Welcome to Tenfold!

In this episode, Andrea and the production team discuss the origins of the podcast, where the name Tenfold came from and how excited they are to launch this podcast!

1. Let's Talk Community Engagement

In this episode, Lisa Attygalle from the Tamarack Institute joins Andrea to talk about community engagement.

Lisa describes community engagement as working together with the community to create the future that we want. Figuring out what we want the future to look like is an active conversation: once we have the future we want define, we can decide how we will work together to create it. Lisa recommends the IAP2 Public Participation Spectrum as a community engagement model. The spectrum describes engagement on five levels: inform; consult; involve; collaborate; and empower. 

Community engagement is a critical part of public health practice as it’s important for communities to be involved in developing the solutions that affect their lives. Communities are context experts: they bring the voice of lived experience to the content experts (usually people in paid professional positions within the health sector). Pairing content and context expertise makes for better solutions that have community ownership.  Not engaging communities can mean that our programs and services don’t meet the needs of communities and risk wasting resources. In this way, engaging communities can be a key to efficiently spending resources such as time, dollars, relationships and trust. 

Before developing an engagement strategy, it’s important to consider WHY you are engaging prior to jumping determining the method of engagement (such as a survey or focus group). Lisa has 4 WHY questions:

1. WHY is community engagement important to the project and how will it contribute to the results of the project?
2. WHAT are your objectives? For example, to inform decisions? To make decisions together? To establish relationships? To enhance community leadership skills?
3. WHAT is the benefit to the community? There must be a reciprocal benefit to the community. 
4. WHAT is on the table and off the table? Set the parameters for what is possible, in terms of time, budget and solutions. 

One piece of advice that Lisa would give to those working in community engagement is to “close the loop” with communities. In other words, give feedback to the community on what was heard in the community engagement process and what was done with their ideas. You don’t have to have all of your “ducks in a row” before communicating with the community.

The Tamarack Institute’s many Community Engagement tools and resources can be found here. In particular, the article on Community engagement: a foundational practice of community change is a must read!

2. Engaging with Indigenous Communities in a Good Way

In this episode, Andrea chats with Nicole Blackman from Durham Region Health Department about engaging with Indigenous communities. Nicole has three pieces of advice:

• Take time to build relationships. Relationship building is the foundation of community engagement. There can sometimes be a conflict between the timelines our agencies and programs often have and the time needed to build strong relationship. At Durham Region, they focus on relationship building for the first year of new projects/programs. 
• Take time to learn about Indigenous communities. To do this, Durham region conducted a community profile to identify Indigenous organizations and assets in the community. 
• Focus the collaboration on community wants and needs, rather than on the goals of the organization/program.

Before engaging Indigenous communities and organizations, Nicole recommends taking cultural awareness training to learn about Indigenous history and its impacts on health, social wellbeing and place in society today. The Ontario Federation of Indigenous Friendship Centres offers Indigenous Cultural Competency Training. The Southwest Ontario Aboriginal Health Access Centre also provides an Ontario Indigenous Cultural Safety Program. You can also check out PHESC’s webinar series on Indigenous Health Equity.

3. Embedding Community Engagement into an Organization: Peterborough Public Health’s Experience

In this episode, Julie Brandsma from Peterborough Public Health joins Andrea to talk about embedding community engagement at the organizational level. Peterborough Public Health’s (PPH) community engagement journey began in 2013 when the health unit developed their strategic plan. “Community-centered focus” was identified as one of four strategic directions. This direction was important in order for the health unit to be accountable not only to the Ontario Public Health Standards, but also to the public and community agencies. The strategic direction recognizes the growing interest from the public to be involved in making decisions. The health unit selected the IAP2 Spectrum as a model to recognize what has already been done and to provide guidance on deepening efforts. This was approved by health unit managers. Next, PPH adapted the City of Peterborough’s community engagement guide for the public health context. The guide includes definitions, a step model and a variety of tools to help staff implement community engagement. To supplement implementation of the guide and tools, a core group of public health staff provide guidance around training and learning needs. PPH also has a set of “organizational expectations” that speak to the essence of what community engagement is and how it is done in the Peterborough Public Health context:

• There is clarity and purpose to the community engagement strategy
• The engagement will be meaningful to the community that you are engaging
• Engaging community members is intentional, planned in a way that will sustain relationships and trust between community members and our organization
• Move towards the empowerment end of the spectrum (where appropriate)

Regular listeners know that we end each podcast episode with an action step or concrete action that listeners can start with. Julie’s advice is to recognize that we have already started- we all have examples of what we/our organizations are already doing to involve communities in our work. Take time to stop and reflect on what you are doing now, how it is going, how we can build on strengths, and what you could change to make the engagement more meaningful and purposeful for the community themselves.

You can check out PPH’s community engagement tools on their website or contact info@peterboroughpublichealth.ca with any questions.

4. Knowledge Translation and Community Engagement

In this episode, Andrea is joined by Dianne Oickle, Knowledge Translation Specialist at the National Collaborating Centre for Determinants of Health (NCCDH). Dianne and Andrea talk about knowledge translation, community engagement, and the relationship between the two.

Knowledge Translation (KT) can mean a variety of things, depending on the context and the person using the term. There are also a variety of related terms such as knowledge exchange, knowledge transfer, and knowledge mobilization. For this reason, staff at the NCCDH use the term “K-star” rather than Knowledge Translation. They define K-star as a two-way relationship, where information is put into a format that the audience can use. K-star products or services can include workshops, conferences, webinars, podcasts, conversations, newsletters, articles, and story-telling. At the NCCDH, knowledge is viewed not simply as coming from experts or people in power: rather knowledge is “found” in communities, the public health field, and with people that live with inequities. The NCCDH’s role is to package or format that information, and re-communicate it in a way that can be used in practice.

K-star and community engagement have a circular relationship. The IAP2 continuum (which we often reference in the podcast) can also inform K-star initiatives. In particular, Dianne encourages public health folks to think beyond the informing and consulting stages of the continuum. Consider involving communities in the development of K-star initiatives, collaborating with communities, or even empowering communities to share, translate or mobilize the knowledge they have generated. K-star can also be a part of the engagement process. For example, a critical part of community engagement is a feedback loop with the communities you have engaged. This needs to be more than simply “reporting back” to communities: rather it’s about being accountable to the community that you are working with by telling them how their information is being used, and what decisions have been made and why they’ve been made. Having K-star principles in mind will help you think about communicating with communities in ways that are preferred by them and safe for them- not easiest for you.

Dianne has two pieces of advice for listeners. The first is to step back to look at the focus of your work, and ask at every stage “where could community input help shape what I am doing?” and in particular, where communities with lived experience could be involved. The second is to think beyond knowledge transfer towards knowledge exchange and mobilization, and consider how the community can be involved in these two-way approaches.

Dianne selected four articles that might be of interest to listeners:

• Is KT without patient or community engagement flawed?
• Patient and public engagement in KT research: are we there yet?
• Community engagement in children’s environmental health research
• Towards equity focused intersectoral practice

5. Power and Privilege in Community Engagement

Gillian Kranias joins Andrea to explore the concepts of social power and privilege, and their role in community engagement. The dominant groups in our society- in Canada, in Ontario, in the towns we live in and in our communities- carry power and privilege, which means that non-dominant groups are historically and continue to be marginalized and oppressed. There can be a distance between those that carry social power, and those who lack it. Being aware of those distances, noticing who we do not hear from and who we are not connected to, and then beginning to listen, can help to shorten that distance.

Having power gives us access to resources: money, access to space, time, mental energy, staffing etc. Gillian suggests several ways to shift power to communities:

• Focus on relationships first!
• Handing over resources: for example, funding grass roots groups to do research or hire peer researchers, sharing office supplies or materials that groups might not be able to afford
• Support community to meet on their own to share their ideas and prepare for meetings with staff
• Check in regularly (perhaps at the beginning of each meeting) and provide ongoing opportunities for dialogue. Participatory evaluation techniques such as “Hands-on rating” can be a good exercise to start conversations. 

Gillian’s closing piece of advice is to think about what relationships can support you in an ongoing way in your learning journey to becoming better professionals. Perhaps that’s a peer or colleague that you can connect with regularly, or perhaps journaling or reflecting on your own. This helps to make an ongoing commitment to the work.

Suggested Resources

First and foremost, let’s “change who we are learning from…” Here are some podcasts made by community members we are listening to:

• Crackdown is a monthly podcast about drugs, drug policy and the drug war led by drug user activists and supported by research.
• What’s Your Safe Word? Declarations of Resistance is a bi-weekly podcast from WomenatthecentrE, a Canadian incorporated organization created by survivors of gendered violence.
• Media Indigena is a weekly current affairs roundtable featuring guests from the worlds of activism, arts, academia and beyond join Rick for lively, insightful conversation that goes beyond the headlines to get at what matters most to Indigenous peoples.
• Talking Poverty Podcast from the BC Poverty Reduction Coalition.
• Secret Life of Canada, a history podcast about the country you know and the stories you don’t.

Here are some resources designed by professionals for professionals:

• The Collaborative leadership in Practice (CLiP) website has a number of resources, stories, research and tools to help you decentre power and share resources.
• Becoming an Ally in Partnerships – Powerpoint presentation by Lauren Burrows. She explains the triangle of oppression, and how it is often like an iceberg (much happens below the surface of everyday awareness). The title of Lauren’s webworkshop recalls the book Becoming an Ally by Anne Bishop
• Self-evaluation Tool for Action in Partnership – Angèle Bilodeau et al. 2017. This evidence-based tool includes 18 questions related to conditions for ensuring our partnerships really are places for equitable, innovative, and collective action. This tool comes from Quebec, where equitable community engagement thinking is thriving – in French.  
• Hands-on Rating on page 15 of the Participatory Evaluation Toolkit – This technique, used with any ladder or continuum of community engagement, allows for process reflections. Once ratings have been made, affinity group discussions (i.e. community members alone together) can bring out reflections on areas of consensus and difference and learn from the people around you.
• Bringing stakeholders together for urban health equity: hallmarks of a compromised process Amy Katz et al. 2015. The article highlights all the complexities of power and marginalization, and the different kinds of “harm” that can be caused when municipalities practice community engagement that is ignorant to the complexities of power. It puts into question whether communities benefit from getting involved in our engagement efforts, if it compromises their time or positioning to organize independently.  

6. From the Boardroom to the Kitchen Table: Niagara's Lived Experience Advisory Network

In this episode, Andrea is joined by Brandon Agnew and Donna Mills from Niagara Region Public Health, and community member Jennifer Symonds to talk about Niagara Region’s Lived Experience Advisory Network (LEAN).

Niagara Region started LEAN in 2018 to bring two parties together- public health, and people who experience poverty- to talk about the intersections between poverty and health in Niagara, and problem solve solutions to improve health outcomes. LEAN leverages the skills, talent and experiences of people who live in poverty and empowers them to be community leaders, to think outside of the box and look for innovative solutions. LEAN is also creating social connections between network members, and community connections between service providers.

There are several “ingredients” that allow LEAN to be successful:

• Public health leaders had an understanding of the importance of community engagement. This meant that staff didn’t have to “sell” the idea of LEAN to leadership.  
• LEAN builds on success of the Youth Advisory Committee which has been running successfully for several years.
• Public health staff leveraged existing relationships with community members who already knew and trusted them.
• LEAN members’ feel like their voices are heard and their advice is incorporated in decisions.
• Both LEAN members and the health unit are benefiting equally.

An important consideration when engaging people with lived/living experience is making meetings accessible, safe and comfortable. Brandon and Donna asked community members to choose how often they want to meet, where they want to meet and select meeting spaces that are comfortable (for example the atrium or cafeteria as opposed to a boardroom). Every monthly meeting includes dinner, which everyone eats together. Children and youth are welcome at meetings. Brandon and Donna promote car sharing, provide gas cards and taxi chits to make it easy and affordable for members to attend meetings. LEAN members are provided with an honorarium for each meeting. When shaping each agenda, Brandon lets the community set the pace in terms of meeting frequency and topics, and alternates meeting formats to include celebrations and casual conversations.

We end the episode with advice for listeners to consider as they engage people with lived experienced. Jennifer’s advice is to “just do it”: the benefits outweigh any risks or challenges. Donna’s advice is to make the engagement authentic and be ready to implement the advice and suggestions that you receive. Brandon’s advice is see the gifts and talents that people have, as opposed to the deficits.

Thanks to the Tenfold team and Niagara’s IT folks for making this episode possible!

7. Engaging People Who Use Substances: A Needs Assessment Project in Guelph

This episode is a conversation with Kyley Alderson from the Wellington-Dufferin-Guelph Health Unit about a needs assessment Kyley was recently a part of. Work on this project began in 2018 when Guelph was experiencing an increase in harms related to opioid use. The health unit wanted to engage the community and people who use illegal substances, in order to understand the context, what people use and how, what gaps exist in the community, and what ideas for solutions people have.

Staff from the health unit established an advisory committee, made up of local coalitions and agencies as well as people with lived experience of substance use. Through partners who had established relationships, 3 peers (people with lived experience of substance use) were hired to take part in the advisory committee and be peer researchers. The advisory committee developed the needs assessment strategy, which focused around interviews conducted by peer researchers, developed the interview guide, completed the ethics application, and selected the locations to conduct interviews.

The community engagement approach to conducting the needs assessment had several benefits:

• Planning: Approaches for the surveys were well planned out for the survey audience.
• Recruitment: Peer researchers helped with recruitment and led recruitment in ways that were appropriate for them and the audience. Peer researchers had trust and relationships with the audience, which allowed respondents to answer questions in open and honest ways.  
• Shared language: Peer researchers understand language around using substances, which helped with designing the survey questions and conducting the interviews.
• Analyzing and interpreting results: Having peer researchers who really understand the context helped with interpretation of the data and choosing what to highlight.

The community engagement strategy had a number of impacts. The findings were shared with community members, leaders and decision-makers, who were impacted by the data and stories collected as part of the project. The power of story helped to broaden and change thinking about people who use substances. The findings informed a number of grant applications, the development of new projects, service planning for the community’s consumption and treatment service, and the development of a substance use strategy for the health unit. The findings also helped to inform a second phase of the needs assessment, which focusses on people who weren’t reached by the interviews (for example, people who don’t live in Guelph and people who don’t use the services where the interviews were held).

Kyley’s advice for folks who are beginning peer research and/or working with people who use substances is to focus on relationships and connect with the community. Building trust with community partners, with peers and with people who use substances is a foundation for all meaningful work. Caring is important as well: to care about building relationship for the purpose of making the community better.

Kyley wants to acknowledge the project’s Advisory Committee members and staff who helped to meaningfully engage the community. Specifically, Patty Montague, Melissa Potwarka, Jennifer MacLeod, Moira Barber, Steph Beaumont, Todd Mansfield, Colin McVicker, Tom Hammond, Adrienne Crowder, Sarah Haanstra, April Fyfe and Chanelle Lobo.

Kyley and Andrea have the following resources to share:

• Research 101: A Manifesto for Ethical Research in the Downtown Eastside is a “how to” manual, informed by people who use substances.
• To learn more about the experiences of people who use drugs, check out the Crackdown Podcast for a Canadian perspective and Drugs Uncut from the Scottish Drugs Forum.
• The BC Centre for Disease Control has a guide for peer payments that created in collaboration with peers and providers. The guide provides rationale for questions that are often asked in organizations.

8. Engaging Leaders: The Good, The Bad, and The Ugly

In this episode, Andrea is joined by Darrin Canniff, Mayor of Chatham-Kent, Ken McEwan from the University of Guelph Ridgetown Campus, and Karen Loney from Chatham-Kent Public Health. Darrin, Ken and Karen are all involved in the Chatham-Kent (CK) Community Leaders’ Cabinet, which brings together government, industry, health, education, and First Nations leaders to develop collective solutions to improve quality of life in Chatham-Kent.

The Cabinet began several years ago when, following a two year journey to engage communities in support of smoke-free outdoor spaces, the motion was defeated at Council. The health unit realized that in order to make policy change happen they needed to engage leaders and decision-makers more. The (former) mayor was approached to become a champion for health and bring leaders together. The mayor offered a physical location and the resources of the COA’s office and as Karen was working in the healthy communities portfolio, they allotted a portion of her time to be the coordinator of the cabinet.  The Cabinet is a unique structure; it has no mandate to come together and no official funding source, outside of the health unit covering Karen’s time. The Cabinet comes together out of goodwill and ultimately because they believe that collectively they can do more than one organization can do alone. 

One of the early successes of the Cabinet was the successful passing of the motion to ban smoking in outdoor space, following its initial ban- this time, with the support of the Mayor. The Cabinet led the community in pledging to make Chatham-Kent tobacco-free, community organizations provided smoking cessation workshops and strengthened their own smoke-free spaces policies, and when the vote went back to council it had 100% support. Other items highlighted included a Summit on Mental Health and the current focus on workforce attraction and retention that has three action teams.  

Our guests have some advice for listeners who would like to begin engaging leaders. Karen’s advice is to give yourself time, stay committed, and focus on building relationships with trust. Ken suggests to narrow the scope of the work so that people have something tangible to bite their teeth into. Mayor Canniff advises the “rob and duplicate” approach, so that you can replicate good work that is happening elsewhere and share ideas of what’s working.

If you like to reach out to the Cabinet with your questions or to find out more, email CKCommunityLeadersCabinet@chatham-kent.ca. For more information around system leaders, Karen recommends an article entitled The Dawn of System Leadership by Peter Senge, Hal Hamilton, & John Kania.

9. Engaging Community Partners: Toward Common Ground

In this episode, Andrea is joined by Sarah Haanstra from Toward Common Ground and Anna Vanderlaan from Wellington-Dufferin-Guelph Public Health to talk about engaging Wellington Guelph community partners in a community planning model.

Toward Common Ground (TCG) is a community planning model that brings together 13 leaders from social and health services to respond to shared needs and gaps in Guelph and Wellington. TCG does not have a “backbone” organization: it is guided by a steering committee, made up of member organizations that contribute resources (such as staffing, dollars etc.) and is not bound by any single mandate. A steering committee keeps a bird’s eye view of wellbeing in its broadest form: the social determinants of health, physical and mental health at the community level. No one organization’s logo is bigger than anyone else’s logo!

As Manager of TCG, Sarah is connected to many organizations and partners across Wellington and Guelph. As part of her role, she heard about a number of organizations working separately to address Adverse Childhood Experiences (ACEs). Sarah brought those organizations together to work collectively, now known as the ACEs coalition. Following a Call To Action Day, the ACEs coalition conducted a local survey to measures ACEs and resilience to provide a baseline for the work of the coalition. Community partners were involved in designing the survey: in a great example of a “win: win” situation, the local Ontario Works office were interested in knowing how ACEs might have impacted their clients. A question was added to the survey to provide this information, and in return the OW office promoted the survey to their clients.   

There are several key factors that contribute to TCG’s success:

• Partners are committed to the greater good in community, and the concept that health and wellbeing is not determined by any one factor. Partners understand the need to push levers in different places to have a collective impact.
• Partners are willing to be flexible, nimble and responsive to community needs. This means that priorities might occasionally shift to accommodate new work.
• Partners trust that organizations’ mandates are set aside for the common good, and partners also trust in the process until there is clarity on what’s next.
• Partners have identified the individual strengths that sit around the table and trust the partner with that expertise to lead those pieces.
• Partners are engaged and re-engaged in continuous communication, with formal and informal updates.

To end the episode, Anna and Sarah provide advice for those seeking to work as a community planning model. Anna’s advice is to spend time up front to build a collective or shared vision. The ACEs coalition spent time to build a theory of change that grounds the work of the coalition, prior to beginning more concrete action. Sarah’s advice is to be deliberate about what one meeting or one gathering means in terms of the bigger picture: one step leads to the next and leads to a little more clarity – and to the common vision.

To learn more about Toward Common Ground, visit their website at http://www.towardcommonground.ca/en/about/about.aspx. Visit the ACEs Coalition website at https://acescoalition.ca/.

10. Season 1 Wrap Up

This week, Andrea is joined by the PHESC team to reflect on highlights and lessons learned from the season. What lessons have affected you? How will this change your work? Chat about it with your friends and colleagues (or with us!).

We’re excited that we’ll be coming back for a second season! Have a story about community engagement or know someone who does? We’d love to hear from you! Email phesc.dlsph@utoronto.ca or tweet @PHESC_ON to get in touch.

Thank you to all of our wonderful guests and listeners for making season 1 of Tenfold such a success!