This proposal builds on the work of a group formed with participation from members of the Community Action Team, local high school students, parents, teachers, and other interested community representatives from a wide variety of backgrounds. The intent of this proposal is to develop a plan to address the concerns identified and clarified by this group. The purpose is to improve the health and wellbeing of the teens of secondary school age in Valley, British Columbia.
Summary of the Community Aggregates Assessment
Using the Community as Partner model, the group completed an in-depth assessment of the high school aged teenagers in Valley, British Columbia. During this assessment a number of areas of concern were identified.
The first area of concern identified was the use of drugs and other substances to the point of impacting students ability to focus; their grades and dangerous behavior. A minimum of five students in the aggregate group have died per year in accidents involving drug use or a combination of drug and alcohol use. Many more students were injured or had their health negatively impacted due to substance abuse. The aggregate group of teenagers of high school age in Valley BC consists of less than one thousand teenagers. The rate of death or injury resulting in hospitalization as a result of drug or a combination of drug or alcohol use for this aggregate is greater than 3% with an increasing trend over the past five years. This area was identified as part of the Education and Health and Social Services portion of the community assessment wheel. (Vollman, Anderson & Mcfarlae, 2012, p 227 figure 13.1)
The second area of concern identified was the increase in what the group termed petty crimes. These generally involved small thefts or vandalism. The group included in this area the lack of activities or groups available for students to participate in. This area was identified as part of the Recreation and Health and Social Services portion of the community assessment wheel. (Vollman, Anderson & Mcfarlae, 2012, p 227 figure 13.1)
Developing the Approach
The behavioural or lifestyle approach is summarized by Stamler and Yiu as an approach that uses, strategies that encourage the adoption of behaviours or lifestyles that promote functional ability and well-being. (Stamler and Yiu, 2012, p91) The socio-environmental approach focuses on the relationships and dependence between an individual and their environment, which would include family, community, culture, as well as their physical and social environment. (Stamler and Yiu, 2012 p92)
What does this mean? Which approach is best and what are the key factors involved in each? Labonte (1993) provides a high level comparison of the various approaches (Labonte, (1993, in Stamler and Yiu, 2012, p90). The comparison identifies that behavioural/lifestyle focuses on behavioural risk factors while socio-environmental focuses on psychosocial and socio-environmental risk conditions. The behavioural/lifestyle approach is focused more formally on areas such as education, social marketing/communication and regulation or polices. This is contrasted with the socio-environmental approach which focuses on the environment and empowerment strategies.
Both of these approaches have strengths and weaknesses. Changing behaviour requires that individuals be educated to understand why a specific behaviour is high-risk or needs to be changed. The behavioural/lifestyle approach with its combination of health education, social marketing and regulation can definitely be successful. These are strong points in favour of this approach. The socio-environmental approachs strength lies in the fact that as Labonte states it, goes beyond physical-emotional well-being to include social well-being at individual and community levels; may be viewed as a resource for daily living rather than a state that one aspires to. (Labonte, 1993 as cited in Stamler and Yiu, 2012, p90) There is overlap between some aspects of the two approaches. Both approaches address to varying degrees, the social aspect of change. The behavioural/lifestyle includes social marketing while the socio-environmental takes a much stronger approach. The socio-environmental has, as its name implies, a strong focus on the social aspect developing strategies to create supportive environments and empower individuals. Both of these approaches however fail to fully embrace all of the needed aspects for successful long-term and widely adopted change. A high-risk group or individual engaging in high-risk behaviour requires the education aspect as well as a supportive environment and personal empowerment to help them break free of these behaviours. The argument could be made that through the principal strategies addressed in the socio-environmental approach the Ottawa Charter and empowerment strategies do involve education. This aspect on its own is inadequate to the needs of the community.
Final Approach and Rationale
The final approach chosen by the group was a more comprehensive approach than that described by Labonte. The team did feel that the socio-environmental approach, although not overtly stated did address areas covered by the behavioural/lifestyle approach that the team felt were required. The group decided to adopt a modified socio-environmental approach. This approach was to include the strategies and health determinants that are typically used and focussed on with the socio-environmental approach. (Both psychosocial and socio-environmental risk factors/conditions) The modified approach however is intended to also include the success criteria of a decrease in behavioural risk factors (such as substance use and risky behaviours during substance use) as well as a more formal inclusion of education similar to the behavioural/lifestyle approach. (Labonte, 1993 as cited in Stamler and Yiu, 2012, p90)
The teams modified approach also included a strong focus on the inclusion of cognitive behavioural therapy concepts and techniques similar to cognitive processing therapy.
Cognitive processing therapy, a firstline treatment for PTSD, was initially developed for the treatment of rape victims, but has been found to be effective in treating combat-related PTSD, as well. It incorporates the core elements of cognitive therapy identifying false or unhelpful trauma-related thoughts, then evaluating the evidence for and against them so the patient learns to consider whether these problematic thoughts are the result of cognitive bias or error and develop more realistic and/or useful thoughts. Cognitive processing therapy, however, focuses primarily on issues of safety, danger, and trust relating to patients views of themselves, others, and the world. Patients are asked to write, and then read, a narrative of the trauma they endured to help them challenge troubling thoughts about it. A woman undergoing treatment for PTSD relating to a sexual assault, for example, may initially think, All men are bad. Challenging this thought by examining evidence for and against it may help her replace it with the more realistic belief that somebut not allmen are bad. Vinci, C., Coffey, S., and Norquist, G. 2015, p18)
The use of cognitive therapy was deliberately introduced to facilitate and improve the likelihood of long-term success in changing behaviours.
Behavioral theory provides a theoretical basis to understand the development of human behaviors and to modify pathological behaviors. Most human behaviors are acquired through learning, and maladaptive behaviors frequently result from erroneous learning. Thus, behavior modification techniques can help rebuild healthy behaviors and lifestyles through intense training procedures, which represent a relearning or resocializing process. In order to be effective, behavior therapists should encourage patients to follow all requirements of the therapeutic approach, to practice healthy behaviors, to maintain therapeutic achievements, and to turn healthy behaviors into an intrinsic part of their daily life. Only when the behavior modification techniques become an intrinsic part of daily life can patients return to healthy behavior in their daily life. (Yang et al., 2014, p43 )The inclusion of cognitive behavioural therapy was the first step in developing an approach that would assist in changing the teens behaviours in the long-term. The second aspect was the strong emphasis on the use of Ottawa Charter strategies and empowerment strategies. The team felt that the involvement of the community was critical. Development of strong supportive environments both within the school as well as within the community were determined to be a high priority.
Developing a Program Proposal
In developing a successful implementation plan, the CAT team choose to follow the model demonstrated in the study, Integrating health planning and social planning: a case study in community-based partnerships for better health (Ambrose and Short, 2009). This study noted three critical components in the planning and implementing a community based program. These components are cited as professional development, social networking and active inclusion of individuals involved. This was translated into the development and implementation plan developed to address the items identified primarily education needs and activity needs (organized, drop-in, and volunteer). The end goal was to modify the teenagers behaviour in the long-term.
Two major components of the program were identified. The first component identified was the need for the program to be delivered through both the school and community. The challenge with this was to develop this portion of the program while still complying with the strong regulations resulting from the various collective agreements and legislation. In their review of school based interventions, Busch et al., (2013) state, interventions should be organized through existing school infrastructure; that they should be centrally organized within a school; that they should to be fine-tuned to the target population (not a one-size-fits-all approach); and that they should be embedded in the family and neighborhood environment as well as in the school environment. (Busch et al., 2013, p 521) The second major component was the inclusion of education in a variety of methods such as formal and informal; peer to peer; community based and professional formats.
The representatives added to the team were primarily students with a few teachers and parents as well. The combined team met regularly with a socialized atmosphere, typically having a pot-luck meal with socialization time as well as working time. These representatives kept a strong and open communication with their peers using many forms of social media including Twitter, Facebook and a School Blog. Feedback and suggestions were actively encouraged from the teachers, students, parents, the community action team and professionals consulted at various points throughout the process. Evaluation of the program has been loosely based on the implementation evaluation methodology identified by Khodyakov et al., (2014). This study discussed the effectiveness of using a mixed-method approach to data collection in evaluation.
Through a strong collaboration with the community, various professionals and the aggregate group a program labelled Youth Success has been developed. This program relied on research conducted through the local community, professionals, StatsCan, and provincial resources. It also is based on the results of strong qualitative surveys completed by the aggregate group (the secondary school teenagers in grades eight to twelve) as well as other key groups that interact wit...
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