted from writing scientific articles. Then I realized I was at a stage where I could deviate from the traditional career path.


life outside of work and best practices
I am interested in politics. I read quite a lot on the politics of gloabilization, socialism and capitalism, development and so on. I spend a lot of leisure reading in that area. I used to spend a lot of time with literary fiction, but now I want to spend time with other subjects so I am not just entertaining myself, but working my mind. My wife and I live close to the mountains and spend a lot of time in the mountains on tour with our dog. We go on walking vacations all over the world. We like food, that's why we have to walk a lot. My wife is a wonderful cook, and I like to cook, so we spend a lot of time with the cuisines of the world. You won't be able to verify this, but I make the best pizza in the world.

This profile is based on an interview with website editor Barbara Kahan.


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October 2005 Profile of Alison Stirling

Alison Stirling is a health promotion consultant with the Ontario Prevention Clearinghouse in Toronto, Canada.

work and home
For 17 years, I have been working as a health promotion consultant at the Ontario Prevention Clearinghouse [OPC], a provincial non-profit organization that helps individuals, groups, and communities use health promotion strategies to achieve health and well-being. We work to support the capacities of people involved in health promotion in their communities, to find the information, programs and strategies they need.

Matching my work and my beliefs, I live in a model of a healthy community. I live in Toronto on Ward's Island, a small car-less community in the park of Toronto Islands. My home is a wonderful small cottage in a tightly knit "village" in the middle of the big city where everyone actively takes part in community life - from keeping "noise logs," to taking care of ill neighbours, to regular social gatherings.


current work affiliation and focus
Last year I was on an educational leave of absence, having entered the masters' program of Information Studies at the University of Toronto. I decided that I needed to learn more about how to make the rich body of knowledge and resources of the health promotion field more organized and more accessible and more useful to people, through online and manual information systems - I've been learning to be a 21st century librarian.

At the beginning of September I returned to OPC to work on a special project for seven months with the Health Promotion Affiliate of the Canadian Health Network [CHN]. This project brings together my 20 years of work in health promotion with my new skills and perspectives on knowledge organization and information management. I am very excited about this project - I will be working with 24 affiliate organizations of the CHN to merge the CHN Health Promotion and Determinants of Health Collections and to develop health promotion standards for implementation across CHN.

That task involves seeking consensus from other affiliates on a shared understanding of health promotion and the determinants of health and a "standard" language, terminology and framework for health promotion. I'm working collaboratively with the other affiliates to ensure minimum health promotion content, consistent health promotion messages and approach across CHN, and to assist affiliates in assessing if their collections cover the breadth and scope of health promotion strategies, settings, actions and approaches. To do that, we need to consider the goals, values, theories, practices and evidence of health promotion in the context of the users - a definition of best practice. [See a
reflection by Alison Stirling for a further discussion on defining best practice.]


involvement with best practices
At OPC I have been part of many discussions with the best practices advisory committees (English and Francophone) on how to use the IDM in health promotion. I have had the pleasure of working with two CHCs [Community Health Centres] who were part of the IDM Best Practices pilot project, and looked at how to use the IDM Framework and approach in their current work. "Best practices" in health promotion, in planning, in nutrition, cancer prevention and in public health have all been part of the work that I have done at OPC. I have emphasized the foundations of best practice - values and principles, goals, theories, evidence or data or knowledge that is available, understanding the context and environment - all come as part of practice. When someone asks for an example of an effective program so that they can apply it in their organization, I always discuss their interests, needs, goals and situation, and encourage them to put "evidence" of a previous practice or program into a mix of their own "best practice."

When working on strategies or undertaking certain programs I have used the IDM to ground the discussion. It's been very useful - often when I'm talking to people they ask an initial question such as, "Can I get an example of a program on diabetes prevention?" I ask them, "How did you get to this point, who else is involved, what kind of perspective are you bringing to it?" They start thinking about that, they realize what else they need to know besides who else has done it before, they think about their own beliefs and values that they bring to their program. You can put it in a strategic plan format but that leaves out what I think is very important in terms of a values base. It's not just "here's the objectives and plan" but what's underneath that's driving it.

life outside of work and best practices
Currently, with my graduate studies, and working, there is not much time to take up other interests (beyond eating, sleeping and enjoying home life). Every chance that I get I enjoy the sanctuary of my island cottage home with my partner and our cats. I'll cook, garden, read, visit with neighbours, and take part in numerous community events and activities such as the building of a seniors' residence (my future home I'm sure!). When I can squeeze more time and get away I love to bicycle over country roads (and the city), travel throughout southern Ontario, and anywhere else in the world, and go to concerts and learning events. I'll never stop learning, it's a joy in my life.


This profile is based in part on a contribution by Alison Stirling and in part on an interview with website editor Barbara Kahan.



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November 2005 Profile of Mary Martin-Smith

Mary Martin-Smith is a board member of the Canadian Public Health Association and of the Community Health Nurses' Association of Canada. She lives in Regina, Canada.

work projects
One satisfying project I have worked on is smoke free enclosed public places - the Tobacco Control Act came into play January 1, 2005. It has been fascinating to watch policy unfold. Another project - Healthier Places to Live, Work and Play - is very exciting to me, an exciting piece for Saskatchewan. This population health promotion strategy has far reaching implications and I'm proud of that because Saskatchewan - the province of Saskatchewan, not just Saskatchewan Health - is a leader in population health promotion. The Saskatchewan strategy was based on a community consultation process and identified mental well being as an emerging issue. We did 11 regional consultations across the province - health regions invited their community partners who came up with the key issues in their communities.

The strategy was released in 2004 and has four priority areas: accessible and nutritious food, active communities - physical activity, decreased substance use and abuse, and mental well being. When we did the consultations we didn't hear those four issues, instead we heard people talk about drug addictions, diabetes, heart disease, violence, all those things which are downstream - the diagnoses. We told them at the beginning that we wanted to know their issues and that they would still be able to see their issues in the end, but the issues would not look the same because we wanted to frame them upstream. We did a module where if they said "diabetes" we would back it up to look at the root causes, to get at the health promotion end of things.

We went with community consultations because we wanted to honour community wisdom and build on that. Honouring community wisdom is a challenge for governments, for health regions and for NGOs [non-governmental organizations] - but from a community development approach you have to start where communities are at. Most other community approaches look at the evidence first and then go to the community, telling them "this is a problem in your area, you need to do something about that." We reversed that approach. We didn't know in advance what the communities would say, and after we heard what they had to say we put it all together and found common themes and then we looked at the evidence. Sure enough, what people said in the consultations was supported by the evidence.

We wanted to move health promotion across the province; we wanted issues that were meaningful to people. As a result there's been a lot of buy-in from health regions and communities. Although it would have been much easier for us to identify issues from the evidence, it is much easier for communities to coalesce around an issue they've identified themselves. The consultation process was long but it paid off in the end by getting consensus. For me it was definitely worth the time.


application of best practices
As a nurse, for me, paying attention to best practice is a professional skill, related to reflective practice and evaluation. It's about asking: Is this the best way to do things? Did what do we do work? If we had to do it over again how would we do it?

In Saskatchewan, most people use Hamilton and Bhatti's population health promotion model. It forms a common frame of reference and a common value system for health promotion people as they talk to each other. I do think that in terms of guiding practice people need a model to hang on to because it serves as a check and balance, to make sure we cover the basics.

When we did the primary prevention of type 2 diabetes demo sites and also the population health promotion strategy, we gave people examples of best practices - not in the hopes that they would go out and apply them exactly as written but to give them ideas of using a different approach. Its important to give examples of things that worked in other places just to give people ideas of things they might want to try. It's hard to say "do things differently" without describing what doing things differently might look like.

I like my volunteer work with boards - it is a way of being connected and understanding the broader influences that might impact on an issue, of being aware of opportunities that might open up for health promotion, and of having discussions on best practices. In addition to my volunteer work with the Canadian Public Health Association and the Community Health Nurses of Canada, I am doing a bit of best practices work as co-chair of the Canadian Council of Health Service Accreditation's national advisory committee to develop accreditation standards for public health.

In general I am uncomfortable with the term "best practice" because something may be best (likely just better practice) at the time but not for long. The missing pieces are often the theoretical components and community wisdom that identified "this will work because of this, or won't work because of that."


life outside of work and best practices
My family is my top priority. I like reading and out door activities such as gardening, skiing, hiking and walking, but I don't always get to do them as much as I like, depending on what else is going on in my life.


This profile is based on interviewed with website editor Barbara Kahan. Click here for a reflection by Mary Martin-Smith on Creativity and best practice.



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December 2005/January 2006 Profile of Nancy Dubois

Nancy Dubois is a Health Promotion Consultant currently working on the development of a "Best Practices System" for Canada with the Centre for Chronic Disease Prevention and Control with the Public Health Agency of Canada.

home and work
I live in Scotland, Ontario, a little tiny town amid the tobacco fields - a bit challenging as my kids have often wanted to work in tobacco in the summer but I would not support THAT. I work in the whole province, I'm in a different city every day - it's a wonderful opportunity but a lot of travelling. I work for myself, not for any particular organization - but there are some constant contracts. It sounds glamorous to say I stay in a hotel two or three nights a week but it gets wearing. I look forward to stretches when I don't have to. I try to protect one day a week to be in my office but it doesn't always work.


current projects
I am currently very excited about working with the Public Health Agency of Canada on a best practices system in chronic disease prevention. There is a strong commitment to make this happen. I am helping to manage that project that in conjunction with a Steering Committee and three work groups, some international in scope. I am also helping the Ontario Chronic Disease Prevention Alliance develop a provincial prevention strategy.


definition of "best practices"
From my perspective there are two aspects to best practices. One is the actual best practices program - an intervention that has been evaluated and shown to be effective at least in the context in which it was developed. The other is principles of best practices, the things that go beyond one single program and reinforce what's important to consider when planning or implementing a certain type of program, for example, working with youth to improve health.


nature of involvement with best practices
I was part of the initial team that worked with the University of Waterloo to develop the Heart Health review process seven or eight years ago. For the Heart Health Resource Centre I did a workshop on concepts of best practices - the different labels, how to look for good evidence. I teach about it at York University, share the best practices and make connections between people - who to talk to - as much as I can. As a trainer or consultant I'm constantly working with groups to help them identify and use best practices. Often the first thing groups want to do is develop something new; I try to be an ambassador for the concept of best practices - look at what you can learn from elsewhere.

I also developed a model for Effective Dissemination of Best Practice under funding from the national Canadian Diabetes Strategy. The project stemmed from information gained through an evaluation of The Heart Health Resource Centre that communities were not using the identified best practices posted to their website.. I got involved in their efforts to understand what effective dissemination of best practices looks like from the literature side, for example from the knowledge transfer field, as well as the practical aspects. My colleague, Tricia Wilkerson, and I developed a hybrid model with three components to it. First is to look at the development of the material to see if it is relevant and timely and so on. Second, is there a knowledge broker who's distributing it - what can they do to enhance eventual uptake? Third is the role of recipients in passing it on. Five communities are now piloting this approach in Ontario. Sometimes when you develop a theoretical model it doesn't go anywhere; it is nice to see this being used.

I have also been working on formal best practices criteria for policy with the Canadian Population Health Initiative at the Canadian Institute for Health Information. The interview process included experts in three different fields - people who knew best practices as they relate to health promotion, government decision makers who might use the policy options presented, and the researchers who are creating them. The best practices reviews I've looked at have often excluded policy interventions because the assessment criteria often don't fit. However, we can't just ignore best practices and policy.


impact of best practices on work
How best practices impacts on my work - I try to promote this notion of building on the experiences of others with groups of all kinds that I work with. This means making connections between programs and being "up" on what these best practices are.


comments about using a best practices approach
The challenge is finding how much you can change a best practice to make it relevant to your community - to make it fit with the context. You can never just pick up a best practice and transport it. But it's difficult to know, if you find a program that someone has labelled as a best practice, how much you can change it without damaging its integrity. The closest I've come is to try to be transparent with the assessment - publish the tool and results so everyone knows what scored well and what didn't so you know which pieces are most important. It comes down to that transferability question.


main interests outside of work and best practices
I love to downhill ski and to sew - crafts and clothing. I don't do as much as I would like though! I love to spend time on the beach at my cottage - that's my favourite place. I have two daughters, a 20 year old who's working out in Jasper and my younger in grade 12 who is 17, and the president of her student council.


This profile is based on interviewed with website editor Barbara Kahan. Click here for a reflection by Nancy Dubois.



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February 2006 Profile of Evan Morris

Evan Morris is a consultant with his company EcoTech Research Ltd and an instructor with the University of Regina and with the Saskatchewan Institute for Applied Science and Technology (SIAST). He lives in Regina

work focus
I work half time for myself - I have a consulting business - and the other half I teach at the University and at SIAST. I try not to work between two and four months a year - I like my summers, where I work on projects that I'm excited about that I don't get paid for.

At SIAST I train second year students in a health information management program. I teach them data analysis, statistics, data base programming. I enjoy teaching this class because I'm really familiar with health records and health information - how they're used and what they're used for. I can give the students lots of examples of what they may end up working on. Also the students are really keen - they want to be there, they're interested in the profession - and they have very diverse backgrounds in terms of age and where they come from in the province.

At the university I teach research methods, statistics and some other courses in sociology, and I teach a geophysics class for the geology department.

With my company the work is really diverse. I've done quite a bit of geophysical research and contract work over the years, as well as statistical analysis and evaluation for various government departments. One work project that I was involved in was the study of the Family Health Benefits program in Saskatchewan, where benefits are made available to low income families. After that project I collaborated with other people in our research group and wrote a couple of articles.

I'm interested in how changes in health lead to changes in income - often people see that low income leads to poor health, but the reverse is also true, people's poor health can result in low income. I'm also interested in the sociology of science and math, I've done some work on that in the last year - what gets scientists and engineers excited about new mathematical techniques, why they start using them and why they don't. On the geophysics side I spent a few months last summer working on developing new techniques to help farmers find near-surface water sources and to check for near-surface pollution.


defining and using best practices
Even in geophysics I do best practices. The definition varies depending what I'm doing. For example in geophysics people have used many different methods to search for minerals and oil and a lot of these methods are taught in text books but it's not usually explained when one method is better than another - so I spent a couple of summers going over a number of commonly used methods to figure out criteria for which method would best be used in which circumstances.

On the health promotion side I knew very little about best practices until I learned about the IDM. It was in the process of developing the IDM computer program that I became familiar with the literature and started to understand some of the concepts. Prior to that I hadn't thought about it - I'd heard the phrase "best practices" but I thought they were specific to certain techniques, for example the best way to cure a disease or to do an operation - I'd never thought about it in broader terms such as population health terms.

What was interesting about writing the computer program is it involved two things. One was that the whole program was to help people develop best practices in the health field - but at the same time it made me conscious of best practices in computer programming. There are lots of courses and books that train you to do computer programming and many projects are large and you have to collaborate with people just as you would in health fields and there's a lot of talk about making sure users of computer programs are involved in the design of the programs - if users aren't happy with the design they won't use the program. I could see a lot of parallels between the two, computer programming and health.

Writing the IDM computer program forced me to think more about connections. Some connections I was familiar with - for example, looking at evidence - but particularly the values connections I hadn't thought about. Now even in other areas I think about that more, how do underlying values affect what methods people use to achieve their goals, even what goals they choose.


main interests outside of work and best practices
I like doing research and I like working with people when I do it - the collaboration, being able to bounce ideas off other people is a lot of fun. I also like travelling and exploring and being adventurous.


This profile is based on an interview with website editor Barbara Kahan.

Click here to see a reflection by Evan Morris, and click here for a Resource of the Month developed by Evan Morris: Estimating the required sample size for small populations.



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March 2006 Profile of Guy Ewing

Guy Ewing is an adult literacy worker and researcher in Toronto, Canada.

current projects
I am working on a national project funded by the National Literacy Secretariat - identifying inclusive models of life long learning in Canada, which we now call the Learning Circles Project. [See this month's reflection for Guy Ewing's discussion of learning circles.] Research is taking place in three kinds of communities. I am one of two researchers studying learning circles in Toronto and other urban communities in Southern Ontario. The rural communities included in the project are in Digby County, Nova Scotia. A researcher from the National Indigenous Literacy Association is looking at circles in Indigenous communities. In addition to being one of the researchers, I'm facilitating a learning circle for a literacy group at the Parkdale Activities and Recreation Centre [in Toronto], a club for psychiatric survivors where members have a large role in running the club.

Another project I'm involved in is a workshops research project out of Festival of Literacies at OISE/UT (Ontario Institute for Studies in Education of the University of Toronto). The Festival of Literacies is a program that brings together academic researchers, students and literacy workers to explore issues of literacy and literacy work - a way of bringing together academics and non-academics, bringing together different kinds of knowledge. This is the second year of the workshops project. It is designed to support literacy workers who want to do research along a continuum - some may want to do more reflective practice, some may want to be involved in focused research to improve their program, some may want to do research on big issues related to literacy. The main theme of the workshops is to help people relate knowledge creation that happens in literacy to knowledge creation that happens in research. If you make that link then you can do research in practice. The workshops are based on the view that most knowledge creation happens in work itself and that you can support that with research.

I'm also teaching courses at OISE/UT. The course I just taught was called Rethinking Literacy: Learning in Communities of Practice. It was an investigation, with the students, of an approach to social learning theory which is called a communities of practice approach - we looked at it to see if it would be useful or not. I'm going to be teaching another course called Knowledge, Literacy, Power. In the dominant culture knowledge is associated with power and literacy with knowledge. This notion is questioned.

In these courses, I am trying to use theory as a support for the people who are doing the work outside of an academic context - not using it as "here's theory and how do you apply it in work," but as a way of helping people to understand the theory, to see whether it applies, what can they take from it and assimilate in what they're thinking. And, to get academics to pay attention to what literacy workers think - a lot of what literacy workers say links theory and practice.

My motivation for getting involved in this kind of work is years of hitting my head against the wall and saying to people in government and elsewhere "you should be listening to the knowledge from people working in literacy rather than hiring 'experts' - what they come up with is irrelevant." The work I am doing now addresses the basic attitudes people have, rather than fighting it out in the day to day battles.


definition of best practices
In general good practice is practice which is open to learning by practitioners and open to experience the way research is, and continually changes. Best practices is a process rather than a particular set of how to do things. You have to put the process in place and what you do will evolve for the better, because of the process and because of changing conditions. Best practices can be a trap - if you codify ways of doing things so they don't evolve that would be bad.

I'm not sure people inherently want recipes and lists but in environments where those become the basis for evaluation and the way the organization operates of course they want lists. The organization has to create an environment where people are freed up a bit - create a framework that's helpful without pushing people into stupid lists but a creative process, a process that has integrity.

There's a way in which you need a list though, because you forget things that you meant to address. That happened to me recently when doing some transcribing. The pieces that I transcribed lost track of certain questions that we wanted to look at.


thoughts on literacy and health
People who are poor have a lot of health issues and a disproportionate number of poor people have difficulty with written language. Often in health the issue is seen as helping people to understand written health information. Writing is a less labour intensive way of communicating information but if it's more effective to communicate face to face that's the way it should be done - this would serve the main purpose of health services which is taking care of people's health. It's a mistake to think in literacy that we're addressing someone's deficit - they might have difficulty around reading and writing, but the health professional may have difficulty communicating orally. Both need to be taken into account.


main interests outside of work and best practices
I've been writing poetry seriously lately, after a long period of not writing poetry. It's something I've now been able to do because of not being in an administrative job, which is quite draining and takes up your head space and doesn't allow for expression. A lot of administration and even advocacy work doesn't allow for expression, it's articulating and negotiating things on behalf of other people.


This profile is based on an interview with website editor Barbara Kahan.

To see past reflections by Guy Ewing, click here and here.



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April 2006 Profile of Janet Carr

Janet Carr is a public health nurse with Ottawa Public Health in Ottawa, Canada.

current work focus
As a public health nurse with Ottawa Public Health, I am currently focusing on integrated disease prevention, workplace health and pandemic preparedness. As part of my workplace activities, I am a member of the Canadian Healthy Workplace Council, a group that is dedicated to promoting a comprehensive approach to workplace health in Canada. I am also actively involved with the Council's strategy committee that co-ordinates the annual campaign for Canada's Healthy Workplace Week.

definition of best practices
"Best practices" is a widely used but misleading term that suggests that an exhaustive search of all possible options has been conducted. An alternative to this term, and one that I prefer, is "evidence-based practices." I define "evidence-based practices" as policies and programs that have been evaluated and have demonstrated a positive measurable impact on an individual, family or population in a specific environment. It is important to consider the theoretical underpinnings that have contributed to the elements of the practice and also the strength of the evidence supporting that practice.

One also needs to be aware of the context in which the practice was developed. Ultimately, the transferability of a practice from one setting to another is limited by contextual factors. These include: target audience, training needs, resource allocation, leadership and organizational culture. However, we should not close our minds to the possibilities that exist for us to expand the learning beyond our own "universe" and to embrace innovative ideas from other disciplines.

involvement with evidence-based practices approaches
Last year, I was invited by The Health Communication Unit at the Centre for Health Promotion to participate in the development of a new catalogue to encourage workplace health intermediaries in Ontario to use effective assessment tools in their work. Intermediaries appreciate having access to evidence-based practices, but do not always have the time and skills to do all the research themselves.

Our review panel used a web-based application to rate a number of assessment tools according to effectiveness (as measured by reliability/validity), plausibility and practicality. Each member reviewed three to five tools, discussed their ratings with another member of the panel by phone, and then came to agreement on the overall rating of the tool. A decision tree assisted us in determining whether a specific assessment tool was recommended, promising or not recommended.

The result of our work was a catalogue, Comprehensive Workplace Health Promotion: Recommended and Promising Practices for Situational Assessment Tools, available at http://www.thcu.ca/workplace/sat. It contains information about 29 recommended and promising tools in six categories: needs assessments, health risk appraisals, workplace environmental audits, employee interest surveys, current practice surveys and organizational culture survey. I enjoyed being part of the developmental process that allowed me to have input into the inclusion criteria, the rating of the tools and the dissemination plan for this very useful resource for workplace health intermediaries.

impact of an evidence-based practices approach on work
I use the Canadian Community Health Nursing Standards of Practice to guide my practice as a registered nurse. Community health nurses integrate multiple types of knowledge into their practice and critical examination of this knowledge provides for evidence-based community health services. In fact, understanding the need for health policies and programs to be based on evidence and applying the evidence appropriately could be considered a core competency for all public health practitioners.

The Registered Nurses Association of Ontario launched the Nursing Best Practice Guidelines Program in November 1999 with funding from the Government of Ontario to support nurses by providing guidelines for client care. In summer 2005, I was invited to be part of the stakeholder review of the Healthy Workplace Environments Best Practice Guideline on Developing and Sustaining Leadership, which is now in the final editing stages. Currently, there are nursing guidelines available on over 29 topics and more are being developed each year.

Comments on Using an Evidence-Based Practices Approach
Nursing and other healthcare students are being taught to critically examine the evidence that is available and consider the context before choosing a course of action. Having a student question why I am doing things in a certain way is one of the best ways I know to ensure that I am implementing practices that are ethical, grounded in theory and based on the strongest evidence that I can find.

life outside of work and evidence-based practices
My family is very important to me and I follow with great interest the activities of my daughter, age 24, who is in second year medical school, and my son, age 21, who is in third year commerce. My husband is an organization development consultant and I'm struck by how much convergence there is between our fields of work. This leads to many engaging discussions at the dinner table!

I have always enjoyed being active and, up until a couple of years ago, my passion was playing competitive soccer. More recently, I've taken up running 5K and 10K distances and trying my hand at curling. Whenever I feel a little lazy about going outside to get some exercise, I can always depend on my six-year-old yellow lab to remind me that it's time for a walk!

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May 2006 Profile of Miriam Hoffer

Miriam Hoffer is a dietitian at Health Watch at Women's College Hospital in Toronto, Canada. She is the author of the book Fuelling Body, Mind and Spirit: A Balanced Approach to Healthy Eating (Sumach Press, 2003).

work affiliation
Health Watch is a wellness clinic that caters to women in mid-life who come to get a physical exam once a year. It began over 50 years ago as a cancer prevention centre, one of two places in the province that did pap tests when they were first developed. Even after pap tests became more widely available, the women still kept coming; some travel as much as two to three hours each way to get there. The women come because they have trust in the hospital, which has a reputation for excellence combined with compassion; they know they will be treated well. Some come because they don't have a family doctor, some because their doctor is their next door neighbour, or they want a woman doctor. And partly they come because of the nature of health care, where family doctors don't have the same amount of time to talk to their patients. About 10 years ago the name of the clinic was changed to Health Watch from the Cancer Detection Centre to reflect its prevention and health promotion nature. A dietitian was added at this time to talk about healthy eating and later a physiotherapist was added to address healthy activity, among other things. We never advertise, and yet there is a year's waiting list. Word of mouth brings people in.

work motivation
At the root of my work as a dietitian is my passion for nutrition. I went into nutrition with passion, and I have it still after thirty years. It is this passion that I try to pass on to other people. I sometimes think of myself as a saleswoman. There aren't enough hours in the day for people to do everything that is healthy for them so I'm trying to sell them on the idea of spending some of their time in my area of nutrition. I can't sell anything I don't believe in or that I don't practise myself. I eat in a healthy way and I want them to as well. I am also a storyteller in that I try to illustrate the benefits of healthy eating through stories.

work supports and limitations
The major thing that helps me is that my workplace trusts me to design and carry out my job as I want to - I've been able to create my own milieu. It's very liberating, and I feel privileged to work there. The people I work with are amazing. We have a common goal of patient care and we work well together. The women who come to the clinic are also amazing. Every person brings some knowledge of life or spirit with her which makes my day richer. Women's College Hospital is a wonderful place to work, it's a small place so everyone knows everyone. If I had a complaint I could talk to the president if I wanted to.

Nothing gets in my way except my own personal limitations-the boundaries of my own imagination to create the best message possible. I feel constrained by the powerful counter nutritional messages my patients get from the society at large. My message is one of health which I consider to be quite different from the message of weight they are bombarded with. As well, people are not taking the time to sit down to eat; family meals seem to be disappearing.

best practices approach
I try to keep up to date and to have a broad range of knowledge. I do this by reading journals, attending workshops and by making full use of internet resources. I talk to other dietitians. My interest goes beyond nutrition - I like to read about such things as stress reduction or spirit building, or how we can design communities that promote healthy living. It's important to keep informed not only to be able to answer patients' questions but also to be able to relate my message to something that is meaningful in their lives.

The time I feel worst at Health Watch is when I feel I have not respected somebody, that I've let my own personal need for her to hear me override her needs. I feel best when I feel that I have connected with that patient, that I have helped her feel better about herself or that she has learned something. With each new patient I have to decide how to start, to find the path into her trust so she will hear me or to find something that resonates with her. I treat all of my patients as unique individuals and I think of my time with them as precious moments. I want them to know that nothing is more important to me than spending this time with them.

As a best practice I've made a policy to never let them think that what I'm saying is boring, even if I've repeated the same message several times over. I want to give each person the same energy whether they are my first or my last patient. I believe every person deserves the utmost respect and consideration.

My best example of best practices is a patient who had been to many doctors who, she told me, dismissed her. I believe they were put off because she was so whiny. But the more the doctor pulled away, the more she complained which made them withdraw even more. I felt myself also pulling away but instead turned my aversion to one of acceptance and sympathy and she calmed down. I forced myself to find something to like so I could connect. I think that connection, even if it's not a dietary thing, is a spark from God. If there's that connection then my patient got health that day - you can't quantify it but I really believe it's there.

life outside of work
I read lot, I like to walk and be outside, I spend time with family.

This profile is based on an interview with website editor Barbara Kahan.

To see a reflection by Miriam Hoffer, click here.

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June 2006 Profile of Mark Cabaj

Mark Cabaj is Vice President of Tamarack Institute. He lives in Edmonton (Canada).

work focus
Half of my time I am coordinator of Vibrant Communities. [According to the Tamarack Institute website, Vibrant Communities is "a community-driven effort to reduce poverty in Canada by creating partnerships that make use of our most valuable assets - people, organizations, businesses and governments."] The six Vibrant Communities' trail builders - Edmonton, Calgary, Victoria, Niagara, St. John, Montreal - are midway through the implementation of their poverty reduction plans. There are 11,000 families involved and plans for another 8,000, it's impressive, communities can get scale. They moved from projects to system changes, not just one offs but reoccurring - things like policy adjustments, changes in administration of policy. Vibrant Communities is an intentional experiment with an integrated architecture for learning.

The other half of my time I focus on stuff around community collaborations dealing with complex problems like poverty, safety, renewal, research and development. I am quite interested, when I get back [from paternity leave], in working more on the operational implications of working collaboratively when there are lots of stakeholders. We tend to reach for old tools which don't work when there is technical complexity [unclear cause and effect relationships] and social complexity - lots of stakeholders with diverse interests. Competencies and approaches for complex situations are emergent at this point. It is a struggle to be adaptable as things unfold, we're not a culture to have dynamic problem solving processes. What happens is people prepare models first - for governance, planning, evaluation - and then launch things. But groups that are more responsive and adaptive seem to have a better time of it.

discussion of "best practice"
I think that the term is often used incorrectly - it assumes we have a lot of information on outcomes, but often people don't because it is hard to get that verifiable information. So what it means is "interesting" or "high profile" or "innovative," not "best" as there is no info on outcomes, because real good evaluation is damned hard to do. Also, how do you get info on what works in a standardized way? For example, in Calgary the solution to a particular transportation issue is straightforward, but conditions in Edmonton are different and Calgary's solution won't work. It's like a kaleidoscope, you turn one notch and everything is different.

I don't use the term often with emergent or complex work: it's difficult to talk about "best practice" and "innovation" in the same sentence because they are two different ways of going about change. Best practice informs work with what's happened in other places. With innovation you have a set of circumstances that keeps moving and you make your best guess about what will work. Innovation is risk oriented and experimental; with best practice you build on what's gone before.

I like "promising" or "pretty good" practice where you use practice from other places as a lesson but you're not tied to it. I was once at a conference in Britain, in Leeds, with the Rockefeller Foundation. It was all about why practitioners did not use evidence based decision making. The conclusion was similar to mine - because information is only part of what goes into the day to day reality of making change.

applying best practice to work
I try and find out what's happening with a situation - the partners etc. - and understand that processes are dynamic and unfolding, they're complex. This means being patient to find a legitimate entry point and once I find it get ready to adapt. Framing the issue up front is important - I spend an inordinate amount of time trying to understand the situation without going overboard. I also rely heavily on relationships - I think relationships are about half of it. If I don't feel right, if there isn't the chemistry, I won't go in. There has to be trust, it's like white water rafting, you need to feel good about the other people in the boat. Otherwise you end up in a situation where the people you're working with start out by saying they want hamburger, but later change their mind without telling you that they now want pizza, so when you give them hamburger they say "what a shitty pizza."

Someone, I forget who, once said that change is about "relentless incrementalism, you have to keep pounding and pounding." I also keep in mind the saying from the Torah, "it's not for us to finish the task but to start it." Then there is Bill Shore with his "cathedral within" metaphor - in medieval times people working on cathedrals treated it as craft work, something you do as well as possible, and trust that you are building something bigger without feeling the pressure or hope of seeing it finished.

main interests outside of work
I'm into gardening. I'm a little into environmental design for homes, I'm reading about that. Cooking - I like Indian and Caribbean and Thai, spicy food. I'm trying to be in the moment with my kids.

This profile is based on an interview with website editor Barbara Kahan.

To see a reflection by Mark Cabaj, click here.

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July/August 2006 Profile of Peggy Schultz

Peggy Schultz is a health promotion consultant with Ontario Prevention Clearinghouse in Toronto, Canada.

work affiliation and focus
I am part of the Health Promotion Resource Centre team of Ontario Prevention Clearinghouse (OPC). OPC is a non-profit voluntary organization committed to a comprehensive approach to prevention and health promotion. I have worked at OPC for many years and through its many changes; the essence of our programs and services is to facilitate, support and amplify an agenda that raises and sustains health promotion, social equity and access. I, along with my colleagues at OPC, have the privilege of working with people such as community activists, public and community health practitioners, planners, researchers, volunteers. We provide a range of learning opportunities, consultations and networking along with strong information and knowledge exchange for people who are trying to integrate health promotion perspectives into their work, with emphasis upon the social and economic determinants of health.

Currently I and others on the team are most focused on the areas of inclusion, dialogue and mental health promotion as these areas help us broaden our understanding of the structures that support or detract from health. This year we convened six Count Me In! community forums in Ontario: two in French and four in English (www.count-me-in.ca). These events helped me understand the complexity of concepts about inclusion. In particular, how do we create a "culture" of inclusion, health and well-being? How do personal, professional, organizational and community efforts at inclusion increase human capacity and social capital? [For more discussion about inclusion, see Peggy Schultz's reflection on the website this fall.]

definition of "best practices"
The definition I know best is the IDM's, where we pay attention to revisiting and aligning our approach, strategies and activities with health promotion values. The core vision and values don't really change over time; the IDM framework provides an anchor to keep us on our path AND to help us see when and where to try new or different paths. An underlying premise of IDM is inclusion although it was never stated explicitly.

While understanding the IDM approach I continue to grapple with the term "best practice." The world we work in often defines "best" as excellent - in that sense of surpassing others - but for me at the end of the day it's knowing we've done our best. As well, we need to be assured that we are considering best practices at all levels - not only programme and community intervention but at policy levels where determinants of health need to be addressed.

Sometimes the success of the past can blind us to the needs of the future - so I hope that we use best practices approaches to pay attention to the changing context in which we work and to help us innovate. Some frames of reference may not serve us well unless they give us space to deal with the unknowns. Sometimes there is an underlying expectation that "best practice" is about having all the answers and pinning everything down. Ideally a framework such as IDM keeps us focussed on sense of purpose so that we can face the unknowns together (in our programmes, organizations and/or communities).

involvement with best practices
I was at the international conference that led to the start of the Best Practices Work Group through the Centre of Health Promotion at the University of Toronto. As OPC's representative on the original work group I was part of the early development of the IDM best practices approach. I continue to keep in touch with [website editor Barbara Kahan] on a monthly basis to talk about best practices issues in the context of current work and challenges. The IDM does influence me - some of that does feel like it's embedded in me, although some of my colleagues would say I never get to the point of action…for me the process and reflection are the action.

Currently, at OPC our francophone consultants have activated the IDM framework in some very interesting ways [for example, see the reflection by Hélène Roussel]. This grew out of the francophone Best Practices workgroup which OPC spearheaded alongside the earlier workgroup through the Centre for Health Promotion.

main interests outside of work and best practices
Reading, drawing, walking, taking photos of flowers and enjoying time with friends.

This profile is based on an interview with website editor Barbara Kahan.

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September 2006 Profile of David Groulx

David Groulx is a public health nurse with Sudbury & District Health Unit in Ontario (Canada).

work-related interests and activities
I have recently joined the school health promotion team. The team attempts to address the health needs of their population through the implementation of a comprehensive school health approach. Team members attempt to assess each individual school's health needs and address these issues within the school community - not just with teachers, but students, parent councils, and administration as well. There is much of the work that focuses on youth empowerment utilizing available community resources.

We're starting a new project to address the misuse of prescription medication among youth, I'm really excited about that as the circumstances precipitating this project were quite tragic- recently there were a couple of youth deaths due to OxyContin misuse. We are currently reviewing recent statistical data regarding youth use and misuse of prescription drugs as well as the current evidenced based practices in addressing this issue. We are in the process of developing a logic model for the project. Working on this project are public health nurses, a health promoter and a community agency.

I have developed an interest in the determinants of health and a public health approach in addressing these in improving the health of the population. There is a significant amount of evidence with respect to their impact on the health of a population. I'm also interested in globalization and its impact on populations, be it good or bad.

I am working towards a Master's degree but have put it on hiatus for a while - I'm focusing more on family than anything else right now. My focus for my Master's is on youth tobacco cessation. The knowledge I've gained has certainly helped me with my practice as I am able to advocate more effectively for the provision of youth tobacco cessation services.

experience with best practices
I was involved in pilot testing the IDM best practices approach at two different sites, in the southern part of the province with Durham Public Health and here in Sudbury.

defining best practices
Thinking back to my initial response when I was asked how I would define best practices [as part of the IDM best practices pilot testing] I notice a significant difference. My involvement with the IDM approach has influenced the way I think about best practices and has shaped my current definition of the concept which is: Best practices in public health are those actions and/or processes that are designed and implemented taking into account one's environment, best available evidence, principles, theories, beliefs and values, to ultimately address the health needs of a population.

I believe best practices vary from individual to individual. Upon review of the IDM model one clearly sees that the domains do not function in isolation of one another but are instead influence by one another. Furthermore, we as individuals have different interpretations of the environment, different understandings and/or views of evidence, practice and health promotion values/beliefs. We vary in how we see organizational issues and our understanding of such factors. Taking this into consideration, it is my belief that what one individual may see as best practice (taking available evidence and attitudes and beliefs etc. into account) will vary from another individual's ideal of best practices because of their differences in understanding, experiences with, and interpretation of their internal and external environments.

main interests outside of work and best practices
My main interests are my family. We have two boys, Christopher and Marco, one almost five months old and one almost two and a half years. They are named for explorers because the characteristics that make up an explorer - the inquisitiveness, leadership ability, intelligence, adventuresome and boldness - are ones I would like to see in my children. Also we chose them because my wife is Italian, she wanted an Italian name - hence the name Marco.

This profile is based on an interview with website editor Barbara Kahan. For more detail about David Groulx's thoughts on using a best practices approach, see his reflection.

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October 2006 Profile of Josephine Pui-Hing Wong (Part I)

Josephine Pui-Hing Wong is Health Promotion Consultant, Planning and Policy, Toronto Public Health, and Community Researcher and Consultant, Hong Fook Mental Health Association. She is also a doctoral candidate with the Social Science and Health Program, Department of Public Health Sciences, University of Toronto.

work focus

I have been working in public health for more than 15 years. I have always worked in sexual health, including counselling on the AIDS-Sexual Health InfoLine, STI [Sexually Transmitted Infections] case management, frontline sexual health education and promotion, research and policy development. Right now, at Toronto Public Health, one of my key assignments is using social marketing as a strategy to reduce chlamydia infection among youth.

In Toronto, the rates of chlamydia infection are highest among youth aged 15-24; however, chlamydia does not affect all youth in Toronto equally. Geographic mapping of chlamydia rates suggests that the rates are highest in a number of priority neighbourhoods. To develop effective sexual health promotion, we need to gain a better understanding of the factors influencing the sexual health of youth from different locations and contexts. Thus, last spring, we conducted 5 focus groups with 49 young women ages 16 to 19 and 19 to 24 in focus groups to explore their knowledge of chlamydia and experiences in accessing sexual health care, i.e., where do they get sexual health information, who do they see for sexual health care, what is their knowledge of chlamydia and testing, what ideas do they have about an effective social marketing campaign? We also did a study with physicians to explore their current chlamydia testing practices, and to identify key influencing factors that promote proactive testing among physicians. Although the research required a lot of time and resources, we felt that it was very important; we were able to use the research findings to guide the development of the social marketing campaign, which will first target physicians and then youth. For me, best practices require the use of evidence that is inclusive, i.e., going beyond the published literature to include voices from local stakeholders and clients whose life is affected by the specific health issue. I also believe that programs and strategies must be relevant to and reflect the reality of our target populations.

Another project I am involved in is a community-based research project that focuses on access to mental health services by immigrants, refugees and non-status people living with HIV-AIDS [I&R-PHAs]. As a co-investigator, I worked with a team of researchers from different disciplines to develop and implement a study that is underpinned by the principles of health promotion, access and health equity. The research is one of the many projects carried out by CAAT [Committee for Accessible AIDS Treatment], a coalition of more than 20 agencies - hospices, public health, AIDS service organizations, community health centres, etc. In the past, CAAT has successfully lobbied for HIV medication access for PHAs who do not have health benefits and do not have access to HIV medication.

This CAAT research project explores the experiences of I&R-PHAs in accessing mental health care. Specifically, we want to explore how I&R-PHAs define mental health, their self-identified mental health needs, and their experience with mental health care. We are also exploring the knowledge, attitude and practice issues faced by service providers. Findings from these two components will be used in conjunction with existing knowledge on health promotion and best practices to develop an inclusive service model, defined collaboratively by the I&R-PHAs, service providers and other stakeholders. Again, this research project will demonstrate the importance of community-based "action" research that upholds the principles of meaningful and equitable participation of people affected by a health issue (in this case, I&R-PHAs). For me, this type of inclusive research is key to community empowerment and is an example of best practices.

For me, research and practice are intertwined, not only because they inform each other in a best practice cycle, but also because of how we experience our work. I am a co-trainer in a peer leadership training programs organized by the Ethnocultural Treatment Support Network [ESTN], which was also "born" out of the advocacy work of CAAT. The peer leaders are PHAs from diverse cultural and language backgrounds, social status, and sexual identities. The two key components of the training are treatment information and peer support counselling. We know from research that knowledge of HIV treatment and medication is essential for effective self care among PHAs. We also know that the mental health of PHAs can also affect their ability to manage their HIV related illnesses and their adherence to HIV treatments. Thus, the training program integrates both elements - the participants gain knowledge of HIV and HIV treatment through presentations, group discussions, and self-directed learning; they also receive training on communication, peer counselling, leadership and collective actions. The "peer-to-peer" philosophy is important as each of the trainees can provide support to other PHAs within their own community, using not only intellectual or scientific knowledge, but also their own lived experiences which are invaluable.

Personally, when I interact with the peer leaders, I am touched by their vulnerabilities as well as their strengths, their genuine care for each other and their collective spirit. Every time, after a training retreat, I feel reenergized and reaffirmed - feeling the pain of the peer leaders' suffering related to social discrimination and injustice, but at the same time, gaining new insights about humanity, hope and the power of our interconnectedness. I am also grateful for the opportunities to work with colleagues who share similar values and vision. I learn so much from them.

PhD thesis focus
My doctoral research will focus on youth and sexual health. There is a relative lack of research on adolescent male sexuality and sexual practices. I feel strongly that unless we have better understanding of young men's perspectives, we won't be able to identify effective strategies that promote young men's sexual health or the health of their sexual partners. This is particularly important for heterosexual young women. So, I hope to explore the identities of young men, not just sexual but cultural identities, and how they affect their sexual practice. I want to explore these issues through a sociological perspective. Public health epidemiology data shows that youth in some neighbourhoods have much higher rates of gonorrhoea and chlamydia - my goal is to understand why and identify the possible explanations; for example, how does class and gender affect sexual practices. Most of all, I want to do a study that will become useful in guiding our sexual health promotion practices, not just another just another thesis sitting on a library shelf.

This profile will be completed next month. For a reflection by Josephine Pui-Hing Wong, where she provides her definition of best practices, click here.

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November 2006 Profile of Josephine Pui-Hing Wong (Part II)

Josephine Pui-Hing Wong is Health Promotion Consultant, Planning and Policy, Toronto Public Health (on educational leave as of November 8), and Community Researcher and Consultant, Hong Fook Mental Health Association. She is a doctoral candidate with the Social Science and Health Program, Department of Public Health Sciences, University of Toronto.

Comments on best practices
I would define best practices as policies, programs, services, activities and actions that are equitable, inclusive, responsive and effective. Here I use "best practices" as a single holistic entity as it is a set of coherent practices. Best practices is a cycle of "actions-reflections-actions." When I was working with a team of colleagues to develop our practice framework, I was delighted to see that best practices as outlined in the IDM is grounded in a number of fundamental principles. The IDM made "explicit" the underpinning and domains of best practices. I thought, "Wow, at last, a model that explicitly identifies values, beliefs, and social and political forces as important elements that interact with and influence our practices." These underpinnings are often avoided, implied or kept invisible because of their contentious nature.

For me, best practices is inclusive and relevant to our diverse populations; it is realistic and dynamic with a critical understanding of the social, economic and political forces affecting the lives and health of our populations and our own practices; it stands on clear principles and values of social justice and health equity; and it is a cycle of practices that embraces ongoing evaluation and re-evaluation of our priorities, the way we deliver programs and services, and our accountability to our populations.

Involvement with best practices
In 2000, I was seconded to the Access and Equity Program at Toronto Public Health (TPH) to work with a team of passionate colleagues to identify ways to address health disparity in the context of our practices. The first step was to assess where TPH as an organization was at in terms of our practices, challenges, constraints and strengths. I was the principle researcher in this study. I was impressed by the enthusiasm of many TPH colleagues who participated in the research; they wished to contribute to our development of best practices. The study identified a number of key elements to guide organizational change - an overarching practice framework for all programs/services, access and equity policies, staff development and provision of resources to support the implementation of the framework and policies.

After we completed the development of our Access and Equity Policies, we embarked on The Path to Excellent Practice: Embracing Diversity and Building on Strength Project, with funding support from the Multicultural Program of Canadian Heritage. This project consisted of the development of a practice framework, the development of a staff training curriculum on diversity and equity, a set of toolkits for program planning and evaluation, and a communication campaign to promote awareness and influence attitudes within TPH. I was assigned to co-lead the development of the practice framework with my colleague, Caroline Wai, and a team of multidisciplinary colleagues in a reference group.

Our beginning step was to do a scan on what had been produced in this area. I reviewed different publications and text books on best practices related to public health, diversity, anti-oppression, access and equity, etc. During this time, TPH had adopted Health Canada's "Population Health Promotion Template" in principle. Our task was to adapt and transform this template into a framework that is relevant to the diverse urban populations of Toronto. When I came across the IDM, I thought, "Here is a model that has been developed based on comprehensive reviews of practice models and relevant materials. We shouldn't be reinventing the wheel or duplicating the efforts." So, Caroline and I worked closely with the reference group (through many reflections and debates) to identify and to extract relevant elements from these two models. We then integrated these elements with those gathered from our Access and Equity policies and related materials in this area to formulate a practice framework. The end product was a comprehensive framework with three core domains that are interconnected and mutually influencing:

  1. 1. Diversity dimensions: the diversity dimensions (gender, racial identity, class, citizenship status, language, literacy, education, sexuality, ethnicity, etc.) that make up the social reality and identities of individuals, families and communities within the power structure of our society.
  2. 2. Foundation of practice: the underpinnings that interact with and influence our practices (vision and values, goals, ethics and law, theories and concepts, beliefs and assumptions, understanding of practice context, core competencies and practice standards, determinants of health, inclusive evidence, etc.).
  3. 3. The practice cycle: assessment, priority setting, taking actions, and evaluation/research.

Main interests outside of work and best practices
My aspiration is to become a "political" comedian, i.e., put forth political messages on social justice and challenge social oppressions through comedy. I also enjoy gardening, which is an important way for me to let go of stress. Somehow, touching the dirt helps me to become grounded, and watching the cycle of growth and decay through the four seasons reminds me of my own mortality; it helps me to appreciate the here-and-now. Last year, I lost my mother to cancer, and I was in deep sorrow. A few friends got together to support me through meditation practices. Since then, we have established a weekly mindful meditation circle at my home. Meditation is another way for me to get in touch with the universe. I feel grateful and blessed.

For part 1 of this profile click here. For a reflection by Josephine Pui-Hing Wong, where she provides her definition of best practices, click here.

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December 2006/January 2007 Profile of Helen Thomas

Helen Thomas is Associate Professor with the School of Nursing, McMaster University (Hamilton, Canada), and a clinical consultant with the City of Hamilton Public Health Services for the Public Health Research, Education and Development (PHRED) Program.

current projects
I am on the steering and methodology committees for the national consortium for best practices in chronic disease and health promotion.

I continue to be excited about the
Effective Public Health Practice Project, which does systematic reviews of the effectiveness of public health interventions. The other project that I am truly passionate about - Community Access to Child Health (CATCH) - is a community development project in a disadvantaged area of Hamilton, where people come together and decide what they want and need, it's very exciting. There is an advisory committee - staff and community residents and other members - which decides actions. I'm co-chair. The staff that work there are wonderful. CATCH is about health in the broad sense, about the social determinants of health. It includes things like a parent-child drop-in centre and after-school programs. CATCH is also going to start a project for teens living in an apartment building full of drug dealers and gangs and shootings. It will be an evening program with mentors and tutors for the kids who are failing in school. Currently I am trying to get computers for this evening program. CATCH is something quite different than the academic projects I usually work on, it keeps me grounded.

I really believe that this kind of community development works, but it isn't popular because professionals find it hard to believe that people know what they need. We have to get beyond thinking we're such experts that we can tell people what to do. Very often people's identified needs are different from the needs identified by the professionals. For example, community members say they need jobs and nurses worry about whether the kids had their immunizations - although both are necessary, there is a big disconnect.

defining best practices
The problem about this whole area of best practices, definitionally and otherwise, is that there are a whole variety of different people involved with different backgrounds and different values and approaches coming at it from different perspectives. Sometimes to get on with things people duck the question of definition because we could probably spend the rest of our lives discussing it. In one group we came to some kind of definition but it was a huge compromise - but one that reflects the place and time that we're at.

I think my definition is that best practices fit with a community's values and with the evidence. I put a lot of emphasis on evidence whereas other people would emphasize other parts. I'm keen that we have a strong evidence base before we go on - others prefer to emphasize context. But both need to happen. Of course another lengthy discussion we could engage in for a couple of years is "what is evidence."

evidence challenges
I know how to do systematic reviews and I once thought putting them into a user friendly form would help policy makers use them. But this doesn't always happen. We need to incorporate those other factors that enter into policy making and practice, I'm not sure how to do that - we need to look more into qualitative evidence and maybe not such rigid methodology. Maybe we need to do a literature review about this. I'm not any less committed to rigorous research but we need to include more, we need to combine quantitative and qualitative, we somehow need to sort out a method of reviewing qualitative evidence. We need to figure out how to incorporate case studies - write ups from the community - into the evidence.

main interests outside of work and best practices
My family. And I like to ski down hill - I like the adrenaline rush. Also I am interested in social justice issues, I do a fair amount of advocating here and there. But trying to campaign to get something to happen takes hours of time and you end up talking to people you wouldn't otherwise. So things like that, I take them on one at a time - sometimes they succeed and sometimes they fail.

This profile is based on an interview with website editor Barbara Kahan.

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February 2007 Profile of Warren Linds

Warren Linds is Assistant Professor of Applied Human Sciences at Concordia University (Montreal, Canada).

current health-related project
I am working on a project with Aboriginal youth and healthy decision making. We will be using drama and a particular method called Image Theatre to explore what "healthy" and "unhealthy" decisions are and how they are made.

In Image Theatre "a picture is worth a thousand words." The idea is that people use their bodies to sculpt a representation of their experiences and then people outside this "image" interpret it. [This involves] a negotiation process of finding what the community interpretation is. I might go back to the "presenters" and say, "it doesn't sound like you have presented it clearly enough, can you tweak it to be clearer, again without words."

One of the constraints of working this way is that we need a longer period of time than just a one day workshop because we need to develop a sense of trust and safety within the group we are working with. We use a community development approach that starts with people's stories of their own experiences, the analysis of these stories and developing a plan of action to transform [the situation]. We call this the spiral model.

[Community development is] the only approach I know! [because] change has to be rooted in the people, rooted meaning heart(h)felt - in the "heart" and in the "hearth" (home). [Community members] have an expertise that I don't have, so it is a meeting of expertise. There is a wonderful book by David Turnbull called Masons, Tricksters and Cartographers where he talks about the practices and knowledge of western science meeting those emerging from oral cultures. It is in the meeting of the two there is something new that emerges.

I am also engaged in a project that will use online technology to help workshop facilitators learn from each other about workshop facilitation using this image process. Often this only happens when we work together or meet at conferences. One of the questions I am interested in investigating is how the context/community within which we work determines the nature of the activities we develop and lead in workshops.

defining best practices
[My definition is] practices that are appropriate to the context. I am quite interested in how one as an outsider comes into a "system" (what we call a community or organization) and figures out through the work itself what will extend the system or push its boundaries, albeit not too far. I remember talking to an environmental educator from Brazil who was studying in England and then went back to work with youth in southern Brazil. I asked her, "how did you make the necessary adaptations necessary for the new context?" She replied, "Well, the techniques had to change, we were in a different place, so the content was different." The methodology she had learned in England changed as she applied it in the realities of poor communities in Brazil. The method had to change in action. It then became easier to realize its potential and difficulties back in Brazil. This is not something you can plan, you have to be present and attentive in the carrying out of the work in whatever the context.

Evidence emerges in the work. Values do too...or a "decalage" between values and evidence. I like to think of theory/reflection or practice/theory as praxis. [Regarding a role for documentation of "evidence"] the struggle is how to use words to describe images! Sometimes people suggest the use of video tape. We are exploring the use of photos and websites to help practitioners engage in reflective practice.

applying best practices
[If planning a project with seniors using best practices] talk to the seniors! I have a whole model that starts with me reflecting on why I want to do a particular project. What do I know about this community or group. What are the gaps in my knowledge, etc. "Alternative solutions" are part of the process. The other night the group couldn't come to a consensus on an ideal society that didn't have discrimination! But what they came up with enabled questions to emerge. I try and be transparent with people I work with - so if there is a need to reconfigure, it is a matter of checking in with them.

main interests outside of work and best practices
Tennis! And cross country skiing. (I don't know if I play tennis to get in shape for cross country skiing, or do the skiing to get ready for tennis!)

This profile is based on a written Skype interview with website editor Barbara Kahan.

Click here to read a reflection by Warren LInds.


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March 2007 Profile of Hélène Roussel

Hélène Roussel is a health promotion consultant with Centre ontarien d'information en prévention/Ontario Prevention Clearinghouse (OPC). She is also a volunteer board member with Association des communautés francophone de l'Ontario - Toronto, Canada.

Note: MDI stands for Modèle des Domaines Interactifs, the French-language version of the IDM, Interactive Domain Model.

current focus of paid work
My focus is mostly with francophone minority groups within Ontario. I work on a wide variety of projects - mostly organizational development, program planning and evaluation. Since the resource centre I work for has a generic mandate, I offer a wide variety of consultation service (building successful partnerships using the MDI, volunteer management, community development, strategic planning, various models and theories in health promotion, etc.). I also do information specialist kind of work as I am in charge of producing Le Bloc-Notes (www.leblocnotes.ca), a French language health promotion e-bulletin.

I've been keeping my eye on research in the area of francophone health issues and how we can summarize that research and bring it to the front line workers. I try to make sense of it in terms of their every day work - what does it mean to them in their community? I'm thinking, for example, about research work done by researchers at the University of Ottawa on the vitality of francophone communities across Canada. This may not sound like health to everyone but it is so strongly related to health. Creating a healthy community is not just putting together lifestyle programs but all the things that compose what a community is about.

The last few years I have done lots of work on inclusion. For me, we should have an inclusion lens in every program we do. One day I got a phone call from a community worker who was looking for ideas on developing a physical activity program for francophone youth in eastern Ontario. Since soccer is the fastest growing sport amongst young Canadians, I suggested an asset based inclusive approach to the development of her program. The idea was to use the skills of African youths who are great at soccer to teach and coach born and raised franco-ontarian youth.

As a health promotion consultant my work is to bring people to start looking at the health of our community in an upstream manner. Therefore, I feel that we constantly have to ask ourselves some key questions. How did we create this problem? What were the conditions that brought us there? How can we influence those conditions? What new conditions need to be put in place to create health? How aware are we of the multi-dimensional aspects of the problem? How can we be more creative and innovative in our approaches? The constantly changing environment in which we have to perform our work demands that we develop strong reflective practice approaches which assist us in adjusting our strategies along the way.

using the MDI with volunteer work
In my volunteer work I am working in innovative ways, especially around inclusion. Right now we're building a program called Francophone Ambassadors of Toronto. We have been using the MDI for planning. Last year we did phase one and some of phase two - objectives to reduce the gap between the ideal and actual situation and a review of resources. We will look at the objectives again and maybe revise some. We are ready to move into implementation and find ways to finance the program.

With the MDI we're always asking ourselves what's going on with the internal and external environments. We asked, how can we start including all of those francophones in Toronto who are lost - some have been in Toronto 10 years and don't know what's going on in French. Yet we hear these people speaking French on a regular basis in the subway and other public spaces. Our idea is that we will recruit volunteers who will stop people on the street when they hear them speaking French, and create a database of people who want to be kept informed of what is happening in the community. This is innovative because we are using an interpersonal social marketing approach and we are creating an outreach program that has a strong sustainability potential since it won't be very expensive to keep it alive.

Another volunteer project where we are planning to use the MDI is our words academy project, a very different kind of French language school. In this project we are more at the first stage with the MDI, which is to start talking about values and identifying some theory and evidence-based research that will support the kind of approach we want to use. What we would like to do is bring children ages 7 to 13, who have one parent who speaks French and one who doesn't, into the school with the English-speaking parent on a Saturday morning. There are not a lot of family oriented possibilities to socialize in French in Toronto. We are trying to create an opportunity for the uni-lingual parent to socialize with the child in French in an understanding environment. The child will teach the parent to speak French, giving power to the child, and the uni-lingual parent will feel part of the solution rather than part of the problem of assimilation. There will be a feeling of belonging and empowerment.

At Association des communautés francophone de l'Ontario - Toronto (ACFO-TO) we have used the MDI from the beginning. [
Click here to see Hélène Roussel's reflection on the IDM/MDI and ACFO-TO]. It has helped us to be strategic, in the sense of being reflective. This reflective process is really part of the model. We don't use that much of the whole bottom part - we've adapted it by using a SWOT [strengths weaknesses opportunities threats] analysis. It is less complicated to understand and serves the same purpose. The key is where are we at, where do we want to go ideally. This is really fun when you start asking these questions. We are also planning to use the MDI for our next three years' strategic planning session at the end of March 2007.

definition of best practices
We need some kind of demonstration that there's a recipe here - if I put this ingredient and this and this in, it will create a cake and not a chicken. There has to be some evidence that things are linked together in a coherent way and that it works at the end. Also, it's constantly about values - first and foremost about foundations, about the first left quadrant of the MDI model. For example, there are all different kinds of cars. The best practices to build a car if we don't care what it's like as long as it's a car that runs, that's one thing - but if we want an environmentally friendly car that's another ball game. If you don't address that then you're travelling without a map - it may be fun and you may learn things but I'm not sure you'll accomplish what you want to accomplish at the end.

main interests outside of work
I love animals, they bring us into a different space. My beagle - Mocha - who is old and has quite a few health issues is a best practices also, I suppose. My pet has been diabetic for nine years, most diabetic animals don't last more than three years after the diagnosis. I'm a bit zealous with my doggie, I make him homemade food with lots of healthy ingredients - vegetables, algae, grains, legumes, meat and of course lots of love and hugs. Hey, I'm obviously doing something right here. He is old but still very happy and full of life.

This profile is based on an interview with website editor Barbara Kahan.

Click here to read a reflection by Hélène Roussel.


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April 2007 Profile of Barbara Kahan

Barbara Kahan is a self-employed consultant in Regina, Canada, a Member of the Centre for Health Promotion, University of Toronto, and editor of this website.

current focus of paid work
Currently I am working with several other people to develop the third phase of the Regina Community Plan for housing and homelessness. One person is interviewing front line agency personnel, a second is interviewing people who are homeless, and a third is collecting statistical information. A one-day community session is planned for the middle of April. Currently I am synthesizing the results of interviews I conducted with senior management and policy people, and then I will move on to synthesizing the results of the document review I conducted. After the completion of all these different tasks - mine and others - my role will be to pull everything together into a final report. I am delighted to be working on this project for a number of reasons. One is that I am always moved when I meet people who are passionately dedicated to improving conditions for people living in extremely challenging circumstances. Another is that I am always enthusiastic when working on projects that are directly related to addressing the determinants of health. A third reason is that I have been given the go ahead to use a comprehensive best practices approach - that is, the IDM - to frame the report. So, I have been having a lot of fun thinking and reading and talking with people about values, theories, evidence, the environment and practice.

current focus of unpaid work
I spend a lot of time on activities related to the IDM. Preparing this website takes on average a couple of days a month - interviewing people, which I always enjoy, for profiles and reflections; writing my jottings, which help me clarify my thoughts on different issues; searching for different resources; email correspondence with people who are contributing reflections or resources; and general maintenance of the website. Perhaps this is the place I should mention that if any of you reading this would like to contribute a profile of yourself or someone else you know who is working in the area of best practices and health promotion, public health or population health, or if you would like to contribute a reflection - that would be wonderful! Sometimes I do find it hard to fit this volunteer work in, especially when I am working on a contract with a tight deadline, such as right now. Another IDM best practices activity I am working on - with David Groulx and Josephine Wong in Ontario - is a chapter on the IDM for a book on emerging theories on health promotion. As part of the preparation for this chapter, as well as to collect information to improve IDM materials and processes, we have been conducting a follow up with people who have used or been influenced by the IDM, or who thought about using it but didn't. So this is where I mention something else - if you haven't already contributed your thoughts or experiences on the IDM for this follow up, please feel free to do so! I also spend time answering emails about the IDM and having best practices conversations with people. I feel very fortunate that I am still in touch with a number of wonderful people from the original Centre for Health Promotion Best Practices Work Group and the pilot testing sites.

using the IDM
I have used the IDM extensively in my evaluation work. I find it very helpful for structuring the evaluation approach. It is capacity building for organizations to reflect on values and beliefs and environmental issues and how everything fits together. And the IDM best practices evaluations contribute evidence which is as consistent as possible with the values base of the particular organization. For example, inclusion is a common value and the evaluations I work on make every effort to include the perspectives of the people the programs are for. The information that is collected based on the IDM approach has been useful in improving practice.

definition of best practices
It won't be a surprise to anyone that I use the Interactive Domain Model (IDM) best practices definition. In the IDM perspective, the best practices are those processes and activities that reflect health promotion or public health values/ethics, theories/beliefs, evidence, and understanding of the various organizational and health-related environments - and are most likely to achieve health promotion or public health goals in any given situation. In other words, there is no one best practice, best practices depend on a number of interactive factors.

main interests outside of work
I spend a lot of time with family and friends. I love to read and belong to a book club which meets once a month. I have weekly tai chi lessons, one where I am a student and one where I teach. I am lucky to have a great teacher and great students. I have recently discovered sudoku and Dance Dance Revolution, the most fun exercise I have ever had. I also spend a fair amount of time on my own writing projects such as poetry. And now that summer is fast approaching I am really looking forward to hiking out in the countryside which I enjoy tremendously. The picture attached is from one of our excursions to the south of the province - I am coming out of a cave at Big Muddy.

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May 2007 Profile of Catherine Macpherson

Catherine Macpherson is Product Manager for the LifeWorks division of Ceridian. She lives in Ann Arbor, Michigan.

work focus
LifeWorks is about balancing life with work, helping employees be healthier and more productive. It includes EAP (Employee Assistance Programs), financial and legal assistance, counselling, elder care, and child care. We deliver health and wellness coaching to individuals enrolled in worksite and health plan programs for weight management, smoking cessation, stress reduction and cardiovascular health. We will be adding more products.

The health coaching is mostly on the telephone, although there is also online coaching. Most programs last for a year and the coach works with the same person through that time. A lot of people are ambivalent about change, "I want to lose weight but I don't want to give up ice cream." The coach will help the individual overcome their ambivalence, find their own motivation, and work towards their goals. The individual owns it, the coach just asks probing questions: why do you want to quit smoking, if you didn't smoke how would it feel when you wake up in the morning, what would you do with your time, how would you cope with stress, what is the role of smoking in your life, what are your values related to it, what would the new values be without smoking? Asking the right questions, helping the individual do some thinking - coaches use appreciative inquiry, stage of change theory, motivational interviewing techniques. It's very non-judgemental, coaches meet people where they're at.

There are two new projects that I'm working on. One is on cardiovascular health, to avoid heart disease - to help people improve their blood pressure, cholesterol, and glucose measures. If someone has type 2 diabetes, on average they get heart disease 15 years earlier than others. The second new project is a family program that will focus on preventing childhood overweight. A lot of participants asked if they could sign up their children or adolescents - we're creating a program for families where they can talk on the phone with a health coach - about ways to be physically active together, how to model healthy behaviours for children, good nutrition - giving quick healthy ideas for eating, ideas for getting children involved.

defining and using best practices
In best practices your approach to practising something is based on evidence if that's available. If evidence isn't available, look at case studies or your own experience. As I've learned from the IDM and through broadening my thought, practice has to align with our beliefs and passion - it is hard to have a best practice without passion.

Using a best practices approach is like cleaning your house - you feel so organized, there's more meaning to your work when you have a best practices approach overlaying everything you're doing. The IDM was great for our organization.

main interests outside of work and best practices
Outdoor activities - hiking, jogging, skiing. A favourite is to come home and play soccer with my kids, they're four and a half and six and a half years old.

This profile is based on an interview with website editor Barbara Kahan.


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June 2007 Profile of Anne Luke

Anne Luke is the founder and former executive director of the Regina Early Learning Centre in Saskatchewan, Canada.

work focus
At the moment I am transitioning out of the job I've held for 29 years. My role has changed. I still maintain some work with the preschool such as professional development work with staff, consulting with the leadership team and some committee work. I sit on the United Way's early childhood impact table, which is exciting because we're trying to grapple with nitty gritty issues such as how to streamline families' access to programs and how to engage more players. Rather than continuing to speak to the converted we're planning strategies around how to reach the business community and spread the word that the whole community benefits when early learning and healthy child development are given the support and attention they need. Anything to do with early childhood and professional development in that area is inspiring to me.

At some point I will have to put all my attention to the capital campaign I am designing for the Regina Early Learning Centre. The building we inhabit is up for sale. We hope to raise a million dollars to purchase and renovate the building and set up a fund for maintenance and capital expense. I've been trying to look at what the important elements were when the Centre began and frame the current campaign that way, for example what collaborations were needed then and what different collaborations are needed now. There are similar patterns. It's a large sum to commit to raising and it's a steep learning curve for me but I'm trying to frame it as an invitation to join in the important work we do in the low income community. There are many good people giving me advice.

We're a small local organization as opposed to a provincial or national one. We don't have strong links to the corporate sponsors, the people capable of making significant gifts. We need to bring them on board and create an understanding that they've got money to give but, at the same time, we have something important to contribute too - our work in making Regina a better community. We also have a strong track record in the community for our innovative approaches and fiscal management. I'm hoping different levels of government will step up to the plate as well as foundations and corporate and private donors.

defining and using best practices
I think best practices are a code to live by. Generally it means looking at the context of the whole and aligning what you do with principles and values. From a social justice foundation it means understanding people's history, where they're coming from, what they're facing, what they have to share and what I have to share too - what we can learn and put into practice and then reflect on. Things don't stay the same, new people come along, we learn from what we do. You constantly have to revisit what you do in light of what we know now - the knowledge base changes. The knowledge changes but the basic principles - respect, mutuality - stay the same.

Adjusting our work based on reflection - that's where our "plan-do-reflect" cycle is useful. When someone says "we're doing enough or too much already, there's no room for change" - they're already dead in the water. Life changes, grows, moves on. I've always seen that as my job - to plant the seed, ask the question that guides people to reflect on what they're doing, give it time, and eventually they claim change as their own if given the opportunity to reflect and test things out and engage.

A university student once asked what early childhood method we follow - Piaget? Montessori? I answered that we draw on Piaget, Montessori and others, and then we put it together for ourselves and create the approaches that work here, in our community. We acknowledge the research out there and what's applicable to our situation. We see existing knowledge as useful but we have a hand in creating knowledge too, with what we've gathered and reflected on.

Best practices happen if all stakeholders are aware and buy into ideas and feel they have something to contribute. With input from all stakeholders, it becomes the touchstone against which you measure what you are doing. To me it's the first thing you do, get people involved. There's an assumption that if people are poor they don't have anything else to offer. We've found they have so much to offer. Parents have good ideas - I've learned so much from them.

main interests outside of work and best practices
A blend of quiet reflective nurturing things and active things. I love classical music, art. I'm a member of a book club, I attend the Globe Theatre. I love discussing ideas, gardening, tai chi lessons when I get there. I have grandchildren I love. And I love walking in quiet places such as Wakemow Valley in Moose Jaw, finding quiet beautiful places to walk and reflect is something I enjoy.

This profile is based on an interview with website editor Barbara Kahan.


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July/August 2007 Profile of Lana Phillips

Lana Phillips is a Policy Analyst with Housing Policy and Program Services, Community Resources - Housing Division, Government of Saskatchewan.

work focus
Generally we write housing policy. We've just announced our new housing programs, right now we're trying to finalize the program details. I also have my regular business to take care of - I do homelessness work, housing market need and demand studies, briefings for the Minister on various topics including preparing for the legislature. I have worked on special projects with Canada Mortgage and Housing Corporation (CMHC) helping them select research projects for their External Research Program (ERP). I was also on the selection committee for the CMHC Housing Awards for best practices for Canadian affordable housing projects. Working with CMHC was a wonderful opportunity. I met with housing experts from across Canada and learned about their areas of research and their priorities for the future of housing development related to the physical unit, the environment, the economy and social outcomes.

I like the homelessness work [with the Regina Homelessness Committee] the best. I enjoy working with people in the community and am inspired by their ideas, challenges and enthusiasm. Otherwise research and policy work could be just me at the computer with the internet and data from Statistics Canada. I like the opportunity to connect with people in the community, to work with the municipality and CBOs (community based organizations) and individuals and to make links with colleagues at the Department of Community Resources (DCR).

In the past Housing Division didn't necessarily have clearly stated social goals. Now that we're part of the DCR we're trying to achieve social outcomes and trying to meet the Department's goals. For example, one of our goals is retargeting the housing portfolio to those with deeper needs. Many of these people are DCR clients who have unmet housing needs. Housing Division does not provide supports. We partner with agencies which have the mandate and resources to provide services. As these partnerships are created the deeper need clients can be housed.

A policy question that arises with homeless people is: Do we take a "housing first" approach or a continuum approach where they achieve independence first before moving into permanent housing? Do we choose one approach or the other or a blend? I am reviewing current studies and consulting on this topic to recommend a policy direction. One of the findings is that it's really hard to find support services. So even if we have space for the deeper need tenant where does that person get the services if they don't exist? The system has to be there and the services have to be dependable. There are other issues involved too. For example, housing may have to change the nature of the properties that it holds. Right now we house mainly families and seniors - we can't place high needs individual with multiple problems such as addictions and a history of incarceration in a unit next to a single parent family where the kids are home alone after school. Safety and community continuity will be maintained. We can purchase or build new rental housing that can accommodate these high needs singles.

link between health and housing status
In the past we didn't have hard data on the impact of housing on health beyond knowing there seemed to be a link - for example shelter/housing is one of the basic human needs identified by Maslow's Theory. In the last five years the link between housing and health has been statistically validated. This is one of the key pieces of information we use to qualify the importance of good quality housing, it's a clear indicator we can point to. If having good housing can contribute to good health, then being homeless must be right off the scale in the other direction.

defining best practices
We use the information from evaluation studies across the country to ensure that we get the best outcomes for the amount of money spent on programs. There's a variety of sources of dependable information available now with the internet and with more groups doing better reviews with their programs - we need to ensure that we're using the most current information for program decisions. I would include qualitative as well as quantitative information in evaluations, both are necessary.

nature of involvement with best practices
When I first worked for the City of Regina one of the projects I was given was developing a plan to implement "managing by results." This was the first time I had thought about policy in that way - about looking at outcomes and what steps to take to achieve those outcomes, and then evaluating to see if we were achieving the outcomes.

At Housing Division we try to create programs and types of approaches that could best meet our policy and program objectives given the resources that we have. We do some of our own evaluations to find the outcomes of our housing programs and I also review the literature to make sure we're going in a direction that makes sense. Our main best practices sources for decisions on how to approach housing is literature, mainly from CMHC, but also from Housing and Urban Development (HUD), the American equivalent of CMHC, and from Great Britain and Australia. While my current job does not involve designing statistical evaluations, I do identify information that I think would be legitimate based on my knowledge - "this study is legitimate because they've done x, y and z and we should consider this as a policy." I look at study design, outcomes and whether the program is relevant to our work - the nature of the population, do we have that problem here.

We're trying to become a leader in best practices as well and provide information on the outcomes of our approaches to others.

comments on using a best practices approach
CMHC has an excellent library of materials on housing for people to refer to - written in a short form, easy for people to get through. I would say for people in university it's really important to take those statistics and research classes, that will get you a job in government if that's what you're interested in. It's important for non-profits to have work evaluated and show that their work is making a measurable difference in the lives of their clientele - although I know it's costly and hard to work into everything else that non-profits have to do. But it's the way of the future - the only way governments are going to provide funding for their programs and third party programs is if they can show they are achieving appropriate outcomes for their clientele.

main interests outside of work and best practices
My family. We have one son and one daughter. We go on bicycle rides, attend sports events and music lessons and school activities. I also love gardening.

This profile is based on an interview with website editor Barbara Kahan.

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September 2007 Profile of Dave Hedlund Part 1

Dave Hedlund is Executive Director, Mental Health and Addictions Services, Regina Qu'Appelle Health Region (Canada).

work focus
I would define my role as having three parts, or areas of emphasis. One part is administrative oversight-the management of existing programs, making sure that the environment remains one where qualified people have what they need to do their work well. Then there is the developmental emphasis where we look at gaps and shortfalls in our own service system - areas where things should be better, and we attempt to find or allocate the resources to meet the needs as they become apparent.

The third emphasis involves collective effort in the larger community, or in the human services community. To use an urban analogy, there are often "green spaces in between surrounding buildings" which are no one agency's "property" and no one's clear responsibility. Yet when approached collectively, they may become common ground where important progress can be made. Put another way, some things seem to be no one's business, yet they are everyone's business - they actually affect the need for, or the ability to respond well to the service mandate of many different agencies.

The determinants of health can be seen this way. Some of the same factors that determine health also determine lower crime rates, success in school, employability, and the many other things that make for a high quality of life. These are no one's sole responsibility but all human service organizations, governments, and the whole community really have an interest in and a collective responsibility for promoting them or ensuring they are present.

This third area of focus and activity needs to happen within a larger community, and cannot typically happen effectively within an organization. I think that being a leader in a human services agency comes with the responsibility to collaborate and provide leadership in this "green space" where successful communities are formed and nurtured. We may be family members, but we are citizens too.

initiatives most excited about
I'm excited about the early childhood development initiative that began here in 2001. I'm also encouraged about the successes with the Regina and Area Drug Strategy that we've seen, as it has been supported in Regina and elsewhere by the Premier's Project Hope initiative. There has been new funding and support for some of the ideas Regina people thought were important for the community related to addictions and its impact. I'm excited about the recent establishment of the Mental Health Commission and what seems to be a growing awareness of the burden of mental illness on individuals, families, communities and the country. I think people are starting to see how profound the impact of this actually is on all of us. This is good to see.

Our community now has a lot of experience with successful interagency initiatives. Building upon this success, we are beginning to gather various human services agencies together to talk about the determinants of health, and how we could establish a broad strategy to ensure these determinants are fostered and maximized. It's too early to tell, but I am optimistic about where this could lead us. The Regina Qu'Appelle Health Region has revised its key directions and one of these clearly states our board's support for work and leadership of this kind. I'm anxious to see how we do with that in the years ahead.

main interests outside of work and best practices
I have an interest in governance in the non-profit sector. I've been active in the leadership of the South Saskatchewan Youth Orchestra, my church, and I'm half way through a two year term as chair of the Regina Symphony's board of governors. I do quite a lot of physical activity - walking, swimming, some roller blading and also some canoeing. A couple of summers ago I rigged my canoe for sailing which worked pretty well, and is a lot of fun. I do as much reading as I have time to do. This summer my family gave me an IPod and I've now entered the world of iTunes and podcasting. It's great to have a choice of documentaries to listen to while I walk. The music is great too, of course. We have done a fair number of home construction projects, but lately I've gotten more involved in gardening. My wife and I like to travel, especially in BC and Atlantic Canada. Our three children are going to, or finishing university and are still at home. They are good company, and it's good to spend some time with them too.

This profile is based on an interview with website editor Barbara Kahan. See October's website monthly features for Part 2 of this profile.

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October 2007 Profile of Dave Hedlund Part 2

Dave Hedlund is Executive Director, Mental Health and Addictions Services, Regina Qu'Appelle Health Region (Canada).

defining and applying best practices

I often hear the term "best practices" in the context of my mental health and addictions and other service environments when program changes enhancements are being considered. I don't usually hear the term or use it myself when considering strategies for change in systems, although I think the approach we take in those situations is consistent with a best practices approach too.

A best practices process usually comes into play when there is some kind of gap or opportunity or some suggestion that a gain or improvement could be made. First, someone has to find out what's going on elsewhere. You spend some time finding out what the literature says - what thoughtful, well informed people who have documented their experience have to say about that topic. Then you have to talk to people in various parts of the world where they are dealing with a similar challenge and have found ways to deal with it. Then if you can, you should visit places where the most promising results have been achieved. Without the research, you don't know if you're naively going down a trail that's already shown to be unhelpful or ineffective somewhere else. With this information in hand, you then have to sit down with a group of people and figure out how all of it applies to the uniqueness of your own circumstances - how it can be adapted to conditions in your own part of the world. The next steps are to develop a plan, implement it, monitor and evaluate it.

Taking action this way is a common sense kind of thing really, when you think about it. You do it as a natural process with a small house renovation, or a back yard gardening innovation. You ask what the problem or potential improvement is, you ask what's known or can be found out about how others have resolved it, or done it. With that in mind, you, make a plan and carry it out. You evaluate it too, usually in an informal way, and if you need to, you change it. It's how a normal, thinking person lives life - adapting and bringing about change in their environment.

Implementation of a good practice in the human services, or any other environment, is not necessarily simple though. You need the right people, enough time and money, and for many things, a place where the activity can happen. When a plan or project is too complicated to keep it all in mind at once, trouble results if good project management skills aren't available or used. We can end up late, over budget, or even with something different from what we wanted because of a poorly executed plan.

Over the years I've been on the steering committees or implementation teams for many initiatives where we have followed the best practices steps just outlined. Someone experienced in program development writes a proposal based on the initial research piece - based on the literature review, and on conversations with people from other places. The reference group guiding the initiative then helps to refine it, making sure it is a good fit for the local circumstances. When the plan is complete, and if you have the money, you advertise, hire good people and start implementation.

To give some examples, we used a process like this when we developed the Adolescent Psychiatric Unit which was opened at the Regina General Hospital in 2004. Another example was the Transitional Care program for people with mental health conditions, established not quite a year ago, which makes supports available to people leaving our psychiatric hospital. Another was the Secure Youth Detox facility in 2006, but it evolved a bit differently from the others. In that instance, we knew about good practices for components of the program and related systems - residential youth care, detoxification, and design of residential care facilities - but a mandatory youth detoxification function was based in new legislation, and had not been done in any other jurisdictions. We took the best practices knowledge from various sectors and used a project management and design approach to do the best we could, given what we knew.

The best practices approach has become very widely accepted, and has been part of the thinking of any major project in which I've had a part to play for a long time now.

I think of a vision as what a person or a group thinks they are working to achieve, with clarity about why reaching the goal matters. Establishing a vision is critical, especially for initiatives where multiple organizations are involved. This was illustrated well during the implementation of the KidsFirst program in Regina [a comprehensive home based support program for families with young children living in challenging circumstances]. People in the city had known for years that we needed a targeted early childhood development program in the community, and had hoped it would become a reality. When provincial funds became available, the province's program guide had a set of defined program components and structures which needed to be built upon and which were consistent with the local vision setting work which had set out what we thought was needed for children 0 to 6 to get a good start in life. In the case of the Regina and Area Drug Strategy, we spent a number of months, and talked with hundreds of people, and eventually, produced a document which consolidated the advice and various perspectives which had been documented. The result was a broad action plan. We brought everyone together to talk about it and because of how it was created, it was readily endorsed. We have reviewed it about every 18 months to see if the set of things we are working on remain the priority issues and projects. For the Drug Strategy, we have used repeated strategic planning processes, professionally facilitated, as a means of developing and reinforcing a common vision.

It seems to me that our principles aren't always explicit and I don't know if they always need to be. Different professions and sectors have strong values, ethical principles and priorities which are part of their organizational and professional culture. They "go without saying." When you have worked over the years with groups and individuals with common perspectives you don't usually get into difficulty as a result of differences in values. It's because you have confidence in their integrity and know their intentions are good, even though you have some differences. You have been through a lot together and you know who you're dealing with. Common perspectives are created when people respond to situations collectively, from a base of common values. With a fair bit of experience in successful interagency projects, colleagues get to the point where they don't need to spend a lot of time sorting out assumptions. But when you are in a position of hiring new people, or bringing in new partners, you do need to have the conceptual underpinnings clear. In a treatment program, for example, a manual that outlines the philosophy of treatment and at a very basic level, what values apply in dealing with the people in the program is important. Generally, the less common experience and history we have with people we're working with, the more susceptible we are to being surprised or set back by newly discovered values or interests which come into play. Spending some time to sort out first principles with newly formed groups saves time later on.

See September profile in these archives for Part 1 of this profile.

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November 2007 Profile of Rosanne Glass

Rosanne Glass is executive director of policy, evaluation and legislative services for the government department Saskatchewan Learning.

relationship of education to health

Education is such a critical determinant of health. We really need to understand the broader factors that influence health in order to achieve long-term health goals. For example, we know that better social and economic conditions mean better overall health. Education is key to this process - from understanding the critical importance of early childhood development through to the health consequences of income, and a focus on social justice - locally and globally. Education is part of any excellent prevention strategy. And at the heart of many education processes is empowerment of communities. Authentic community development approaches will produce the most effective outcomes.

current work focus

We've begun to take a good hard look at rural and remote education now that restructuring of school divisions is complete. This has really preoccupied government and the education sector for the last five years. It is the most major educational restructuring since 1944. The number of school divisions has gone down from 82 to 28. Now we are getting on to more focused policy issues. The central policy question related to rural and remote education is how to ensure equitable access and excellence of opportunity for kids in remote areas, given the huge change in the landscape. The introduction of e-learning and distance learning can have a major impact.

We are looking at funding and curriculum delivery models, and turning over every stone to ensure best practices get into every policy. We are in the information gathering stage right now. We started with an international literature review and are doing a review across Canada to see what other jurisdictions are doing. We will also have important conversations with stakeholders across the province.

A major stakeholder group is Aboriginal communities, on and off reserves. We have a Memorandum of Understanding [MOU] with FSIN [Federation of Saskatchewan Indian Nations]. This MOU is quite groundbreaking, there is nothing like it elsewhere in Canada. It is an agreement to engage with each other at the ground level rather than using the traditional white European model to develop plans and then lay them on the Aboriginal community. So we will be doing a lot of on- and off-reserve engagement.

We will also talk to directors of school divisions, principals and teachers. We will also talk to the RICs [Regional Intersectoral Coordinators], to parents and to youth. We already have a youth advisory committee set up.

most exciting projects

I am most excited by projects that involve youth engagement and youth development. I am fortunate to work in areas where we can use processes that really engage youth no matter what the topic is. I feel really good about that. The years I spent developing community schools was so rewarding that way. It's an area that really excited me and continues to excite me. I work with people that have serious expertise in youth engagement; they really walk the talk. I've learned so much from that. The groups out of Saskatoon that help are connected with the National Centre Of Excellence for youth engagement; they are really up on the latest best practices.

main interests outside of work and best practices

I like nature and spending time with family and friends. I like music, reading, chi gong, and cooking. When I have time I like to experiment in the kitchen, try new recipes. And I like a darn good adventure movie!

This profile is based on an interview with website editor Barbara Kahan. See Part 2 of the profile on Rosanne Glass in December.

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December2007-January 2008 Profile of Rosanne Glass Part 2

Rosanne Glass is executive director of policy, evaluation and legislative services for the government department Saskatchewan Learning.

defining and using best practices

Best practices are probably something many people intuitively strive for. I believe best practices should evolve for the time and context, and never be frozen in time. Evaluate them, alter them as you go along, make changes as needed; use that continuous renewal process all the time. Best practices require engagement with a broad group of people to get many perspectives on whatever the item or topic is. It's also having an evidence base; part of that might be a research approach where you take the best of the international literature and modify it to local conditions. In our case we "Saskatchewanize" the results. Of course any policy or practice has to be grounded in a core set of principles. It's also important to leave room for innovation and risk taking. There needs to be a culture of practice where a degree of risk-taking is acceptable, where you can try something new and learn from it. If it didn't work, examine why, and apply the learnings to the next initiative. It worked - great! It's part of the construction of new knowledge and practice.

addressing best practices challenges

Working in a structured system like I do, there are many time constraints. Sometimes you need to see if you can negotiate the time line; if you don't think it's doable. I make sure I communicate each step of the way to the deputy minister who might be able to intervene with extra supports, resources, or give me permission to not focus on other things. Communication is really key.

Developing trust relationships is key when working cross culturally. Relationships are so key; nothing will move forward until you spend the time developing trust and understanding. Best practices require attention to people, to the human element, whatever the situation.

One of the challenges, and also the richness, of using a best practices approach comes from finding the ground between opposing views. What is critical is the process that's used. Make sure that everyone is heard and feels heard, that everyone is truly engaged, and that everyone comes to an understanding of all the perspectives. Even if some people don't agree with the final decision they at least understand where it comes from. In smaller groups I find the Aboriginal practice of talking circles very helpful. I also like to use a talking circle at the end of meetings in order to express how our hearts are connecting to our work.

This profile is based on an interview with website editor Barbara Kahan. See Part 1 of the profile on Rosanne Glass in the archives.

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February 2008 Profile of Ursel Broesskamp-Stone

Ursel Broesskamp-Stone, Dr.PH, MPH, is Senior Policy Advisor and Head of International Affairs, Health Promotion Switzerland.

current work affiliation and focus

I live in Berne, Switzerland and work at Health Promotion Switzerland, the Swiss national organisation for health promotion. Our foundation has two offices, one in Berne (German speaking part of the country and the capital city) and one in Lausanne (the French speaking part of the country). We are a rather small organisation with about 30 full and part time staff members. As a public foundation we are a body close to the government but not governmental (the strongest parties on our executive board are the health insurance companies and the "cantonal"/provincial governments).

In 2007 I became "senior advisor policy" while remaining "head international affairs." From 2004-2006 I headed both international affairs and the work area "evidence" - the letter receiving only 30-40% of my time. However, our organisation's work on "evidence" was started as a work domain complementary to an existing domain on "quality and evaluation" in health promotion.

I am very happy that in 2007 our organisation finalised and published its "best practice" concept. While developing it, we went through two major re-organisations which delayed some work. Currently we are working towards implementing the best practice approach, also as an overall policy in our organisation. In some work areas it has already influenced our work and that of our partners; in other work areas, not at all yet.

As head of international affairs I represent our organization at the international level. We are active members of the IUHPE (International Union for Health Promotion and Education), the European network of national agencies EuroHealthNet, and the International Network of Health Promotion Foundations (INHPF). We are very happy to contribute to the international field of health promotion, to learn from others and participate in knowledge exchange. With a view to the work on evidence and best practice, the technical exchanges and collaborations internationally allowed us to learn and progress much quicker that we would have otherwise - a crucial point in light of very limited resources of the time.

definition of "best practices"

We defined best practice as follows:

"Best practice in the context of health promotion and prevention means systematically taking into account the values and principles of health promotion and public health, building up on current scientific knowledge and knowledge from experts/from experience, observing the relevant context factors and having achieved positive effects in the sense intended."

developing a best practices approach

The main issue in 2003 was to get the evidence issue on the agenda of our organisation. We were very advanced and focused on quality project management and evaluation; however, the latter started usually with reflecting on the quality of the formulation of goals but did not usually ask whether the goals set and the planning of the activity matched or were based on up to date knowledge or the evidence base.

Thus, with quite limited human resources we started to clarify our view on "evidence-based health promotion" in a few small workshops with international colleagues. From that, we - i.e. myself and two members of the senior management board - shifted to a best practice approach [see note below for more information on this approach]. We were inspired and encouraged to do so also on the basis of the Canadian work on best practice. We appreciate the exchange with Canadian colleagues to date.

Since autumn 2007 our senior management board has completely changed. The same applies to the whole organisational structure. Regarding "best practice" my own emphasis right now is to make sure that also in the new organization there is recognition for the best practices approach for health promotion and disease prevention. Ideally, it will be taken as an overall policy frame for the technical work of the organization.

impact of best practices on work

My own work hasn't changed much because the whole approach grew with me and in me over the years. The evidence and knowledge base (scientific and from experience); the values underpinning health promotion and public health; and the particular context - it's natural for me to consider all those dimensions when I work on anything. However, today, these considerations are more systematic, explicit and refined.

interests outside of work and best practices

Family activities are first beside my work. Particularly I try to spend (and wish to spend even more) time with my 8-year-old daughter - playing, reading and outdoors. I am a hiker and walker and strive to spend more time "outdoors," but my family so far is not very involved in that. "Feldenkrais" (body work), jazz music and contemporary art and painting are important sources of joy and wellbeing.

Note: For more details about the best practice approach Ursel Broesskamp-Stone has been working on in Switzerland, click on one of the following links:

This profile is based on an email correspondence and interview with website editor Barbara Kahan.

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March-April 2008 Profile of Nina Jetha

Nina Jetha is the Lead of the Canadian Best Practices Initiative, in the Public Health Agency of Canada's (PHAC) Evidence and Risk Assessment Division, Centre for Chronic Disease Prevention and Control.

home over the years

I arrived in Ottawa at the age of four, from Kampala, Uganda. I also spent a number of years in Montreal where I did my undergraduate and some early graduate work, worked for a number of pharmaceutical companies doing market research and developed a passion for fashion.

current projects

I have been working in the public health field since the year 2000. My career in public health started at Health Canada, in the Population and Public Health Branch, and since 2003, I have been working in the PHAC as a Project Analyst and now a Manager for a National program, the Canadian Best Practices Initiative (CBPI), which consists of three components: a web-based Portal through which best practices related to chronic disease prevention and health promotion can be easily found, a knowledge exchange component that supports the building of capacity in those considering the use of these best practices, and a commitment to monitoring what happens to these practices when adopted or adopted in a Canadian setting.

A big part of my role is to engage the right internal and external stakeholders at the right time and to foster and build the network of stakeholders in the area of best practices pertaining to chronic disease in order to to learn what others have done in the area of chronic disease prevention and build upon it. This part of my job has been the most rewarding for me - I can't believe how much commitment and support we have from our partners.

I am very excited about this phase, phase 2, of the Canadian Best Practices Initiative. In this next phase we will be expanding evidence to new thematic areas, such as obesity prevention, social determinants of health, and mental illness prevention, which will give me the opportunity to work closely with other Centres and Divisions across PHAC such as the Centre for Health Promotion and Strategic Initiatives and Innovations Directorate, and other non-governmental organizations. We are also going to expand the Portal to include a broader range of practices with different levels of evidence and outcomes and knowledge exchange tools/aids to help practitioners make planning decisions in their communities.

Although practitioners and researchers strive to ensure programs and practice are informed by evidence of effectiveness, the reality is that for many interventions evidence is not available, is inconclusive, or is of questionable relevance. Programming decisions must often be made in the face of uncertainty. Interest in identifying "promising practices" to help provide additional information to inform decisions emerged in this context. Since the spring of 2007 we have been working with partners to determine how to incorporate promising practices into the Portal. Being involved in such innovative and cutting-edge program development is what makes me excited to come to work every day!

definition of "best practices"

"Best Practices are those practices that have produced outstanding results in another situation and that could be adapted for our situation. Like all knowledge, it is contextual. A best practice is what is best for you."
- Carla O'Dell, Jack Grayson Jr., Nilly Essaides in If Only We Knew What We Know

A best practice is a process that has been shown through research and practical experience to lead to the desired result. A commitment to using best practices represents a commitment to using all available knowledge to increase the likelihood of success. In the public health/chronic disease prevention context this means population and community based interventions aimed at health promotion and chronic disease prevention. Best practices span a variety of approaches, from policy to programs to media outreach, and cover a variety of settings and populations - and result in evidence of effectiveness.

involvement with best practices

I've been working on the project since 2002 when the Centre for Disease Prevention and Control in collaboration with a broad range of experts in health promotion practice, policy and research began to develop a framework for the Canadian Best Practices Initiative. At that time the goal was to develop a systematic evidence-based approach to evaluating information sources, and to sort through the available information to see whether it meets a set of stringent criteria. Information sources that passed the test would be considered best practices and we would be able to offer to them to researchers, policy makers and practitioners with confidence. Our first product was a Gap Analysis that looked at risk factors, diseases and settings related to chronic disease prevention. The result of this preliminary work demonstrated the need for trustworthy and reliable information that could be accessible across the country. We determined that a web portal would be the best way to disseminate information to the widest audience - that was my role, to develop the Portal. It was launched November 2006 at the CDPAC [Chronic Disease Prevention Alliance of Canada] conference.

Everything we do involves consultation and review by experts. We have a Content Review Committee, a peer review committee to review Portal content - nothing goes on it without being reviewed stringently. Every thing we link out to is based on evidence - it is trustworthy and reliable because so many people, the experts in Canada, have endorsed it.

interests outside of work and best practices

I have an 8 year old daughter who takes up most of my time. She has a real passion for drama and the arts so we often go to the NAC [National Arts Centre] and live theatre and visit the galleries and other local cultural activities. I hope to spend some time in the next year on a pet project I've been working on for a few years - I'm writing a book for my daughter. It's about best practices in life, tips I've collected over the years about how to survive personally and professionally in our crazy world. I hope to have it done by the time she needs my advice. One tip is not to stop after a Bachelor degree - keep going; don't get enticed by a biweekly paycheck! Also, I love shopping. I'm going with my daughter to Rome for March break, what better place to see fashion live than Italy?

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May-June 2008 Profile of Ana Lúcia Ferreira de Mello

Ana Lúcia Ferreira de Mello lives in Florianópolis, Santa Catarina, in southern Brazil. She is a collaborative professor at the Federal University of Santa Catarina, School of Dentistry, teaching undergraduate students Public Health Dentistry. She also works as a private clinical dentist, and is a volunteer dentist for three long-term care institutions for elderly people. She has a degree in dentistry (1998), a Masters Degree in Public Health Dentistry (2001), and a PhD in Nursing (2005). In addition she is a Geriatric Dentistry specialist (2003). In 2006 she started a PhD in Public Health Dentistry.

work and study focus

I have been studying and researching Geriatric Dentistry, particularly the oral health care of the elderly people from a public health perspective. I have been researching the oral health care in LTCI for elderly people, dental education for nursing professionals, oral health services for the elderly people, oral health protocols for fragile populations, with a special focus on qualitative research methods. I have been working with Content Analysis, Grounded Theory and Action-Research.

definition of best practices

I very much like the IDM definition. This is the definition that is guiding my research work. However, I consider that best practice is a "mutant" concept. According to the context, environment, time, space, and people involved the idea of what is the best will change. And that is the thing that I most like in a best practices approach: the intrinsic possibility of change.

We do not, or should not, have final answers or impose our magic solutions on people or community. As a consequence, for me, a best practice is one that promotes a healthy and happy life for people (and this is so personal!). From a practice point of view, at a specific moment, a best practice in health promotion should be selected as a result of discussion and consensus with those people who will be dealing with the health situation, directly and indirectly. The best practice should represent them. The most important thing is not to have a list of best practices to follow, but to have a best practice posture of continually improving our practices. It is a different way of seeing life and our work as health professionals, a way that stimulates ongoing reflection on whether what we are doing could be done in a better way.

nature of involvement with best practices

During my first PhD in Nursing, I studied the quality of health services and quality and knowledge management. In some way I believe that these two issues led me to the best practice approach. I found on the Internet the University of Toronto web site and Professor Michael Goodstadt's web site and started to read all the material and references [about IDM Best Practices] that I could access from Brazil. In 2004, I had some contact with Barbara Kahan and Professor Goodstadt, wishing to spend some time studying in Toronto on a scholarship provided by the Brazilian Ministry of Education. Unfortunately, this did not happen. I had the opportunity to study for six months in Granada, Spain, with Professor Montoya. He has a wonderful program, a joint one between the local government and Universidad de Granada, providing integral dental assistance for the institutionalized elderly community of Granada. Since then I have been looking for some answers about the ideal oral health system of care for the elderly, from a perspective of health promotion, for healthy and happy living. Now, I am planning to go to Toronto in June to meet some people who have experienced the IDM Best Practices approach.

interests outside of work and best practices

I am married, but we do not have children yet. We live in a house with a cat, Aureliano, and two dogs, Brida and Tico. I enjoy playing with them. It is difficult to find leisure time when you are doing a PhD! I have promised myself to start doing some exercise this year. In the summer, I really enjoy going to our family beach house, and walking with my husband on the beach. My city is a beautiful island in the south of Brazil. We have 42 beaches, of many kinds. And I love to travel too, when it is possible. Sometimes I like to listen to music: Pop Brazilian and Spanish are in my MP3 now.

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July-August 2008 Profile of Valerie Overend

Valerie Overend is Executive Director of SaskWITT (Women in Trades and Technology). She is also a part-time WITT Facilitator for SIAST (Saskatchewan Institute for Applied Science and Technology), and a free lance consultant.

work focus

Currently I am working with CCWESTT - Canadian Coalition of Women in, Engineering, Science, Trades and Technology on a project called Welcoming Women into SETT (Science, Engineering, Trades and Technology) Workplaces - A Checklist Of Strategies. We have developed a guide and are conducting workshops to assist employers in creating welcoming workplaces. The piece I'm working on involves piloting a project with an emphasis on trades in the construction sector. Currently we are negotiating with the Canadian Home Builders Association to conduct a pilot with the residential component of the construction sector. By the time the pilots are complete, we'll have covered the whole sector - the Construction Association will cover off industrial and commercial components, the Homebuilders Association will cover off the residential component, and Building Trades Unions to cover off labour. The tool will serve the entire construction sector in Canada - it's broad based but very focused at the same time. With further development of our train the trainer piece, trainers will be capable of customizing for their regions and their audiences. Delivering to road builders or to the electricians' union, for example, requires very different emphasis - different retention and promotion and orientation techniques.

I work with both sides of the human resource equation to provide a bridge for women who want to work in a trades occupation. The two sides are supply and demand, the women and the employers. My real satisfaction comes from working with the women, putting tools into their hands - capacity building. Unfortunately I have some strengths at the other end, the demand side, with human resource principles, policies and practices. This part of the work isn't as gratifying to me but it's necessary to do the bridging and make sure women get to work in trades. The problem is the employers say "there are no women who want to work in trades, women don't want to do it," and at the same time there are all these women screaming to get into trades. That's why the bridging is necessary - we need to put them together.

defining best practices

For me best practices absolutely can be measured through personal capacity building - I won't leave a room without giving a person a tool no matter who it is. If you walk out of my workshop you're going to do something different tomorrow - that's a must - I need to see tangible changes in behaviour to measure success. In my best practices, an essential outcome is that someone leaves with an ability to move forward in a positive direction, that they can minimally take one step and, hopefully, more than one.

Another part of my best practices is to be personable. I have a pretty down home presentation style even in front of 500 people - I will never be a polished orator, but I feel effective if I make a personal connection. I talk to people on a personal level and I customize. With my train the trainer workshops I build in "what works for you, what's your strength" and I use that information to work with my audience - there is no sense talking about residential home building if I'm talking to people in industrial construction. I customize every workshop. To do this I take stock in advance - what do I know and what don't I know about the group. The first part of the workshop then is to dig out the information that I don't know so I can deliver information that suits their situation. I try to walk in their shoes and provide tools that will fill in gaps in their environment. Recently, I threw out a workshop partway through a delivery, when I realized it wasn't a fit for the audience, and changed the workshop design on the spot.

Another part of best practices is to always keep your eye on the ball. Who are you ultimately trying to assist? In my case it's women who want to work in trades, not employers. I couldn't do a good workshop with employers unless I was convinced the workshop was somehow going to help women. It's easy to get derailed - everyone's got an agenda and some create smoke and mirrors before your eyes. But getting derailed doesn't have to happen if you remember why you're there, what your ultimate purpose is, and don't let those silver tongued devils take you somewhere else. I know my stuff and I have to keep my eye on that ball - they can say whatever they want and I have to remember that I know what I'm talking about and not lose sight of my purpose. What I care about is women getting jobs and the environment being good enough that they'll stay in the workplace.

main interests

Construction with a creative edge - I'm building my own house. I like all kinds of construction - I can go to any country, any city, and get just as excited about building a milking stand for a goat or building a high rise.

This profile is based on an interview with website editor Barbara Kahan.

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September 2008 Profile of Caroline Wai

Caroline Wai is a health promotion consultant with Toronto Public Health.

main work projects

I am very excited about rolling out the Toronto Public Health Practice Framework and our inclusive program planning tools. The Practice Framework is a template to guide the way we plan all our programs. It has the potential to help us move forward - bringing about organizational change regarding health equity, encouraging best or better practices. It will help make us more cohesive, get on the same page. For example, what do we mean by a population health approach - we throw around key concepts and assume we mean the same thing, but that is not necessarily true. We are not six health units anymore [since a merger into Toronto Public Health], but we have residuals of six ways of doing work. Also, people differ in their perception of how different health promotion is from population health.

The Practice Framework is challenging as it is a theoretical abstract document. It borrowed heavily from the IDM and that whole underpinnings piece can sometimes be overwhelming. But it is important to identify what we mean by inclusive evidence, our value statements, and so on. The Practice Framework may seem heavy but unless you document what people mean by" population health" or "best practices" or other terms you won't get very far. You need to do that upfront work.

I haven't figured out the best way to do knowledge transfer on a document like that. I'm trying to raise awareness about it but everyone is pressed for time and may not have time to read it. That's where the tools come in to help do our program planning, to provide a way to implement our Practice Framework.

We've picked work sheets we like from different tool boxes - for assessment, priority setting, etc., following a population health approach. We pooled everything together so we didn't have to use three different kits. The work sheets trigger questions for each step of planning a program from beginning to end. There is no point recreating the wheel, we used what was out there and only changed what we needed to suit our needs. For example we have added questions from an access and equity perspective. Each tool is now listed on our internal internet where people can read a summary of it and click to go to the work sheet and download it.

I am currently struggling with developing tools for the underpinnings piece on values, beliefs, assumptions. We have statements about them but how do we move forward with them in practice. Team building also comes into it - how do you bring two groups together when some staff want to use a one size fits all approach and others want to use a targeted approach? I am examining the IDM framework and IDM computer program to get ideas of questions to lead discussions. It's a struggle - having to balance limited time and resources with taking a slower approach such as the IDM's where people sit and discuss values and steps to move forward. This takes time, but you get a better product in the end.

Another piece I am working on is mandatory diversity training. This piece is related to best practices as it is very self reflective. It fits with underpinnings, the practice context, ethics, engaging people in thinking about decisions, expectations of the organization from an equity and diversity perspective. You get a variety of answers about what diversity means. I also do program consultations around program access and equity.

interests outside of work and best practices

These days it's all about the family, learning with my toddler. He'll be two next month. They learn so much at that age, they have so much they want to tell you. Anything else has been put on hold while we spend time with our little one. I have all sorts of intentions, for example I'm interested in exploring one pot dishes. But right now I'm an expert in left-overs.

This profile is based on an interview with website editor Barbara Kahan.

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October 2008 Profile of Chris Beingessner

Chris Beingessner is a teacher at Scott Collegiate, an inner city high school in Regina, Canada.

using a project based learning approach

We are trying something new in North Central Regina. Instead of textbooks and tests, we're using large scale, interdisciplinary projects to engage our students. This year two other teachers and I are working with students on a hip hop project. The project is made possible through three key partnerships - two faculties at the University of Regina - Education, and Fine Arts. Both are providing their expertise to our teachers and students. Also, In Motion, who is emphasizing the importance of positive relationships and connection as the way to health, as opposed to the narrow focus on regular daily activity. The project involves the students learning about all aspects of Hip Hop culture: breakdancing, graffiti, scratching (turn tabling), and rapping (or emceeing). The arts component of the project is integrated with an English Language Arts 20 class, which is a requirement for graduation. Two mornings a week we're at the University working in the IMP [Interactive Media Production] lab, started by Dr. Charity Marsh. There are two labs - one with turn tables and another with computers and beat-making machines. Local DJs and emcees come in and work with the students.

When we're not at the university one of the things we're learning about is the visual side - graffiti. We're also working on the dance part. One of our partners is Dr. Ann Kipling-Brown, an education dance professor at the University. Her students work on dance with our students one morning a week. The education students, who are primarily white and middle class, gain a broader perspective when they work with our students, who are mostly Aboriginal and live in either the North Central or Core neighbourhoods. Our students benefit, too, from the increased exposure to post-secondary schooling options.

The English language arts component is not, "Read this novel that's unrelated to anything." Our students are reading about things about the history of hip hop, the beginnings, and about bling, learning how it rose in popularity, and the social implications of how is gold mined. It's a social justice approach in terms of empowering the students and giving them information.

My idea of what makes good teaching has evolved over time. I've learned a lot from the people I worked with and from teaching in different situations with different kinds of students. I've worked in classrooms K-11 in rural Saskatchewan, urban centres, and overseas in Southeast Asia. In terms of the pedagogy of project-based learning, I've read a lot of articles and books in my thesis research, but the most valuable experience was by working closely with colleagues to envision a project.

main interests outside the classroom

I coach the school's improv theatre team, and last year we made it to the provincial finals for the first time ever. My wife and I are both teachers so we talk about education a lot of the time. I am doing a masters of education in curriculum instruction. I'm in my second last class. I have done the literature review and I did my research on the dinner theatre. I just have to pull it all together.

I like to work with my hands. We work on our house a lot - you don't get much tactile experience at school. Before I taught I farmed for five years. We also play cards and go for walks. And with a baby coming in January, we are busy preparing for that.

This profile is based on an interview with website editor Barbara Kahan.

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November 2008 Profile of Gary Roberts

Gary Roberts is a consultant in Ottawa, Canada.

work focus

My work has had a substance abuse and addictions focus - prevention, treatment, FASD [Fetal Alcohol Spectrum Disorder], gambling problems, but of course dealing with any risk behaviours inevitably brings in shared risk factors and comprehensive approaches. I'm extremely busy but I'm interested in all the projects I'm working on so that's a positive. Two of the projects I'm working on right now deal with standards setting in prevention; they get me up and motivated each morning. One project focuses on standards at a program level and the other on standards at the practitioner level. However the two types of standards are joined at the hip.

One project I'm working on is with the UN (United Nations) Global Sports Fund, using sports as a mechanism for substance abuse and crime prevention. This initiative brings coaches and kids together in week long camps to explore ethical dilemmas that arise when playing sport (the next camp is in Cote D'Ivoire). What we're trying to do is quite tough, the UN milieu is challenging because you're working with many different languages and cultures. To do something in that context you have to be pretty patient; often there are so many considerations and the audience is so broad that good practice advice runs the danger of becoming very generic.

Which is one reason why it's refreshing to work at the local level - one provincial project I'm working on has to do with a youth strategy. In this context, in contrast to the international level, you can get more specific, you can get down to the particular values and context of that jurisdiction.

working with teams

I think one of the strongest efforts I was part of was a collaboration to develop a compendium of best practices for preventing youth substance use problems in 2001. We had a team that got engaged in the work in a really active way. The team got its teeth into it, and everyone weighed in on the content, which really benefitted the end product.

This positive experience with teams doesn't always happen, they don't always get so engaged. I don't know what makes the difference. The folks on the team which got so involved had a real passion for that topic area, they had things they needed to say and contribute. Maybe it was also that there was more personal history among these folks, which served as a basis for accountability - "I know you, I have worked with you, I won't let you down."

defining best practices

I have a feeling that the term best practices has lost its usefulness in many ways because it has been used in so many different ways. It's become a shorthand term, a bit like the term "harm reduction," there are a lot of different definitions. When I see the term best practices I find myself going to the sponsoring body's method or basis for using the term. There are quite a few orientations - some have a greater amount of rigour attached to them than others.

I've done a lot of best practices guidelines work over the years and most clients see best practices as involving a fairly rigorous review of literature, which lead to a set of best practices guidelines or principles. Only in a few cases has the process included a mechanism for bringing in the perspective of practitioners. However, I feel that the empirical basis to best practices is an important piece that needs to be linked to context, has to pass through the insights of programmers and practitioners.

best practices in consulting

I don't have particular insights [regarding best practices and consulting]. I work hard to satisfy the interests and needs of each client, I place those interests and needs foremost. So a strong task focus is central to me. The relationship piece is also really important, to allow clients to get to a place where they are fully comfortable in sharing their needs and considerations. That interpersonal element is both important in arriving at a good product and personally satisfying.

main interests outside of work and best practices

My general week to week and month to month routine is to play a lot of squash and tennis. We enjoy outdoor stuff - we ski in the winter, paddle in the summer. My wife and I just came back from a canoe trip to a place two to three hours from Ottawa. We paddled into the campsite and had a lovely weekend with fabulous weather.

This profile is based on an interview with website editor Barbara Kahan.

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December 2008-January 2009 Profile of Z. Sonia Worotynec

Z. Sonia Worotynec is the www.immigrantchildren.ca blogger. She lives in Kitchener, Canada.

background

I began formal training in early childhood education at the age of 17. Like a lot of child care workers, I saw kindergarten teachers doing the same work I was doing, but getting a whole lot more recognition (and pay) than me. I decided to leave the world of child care and became a "real" teacher, enrolling in university. All my summer and part-time jobs, though, were in child care because that's what I knew. One of these jobs was doing research for the York University Graduate Student Union. They wanted to set up a drop-in program for York student parents. I did my research at the Childcare Resource and Research Unit at the University of Toronto. That's where I met Martha Friendly. Martha is - as a reporter once called her - the Sage of Daycare. I cut my political teeth working with Martha, learning about the wider social and public policy implication s of child care. Child care is health promotion, it's early learning, it's family support, it's community development and economic development. I extend that lens - social/public policy - to a lot of other children's issues. I owe a lot to Martha and a great many other women in the Canadian child care movement. After some years working in government child care policy, I returned to school and obtained a Master's degree in Immigration and Settlement Studies. Now, I combine my interest in immigration with my background in early childhood education.

current activities

I spend about 20 hours a month on the immigrantchildren.ca blog. I post something almost every day. During the election I posted every day - immigration was always in the news, And children's issues are always in the news. It was exciting to link the two for my blogership. I'm new to blogging, but I love it. It's very exciting, the blog just celebrated its first anniversary.

I'm on the Academic Council for Mothercraft, a multi-service non-profit organization in Toronto which serves children and families. It has licensed child care centres, operates an Ontario Early Learning Centre, runs the innovative and celebrated 'Breaking the Cycle; program for women with addiction issues who are also parenting. Mothercraft just celebrated its 75th anniversary.

Mothercraft's Early Childhood Education program is unique in terms of its strong focus on anti-bias and anti-racism. Graduates are well grounded in anti-racist theory and practice. I have taught there - now I provide strategic and policy advice to the director of academic programs through my role on the Council.

I have just joined the board of an early years centre. This is very exciting for me - when I worked for the provincial government I was involved in some of the early initiatives for these centres so I know how the program was developed from the provincial government perspective. Seeing how it has rolled out in the community after all years will be interesting.

best practices and blogging

To be a blogger, I think you have to have the curiosity for information and the generosity to share. I blog all on my own time, using my own funds.

main interests outside of work and best practices

I just participated in my first art show. Very thrilling. A number of people in my neighbourhood put on an art walk, opening up their homes and studios to the public. I make papier maché bowls. I did sell a few pieces - but the thrilling part was showing my work to strangers. The bowls are all different - I make collage bowls with magazines and newspapers, sometimes I use tissue paper and other times Japanese paper. Some bowls I paint. They're a lot of fun to make.

One of Z. Sonia Worotynec's bowls.

This profile is based on an interview with website editor Barbara Kahan.

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February 2009 Profile of Awesome Program Implementers

This month's profile is of Saskatchewan program implementers whom I came to know during six evaluations of two different programs, each designed to assist parents of young children living in challenging circumstances. The people I am profiling were either para-professionals (a university degree which is not a professional degree) who mentored mothers, or peer home visitors (having similar backgrounds to the people they worked with) who provided a range of services from advocacy to assisting parents to achieve their goals.

These program implementers have a number of characteristics in common, in addition to working with people struggling to raise their children while living in circumstances that often involve poverty, inadequate housing, mental health issues, addictions, and discrimination.

I have found these program implementers to be extremely committed to and passionate about their work. They have an incredible desire to help the families they are working with, and for the most part want to know how they can do things better to make greater improvements. They work very, very hard, in many cases for very low pay. They genuinely like the people they work with and are empathetic to them, rather than judgemental. In discussions they come up with many insights about the nature of the families' situations and what needs to change to improve their situations.

Thinking of their dedication always moves me.

more profiles and other archives



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March 2009 Profile of Dayna Albert

Dayna Albert is Manager of the Ontario Public Health Association's Towards Evidence-Informed Practice (TEIP) Project. She lives in Toronto, Canada.

current focus

This year our major activity at TEIP is developing and delivering Master Trainer Workshops across Ontario to build capacity for evidence-informed health promotion. To put this activity into context, I should mention that since 2005, TEIP has developed three sets of Tools to strengthen health promotion effectiveness by strengthening use of evidence, program evaluation and program assessment. The Tools were developed in consultation with an Expert Advisory Committee, field-tested with local health promotion practitioners and revised based on their feedback.

Master Trainer Workshop participants are selected by upper management, with the intention that they will train others thus building organizational capacity. Master Trainers receive ongoing support from TEIP and a web-based knowledge exchange forum is under development to discuss concerns and share ideas.

Recently my colleague Christine Herrera and I flew to Thunder Bay to deliver a two day Master Trainer Workshop. Thunder Bay is a thriving community with dedicated and talented health promotion staff. I must admit it was a thrill to see Lake Superior and to taste moose for the first time! I even enjoyed the crisp, cold -25C weather.

It's going well so far. We began in December but still have a lot to learn - How are practitioners using the tools? Are they helpful? What further supports are needed? As with most things in life, the more we do, the better we get. Feedback from our Master Trainers are particularly helpful in improving the training.

We're collaboratively writing two papers for publication to tell the story of the development and formative evaluation of TEIP's capacity-building tools for evidence-informed practice. To accomplish this I'm working with a researcher and a writing team.

Recently we received funding from PHAC [Public Health Association of Canada] Best Practices Initiative to deliver TEIP Master Trainer Workshops in Manitoba. We're working with the Canadian Cancer Society Knowledge Exchange Network who will become Master Trainers for that province - that's very exciting!

TEIP continues to develop online learning modules to support the use of our capacity-building tools. The first one, Program Assessment, is available on our website (teip.hhrc.net). The second learning module - Program Evaluation - will be completed by April, and the third one - Program Evidence - will be ready this summer. Although I believe in the power of hands-on and face-to-face learning, the online learning modules complement and extend the benefits of face-to-face training. They are particularly useful for those who prefer web-based, self-paced learning. The TEIP project has demonstrated that effective capacity-building requires a variety of active and intensive support mechanisms. Simply providing links to tools is rarely sufficient.

past involvement with best practices

From 1998 to 2005, the Heart Health Resource Centre (HHRC) partnered with the University of Waterloo to identify best and promising promises in chronic disease prevention. When HHRC noted there was poor uptake of these best practices it commissioned research to develop a framework for enhancing dissemination of best practices. Out of that framework came many of the strategies that TEIP employs to enhance capacity-building initiatives for evidence-informed practice.

I was involved in developing and pilot testing TEIP's three sets of tools for evidence-informed practice and enjoyed working closely with the five TEIP Pilot Communities in Ontario. Our first tool, Program Assessment, built on the earlier work of the University of Waterloo to identify best and promising practices. We adapted their criteria into a tool that practitioners can use to assess and strengthen their programs along 19 criteria associated with effective health promotion programs. To prepare for the development of the TEIP Evidence Tool I attended a five-day training program at McMaster University. Starting from this foundation, we worked with an Expert Advisory Committee to develop a systematic approach, specifically geared to community-based public health promotion, to identify and use relevant evidence to guide program development.

main interests outside of work and best practices

I'm into yoga these days and singing. I'm currently between choirs - if anyone has recommendations for a choir please let me know! I'd like to do more skiing and cycling - an old passion I'm trying to reignite. I also enjoy cooking with my two teen-aged sons - I'm hoping my future daughters-in-law will thank me one day.

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April 2009 Profile of Irwin Kahan

Irwin Kahan is a volunteer lecturer at the Toronto retirement home where he is a resident. He worked in a variety of positions during his career, including as a member of a team researching LSD, member of the team which initiated research on the use of high doses of nutritional supplements to treat schizophrenia, Executive Director of the Saskatchewan Branch of the Canadian Mental Health Association, and the founding Executive Director of the Canadian Schizophrenia Foundation (CSF). He is the father of website editor Barbara Kahan.

current mental health promotion activity

Twice a week I give a lecture to my fellow residents. We've talked about nutrition, health, democracy, the United Nations. There's been a wide variety of topics. I tell them they can interrupt or ask questions or make comments at any time - I welcome their participation.

I started the sessions because I noticed that so many residents sat around with nothing to do. I thought to myself, "Let's get organized and have something to do." Some people said, "Oh you won't get anywhere." But people keep coming, sometimes up to twenty-four people attend. I notice that they're more articulate - when we started out they'd say a few words and that's it - now they put together ten sentences or more. They don't all participate, some seem happy to just come and listen. I'll continue with these lectures, they're doing a lot of good.

In the discussions they're able to vent, externalize as it were, their feelings. Telling their troubles helps them - lumbago, arthritis, not being able to walk, doctors who don't help much. One person who experienced a personal tragedy a few years ago has talked about it several times. You can tell after that he feels better, because he is more at ease. The fact that their problems are taken seriously makes them feel part of the group. They mention arthritis and about one quarter of the people here have arthritis so this also makes them feel part of the group. They get a feeling of belonging, they're in this together.

When I lead the discussions I try to give the group members concrete pictures. I say, "Suppose you're Harper [current Prime Minister of Canada] and someone came to you and said there are people who don't have enough to eat. what do you do about that?" They say, "You help them out by giving them some money." And I say, "Is that enough?" And they say, "No." They start thinking about the reason that they haven't got any money, that they haven't got enough to eat, that they can't find a job. You go into those kinds of things and you find that the social and economic affects the physical and mental. The group members then say the government should do something - work programs, apprenticeships, schools so people can learn skills and how to get along. We're lacking schools and training sessions that would teach people how to live in this world, be able to deal with social, mental and physical problems, financial problems. The government seems blind to this, they pay lip service but don't get down to brass tacks with mental health problems.

I plan to have Members of Parliament come to the group. Talking about political and social issues makes the group members feel they have something to say and this is very good - they're part of the world - contributing to government policy by asking questions, making suggestions. In the group they can voice their opinion; they have a chance to say what they want.

other activities

I'm part of the choir here and I enjoy the word games they hold regularly. Once a week someone comes in and talks about current affairs, he does a pretty good job. I have a beautiful family, wonderful children and grandchildren that I love to spend time with. This is a great thing to have such great luck.

This profile is based on an interview with website editor Barbara Kahan.

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May 2009 Profile of Nikki Clelland

Nikki Clelland is a National Health And Medical Research Council (NHMRC) PhD Scholar at the Menzies School of Health Research in Australia.

living and work circumstances

I live and work in Darwin - the capital of the Northern Territory (NT), Australia. My husband and I moved here in 2001. I am very fortunate to have a job that takes me to some of the most remote, unspoilt and beautiful places in the NT (and arguably in Australia!).

I'm currently on the PhD journey. I am based at Menzies School of Health Research (menzies.edu.au) - the only Australian health and medical research institute with a primary focus on the health of Indigenous communities and people living in tropical and remote areas. My research is exploring continuous quality improvement in health promotion, particularly in the context of remote Indigenous primary health care centres. We're working with four centres in four very remote communities. Each centre has different staffing, governance, delivery of service.

research description

I'm using a participatory action research framework. That for me is difficult. I'm quite an organized person, I tend to need boxes; in action research you need to be comfortable with ambiguity. I keep learning as we go. We're developing tools that can assess and improve the quality of health promotion practice and of the systems in place to support good practice. We're testing their feasibility. Can they capture the quality of practice? Can they produce information that is relevant for health centre teams? Can they catch change over time? The process is based on a lot of dialogue, conversations with the teams. What we're hoping to see is that with changes in the health centre systems - whether this is increased time or work force development or standardizing plans - we will capture improvements in practice.

The tools cover key factors related to good health promotion practice.. What does health promotion look like - is it just health education or do people look at policy; who is the delivery team; are staff well supported, how well trained are they; do they draw on services and expertise from outside the health centre? How is community involved? This information is fed back to teams who then set goals for improvements.

research challenges

We went out to these communities with knowledge about effective health promotion initiatives drawn from evidence in the literature. It didn't take us long to realise that these "successful" initiatives require well resourced groups, good infrastructure and capacity. This is why they could succeed. We've had to take a step back, and ask the question "where are the communities [we're working with] at now?" We've had to challenge our assumptions. I've learned a lot about health promotion practice - you can come in armed with the literature and experience from other settings; then you walk alongside people working in the health centres and really get a reality check! The people working in the health centres, day in and day out, operate in a primarily clinical environment - every day there is always sickness. I am always inspired by these workers for doing this work, wanting to make a difference, and then taking the time to be involved in this kind of research.

This is a three year research project and data are collected annually. We've completed our baseline data collection and found that while there is a strong desire and motivation by staff to improve health promotion, there is huge variation in understanding and approaches to health promotion in these services. This appears to be related to a couple of factors including workforce competencies and organizational culture.

We're about to delve into the next round of data collection. It's exciting but demanding because we're working with teams of people whose background is clinical so they don't have some of the health promotion skills we thought they would have. For example, planning seems to be a very difficult conversation to have. Clinicians have access to patient files, care plans, organised information systems for recording service delivery. Much of the health promotion work is done in an ad hoc way, often unplanned - responding to what might come in the mail, for example, about an upcoming Diabetes Day or other events. People working in these health centres have commented that they have never had any structured time to sit and think and talk about health promotion and what they want it to look like.

reflecting on best practices and quality improvement

For me, best practice is daily. It's not something that I delve in and out of. It's not a one off activity, it's an evolving thing, cyclical - nothing is linear. I have come up with a formula - best practice is the science of evidence plus intuition multiplied by reflection: Best Practice = (science/evidence + intuition) x reflection.

To improve quality requires practice to be informed by theory, research evidence of what makes a program or health promotion activity more successful, combined with the knowledge and experience of practitioners and specialists who work in these communities - combining both worlds and asking "how did that go?" - every step of the way.

main interests outside of work and best practices

My kids my kids my kids! I have two girls - 1 and 3.5 years old. I love being a Mum and all that comes with it. I enjoy reading to them, especially all my favourite childhood books - The Very Hungry Caterpillar, Little Red Riding Hood, Wombat Stew, etc. - and I have discovered many new ones too! We have a house where the renovation/building never ends - our current project is building a deck around our pool. I also love to run (one day I WILL run a marathon); however, the only type of running I get to do right now is after my girls!

This profile is based primarily on written comments by Nikki Clelland, with additional information from an interview with website editor Barbara Kahan.

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All but one of the people in the group photo above are profiled in this website's archives.

June 2009 Five Years of Profiles

Welcome to the IDM Best Practices Website Magical Mystery Tour! Why Magical? Because of all the special people whose profiles and reflections are on the website - people who possess the magical qualities of passion, creativity and reflectiveness in such quantities that they cause amazing things to happen - invaluable programs, frameworks, networks... The resources listed on the website are also pretty magical, in that they have the ability to help us change things for the better. Why Mystery? Because of all the mysterious places these magical people and resources take us to - wonderful ideas and insights that cause us to reflect on things and wonder about things that may never have occurred to us otherwise.

A brief overview of five years of IDM Best Practices Website monthly features follows. [See also archives of reflections, jottings and resources.]

with best wishes, Barbara

The website profiles a wide variety of people. Although most are Canadian, a number are from other countries - Australia, Brazil, the Netherlands, Norway, Switzerland, the United Kingdom, the United States. While most are from what is traditionally considered the health sector - public health, health promotion, population health, chronic disease prevention - some work in areas directly related to the social determinants of health such as income, housing, education, early childhood development, social supports. Represented in the website's profiles are: policy makers, managers, program designers and implementers, researchers, consultants; people working in government and people working in community based organizations; people who use the IDM and people who follow other best practices approaches.

The people profiled provide a range of definitions of the term best practices. Evidence was the element most often mentioned as central to best practices. Other elements mentioned include context, values, continuous improvement, theory, capacity building, outcomes or results. One person noted, "I would define best practices as policies, programs, services, activities and actions that are equitable, inclusive, responsive and effective." A few people specifically mentioned that they use the IDM definition. Several people profiled commented that there are issues with the term best practices - for example, because it is unachievable, anti-innovation, or meaningless as it is used so many different ways.

Reading over the profiles I was intrigued by the similarities, and differences, in people's lives outside of work and best practices. Commonly mentioned were: family and friends; outdoor activities such as hiking, cycling, skiing, swimming, gardening; travelling; cooking; reading; music. Mentioned much less frequently were yoga, coaching improv, writing poetry, doing needlework, quilting, doing construction, dancing the tango, doing photography, doing crossword puzzles, playing Takra, making papier maché bowls.

Below are examples of quotes from people who have been profiled on the website over the last five years. Clicking on the quote will take you to the full profile.

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July/August 2009 Profile of Meldon Kahan

Meldon Kahan, a physician, is Medical Director of the Addictions Medicine Service, which is part of the Department of Family Medicine, St. Joseph's Hospital, in Toronto, Canada.

most exciting current project

I'm involved in the National Opiate Use Guideline Group, called NOUGG. It's an initiative of the provincial medical colleges - to come up with clinical guidelines for prescribing of opiates for management of chronic pain. We already have a draft, which was reviewed by 50 experts. We've given them our revisions, now we're waiting for feedback. Hopefully it will be launched in the fall. It's been a huge amount of work. We did a massive literature search and came up with 50 specific recommendations.

The number of overdose deaths has increased across Canada. In 2008, 130 deaths in Ontario were attributed just to Oxycontin - which is used for treatment of pain such as that caused by arthritis. The rates of addiction have gone up, but there is little evidence of better pain control. The rate increase started in the 1990s when the manufacturer of Oxycontin pressured doctors to increase the dose. It was a brilliant but misleading campaign, unopposed by any pushback from the medical community or researchers to give more balanced information. There is a clear need for guidelines.

relationship of addictions to public health

Addictions are becoming quite common and are causing death through overdose. They also cause family breakup, loss of jobs and loss of educational opportunities. They're a risk factor in suicide. These new addictions are not replacing heroin, they're an add on - adding on to the small number of heroin users. If you look at addictions in general, including alcohol and smoking, it's a massive public health problem.

Canada is one of the highest consumers per capita of cannabis in the Western world. There's disinformation in the media and by activists that it's harmless, that it's "just a herb." And partly because there are pockets in BC and elsewhere where cannabis is big business. Cannabis is not only relatively inexpensive and easier for young people to get than alcohol, it is more potent than it used to be.

Cannabis is far from harmless, especially for adolescents. Older people are less likely to get problems from cannabis use than young people, who may get psychosis, mood disorders, poor performance in school. I've seen in my practice young people with serious problems with cannabis use - their lives are being devastated.

There are degrees of addiction - the risk is less for getting addicted to cannabis than to alcohol, much less. Alcohol has always been, and remains, a serious problem, dwarfing all the others - including cannabis and opiates and cocaine. There are some good trends - the prevalence of drinking while driving, though still a massive problem, has gone down.

relationship of addictions to the social determinants of health

The relationship between the social determinants of health and addictions works both ways. People who are addicted are more likely to become poor; on the other hand, addictions are much more common among people who are marginalized and socially isolated. It's not that surprising - if life is difficult, drugs offer a temporary solution, they make people feel better, help them forget about their problems. Also if they don't have anything to lose, why not take drugs. There is a strong relationship between the social determinants of health and drug use. Which doesn't mean that there is no need for treatment while trying to correct the determinants of health. Both are important.

thoughts on best practices

Best practices should be based on good evidence of efficacy, should address the most serious problems in the population that you work with, look at the most common addictions and the most devastating. They should look at the whole continuum of things, from population health messages to early intervention to secondary intervention - and not just focus on the most severe problem which requires serious treatment but also on milder problems. For example, there are many people who drink too much but are not yet alcoholic - they don't receive information on strategies for cutting down, although it is much better to deal with problems before they become more serious.

main interests outside of work and best practices

I like to watch movies, spend time with my family, go on walks. Vacations of course. And music.

This profile is based on an interview with website editor Barbara Kahan.

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September 2009 Profile of Ralph DiClemente

Ralph DiClemente is a Professor at the Centre for AIDS Research, Rollins School of Public Health at Emory University, in Atlanta, Georgia, US.

most exciting current projects

One project that's particularly interesting is our study of teens and the internet. We have a random probability sample of about 600 young people 14-to 17 years old. We started five years ago and are following them longitudinally. We can see what they're seeing on the internet, rather than having to rely on self report. It's too soon to talk about results, but we can start looking at them pretty quickly.

Another study is looking at HPV [human papillomavirus] vaccine uptake among African American girls. It's a randomized county design. We deliver the vaccine on-site in one county, at another we give vouchers to get the vaccine from a physician or health department, and the third is the control. Given the importance of flu over the last year and now with swine flu, how we deliver vaccine has serious implications.

There are a few other projects such as media effects on young people's behaviour related to HIV. I also teach. It's pretty busy but all enjoyable.

defining best practices

In terms of research, best practices essentially is, believe it or not, following the scientific method - something we should all be doing, but there seems to be some deviation from that. The scientific method involves observation, documentation, experimentation, keeping very clear notes on every level and providing a clear rationale for moving on to subsequent levels.

Another aspect of best practices in research is standardized reporting following the CONSORT Statement. When everyone is reporting differently, it's hard to compare outcomes. The CONSORT recommendations have been adopted by journals such as Lancet and JAMA. [Note: According to the CONSORT Statement website, CONSORT "stands for Consolidated Standards of Reporting Trials"; the Statement "is an evidence-based, minimum set of recommendations for reporting RCTs. It offers a standard way for authors to prepare reports of trial findings, facilitating their complete and transparent reporting, and aiding their critical appraisal and interpretation."]

Best practices in research is following these two sets of guidelines - the scientific method and standardized reporting.

main interests outside of work and best practices

I don't think I have any - my wife was just telling me I need to get a hobby! I love what I do. When I'm not working I play with the family or travel somewhere. I like culture, I like travelling places and understanding their culture - I'm an armchair anthropologist. Luckily I get a lot of opportunity to go places and meet people. The more you travel the more you realize people have a lot more in common than they have differences. They may dress differently, have different customs and language, but the core of people is the same; they want to do well, they care about their family, want their children to advance beyond what they've done. The sense of community, of caring and concern are basic core elements, they're true across the board.

This profile is based on an interview with website editor Barbara Kahan.

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October 2009 Profile of Bruce Rice (Part I)

Bruce Rice is a Senior Policy and Research Analyst with the Comprehensive Planning Branch, Planning and Sustainability Department, City of Regina, Canada.

most exciting current projects

We just brought out our new housing incentive policies. They will make it a lot easier for both small-site and large-site infill housing, which is useful for inner city areas, where you have to be flexible and finding land to build on is a big problem. They will also help with the rental market side. The City is redoing the Regina Downtown Plan, which has a strong sustainability aspect. It emphasizes walking and more access to downtown; it looks at urban design issues. It's a huge project. The new plan has a lot of promise to change the whole nature and experience of living downtown - it will help increase the population living downtown.

We're also carrying on some neighbourhood work in two areas of the city - Heritage, formerly called Core, and North Central. A new Heritage neighbourhood plan is in the works; it is much broader than previous neighbourhood plans, which were limited to bricks and mortar and zoning. The new one is more about working with neighbourhood and sustainability. In North Central we're applying programs that we've tailored to fit its needs. For example we're looking at finding available city lots that can be used for affordable housing. The lot strategy and the housing incentives will be coordinated. It's been a really successful program.

One of the big lessons we're learning is that, even in areas with serious issues, if you get down to component parts you can make progress. If you roll up your sleeves and keep your focus you can make headway. It's very encouraging.

defining best practices

To me best practices are practices that have proven effectiveness. Although you can't always establish some things empirically, you have to follow what's empirically demonstrated to the furthest extent you can.

It's not just about what's on paper, though, it's also about the things you do on the side that makes the paper program work. Best practices are partly defined by what's been demonstrated by the research; they are also about accountability. If you're willing to use input from whoever you're trying to serve in the beginning stages, and if you have enough flexibility to not be locked into the idea you had in your head, this allows a program to grow.

Best practices may not be the flashiest - for example the principles of community engagement and development are sound, they've been there for 30 or 40 years - but we go through cycles of how actively we pursue those practices. Every so often I have to re-examine what I'm doing, ask if I'm actually doing what I know is best. I see it as an ethical question; every field has a responsibility to ensure that what you're doing is changing something - a professional responsibility to ask yourself: "Is this program or service really helping? I know it worked last year, but as the world changes, is it still working?"

main interests outside of work and best practices

I'm a poet in my other life; I've published four books now. I've been pretty involved in the cultural community for a long time, which has a lot of cross-over with my day job. Culture intersects with health - it has to do with identity and validates people. Anything that brings people together helps community. Not defining community as "a problem to be solved" really changes the lens that you look at community through.

This profile is based on an interview with website editor Barbara Kahan.

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November 2009 Profile of Bruce Rice (Part II)

Bruce Rice is a Senior Policy and Research Analyst with the Comprehensive Planning Branch, Planning and Sustainability Department, City of Regina, Canada.

work context

A key overall change I'm seeing is the way issues around sustainability inform policy these days. New people are coming in who are committed to it. It's a generational change - more and more people are educated about sustainability so when they come to work for the City it doesn't matter what department they're in, they understand sustainability already. Also, gradually the private sector, the construction industry, for example, is changing - changing practices to increase sustainability. They are responding to market demand.

When we've done neighbourhood consultations, the green space is one of the things people value most regardless of what other issues they're dealing with. Sustainability values are quite strong. The longer I work at city hall the more I come to appreciate things like urban design, which brings a whole aesthetic aspect to the community. People often have a hard time articulating this but they know it instinctively. Walking through Victoria Park the other day I saw half a dozen people sitting and reading. Why? Besides the fact that it was a nice day - because of the horticulture, the statues, the overall layout which is based on the concept of the British common. It was designed as a place to gather and to be in a certain way.

Another change - disciplines that used to be separate are now working together, for example the United Way and the health district and the housing sector; people are working collectively together.

In a small community the size of Regina a single program can have a lot of visibility whereas in a larger city it may get lost. Here, for example, the Mayor will be aware of some of the better programs and champion them; elected officials are aware of them, they've been through the door and looked around. In larger populations that doesn't happen. It's a huge asset, that accessibility. You don't have all the layers to go through to get to the people you need to convince. Things can happen quickly.

This profile is based on an interview with website editor Barbara Kahan.

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December 2009 - January 2010 Profile of Peter Jones

Peter Jones lives in Ashton-in-Makerfield, Nr Wigan, Lancashire in NW England and works at Ormskirk Hospital, Ormskirk, West Lancashire.

current work affiliation and focus

The hospital provides a base for my community mental health service colleagues and I, our focus is older adults. I work with clients who have organic and functional problems.

current projects most excited about

At work I am engaged in nursing home liaison, spend a day at social services shadowing the duty desk on an integration project. I am also trained as a trainer for HoNOS - Health of the Nation Outcome Scale.

In my spare time Hodges' model is an ongoing mission, with the blog with a global readership. As to what I am most excited about: this would be the new site I am planning using Drupal - the content management system.

definition of best practices

"Best practices" for me are those which are clinically prioritised and yet are holistic, socio-technically oriented and engages learners (including the patient and carers). Theory and practice (this should encompass management also) should be underpinned by a model or framework that is evidence based - I am working towards this in terms of Hodges' model.

involvement with best practices

At present I am trying with colleagues Janet Parry and Lorraine Dempsey to improve multidisciplinary working in residential care and social services. This is supported by improving the quality of information about residential / nursing home bed allocations and improving the quality of referrals from this sector. In the past from 1995-2007 I worked as a clinical appraiser for data standards with the NHS information Authority and from 2005 the NHS Information Standards Board. Previously as a team member we won the inaugural Dame Phyllis Friend Award for the application of informatics in a community mental health centre project.

impact of best practices on work

I am constantly aware of the need for "standards" and the tension this creates in terms of creativity and innovation. Everyone (me too!) needs to consider themselves as a lifelong learner. I enjoy learning from others and passing skills and knowledge on.

comments on using a best practices approach

I wish I had more opportunity to pursue studies in this area - notably Lean - Six Sigma and other quality methodologies initiatives. One area of particular interest as an area for future work is care commissioning and how nest practice "World Class" standards are applied there.

main interests outside of work and best practices

My three children, computing, travel, walking, countryside, gardening, astronomy, SETI, cooking, reading and film.



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February 2010 Profile of Lawrence W. Green, Part I

Lawrence W. Green works with the University of California at San Francisco. He is a Professor in the Department of Epidemiology and Biostatistics, School of Medicine, and Co-Leader, Society, Diversity and Disparities Program, at the Helen Diller Family Comprehensive Cancer Center.

current project most excited about

I'm a member of the US Preventive Services Task Force on Community Preventive Services. Canada started systematic reviews with government sponsorship to delineate best practices and then the US Preventive Services Task Force that reviews clinical practices picked up the methods. Now the Community Task Force, sponsored by CDC [US Centers for Disease Control], is a panel of experts who review the evidence systematically on community interventions. The role I find myself playing there is questioning whether our recommendations are really that helpful to practitioners, especially when they so often conclude with a finding of "insufficient evidence." We could make better use of a wider range of evidence than is currently given credence in the evidence hierarchies used by these panels.

My career has been a revolving door in and out of academia to government and foundations. I've had more opportunity than most academics to see how evidence is used in practice. The Task Force is my best opportunity to have direct influence on how recommendations are formulated and represented to practitioners. Systematic reviews have an obligation to draw conclusions with more attention to what the evidence doesn't say about fit, the applicability of evidence to specific settings.

best practices background

My involvement with best practices - though it wasn't called best practices back then - goes back to the early 70s when I took up my first academic position at Johns Hopkins University, after two years working in Bangladesh. What I was trying to reconcile was all the theory I'd learned in my doctoral degree at Berkeley with what I observed in very different circumstance in Bangladesh, very different cultural contexts.

Later I worked for the US federal government as Director of the Office for Health Promotion and then the Kaiser Family Foundation, which gave me opportunities to test some of the academic ideas. I was in Canada for eights years, at UBC [University of British Columbia] where I headed up the Institute for Health Promotion Research. There I developed guidelines for participatory research. This gave me the opportunity to blend the idea of participatory research with practice-based evidence - to combine evidence from the indigenous wisdom in the community with research evidence. It's the blend that makes best practices.

The job I had with CDC before I declared myself retired in 2004 - which is a joke of course - was Director of Extramural Research. In that role I initiated a grant program for participatory research. The phrase I coined - "If we want more evidence-based practice, we need more practice-based evidence" - was used in making the case for increased funding for CDC research to complement NIH research, which tends to be more investigator-initiated and controlled. The participatory approach has played out in the funding of Prevention Research Centres - we pushed them to give greater emphasis to community based collaboration, participatory action research for example. This is what's kept me going, what I'm most excited about.

This profile is based on an interview with website editor Barbara Kahan.



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people profiles

March 2010 Profile of Lawrence W. Green, Part 2

Lawrence W. Green works with the University of California at San Francisco. He is a Professor in the Department of Epidemiology and Biostatistics, School of Medicine, and Co-Leader, Society, Diversity and Disparities Program, at the Helen Diller Family Comprehensive Cancer Center.

defining best practices

I think best practices are really best processes. I try to urge us not to be so precious about the notion to fidelity of practitioners to tightly defined interventions as best practices - that assumes that the intervention can be applied without any adaptation regardless of situation or population. What I think is important is that we train and support practitioners to exercise good professional judgement in systematically assessing the needs of the population, then using a blend of research evidence and theory to understand the determinants of those needs and interventions that would be appropriate in their context.

I like the definition of IDM best practices, there is nothing in it I would disagree with. I like the idea of starting with processes and activities, not interventions.

best practices advice

My advice on using best practices is directed to structures - agencies and organizations that fund programs, but who protect the scientific status quo by insisting on evidence-based practices defined as those tested in randomized controlled trials. Most practitioners and researchers can't change their practices until the systems of research funding, peer review, publishing, systematic review and best practice guidelines, and academic appointment and promotion change. I work hard on communicating these concerns to research funding bodies, editors of journals, research centres, systematic review panels, universities, practitioners and policy makers.

main interests outside of work and best practices

We've moved back into a house in San Francisco that we bought in the late 80s. It's required major renovations, and a lot of work to landscape. This is a wonderful climate to do gardening, things grow year round. Gardening is a major interest of mine. I also do urban hiking, walking in various neighbourhoods, there's such a variety in San Francisco. I travel a lot - I try to add a day or two on either side of my trips to get better acquainted with the museums and art and natural beauty of other cities. Our four grandchildren are also a focus.

This profile is based on an interview with website editor Barbara Kahan.



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April 2010 Profile of Kerry Robinson, Part 1

Kerry Robinson is Manager, Knowledge Development and Exchange, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada. She lives in Ottawa.

current work focus

My role is to provide shared leadership on knowledge development and exchange for PHAC's chronic disease prevention strategies. The importance of knowledge exchange runs across all diseases and health issues. PHAC's knowledge development and exchange work includes the Canadian Best Practices Portal, the Canadian Task Force on Preventive Health Care and supporting capacity building for evidence-informed public health.

We've decided to focus on developing, synthesizing, exchanging and supporting the use of intervention evidence - what works and how in chronic disease prevention. Much of our knowledge development in public health has focused on identifying and understanding the problem - disease burden, patterns, risk factors, determinants, relationships. This is really important, but insufficient to guide practitioners and communities on how to address these complex problems. We want to shift the focus more from the problem to the solutions. What works when, how, under what conditions, and with what kind of resources?

We also want to shift evaluation from just being about accountability reporting to being more useful from a learning and improvement perspective. We're not getting the full benefits of evaluation if it's just about accountability and not about creating new knowledge and understanding for how we could do better. There are good things about accountability. The public and government needs to know where its money is going and what impact it is having, but we need to have a balance and our funding and evaluation requirements need to support that balance.

We're looking at mechanisms for sharing evaluation findings and other kinds of knowledge for which currently there is no place for them to go. We're planning a knowledge exchange forum on how to better support, strengthen and share evaluation across jurisdictions.

We understand that best practices do not only come from the published literature, they come from current practice, "the field." We also know that having access to information or evidence is not enough to change decisions or practices. We need to know what the challenges are to using the evidence, what supports to put in place with our partners to support the use of evidence in public health systems and organizations. Information is not going to change practice alone - we need capacity building systems.

We're also looking at what kind of a facilitative role there is for others engaged in knowledge development and exchange across the country to avoid duplication - not what we can do alone, but what we can do with others. How to support training, skills, culture around evidence - finding evidence, documenting, sharing it, using it in practice - that's the next big thing we want to focus on. We want to support a learning system, not just a website where you find information. For example, how can we use different types of social media in discussing what people are learning, and exchange these learnings with other practitioners and researchers across Canada?

This profile is based on an interview with website editor Barbara Kahan.



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May/June 2010 Profile of Kerry Robinson, Part 2

Kerry Robinson is Manager, Knowledge Development and Exchange, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada. She lives in Ottawa.

defining best practices

I was involved in the Portal's best practices definition, which is the specific one I think of. I'd say best practices are a combination of effective strategies or activities, evidence from research, and knowledge not just of "what," but of "how" to undertake effective practice based on local conditions and needs. We've tended to focus on the best being "the what," rather than documenting or assessing in a critical way "the how." When we don't do that, people really can't use the information. Most published articles don't get into the how enough so that someone could take the program and adapt it, and understand "that's what I need to do."

My biggest beef about best practices is that everyone means something different by best practices. People assume they're talking about the same thing when they're not.

practice background

I took to heart the advice I received from Larry Green to experience what public health is like at the ground level before I went on to get my PhD - to make that link between research and practice and get that experience and learning.

I was involved with the Canadian Heart Health Initiative studying effective ways of disseminating and developing capacity for chronic disease prevention across different provinces. We found that no one approach works best. What's most important for effectiveness is if capacity building is closely tailored to the system context. We found that in PEI and Newfoundland, which had few technical resources compared to Ontario, personal relationships were so important, because they didn't have the infrastructure support - data bases, training opportunities, those kinds of things. In Ontario, with far more central resources, the personal relationships were less important. The bottom line is that one dissemination strategy is not more effective than another. For example, people like to think that a two way exchange of information is more effective than a one way push approach - we didn't find that.

main interests outside of work and best practices

I have a four year old daughter, she's my biggest passion. We like to get out and explore everything with her - art classes, learning to skate - she keeps us pretty busy. We recently moved to Ottawa and have enjoyed hiking and biking along the Canal and going to lots of area festivals. I've reinitiated my love of soccer and am getting into a soccer league again to keep me moving.

This profile is based on an interview with website editor Barbara Kahan.



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July/August 2010 Profile of Bobbi Soderstrom

Bobbi Soderstrom is a registered midwife on leave of absence from the Midwifery Group of Ottawa, where she is a partner. She is currently Director of Insurance and Risk Management, Association of Ontario Midwives. She is also Associate Professor Emeritus, Midwifery Education Program, Ryerson University. She lives in Ottawa.

current work focus

For the last year we've been providing to members of our organization a 24/7 emergency call-in service so midwives can call on any day or night to get support in the case of critical incidents. I'm the main person who covers the phone line. This is one of the things that probably takes the most of my time. I enjoy it a lot, although it can be stressful. It gives me a lot of positive reinforcement because people are so grateful, knowing there is someone they can call when they need help; it feels so good to know we can help others in that critical time.

Currently a great deal of my endeavours have to do with professional liability or malpractice insurance and related risk management activities. For example, I'm managing the professional liability insurance program.

I have also been supporting others in our professional organization to develop clinical practice guidelines. What might seem like the best standards of practice in one field may not be appropriate for another type of practitioner. Because one should be judged by the standards of our peers, it makes sense that each profession should have its own clinical practice guidelines that represent the particular values of that model of practice.

I promote continuing education or ongoing continued learning. I provide a workshop for students becoming midwives about reducing risks in practice. If there's a critical incident, the first thing to do is reduce harm; when harm has occurred, how do you reduce the risks resulting from harm to both client and care provider? There are many facets.

I have worked to develop a professional practice guide with information regarding peer review and how to respond when there are critical occurrences. Together with others in the Association we provide workshops and continuing education opportunities for midwives. I keep track of the relevant literature and provide a continuing list of recent evidence of interest to midwives in order to make it easy for them to keep up to date.

defining best practices

I can try to provide what might be a text book definition of best practices, but best practice must be seen in the context of being sure one provides sensitive, appropriate care - in this case to women and babies. Inserting the notion of "who the client is" is really important. The way midwifery has entered our society is as a program that is non-authoritarian - the midwife's job is to present information that meets the client's special needs, puts the woman in the position of making the best decision that suits her. I keep coming back to the importance of informed choice.

main interests outside of work and best practices

My main interests are my two grandchildren. My grandson is three and my granddaughter is five months. The rest of my family is very important to me too!

This profile is based on an interview with website editor Barbara Kahan.

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September 2010 Profile of Kara DeCorby

Kara DeCorby holds a clinical faculty appointment and is a Research Coordinator with the School of Nursing, McMaster University, Hamilton, Canada.

most exciting current project

We're just starting the CIHR-funded project Partnerships for Health Systems Improvement. We're working with three Ontario public health units to assist them in a practical way in using research evidence in their decision making. The units are actively involved in designing the interventions with us, in setting out the activities they will undertake with the broker.

Two colleagues of mine will work directly with staff as knowledge brokers - promoting evidence informed decision making within the organization, and then we will evaluate the impact of the intervention on individual and organizational change. We'll collect qualitative and quantitative data including using the brokers' reflective journal, doing some organizational self assessment, using a number of survey instruments, and holding interviews and focus groups with staff.

I'll be looking to ensure that we're measuring what we intended to, that we collect the necessary data to assess change over time, and helping to document the knowledge brokers' interaction with staff.

involvement with best practices

My focus is on supporting evidence informed health care, for example looking at systematic reviews, critically appraising that evidence, and supporting the translation of the results into practice for public health. [Editor's note: Kara had a lead role in developing health-evidence.ca, a website which promotes evidence-informed decision making. She has also worked on a number of other knowledge transfer and exchange projects.]

I like to think that best practices - promoting evidence informed decision making - is embedded in my daily work, whether it's with a particular project, something to do with a research practicum for students in the school of nursing, appraising a systematic review, or answering questions.

I hope that over the years I've gotten better at applying that approach and coming to know the finer points of how to apply the model through on the job learning - through my faculty appointment and the experience of learning from colleagues and supervisors, particularly Maureen [Dobbins]. I've also had the chance to learn from the practice setting when working with health units. Every time we do a work shop we learn from them as much as they learn from us. I like to think I now have a much more comprehensive picture and more tools in my tool box than I did when I started out.

interests outside of work and best practices

I like to spend as much time outdoors as I can. Hamilton and Ontario in general are great for that. The Bruce Trail is close by and is great for hiking. I also like to skate and bike. I look for every opportunity to travel, either locally or as far away as possible. I've been lucky to do some great travelling with work, and often go to western Canada to visit family and friends. The furthest places I've travelled to are Asia, Africa and Australia, but I still have a really long list of places I need to go.

This profile is based on an interview with website editor Barbara Kahan.



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October 2010 Profile of Debora Abood Part 1

Debora Abood is Social Service Programs Manager with the Victoria Native Friendship Centre in Victoria, Canada.

current projects

We have a number of programs right now that are client centred, strengths based and resiliency respected. Those programs work to support the strength in families, honour memory (even at a cellular level), and support families from a holistic place to build family and community capacity. We try to create a balance between honouring the history of people's lives and holding them "able" for their present lives. Our programs honour the strength of the individual, acknowledge the wounds of the past, and embrace the tenacity of survival.

The programs work to strengthen the bonds between children and families and healthy Elders and Community, and try to operate from a diversity of cultural teachings. In the urban Aboriginal community there is a range of cultures that include the Indigenous cultures of Vancouver Island. These are the Coast Salish, the Nuu-Chah-nulth and the Kwakwaka'wakw. In addition there are numerous other Aboriginal cultures such as Cree, Micmac and Saulteaux. The cultural practices are at least as diverse as the cultures in the continent of Europe; but here, the understanding is that an Indian is an Indian, rather than understanding the complexity and diversity that exists. That diversity of culture is a real challenge in delivering programs, but we need to take account of it. Otherwise it would be as if everyone were coming to France from all over Europe - from Italy to Russia - and trying to create one culturally based program for all of them.

One new program is the Elders' Registry, which will connect healthy Elders with families. This program is exciting because it allows all kinds of room for creativity; there is no road map for this. It is an honour and a privilege to create a resource template that will be useful for other Friendship Centres in British Columbia.

Another new program is our pre-school. We have other early intervention and support programs for children and families. We are planning more evening programs where strong families can come together and celebrate the celebrate the importance of who they are and be peer role models. This is an integral part of community development through mentorship.

We have programs that are proactive in supporting youth to build more positive and better lives for themselves and future generations. We have a Youth Council, and the Tribal Journeys program is always great - it creates the perfect venue for a group of youth to come together with other seasoned people in a multi-cultural event. We keep building capacity to encourage youth to stay in school. One of the things that's increasing is the number of youth who are proactive and want to contribute in a positive way.

interests outside of work and best practices

My interests are maintaining a connection to nature through walking, hiking, cycling, visiting different parts of nature - particularly near the ocean and in the forest. Dancing, cooking, eating, gardening, friendships, reading, films, music. Travelling, visiting other cultures.

This profile is based on an interview with website editor Barbara Kahan.



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November 2010 Profile of Debora Abood Part 2

Debora Abood is Social Service Programs Manager with the Victoria Native Friendship Centre in Victoria, Canada.

understanding best practices

I think best practices is about building on the wisdom and knowledge of any individual or collective of individuals. I believe every person in their core sacred being knows what they need. It's about interfacing our own skill base with the truth of what people need in order to move forward, rather than an imposition of what we think others need. It's about dialogue and communication and honouring the wisdom of people, and putting the higher good of all, including our planet, at the forefront.

My definition of best practices would be client centred, strengths based, resiliency respected. Best practices is understanding the truth of the past and knowing current circumstances, while holding people able from an empowerment perspective. How is it helping people develop for their future if one creates a dependency on someone else? If I keep treating you like you will never be able to realize your dreams or visions, then I participate in keeping you oppressed.

Internalized hopelessness is a health determinant. Internalized dependency is the foundation of colonization; it takes away people's independence and invites dependency on the system that has oppressed them. The book Dances with Dependency [Calvin Helin, Orca Spirit Publishing] looks at intergenerational powerlessness, despair, hopelessness and dependency among Aboriginal people - and how to move out of it.

practising best practices on a daily basis

I try to walk my talk to the best of my ability. I have a strong analysis about current and historical conditions - about what my personal responsibilities are in relation to that. How walking my talk shows up in the Aboriginal Community and within my working conditions - I work to join forces for the higher good of all by building unity collectively and trying to deconstruct the lateral violence that is encouraged as a result of colonization. I work hard to build strong healthy working relationships. I do my best to honour the history of people, to support them from a resiliency and strengths based place, while holding them accountable and able.

In the non-Aboriginal community, for example with funding bodies, I do my best to deconstruct the "isms" and challenge the status quo. I talk about systemic racism, I speak to history and current issues and to the experiences that Indigenous People share with me, and I invite solid working relationships with allies in whatever systems there are. This is my approach from a holistic perspective for best practices.

This profile is based on an interview with website editor Barbara Kahan.



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Diedre Desmarais with her grandmother in the 1950s.

December 2010 - January 2011 Profile of Diedre Desmarais

Diedre Desmarais is a doctoral student in the Department of Political Science at the University of Regina, Canada.

current research

My doctoral thesis is on the inequitable access to health for Métis elders. I'm looking at the research from two different directions. One is the effects of colonization on Aboriginal peoples and how that ties into the identity of Métis people. The health aspect - that's my passion - I want to find out the state of health for Métis elderly people.

My Mom was a survivor of tuberculosis, she suffered her whole life. What I had to go through to get her end of life care - I'm a pretty smart girl, but this was unbelievably difficult. If you didn't know how to get through the bureaucracy you'd be lost. I had to put my Mom in a long term facility - she couldn't walk and had Alzheimer's. It was heartbreaking. After my experience with my mother I wanted to do my research on health issues relating to our elderly people.

I'm excited about the whole question of identity. There seems to be a guardedness around who we are as Métis people. The Métis National Council says Métis people have to be able to trace their roots back to the Red River. Others are saying, "I'm from Labrador and I'm Métis, just because I'm not from the Red River doesn't mean I'm not Métis." These divisions are there because the state decided to recognize some and not others. They've imposed divisions that are not natural.

I'm guilty of the same thing. I met this person who insisted that she's Métis because her grandmother was part Métis, and it really ticked me off. I thought, "You're not a Métis person!" I had to question myself, "Why am I feeling so angry?" I started examining this whole question of identity, which led me to do research on how people are identifying themselves and how is identity legitimized. I find it intriguing.

Because of colonization, artificial divisions were imposed on Aboriginal peoples, such as status and non-status. At the same time, the state didn't recognize the Métis. The Métis are Aboriginal people who have been equally affected by colonization but are not able to access the same kind of services as Status Indians, who have a direct relationship with the federal government. Métis people don't receive the same kind of assistance, for example regarding health services and drugs.

understanding best practices

The first thing that comes to my mind is that research has to be done; there's not much in the literature on Métis health issues, everyone acknowledges that. We have to find out exactly what's going on, with more research being done by people who are from the Métis communities. You do better research if you understand the community that you're working with.

Insiders and outsiders have different ways of looking at things. I look at that tree and think it's wonderful to see, a place to sit; someone else will see toothpicks and money. For the most part I don't think non-Aboriginal people are going to understand the issues an Aboriginal person has to deal with. Solutions have to come from the insiders. Unless you know where it hurts you can't fix it - change comes from those who feel it.

We need to have the resources to be able to cope with the situations in our community in our own way - not that we don't want people to come in and assist us, but we are the ones who know what's going on in our communities.

main interests outside of thesis

I teach women's studies, gender studies and indigenous studies. I'm a bookaholic - I read. When I finish my dissertation I'd like to see my own province and then Canada. Right now I'm a "staycation" kind of person.

This profile is based on an interview with website editor Barbara Kahan.



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February 2011 Profile of Cheryl Woelk

Cheryl Woelk is working towards her Masters of Education degree at the Eastern Mennonite University in Harrisonburg, Virginia, U.S., and a graduate certificate from the Centre for Justice and Peace Building.

current activities and plans

I am doing an action research project for my Masters. My topic is how educators engage with language and culture in the classroom, either when they are trying to teach a language or teach peace building. In either case, how do the dynamics of language and culture fit with the concept of peace building? I'm coming at it from a peace education perspective, looking at it in a holistic way. I will be doing interviews with other educators, holding a focus group, sitting in on classes. I'll also be doing self reflection in terms of my own teaching, engaging in a reflective cycle - analyzing what I've done, then doing similar or different things and reflecting on that. I'll be gathering different perceptions - students, educators, the literature, my own. I'll be looking for similarities, themes, what works.

I've been teaching at the intensive language program on campus - international students, and some local students, who want to learn English better. I'll also be teaching, in cooperation with both the language institute and the Centre for Justice and Peace Building, a couple of courses for the Summer Peacebuilding Institute (www.emu.edu/spi) with peace building practitioners who are coming for training over summer sessions. The course I will be teaching will partly be an English refresher course, combined with an introduction to peace building concepts and terminology for the SPI courses.

Peace building takes place in the way that I teach, the approaches I use, the environment I create, the nature of my interactions with the students. To help the students get the most out of the classes, they'll be sharing their experiences, learning about understanding others.

The sense I'm getting from my studies is that I need to go deeper, I'm just touching the surface, in terms of looking at things holistically, at understanding the bigger picture as well as the small interpersonal level. My focus before was mainly on one to one relationships more than thinking about systems' connections. The things influencing conflict are much broader than just two people involved in an argument.

connecting the past to the present to the future

Peace building has been a long term interest for me - I went to Korea because the Korean Anabaptist Centre was starting a peace program, where people could learn about peace and learn English at the same time. I was part of developing that program, which developed into more language learning and peace building programs. Language learning is closely related to culture.

[My partner Scott and I] are both interested in heading back to north east Asia at some point. A lot of peace related stuff is happening there - there's South Korea and North Korea, and China is becoming a bigger power. But wherever we end up in the meantime, we can be involved in peacebuilding - peace building and peace education can happen anywhere.

main interests outside of school

I like music, reading, sports. Scott and I started learning tennis, we play together. I really like learning languages - that's something I do in my spare time. I am fluent in English and Korean and close to fluent in French. I have quite a few students who speak Arabic - it's a lot of fun, I get to practise with them in break time. I have studied many other languages, although not to a point of fluency - it's a hobby for me.

This profile is based on an interview with website editor Barbara Kahan.



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Photo by Kaloozer (Mark Richardson),
taken September 27, 2009 in College Station
where Charles Ridley works; downloaded from
flickr.

March 2011 Profile of Charles Ridley

Charles Ridley is a professor in the Department of Educational Psychology at Texas A&M University in College Station, Texas.

work focus

As a professor I have triad responsibilities of teaching, research and service. I spend the majority of my time with teaching and research. The courses I teach are theories of counselling and psychotherapy, professional issues and ethics, multicultural counselling, and psychological consultation to organizations. Occasionally I teach the practicum.

My research and scholarship are in several areas which converge. I've done quite a bit of work in what is broadly construed as multicultural counselling and mental health delivery service to underrepresented populations. I also do work on psychological change processes and professional competence. All of this is relevant to health disparities, which my wife and I work on together.

What I'm really concerned about are the psychological underpinnings of health behaviour, of health behaviour change - and how service providers incorporate these underpinnings into practice.

I have a major monograph, a series of papers with my former students, on the concept of competence, which is in press and expected out in spring. It's specifically in the area of counselling psychology but is generalizable to any area. The competence movement has concentrated on competencies. I contend that you can have competencies but still be incompetent.

Another project I've been working on is developing a protocol for multicultural assessment validity. Finally, I authored a book called Overcoming unintentional racism in counselling and therapy: A practitioners' guide to intentional intervention.

main interests outside of work and best practices

My main interests are the church - I love God's word, the Bible, I love good preaching and teaching. I love travelling and I love basketball.

This profile is based on an interview with website editor Barbara Kahan.



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April 2011 Profile of Heather Wood (Part 1)

Heather Wood is a registered midwife with Access Midwifery & Family Care in Victoria, Canada.

working with clients

We work with pregnant and postpartum clients, many of whom have lives that have been impacted by some degree of disadvantage whether through racism, discrimination, mental health issues, poverty, substance use, violence, any of those sorts of issues. Our decision to establish a midwifery practice that caters to women with complex lives was based on a social justic philosophy and a recognition that sometimes people with more complex lives are poorly served in the health system.

In the midwifery model we have thirty to sixty minutes for each appointment during which we talk about fetal movement, nutrition, pregnancy tests, labour and birth planning. But it's become a component of my appointments to also talk about food security, housing, substance use and to make sure the door is open to talk about violence in our clients' lives.

Serving our clients may involve more face to face time than with other clients, plus the complexity of supporting them not just with their pregnancy, but to find housing or get into drug and alcohol counselling or whatever it is that's at the top of the list of what they want to be dealing with. We often work with very young clients, First Nations women, new immigrants - a variety. Even being able to give them contact information for social and service agencies, or picking up the phone and calling outreach workers, is helpful. The resources are at our finger tips.

changes in work life

Lorna McRae and I set up the practice in July 2006 and since then the practice has grown to four midwives and two nurse practitioners. We also have students working with us, studying to be midwives, nurse practitioners, nurses, social workers, counsellors, and physicians. It's very dynamic to be around learners.

Two years ago we decided we needed to have more breadth to our clinical capacity so we asked the local health authority to support Access Midwifery & Family Care to be a clinical site for nurse practitioners. Hope, the nurse practitioner who started in April 2009, sees not just our midwifery clients but men, women and children under the age of 50. Her mandate is to provide clinical care specifically to people who are disadvantaged in some way, including not having a primary care provider. She's very busy.

In September of 2010, Lynn, a pediatric nurse practitioner joined us. She has the same mandate as Hope, except her clients are under the age of 19. She sees children from the naval base - naval doctors don't see children. Also, children in foster care might be directed to Lynn, and others who don't have a care provider.

It's an interesting clinical milieu with our different scopes of practice, but there's a lot of overlap. There's a lot of sharing in terms of clinical approaches as well as practical things like community resources. We're very excited about this collaboration.

This profile is based on an interview with website editor Barbara Kahan.



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May 2011 Profile of Heather Wood (Part 2)

Heather Wood is a registered midwife with Access Midwifery & Family Care in Victoria, Canada.

knowledge sharing

We have talked a lot about sharing what we are doing and what we feel we are learning., We've presented at medical education rounds on several occasions.We give community talks. We talk to groups of public health nurses about the work we're doing, the services available, and about woman-centred, trauma informed pregnancy care and health care. The BC Centre of Excellence offers workshops, which we've been a part of, great webnairs, and other training sessions. Several of us have completed the train the trainer workshops through PRIMA (Pregnancy-Related Issues in the Management of Addictions). We presented at the Canadian Association of Midwives conference in Edmonton this past year about the work we're doing and about breaking down barriers to midwives providing care to women with complex lives. We look at those opportunities for what we can learn, ourselves, and also share what we are learning. Our longer term goal will be to do more in terms of publishing.

We're open to evolving as practitioners, evolving our care as knowledge and research changes. At one level change is hard - at another level we recognize there are other ways of doing things. Expanding our knowledge base collectively - that's been pretty cool.

main interests outside of work and best practices

Kayaking. Staying in contact with family. Exploring BC - as a relative newcomer to British Columbia, I enjoy having the opportunity to go to Old Grove Forest on the west shore or walking trails with friends. But - mostly I work!

This profile is based on an interview with website editor Barbara Kahan.



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June 2011 Profile of Maria Hendrika (Part 1)

Maria Hendrika is Executive Director of Regina Transition Women's Society, which runs Regina Transition House, a 24 hour safe shelter for women and their dependent children fleeing any form of abuse.

most exciting current project

I am really excited about our expansion. For almost a decade everyone in the organization has been saying it would be wonderful to have more room. Administration and counselling offices are cramped, our common spaces in the shelter are limited but most importantly we need more space for women.

Our waiting lists are getting longer as our local vacancy rates shrink. For the last number of years we have seen the average length of stay increase (it has doubled over the past five years). We are always near or at capacity but women are staying longer because they are having a difficult time finding safe and affordable housing. Consequently, we are helping less women every year and our waiting list grows ever longer.

We decided to expand our existing space because it's in an ideal location - close to downtown services, social services and hospital, recreational opportunities and a park nearby.

Our expansion will allow us to increase our capacity by 39%. The entire addition will be accessible with an elevator linking all three floors and a handicapped accessible suite. All bathrooms, program areas and the kitchen will be accessible.

improving the health of women experiencing abuse

All women coming into the shelter are stressed. Many women come in displaying symptoms that make me think they might be depressed - they're not eating, they can't sleep at night - certainly given their circumstances it wouldn't be surprising. We see women whose nutrition is not adequate. We see women who are near birthing who are not getting pre-natal care.

Women's health has to encompass their whole being. In fact women who have been traumatized or violated have "dis-ease" in their lives. We're not healthcare givers in the common sense of the word but our workers do make lives better with counselling support, education and information around family violence and linkage to community resources. We make referrals and help women get to their appointments. I think everything we do at the shelter impacts women's health.

Many of our clients have been isolated in their homes. Women may not have sought help from doctors, dentists or other helping professionals because their partners restricted their movements - often because abusers are afraid that the women's situation at home would be revealed.

While the ongoing stress women deal with is probably the most common health issue we see in the shelter, we also see many women who are struggling with addictions and mental health concerns.

In addition to helping women find health care in the community, our programming centres on assisting women in their making decisions that will make their lives safer. Just the fact they're here and they are safe helps improve their health at least in the short term. We also make a safety plan with each woman before she leaves Regina Transition House.

It is important to remember that many women are in more danger once they've left the relationship than when they were in it and could gauge the circumstances better and were less vulnerable to surprises or stalking.

Although we're a short-term crisis agency we do have a voluntary follow up program for women who want to stay in touch - they can access any services except residential. We may drive them to the Food Bank, make referrals to community agencies, or provide counselling. Ongoing contact deals with the distress in their lives - sometimes people just need to talk, and it's easier when they don't have to repeat the whole story again to a complete stranger, when they know that the person on the other end of the phone or across the table understands, when someone is rooting for them.

Our Bridges of Hope program was set up to help provide a bridge to living independently. We want to support women after they leave and if that support prevents a future stay at the shelter and a violence free future then that would be the best of all worlds.

This profile is based on an interview with website editor Barbara Kahan.



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July-August 2011 Profile of Maria Hendrika (Part 2)

Maria Hendrika is Executive Director of Regina Transition Women's Society, which runs Regina Transition House, a 24 hour safe shelter for women and their dependent children fleeing any form of abuse.

working in the broader context

I encourage staff to be involved with committees that are working on reducing violence and to network with employees from other agencies imparting their information and expertise. We work on raising public awareness in our community which reaches everyone from the Rotarians and other service groups to police and nursing colleges and other professional bodies. My hope is that professionals and the public are knowledgeable about the issue of family violence. I believe that is an important step in reducing the incidence of violence in our communities.

We take students from the university who are doing work placements or practicums. Students become more sensitive and aware of the issue of family violence and they take that with them. Their enhanced understanding and experience will add real value to future workplaces and communities.

We hope the women who have spent time here in the shelter will talk in the community about their experience and what they've learned about keeping themselves safe, share it with their sisters, neighbours, peers. Women working together is so powerful and empowering - we really encourage that.

defining best practices

Best practices is based mostly on what you believe - that is what will provide the focus for how to get to your desired outcomes.

The best way is one that respects the diversity and real-life situations of our clients. I want to hear from my staff and I want all of us to hear from the clients. That might not be the most timely way but it is the most respectful way.

Best practice is a process. It means there has to be dialogue and consensus working with staff. This takes a lot more time than saying, "This is how it is to be done." You need to be clear on what you believe, where you're going, and how to get there. Once you determine the outcomes you want, identify what the values and culture of the organization is, then best practices will fall into place.

The evidence piece is whether you're achieving the outcomes. The best practice is how you get there.

I work hard to maintain our credibility in the community. If we don't maintain a good reputation for being a well-run organization we won't get far. Part of maintaining credibility is using best practices on a day to day basis.

main interests outside of work and best practices

I make jewellery - doing the hand work balances the head work. There is so much happening and I tend to take my work home with me. Working with my hands is a good distraction and I can get lost in it.

I have stashes of rocks at home that I have brought back from travelling. I have learned to work with metals and this has given me an outlet to create and combine my favourite things - rocks, texture and colour.

In summer I like going to our cottage and kayaking and swimming.

I love spending time with my family and my friends - most often over food!

This profile is based on an interview with website editor Barbara Kahan.



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September/October 2011 Profile of Jaime Traynor

Jaime Traynor is a home visitor with the KidsFirst program at the Regina Early Learning Centre in Saskatchewan, Canada.

background

In most of my positions I've been dealing with the parts of health that aren't covered by the health system - the other social determinants of health - things like food security, housing, education. Mostly I've been working from an education standpoint; share that with people and they can go forward.

In rural Uganda I worked as a health educator at a maternity and learning centre, facilitating workshops for teen girls. They dealt with a range of topics related to health and wellness, including healthy relationships, HIV/AIDS, mentoring, and nutrition. I also worked with the midwives to develop workshops that they would use as part of their prenatal care.

It was a different sense of time there, a different pace. Even going to the bank could be a whole day long affair. Here we try to pin people down, be on a schedule, ask for something to be done in two days. In Africa it was much more about taking the time to build relationships. You had to be open to the fact it might take two weeks for something to get done rather than the two days you initially envisioned.

In my work there I felt I was learning as much as the people I was working with. It was nice to be in Uganda long enough to develop relationships with the community. I did not want to feel I was parachuting in, imparting expertise, and then jetting out rather than leaving a lasting impact.

In any job, I see my role as being that of a facilitator, not the expert. I want to link people up with things or search out information to answer the questions they have - sort of like simplifying things, doing the leg work. I developed this approach in different ways. Many of my university classes focused on empowerment and using community-based approaches. Also, I saw the woman-centred approach to care used by my mother, and I'd volunteered with an AIDS service organization in Victoria which uses a harm reduction approach - working with people in a non-judgmental and non-confrontational way. And mixed in with all that is my own thinking. [Note: click here to read Part 1 and click here to read Part 2 of a profile of Jaime Traynor's mother Heather Wood; click here to read a reflection by Heather Wood.]

current position

I'm very excited about my new position as a KidsFirst home visitor. I'm really looking forward to working directly with families. Before I worked on programs or projects that eventually benefitted people but where I was a couple of steps removed from the front line. Also, a new piece for me with this job is the early learning component. I'm loving all the training.

The KidsFirst program started in 2002. It's a voluntary program, designed to help vulnerable families with young children (aged 0-5) in Saskatchewan. I help link families with existing community supports and programs, advocate for them with other agencies, and take parents through a curriculum which promotes healthy child development. The program also has a mental health team and dedicated spots at area daycares and preschools for KidsFirst families.

I've been fairly deliberate about picking places to work that are in line with the approach I like to take. The KidsFirst program is researched, evidence-based, well-evaluated; also I like their policies and guidelines for working with families, which see the home visitors as facilitators. It's focused on the individual family rather than treating everyone the same.

main interests outside of work and best practices

Reading. Listening to podcasts, a good way to hear interesting things for free. Since I've just moved back here - exploring Regina by biking and walking around.

This profile is based on an interview with website editor Barbara Kahan.



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November 2011 Profile of Brennan Kahan

Brennan Kahan is a medical statistician with the Medical Research Council (MRC), Clinical Trials Unit, where he focuses on blood transfusion trials. He lives in London, UK. The comments below represent his own views and are not necessarily reflective of the MRC.

current projects most excited about

Red blood cell transfusions are often given to patients who are actively bleeding, and platelet transfusions are often given to sick patients who are at risk of bleeding. In many situations it is uncertain whether a platelet or red blood cell transfusion is beneficial. I'm involved in a number of projects which are trying to resolve this uncertainty. The results from these trials will help to inform how platelet and red blood cell transfusions are used. My work helps inform health policy decisions, which should result in better healthcare for people in the UK and worldwide.

defining best practices

I view "best practices" as ensuring that health policy is based on the best evidence available, and that health policy is updated to reflect new evidence that is made available.

Well-conducted randomised trials generally give the best quality of evidence, as they avoid problems with confounding which can make observational studies difficult to interpret. An example of confounding is when trying to assess whether vitamins improve health. The relationship between vitamins and health may be confounded by the fact that people who choose to take vitamins may be more interested in their well-being than others, and would therefore be more likely to take better care of themselves in other ways. If we ignore this, we would likely find that people who do take vitamins are healthier than others, but it would be difficult to say whether it was because of the vitamins or the other "confounding" factors.

However, in many situations it can be quite difficult to run a high quality RCT for a number of reasons. In these situations a well-conducted observational study may be the best way of gathering evidence. (A good example is the studies that first showed that cigarettes are dangerous). In general, it depends on the specific study, and if feasible I would argue that an RCT should be the design of choice.

disseminating results

Translating trial results into practice generally involves publishing the findings in a scientific journal and presenting the results at scientific meetings. I know, however, that publishing an article and presenting at conferences doesn't always work, so it is always worth considering other methods of translating findings into practice.

I think it varies from situation to situation, but translating practice results from one circumstance to another almost always requires formal evaluation. It's unrealistic to expect other communities or cities to adopt a policy based solely on the opinion of even an experienced practitioner. Formal evaluation allows others to critically evaluate research and form their own conclusions.

main interests outside of work and best practices

I enjoy a number of things including music, reading, and travelling.



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December 2011 - January 2012 Profile of Mark Crawford (Part 1)

Mark Crawford is Executive Director/Advocate, Unemployed Workers Help Centre, a Saskatchewan community-based organization. He lives and works in Regina, Canada.

nature of the work

We provide advocacy services for unemployed workers in Saskatchewan - people who are having difficulty getting information regarding their benefit claim or in some cases are having problems even getting through to the Employment Insurance Commission because of call volumes.

We also make a lot of referrals, for example to Canada-Saskatchewan Career and Employment Services, a department of the Government of Saskatchewan which provides resources and educational support to unemployed workers. We receive some of our funding from Can-Sask to support our work. Sometimes the people we see are in pretty rough shape as far as their emotional and mental health - we may suggest a counsellor, psychiatric services, social services, a doctor.

A large part of what we do is help people with their appeals if they have been refused their employment benefits for quitting a job or being dismissed from a job due to misconduct. We listen to what people have to say, and take them at their word unless there is something to contradict that - 99 percent of the time people do not bull shit us. Although the appeal process is legalistic, the basic thing is for people to go there and tell their story. We don't rehearse at all, we don't say, "Don't say this or that." We simply talk at length a number of times so people will feel comfortable during the appeal. It's nice to see results for people. We're appreciated in what we do all the time. Often the situations are difficult, emotional for everyone, you hear these stories and can't help but be affected - but at the end of the day I feel good about the process.

Sometimes we know an appeal won't be successful - we explain why, and what will happen if they go ahead with the appeal anyway. We say, "You probably won't win but you'll be treated decently, the system is there, it's not as painful if you know what's going on, they won't accuse you, they'll just try to determine the facts." Sometimes we decide to go to appeal because we think we should, even when we know we won't win - because the person needs that confirmation, they need to tell their story. They got denied benefits because maybe they didn't talk to the regulators or whoever or find another job before they quit. But at the time they felt they had no alternative but to quit. They need to be able to have their say to the tribunal.

There are three people on the appeals tribunal - the chair, a Ministerial appointment; an employer nominee; and an employee nominee. The tribunal's decisions can be appealed to an umpire, a Federal Court appointment. Something of significance can go all the way to the Supreme Court. Case law comes from these federal decisions, about 2,500 nationally a year.

I have a student every summer from the University of Regina, either from the Social Work School or the Human Justice Program, who sit down and review the last year's favourable decisions for EI claimants and annotate them for indexing. I edit the student's work, which becomes part of the favourable decision guide, and send it to the Commission which translates it and puts it on their website. People who need help with appeals can access the relevant case law there. It's a major effort for us every year.

As I work with our clients, I don't know how some people manage sometimes - the difficult situations that people find themselves in through no fault of their own. I wonder to myself - gosh, how do you go from there? But after we've had a conversation they'll say to me, "Have a great day." They truly mean that - they have kept their optimism despite their difficult circumstances.


This profile is based on an interview with website editor Barbara Kahan.


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February 2012 Profile of Mark Crawford (Part 2)

Mark Crawford is Executive Director/Advocate, Unemployed Workers Help Centre, a Saskatchewan community-based organization. He lives and works in Regina, Canada.

composite example of a client's story

A restaurant worker, a good employee with some experience and nothing negative on their record, starts working in a new restaurant. The first few months are fine, but then pressures increase on the business. The manager starts harassing employees, bullying them, telling them they can't do anything right, has temper tantrums, constantly berates them. The worker unsuccessfully tries to make things better with the manager, then starts to look for other employment. Meanwhile a final incident of harassment pushes the employee to quit immediately and is refused benefits from the Employment Insurance Commission, which accepts the employer's version that there had been no bullying or harassment, the worker just decided not to come to work. The Commission tells the worker they should have found another job before they left. We go through the process of finding out what actually happened to explain the circumstances. A co-worker writes a letter indicating they are experiencing the same harassing situation. The appeal tribunal decides the worker should receive benefits.

relationship of my work to health

The circumstances our clients find themselves relate directly to their basic health, as far as they are affected by insecurity. You not only lose your job, you lose your income that you thought you'd get from Employment Insurance. Folks often felt they had no alternative but to quit, yet the Commission staff are saying the harassment wasn't that bad, suck it up. Being told by someone who doesn't seem to care that you had other alternatives, or receiving the impression they don't really believe what you're saying; dealing with the stress of having lost your job and not having access to EI income; the employer fabricating things to cast you in a negative light; all this is really distressful to most people. Dealing with all these issues affects mental and physical health, we see that all the time.

The service we provide is to ameliorate that to an extent, helping people get benefits so they have some income; the other thing is having someone to talk to who seems to care about your situation, who understands what's happening to you, who believes what you're telling them - who affirms you in that, shows you some respect and helps you retain your dignity.

Every two years we survey our clients about our services. A common comment is, "Finally someone listened, someone cared." We give people hope.

main interests outside of work and best practices

Carpentry, reading, working out at the lake.


This profile is based on an interview with website editor Barbara Kahan.


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March 2012 Profile of Molly Moss (Part 1)

Molly Moss teaches French Immersion kindergarten at Ecole Connaught Community School, an elementary school, in Regina, Canada.

teaching context

Connaught is a very interesting school. About 50 percent of its students are from the neighbourhood and 50 percent are bussed in from the centre of the city to take part in the school's French immersion program. It was designated a community school because a minimum of 25 percent of the children are First Nations. In terms of economic spread, parents include wealthy professionals who own big houses and have double incomes; people who are artists or artisans with specific creative skills who are not wealthy in general but have a sophisticated sense and experience; people with very little money and education. Some of the families are transient, moving back and forth from the reserve; in some families the parents also went to the school so there is some thread of continuity. A large number of the parents are committed to education; for some families educational success and commitment is not a large part of their background experience.

teaching philosophy

I went into teaching because I thought we need independent, creative people for democracy to work. When I got into teaching I realized it wasn't just independent and creative children we needed but empathetic children with a strong positive sense of self - of who they are as people - and who have a caring attitude to others. Levels of thinking are still part of my lessons but I do a lot of other things to make sure children have good self esteem and develop a sense of responsibility and empathy in terms of social interactions.

When you're younger you think you know what to teach. I did, and still, value a classical education. However, my didactic streak is much less certain. I'm working with children who live in families who may have different backgrounds from mine. I now feel I have less right to decide what their priorities should be. When you come from different experiences, what are the right priorities? Priorities should probably be based on a respect for where children come from - balanced with skill development and an increase in knowledge which will open up opportunities.

My view now isn't to bring up math and language skills and the rest will follow. I might have believed once that if you educate people well everything else would follow - but now I think that's not true, too much else is happening in people's lives.

example of classroom project

I am always excited about what is happening in my classroom. Presently we are exploring life long ago in castles. We will later compare castle life to life long ago here in Saskatchewan. This gives us a chance to think about shelter, heating, food, medical help, spiritual ideas and beliefs, clothing and so much more.


This profile is based on an interview with website editor Barbara Kahan.


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April-May 2012 Profile of Molly Moss (Part 2)

Molly Moss teaches French Immersion kindergarten at Ecole Connaught Community School, an elementary school, in Regina, Canada.

Applying best practices in the classroom

There has to be good communication between home and school. In addition to "meet the teacher night" and report card conferences I phone every parent in October every year just to see how things are going and give my impressions. There are two voluntary meetings available, the first meeting to talk about immersion and the second to talk about pre-reading skills and early reading and how different it is when doing it in a second language. I also prepare monthly newsletters and invite families to special events such as Thanksgiving dinner and field trips. Some parents come in to participate in teaching units, for example in my First Nations unit a mother who makes beautiful moss bags came in. Some children have daily communication books; each night parents know if their children accomplished what they set out to do.

Since for best practices children need a voice in what they're doing, I try to balance the formal curriculum with play time learning which is quite different. I don't have time to do too much of it - but it's among the most important things to do. When you play in the castle French becomes a living language, not a language of instruction. I can use what the children offer and extend it, incorporate it into their learning, rephrase it, ask questions based on what they say. Informal learning is the most valuable. Things are out of whack because there's not enough time for play time learning.

The kindergarten curriculum is fairly reasonable but not entirely. For example some of the math learning isn't age appropriate. And the curriculum is too packed.

main interests outside of work and best practices

Hiking around with my friends. Reading and thinking. I like to study microcosms and make things grow. I like to imagine creating things - I don't like to do it but I imagine.


This profile is based on an interview with website editor Barbara Kahan.


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June-July 2012 Profile of Anne Goodman (Part 1)

Anne Goodman is a professor in Adult Education and Community Development at the Ontario Institute for Studies in Education (OISE) at the University of Toronto. She lives in Toronto, Canada.

Nature of work

I specialize in peace and peacebuilding education and practice, focussed on the community level. I feel my life is like a jigsaw with the various pieces fitting together: I teach graduate students in this area, direct a certificate program in community healing and peacebuilding, and I'm president of an international peacebuilding organisation called InterChange.

I love being in a position to connect community and university. Students can enter the certificate program without the qualifications required for graduate studies-for instance, it's not essential they have an undergraduate degree. The program includes students from a wide variety of perspectives, with some examples being a man from Pakistan who drives a taxi in Toronto, people working in the social services field, or coming from different war-torn areas. Once they're in the program, the certificate students take graduate courses alongside the graduate students. It's nice to make academic work accessible, and I've found my students are amazing and bring so much to the university.

There is also a variety of people in other courses I teach at the university. In the practicum in adult education and community development, for example, I have students from the social movements, the government, health sciences and the downtown Toronto financial district. It's great that people get to meet and dialogue with others from different walks of life. For me personally, having students from sectors I don't know much about such as business and government has helped me get over some of my misconceptions. Indeed I have found that no matter where they work and what their interests are, people are searching for meaning in life.

About InterChange

InterChange started as a research project. I was approached by Rick Wallace, one of my former students from a summer institute course I taught on peacebuilding, who said: "We always hear in conflict areas about warlords and politicians but never about what people at the community level are doing." To address this gap, I did a freelance research project with Rick a third researcher, Edith Klein, a professor in Eastern European studies. We went to several places around the world at different stages of conflict---Slovakia, Northern Ireland, Serbia and Israel/Palestine-and interviewed people doing peacebuilding work at the community level. When we compared and examined our research findings, we discovered that peacebuilders in very different locations and settings had similar needs and concerns. One common concern was the relationship between theory and practice - many of the practitioners we met told us they are curious about theory but have no time to think about what they are doing. They also wonder if theory has anything to do with their reality, and if they can contribute to theory. Another topic was evaluation; many of our informants told us this is often driven by donors and does not necessarily meet their own needs.

We decided to start an organisation for peacebuilders to address the recommendations we had made in the report of the research project.

We had the founding symposium for InterChange in Toronto in 2005. We knew we did not want to have a typical academic symposium with a number of parallel streams and people more interested in presenting their work than engaging with others. We also wanted to hear from practitioners and policy makers, not just academics. We also didn't want keynote speakers who showed up as experts and then left; we wanted everyone involved. We thus developed the symposium from the ground up in a very participatory way, asking participants what they wanted to see included and how they wanted to contribute. We created the agenda from people's responses, and everyone was involved at the symposium at all levels. We used a similar model for a symposium we held in Rwanda in 2007. (The proceedings of both the symposia can be found on our website, by clicking here and by clicking here.

The organisation has developed its own energy. For some reason, most of our members outside Canada come from East Africa, and we have local centres in Uganda and Kenya. Our Board has members in Toronto, Croatia, Nigeria, Kenya and Uganda.


This profile is based on an interview with website editor Barbara Kahan.



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August 2012 Profile of Anne Goodman (Part 2)

Anne Goodman is a professor in Adult Education and Community Development at the Ontario Institute for Studies in Education (OISE) at the University of Toronto. She lives in Toronto, Canada.

Workshops and Toolkit for Peacebuilders

In Toronto we are doing a project to build a culture of peace, developing workshops that communities can use. The workshops are developed from what people want to offer and from what communities need - co-creation on an ongoing way. One workshop - "everyone can be a peacebuilder," about basic peace literacy - is built around the model of a picnic. The idea of a picnic came to us partly because everyone is interested in food, everyone contributes, everyone gains. We bring an actual picnic basket to the workshops and begin by asking the participants what they are bringing to the picnic and what they hope to get out of it. We also do a modified "world café" activity around picnic tables or blankets, using postcards we have developed to stimulate discussion about violence, conflict and peace.

We also do workshops on health and self reflection, trauma healing, conflict and dialogue. One workshop ends with a puzzle- everyone has a piece, which they craft together.

In addition, we are developing a toolkit for peacebuilders. We are asking people to make submissions of resources they find exciting and useful, why and how they use the resources, and where to find them. We want each resource to have a person connected to it, so others can contact them and ask questions. We see this project as being just as much part of our relationship building as of sharing information.

Other parts of life

I love to garden, although there is so little time to do it. I like to be in nature. I enjoy riding my bike, reading, all those sorts of things. I recently became a grandmother -and my husband and I enjoy spending time with our grandson. It's been good for him and us and his parents.

I am also a humanist wedding officiant, which I see as similar to my adult education and peace work. When I meet with couples, they have their own expertise. I feel like I am doing the same thing with different names - creating communities, empowering people to do things important to them. It's all related.


This profile is based on an interview with website editor Barbara Kahan.


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September 2012 Profile of Anthea Darychuk

Anthea Darychuk is a University of Toronto graduate student in the public health, health promotion and global stream.

past experience

I worked with a community development program in San Pedro Sula, Honduras in 2009. All the local water sources were contaminated, and people were living on the riverbed amidst city sewage. We held health workshops on sanitation and latrine building, as well as environmental hazard awareness and health. Getting people together for action requires the same avenues whether it's for a vaccination drive or building a school.

I did an internship at Romero House in Toronto, which is transitional housing for refugee families. I lived there for a year as a companion to three families as they were going through the citizenship process, suffering from the trauma of being a refugee, and experiencing other challenges such as being a single mother going through Welfare Works. Having to relive their experiences when they go to the hearings is not pleasant, it's very difficult. It became visible to me how important it was for them to be in the community. The mental health outcomes for refugee families not in a place like Romero House and not part of a community are much worse. Being able to eat with people, talk in hallways, watch TV. together really did have huge impact on people's resilience and ability to go through the process.

exciting projects

I have been getting involved in InterChange, bridging the link between health promotion and peace promotion. For my master's practicum I am going to Palestine this summer. I will be working with the United Nations Relief and Works Agency for Palestinian refugees. I will be organizing and coordinating with three mobile clinics, doing research and community programming out of Ramallah and Jericho. There is an important link between public health, mental health and community building; I want to see how that looks in Palestine. I'm going to interview women going to the community projects - find out how they feel, what they do to promote a sense of community.

I will have the opportunity to make research personal, interviewing people in their own community about their experiences of community and how their national identity helps them.

In Toronto I have been interviewing women my age, finding out what people think about peace and health and community. My criteria for inclusion has been people who I speak to or see within a month - close friends, acquaintances - some I met in undergrad at Guelph, some I worked with at Romero House, people from community organizations, people from Massey College. The Massey community is a large part of my life, there are lots of events that go on - that is lived community based on a time frame.

In general, I'm excited about the possibility that people can become empowered by education in human rights. That's really key, trying to fight the cynicism that I find around me.

life outside of studies and work

I like going to the art gallery, cooking, salsa dancing, being with my family in Vancouver and Montreal, music, taking photos and making movies.


This profile is based on an interview with website editor Barbara Kahan.


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October 2012 Profile of Cathy Ellis Part 1

Cathy Ellis is a a tenured senior instructor with UBC Midwifery (Department of Family Practice, Midwifery Program) at the University of British Columbia in Vancouver, Canada.

background to global maternal-infant health work

I have been teaching midwifery students in the program since 2004. My specialty area is global maternal-infant health. I'm very excited about teaching a new course I developed, a required theoretical course with a companion global placement, which is optional, of six to eight weeks. Close to two-thirds of the students choose to take the placement, it's very popular. The countries we're currently working with are Uganda and Nepal. We have also worked with a teaching hospital in Zambia.

We work in places where we've been invited, and where there are poor maternal-infant indicators such as higher than average rates of maternal and neonatal mortality. The places have to be as safe as possible for students, so they don't get sick or hurt. We use a partnership model, where our partners tell us what they want and identify the trainers for us to work with. We increase the local capacity and provide materials so they can continue midwifery education after we leave. We go to places that will benefit from our expertise, and where we will also learn from them.

We try to have a targeted approach rather than just going anywhere or all over the place. We work mostly in the public sector and always in coordination with the country's ministry of health. We work closely with hospital staff and with organizations such as the Midwifery Society in Nepal.

During their placement, students also work with our partners to help them develop capacity such as "midwifery ways of working" which are new to some of our partners who work in medicalized models. Midwives and a physician always go with the students and sometimes a nurse. We offer train the trainer courses and refresher courses for nurses, midwives and other staff. We also work on the hospital wards. In Uganda the staff we work with speak English but the women having babies speak Lugandan - with them we we use a "cheat sheet" in order to use some local phrases. We are licensed to work both in Canada and in the country we're working with.

benefits of work

It's a win-win situation. Our students get the experience of practising midwifery in a very low-resource setting and with births that a midwife would rarely attend in Canada, such as twin deliveries; in Canada the obstetrician is the main provider for twin births. The students get to attend many deliveries in the hospital and assist with emergencies, the most common being resuscitation of newborns. More than half of babies are delivered at home in Uganda - mostly only women with problems go to hospital.

The benefit for the sites we work with is that they receive educational courses and some supplies. We don't do medical tourism - our work is ongoing. I've been working with one of the sites since 2005, going at least once a year and sometimes more, and with another for four or five years.

Unexpected benefits have occurred because our students are vivacious and very interested in helping people. As a result of meeting and explaining the maternity situation to other foreigners that they met in Uganda, one of the hospitals we were working with received thousands of dollars of material donations from a British NGO [non-governmental organization]. In another case they decided to raise money to get mattresses made for the maternity ward, where mothers and babies were sleeping on straw mats on the floor after their deliveries. This activity was reported in a newsletter read by members of the Ministry of Health who then provided the rest of the mattresses required. When everyone is working together things get better.

In general the hospitals we work with are improving, fewer women are dying - not just as a result of our project, but because of a number of things happening. We play one little part.

Mother and newborn baby with UBC Midwifery student Tania Lindstrom and Midwife Cathy Ellis, Masaka Regional Referral Hospital, Uganda


This profile is based on an interview with website editor Barbara Kahan.


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November 2012 Profile of Cathy Ellis Part 2

Cathy Ellis is a a tenured senior instructor with UBC Midwifery (Department of Family Practice, Midwifery Program) at the University of British Columbia in Vancouver, Canada.

details of our global maternal-infant health work

A big part of the refresher course we provide is resuscitation of newborns, using resuscitation baby dolls. We also use obstetrical mannequins in our work. In Nepal we took the Hesparian Foundation book called Where There Is No Women's Doctor, which we had translated by a local doctor at an NGO [non-governmental organization] into Nepali. For health education and promotion purposes we want the material to be in the correct language for people to use. We also took another pamphlet, about uterine prolapse - the biggest female health problem in Nepal. We leave the dolls and mannequins and other materials with the trainers we have trained and the nurses and auxiliary nurse midwives who have taken the refresher courses and workshops so they can continue the work.

A different kind of resource we bring with us are baby hats, booties and blankets knitted by people in Canada. There is a need for these - for example, some women arrive at the hospital without blankets because they went into labour unexpectedly. And the women in Canada who do the knitting love to have something to do that's going to make a difference to people in another country. They knit them with a lot of love.

Another part of our work in Uganda is that students do small research projects working with the the Ugandan senior midwives so they become published as well, on topics they also agreed are needed to study.

In Nepal for the last two years we have given workshops in very remote areas. Last year it took two planes to get there. By land, it would have taken three days and three nights. This rural area in Nepal has a 70% rate of children under the age of five stunted in growth. A lot of families are only able to produce enough food for six to nine months of the year. The other part of the year they rely on food from the World Food Bank. However, Nepal is developing quickly. Roads are being built, services are entering the rural areas - things will get better. We are doing one tiny, tiny bit to make that happen.

In rural Bangladesh I'm a midwifery consultant with a Muskoka CIDA [Canadian International Development Agency] project called Interrupting Pathways to Maternal, Newborn and Early Childhood Sepsis. In that project we are training trainers to work with the nurses in rural hospitals to provide clean and safe delivery services as well as improving the hospital facility. There will be a monthly follow up for the three years of the project using case-based scenarios to review the content of the course and problems that they've experienced.

In our training, if people don't understand the first time how to resuscitate a baby, we do it again. Or we'll go through another variation of how to control hemorrhaging. In addition to training, our work involves the development of protocols, so the rural staff have more guidance for evidence-based practice to handle emergencies. We're also working on the humanization of institutional delivery - how to make it a satisfactory as well as a safe experience for women.

In general, on a population health level, we are trying to improve health overall by targeting some of these nurse-midwives who are not recognized as "midwives" under ICM [International Confederation of Midwives] because they haven't trained long enough or have the competencies to be considered a midwife. They are considered to be auxiliary midwives. They are the only ones working with women in these remote areas - if we communicate with them and teach them the best practices, that might help to improve their work and get better health results for the women they're working with.

main interests outside of work and best practices

I like the outdoors. I go with friends and family on short camping trips -there are so many nice places in the Rockies and near Vancouver. We take tents and bikes and ride around and swim in lakes in beautiful places out of the city. I used to be in popular theatre but I don't have time anymore; I teach, I'm taking courses now for my PhD and I have to keep up my midwifery practice.


This profile is based on an interview with website editor Barbara Kahan.


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