Presenter Disclosure

Transcription

1 CFPC Conflict of Interest Presenter Disclosure Presenter: Kathleen Foley, Lisa Kha & Gurpreet Karir Relationships to commercial interests: Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: None Other: None

2 MEASURING WHAT MATTERS AOHC CONFERENCE, JUNE 2016 SRCHC brings people in all people feel heard... This in turn gives the community many great advantages. A healthy community is a strong community and together we all grow stronger..(client survey 2015)

3 QUESTIONS? What steps has your organization taken to reflect the work of health promotion? What is the one question you want to ask your peers about their work, measuring what matters, the work of health promotion?

4 Upstream Drivers of Health Like all health care providers, I quickly learned that it takes more than medicine to make people healthy. It takes clean water. Safe housing. A basic education. Economic opportunities. Freedom from violence and conflict. These are the social determinants of health. They are the responsibility of not just health ministers, but of the whole of government without fair access to these upstream drivers of health, we will continue to face inequity, regional disparities and vulnerable populations. (Minister of Health, Jane Philpot, May 23, 2016)

5 Overview 1. Overview of health promotion programming at South Riverdale Community Health Centre (SRCHC) 2. SRCHC s journey, the tools/processes that we have developed as we try to better reflect health promotion programming 3. What s worked, challenges and next steps 4. Learning from our peers what have you done?

6 OVERVIEW OF HEALTH PROMOTION PROGRAMMING AT SRCHC

7 SRCHC TEAM STRUCTURE Population Focus Newcomers & Families Chronic Disease Urban Health Program Design Inter-professional teams (clinical, allied health, health promotion & workers with lived experience) Low threshold access programs Outreach/community engagement Extending reach of programs through colocation and integration with partners Quality Improvement and evaluation

8 Demonstrating What Matters: Framework Documenting Change Road Map Community Priorities Provincial Framework SRCHC Team Plans and Performance Management Reports SRCHC Operating Plan SRCHC Strategic Plan AOHC Model of Health and Well Being

9 Financial Resources Human Resources Client & Community Empowered, healthy and thriving communities where everyone belongs Increased access to services/programs for priority groups Coordinated quality programs/services Clients & community are engaged in improving their health and health care systems Organizational Health Systems Program & Services Performance management Training & development Staff orientation Facilities enhanced to support programs/services Optimize technology and communication systems to support delivery of programs/services Improve processes that support the delivery of programs/services Enhance partnerships for integrated/ accessible service system Advocacy & community engagement for equitable health care system Organizational Processes Optimizing cost for services Financial strategy

10 Health Promotion Programming at SRCHC FY % Registered clients accessed at least one health promotion program last year Reach -860 people registered to attend a health promotion program -47 registered groups Sessions -652 session held -12% are at off-site locactions -Average of three groups per work day Attendance -7,338 and average of 9 sessions attended for each person registered. Chronic Disease 25 groups Children & Families 6 groups Health & Wellness 16 groups

11 Reflections? 2013, only 5.15% of total healthcare expenditures in Canada was allocated to public health/health promotion activities How many individuals are accessing health promotion programs at community health centres across the province? Are health promotion programs an access point for other services at community health centres? Who is accessing health promotion programs at health - centres?

12 SETTING THE STAGE: HEALTH PROMOTION STORIES

13 At the Frontline: How We Work Client Feedback

14 At the Frontline: The Client G is 33 years old, living at a local shelter with her two children aged 2 and 4yrs. She has been living in the country for two months. A friend at the shelter suggested she come to the Parenting Group. The group has ongoing registration and she starts attending, with her two children, on a weekly basis. After four weeks, G attends a session on sexual health presented by an NP. At the end of the group, she stays behind to chat with the HP staff. She mentions she is feeling really stressed and has no one to talk and also needs help with her refugee application.

15 At the Frontline: Integration and Improved Health Outcomes HP connects G to the program Social Worker ---where they address a range of issues related to housing and her refugee application. At her third meeting with the social worker, G says that she thinks she is pregnant and doesn t know what to do. An appointment is arranged with a NP to discuss options. G has been connected with SRCHC for over two years. She is housed, her children are in daycare/ school. She is in school and preparing to apply to college. She has also secured a part-time job. She continues to struggle with anxiety and depression and accesses a range of services at SRCHC (health promotion programming & projects, clinical, social work, physiotherapist.).

16 At the Front Line: Improved Health Outcomes The project made me realize that art is an avenue or way to express our deep innermost feeling such as, feelings of depression, neglect and isolation. But also we can translate those emotions into something beautiful and by using art we can begin to heal

17 SRCHC S JOURNEY

18 Our Challenge: How Do We Document the Work of Health Promotion How we work? Who is accessing programs? How do we reflect the complexity of the issues we address in health promotion programs? Are we connecting clients/service users to internal and external services? What partners do we work with?

19 Our Approach: We Don t Need to Reinvent the Wheel

20 SRCHC Journey Framework: Development of Evaluation Template Demonstrate: Data Dashboard S F P D C Structure: Work Group Process: Workflow Improvements Celebrate: Telling Stories

21 Structure Health Promotion Evaluation Work Group Membership Health Promotion staff, Data Management Coordinator, Manager of Newcomers and Families Team and Manager of QI Mandate Design of evaluation framework(s) Provide input into the development of indicators that measure the relevancy, efficiency and effectiveness of programs. Develop a NOD data reporting tool framework for personal development groups. Team Different Perspectives, & Different Roles Transparency Sharing Our Work, Learning From Each Other & Identify Common Approaches/Themes QI Framework Small Tests of Change

22 Framework Evaluation Framework for Health Promotion Groups Framework to support planning and evaluation (appendix one) What are the goals for the group? All group programs plan work around common themes: Program Planning - Community Development Community outreach & engagement Peer & volunteer engagement Knowledge exchange (content and process) Each of these areas team defined objectives, outcomes, indicators, processes, and leads for different parts of the project Reflection: This was a good starting point it helped identify common objectives, common challenges, ways of streamlining work etc.

23 Process Process Improvements: Mapping Workflows NOD Group Registration Client Registration Attendance Encountering/ Referral Standardized registration form for all group programs (appendix two) Admin team inputs client registration into NOD If over 20 clients attending group, admin encounters attendance Standardize the use of Encodes for issues addressed and designed internal referral process in NOD for group programs

24 Process Process Improvements: Outcomes Analysis Demonstrate Develop systems for improving how we encounter work Efficient Admin team help with registration and attendance - focus for HP team is on planning & delivering programs Standardize People using common processes and tools to get work completed.

25 Looking at the Data: Developing a Health Promotion Dashboard Access Sociodemographic profile of clients New Clients Determinants of Health Issues addressed in group programming Integration Client Journeyinternal and external referrals in one-toencounters

26 NOD Health Promotion Dashboard Program Planning Program Delivery/Monitoring Outcomes Inputs Program Components Activities Outputs Short Term Outcomes Intermediate Outcomes Staff Partners Group Sessions Individual Follow-up Language of Service Provision # sessions # sessions with internal staff # sessions with partners sociodemographi c analysis (NOD registration # clients # new clients total attendance Average # participants each group Issues addressed in group programming Number of issues addressed in programming Issues addressed mapped to Health Promotion Program Interventions Client Journey # unique individuals served outside group #direct and indirect encounters # encounters by provider type Issues addressed by providers (clinical/allied health)

27 Demonstrate Looking at the Results: Data From NOD Team members using different codes for similar work Minimum encountering of issues addressed in groups Work that was being done not reflected in encounter data Pulling data was difficult and we did not know how many individuals accessing group programs were accessing other services at the centre

28 Demonstrate Data Improvement Plan Map Encounters What issues are you addressing in groups? 33 encodes used by HP staff Mapped encodes to Model of Health and Well Being and Organization Objectives (Appendix Four) Consistency Agreed to reflect range of issues addressed Also use common codes based on discussion of Health Promotion Interventions Make it easy! Set the Encodes up as favourities in NOD Chapter X- social and community codes Results 47% increase in the number of issues addressed in group programming Better reflects work of health promotion

29 Demonstrate Shared Health Promotion Interventions Barriers to Access Map Encounters Determinants of Consistency Health Approach Results Transportation Social Isolation Health Education Social Support Food Security

30 Demonstrate Improvements Made: Small Test of Change Transportation Health Education Almost doubled the number of issues addressed in group programming compared to previous 3 month period (261to 495) Social Support Food Insecurity Social Isolation Number of Encounters Better reflection of health promotion work being done, especially re: food insecurity and access issuestransportation

31 Demonstrate Data Improvement Plan: Moving Forward Review Data Regular reporting and monitoring, shared with the team, supports staff and program managers, Document Training, Encountering supports and process improvements Improvement Plan Identify areas for improvement, goals for change and monitoring

32 THE STORY WITH DATA

33 Health Impacts: Model of Health & Well-Being 48% 13% 22% 80% Determinants of Health 48% of issues address addressed in group settings address poverty/housing/ food access Integration 13 % clients linked with other services at SRCHC. 50% clients linked to social work 70% linked with MD/NP Average of 28 encounters Total of 3,327 encounters Access 80 % of clients accessing group based programs have annual income of less that $25,000 10% couch surfing/shelter or living on the street Complexity 22% of most complex clients are accessing health promotion programs 60% of individuals referred attend 3 or more group based programs

34 Client Journey: G s Story Access Programs/Internal Referrals Integration (internal) Integration (External) Access Point Health Promotion Clinical Allied health 55 encounters; 165 issues addressed by a team of 4 providers External referrals Housing, Employment Childcare and Schooling Groups 110 Group Encounters

35 Lessons Learnt Inter-professional team. Create space and time. Celebrate success- telling our stories The group programs.. helped me clean up my life, promote education and has given me the incentive to connect with family and find employment. Support from leadership

36 Next Steps Developing visual. data dashboard Ongoing. monitoring and improvement Spread. to other. Teams.. Sector conversations?

37 Thank you & Questions