PHO Grand Rounds. Tuesday, March 11, 2014

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2 Lowering the drawbridge: Learnings from the CASTLE project The role of Community Health Brokers as a cancer screening intervention in priority neighbourhoods PHO Grand Rounds Tuesday, March 11, 2014 Jessica Wallace, Public Health Nurse, Hamilton Public Health Marty Mako, Health Promoter, Niagara Region Public Health Funding provided by the Public Health Agency of Canada

3 AGENDA: CASTLE project background Priority neighbourhood site selection CASTLE strategies Community Health Broker (CHB) role What is the role of Public Health? Preliminary evaluation results Lessons learned Sustainability

4 Creating Access to Screening and Training in the Living Environment

5 CASTLE Goal To implement an innovative model to increase cancer screening among the Under or Never Screened Focus on breast (mammogram), cervix (Pap test) and colorectal (FOBT) cancer screening

6 Community Health Broker Role

7 Site Selection Process Site Selection Tools: Neighbourhood Partnerships Mapping of Neighbourhood Profiles Cancer Screening Mapping Decision Matrix Geographic/ Political consideration Low cancer screenin g rates Community Assets Within the region of the project Low income neighb ourhood Appropriate Site

8 Decision Making Matrix Neighbourhoods A B C D E F G Criteria F F F F S S F Status of tenant associations/social committees Status of community development efforts Readiness of tenants to participate (i.e. volunteer) # of Housing Units Housing Unit Population # tenants aged yrs # tenants aged yrs Health Care Office to Pop Ratio # of Health Care Offices within 10min Distance to Hospital Distance to CHC/Walk In/HCP Suitability Score Qualitative Criteria Status of community development efforts Volunteering and leadership Existing social networks Quantitative Criteria Age demographics GIS mapping # of units/ residents Family vs. Senior building Suitability Rank

9 CASTLE Strategies Network and Workgroups Regional Leads (Public Health) Community Health Brokers (CHBs) Promote CASTLE Address barriers Develop strategies with the community Train & Mentor CHBs Outreach Advocacy Community engagement Build community trust Provide education Website Posters Training Manual Newsletters Support/mentor CHBs Problem solve barriers Advocate for needs Connect to Health Services Cancer screening support Community dinners Neighbourhood fairs One on one conversations

10 Innovative Social Marketing Contacts or

11 Community Health Broker Role CHBs Build Trust by: Going to, working with, and connecting with priority neighbourhoods Working to breakdown barriers, build pathways and promote access to cancer screening Using a strengths-based approach that builds selfadvocacy and capacity for cancer screening tests. Supporting neighbourhoood residents to attend cancer screening

12 A Day in the Life of a CHB

13 A Day in the Life, in their words I know more and more of the residents by name. I am able to follow up with conversations from previous weeks depending on the state of mind of the resident. It is interesting to note how their mental state does change from week to week. Sometimes they are interested in relationship, and other times their illness is too loud. For example, there is one woman whom I am visit with every week. She is usually happy and talkative. However 2 weeks ago she was very, very down. She wouldn t look at people and would only whisper. She kept saying there was a fire going on in her head. She said it was so loud it was hard to hear and it was obvious that was her experience as she didn t respond to people who were talking to her unless they spoke loud and were right beside her I am not sure how to work yet with these people, but those who know them best, say it is worth the time to educate them and work with them So that is my plan for now: keep building relationships, keep bringing up cancer screens when I can, and keep in touch with the staff to talk about how to reach this target group Community A was another heartfelt experience this week as I did the mammo-graham workshop. The initial reaction was a wave of laughter as the women expressed their embarrassment about building marshmallow breasts in a graham cracker mammogram. I started the workshop sharing about my own mothers battle and consequent loss to breast cancer 24 years ago. I likened the process with the right to vote and how, because she had been of the generation that truly understood the value of that right and privilege that she was very serious about women and politics. Having watched my mother die from breast cancer I too am very serious about getting screened. I spoke to the power and impact of early detection and that the advances in medicine have made breast cancer treatable, curable and survivable. I put it out to the group to discuss why women don t go? I had to leave the meeting early as today was my first clients MAMMOGRAM and I am so excited. I have to say that in the back of my mind is a little fear that she will back out at the last minute but fingers crossed she will be there. I got to our meeting place and there she was, nervous as heck but she was there. This is so exciting. We got to the imaging dept. at the hospital and she started to cry just giving her health card. I got her calmed down and into the room, helped her fill out forms and she went in to have mammogram done. She was in there less than 5 minutes. No kidding. She came out crying and I asked her why and she said because she felt so stupid for waiting so long because it didn t hurt at all and that was why she waited. We had a great laugh over this and she thanked me for being her friend which almost made me cry.

14 What is Public Health s role? Public Health/Regional Lead role Relationships with CHB s Advocacy

15 Project Partners Housing & Social Assistance Regional Cancer Programs Community Health Centers Canadian Cancer Society Neighbourhood Associations Cancer Care Ontario Recreation Services Health Care Practitioners Senior Services

16 Evaluation: Year One Preliminary Results: Knowledge gaps/misunderstanding/low understanding of cancer screening messages Fear- of tests and results; of asking questions Feelings of shame and being marginalized by health care system Community-preferred information sources: What: Posters, information handouts, TV ads Social media specifically Facebook How: Using humour, celebrities/local heroes to give messages Where: At local settings where people go in the community

17 Evaluation: Year One Cancer Screening Barriers: Lack of trust in the health care system Uncomfortable talking to service providers Lack of transportation or family care Cancer Screening Enablers: Trusting relationships with CHB Health care providers who listen and address system barriers Family encouragement Attributes of CHB

18 Lessons Learned Partnerships are key most challenges lie outside the realm of traditional Public Health Solutions must be locally drivengaining trust is a huge first step People tell you what they need if you spend more time listening than talking It s not about you or your priorities - meet them where they are and go from there!

19 Sustainability: Beyond 2014 Funding Community-supported Knowledge Transfer

20 Thank you facebook.com/castleknownow twitter.com/castleknownow

21 CASTLE Project Team PI: Olive Wahoush, RN, PhD Co-PI: Angela Frisina, RN, MHSc Co-I: Faye Parascandalo, RN, BScN Project Manager: Elizabeth Molinaro, MA Regional Leads: Tricia Hack, RN, BScN; Melanie Seguin, BA (Honours); Marty Mako, MBA; Diane Peart, RN, BScN; Jessica Wallace, RN, BScN; Eric Robertson, RN, BScN