1. Improving Group Programs Through Feedback and Reflection Centretown Community Health Centre

2. Quality Improvement QI is based on understanding: The current system/environment The complexity working with people How the environment and complexity creates variations AND HOW to …. Use knowledge/information to influence outcomes.

3. Quality Improvement – With Group Programs The system/environment Many different health education groups, Each with different specific objectives Complexity of working with people Different populations (age, gender, culture, socio-economic status) Different modes of delivery Different levels of literacy/knowledge of English

4. Lots of Different Groups …. Children’s Self Esteem Women of All Cultures Living with Stress Walking Group Senior’s Tea Breastfeeding Drop-in Challenge of How to assess these groups and implement change in a consistent manner

5. Not your typical health care QI setting … Non-clinical “soft” interventions/outcomes – i.e. improve self esteem Difficult to measure change/impact with limited resources

6. Evaluation And QI Issues in Health Promotion and Community Development Unit of FocusIndividual OR Group, community, system Type of evaluation Outcome OR Include process and context IndicatorsBiomedical OR Community capacity; social health EvidenceRational & “scientific”; valid/reliable OR Theory-based, practice-based How to evaluate Standardized tools; quantitative OR Participatory & capacity building; qualitative

7. Quality Improvement

8. 1. Plan – Group Logic Models InputsStaffing, supplies etc. ActivitiesSessions, activities etc. Target GroupsWho the group is being targeted for Outputs # of sessions, # of participants Outcomes (short term) What is hoped to happen by the time the group is complete Outcomes (long term) What is hoped to happen if the impact/knowledge/skills are maintained Goal Macro level – (e.g.. decrease in chronic conditions) (but not full influence)

9. 2. Do – Carry Out Group

10. 3. Study – Feedback Forms Group Feedback Form Name of the Group: Date: (Day/Month/Year) Number of sessions attended: 1. How satisfied were you with the group program? (Circle the number that best expresses your opinion.) 1234 5 Not at all Somewhat Very satisfied satisfied satisfied 2.What have you found useful about the group program? 3.How much have you learned as a result of participating in the group program? 1234 5 Little or A moderate A great nothing amount deal 4.What, specifically, have you learned? 5.How much change have you made as a result of participating in the group program? 1234 5 Little or A moderate A great none amount deal 6.In what ways, specifically, have you changed? 1.Specific question to your program 2.Specific question for your program 3.Specific question for your program 10. What suggestions do you have for improving the group program?

11. Review feedback and observations Reflect Write up summary 3. Study – Feedback Forms

12. 4. Act Recommend changes to group structure

13. Children’s Self Esteem Teaching participants about the importance of both children’s and their own “emotional tank” and how to “fill it up” to have high self esteem. 9 participants, from catchment area (6 new immigrants) 2 sessions. Childcare provided

14. Children’s Self Esteem Group What was trying to be accomplished? Importance of Self Esteem Skills and techniques to develop self esteem. How did we know if intervention was an improvement? Participants listed techniques they were now using “physical touch/positive talking” What changes can we make that will result in an improvement? Moving location of parent’s session so they will have fewer interruptions from the children

15. Women of All Cultures Program designed to decrease isolation and increase knowledge of Canadian system and services Intended population: newcomer women 8 sessions average 14 participants/session Intended short term outcomes (from logic model): –Participants have increased knowledge of topics. –Participants are more aware of Canadian systems. –Participants are more aware of community services.

16. Women of All Cultures What was trying to be accomplished? More awareness of Canadian systems and community resources Decreased isolation How did we know if intervention was an improvement? Participants listed “information, knowledge and friendship” and change in “nutrition habits and knowledge about health” What changes can we make that will result in an improvement? Develop a program specifically for immigrant seniors. Focus on informal reciprocity Limit amount of printed material

17. Living With Stress Stress reduction workshop designed for use in community with marginalized populations Intended population: women on low income, homeless or at risk of homelessness, unemployed or underemployed, social isolation. 5 sessions, 9 unique participants Intended short term outcomes (from logic model): –Increased knowledge/awareness of: what our stressors are; how we react to stress (in the body, behaving, thoughts); healthy ways to respond to stress; link between stress and chronic diseases –Gain skills in relaxation/stress reduction skills & techniques to calm the body/mind/breath

18. Living with Stress What was trying to be accomplished? Stress reduction training for marginalized populations How did we know if intervention was an improvement? “exploratory” group – what did we learn? What changes can we make that will result in an improvement? Less focus on the body Focus on specific stressors – not generalized Improve general poverty advocacy within the Centre

19. Factors for Success Commitment from staff to complete the summaries Investment in evaluation resources within the Community Health Promotion/Early Years Programs Increased interest in results when there are similar comparisons between groups. Centre philosophy of group service delivery

20. How we could do this better? Repeat for similar groups Working database developed for input and automated summaries of feedback form data. Reports back in a timely manner so that facilitators can use the results in planning and evaluation Ensuring each group has specific questions linked directly to the group’s logic model

21. Thank you – Questions?