BETTER HEALTH AWARDS ENTRY

The Better Health Awards recognise the diverse ways in which innovation and excellence in public health and healthcare is achieved. The six categories, which are aligned to the Victorian Health Priorities Framework 2012-2022, honour initiatives and services that demonstrate excellence, innovation and quality.

Organisation Knox Community Health Service

Entry contact person Chris Potter

Email Chris.potter@kchs.org.au

Telephone (03) 9757 6202

CEO endorsed Yes

Which Better Health Award are you entering? Tick one Award

� Optimising the health status of Victorians �

� Excellence in supporting self-managed healthcare

� Excellence in healthcare outcomes through person-centred care

� Excellence in healthcare outcomes

� Excellence in service provision

� Excellence in enhanced quality healthcare through e-health and communications technology

Entry title: Mothers Living Well

Has this initiative previously been commended or

won a Victorian Public Healthcare Award No

The subject of this entry has not been entered into

another 2011 Awards category? No

Abstract The aim of Mothers Living Well (MLW) is to promote social and community connection and create walkable, attractive and inclusive environments for mothers and their families in Bayswater. The project commenced in 2006 and has a focus in two specific geographical areas: Bayswater central shopping area and Bayswater West. The project has worked with mothers, particularly those parenting in difficult circumstances, to identify environmental and community level improvements that will be the basis for sustainable, physical and mental health outcomes for mothers and families. A range of partners have been involved, including Department of Transport (DOT), Knox City Council (KCC) and local community organisations and residents. Planning and preparation The project commenced in the 2006-2009 Integrated Health Promotion (HP) Plan, and comes under two State government priority areas: improving mental health and wellbeing, and increasing physical activity and creating active communities. Local data informed the original project planning including the VicLANES survey (Kavanagh, 2005) which identified that Knox women in

the 35-54 age groups were significantly more sedentary than those in other municipalities and that children were reported as the main barrier to women walking and cycling. Other data indicated issues for local mothers in terms of isolation and impacts on mental health, particularly in the more disadvantaged areas including Bayswater. This semi–industrial suburb has the lowest SEIFA index in Knox, the highest number of single parents, people on disability support and other pensions, higher rate of crime and a lower perception of safety. In recognition of the long-term approach required to impact environments, the work continues in the current HP plan (2009-2013) where it complements organisational priorities from our current Strategic Plan. Objectives Prior to 2009, the two project goals were:

• To increase active transport (walking and cycling) by mothers and their children in Bayswater; and

• To enhance the mental wellbeing and social connectedness of mothers parenting in difficult circumstances living in Bayswater.

For the purpose of the project,) “difficult circumstances” included women parenting solo, experiencing isolation or disconnection, living with disability or caring for people with disabilities. These groups are often excluded from community life by physical, social or financial barriers (Yantzi et al, 2006; Bostock, 2000; Whitzman, 2007; Whitzman & Pike, 2007). Project objectives were developed out of an extensive literature review and a comprehensive community research phase led by local mothers. This revealed mothers felt strongly about the environment and how it either enhanced or prevented them and their children from participating in active transport and connecting with others socially (Lime Management Group, 2010). It also supported previous findings that walking locally is linked to increased social connectedness (Whitzman, 2007; Whitzman & Pike, 2007; Semenza & Krishnasamy, 2007)). Recognising the linkage between these two areas; that local neighbourhood environments need to be interesting, attractive, accessible and child and youth friendly; the two goals were merged in 2009 and became “To enhance mental wellbeing for mothers and their families in Bayswater by increasing social inclusion and community connection and rates of active transport”. Methods and implementation The project’s initial community research phase combined the DOT’s Travel Planning process

(DOT, 2011) with a community-based participatory research methodology (Minkler & Wallerstein, 2003). In 2007, 13 local mothers were trained as “Mum2Mum” peer researchers and investigated social and environmental community factors which influence mothers’ mental and physical wellbeing. They interviewed 37 mothers, launched a photo-collection and participated in 2 community environmental audits. An additional 173 women were surveyed by partner organisations.

The outcomes of this community-based research were summarised in the action-oriented Bayswater Community Plan. Additional activities were instigated by the community through the two following structures:

• The Welcoming Bayswater committee comprising disability agencies, traders, local organisations and residents in the Bayswater Shopping area). Activities include the Bayswater Buzz community newspaper and Annual Social Inclusion week Street Party.

• The Bayswater West Community Hub group comprising Primary School, Church, Maternal child health centre, sports clubs and residents. Activities included the Streets4Living project, Outdoor Cinema Night, Community café and planning improvements at the Guy Turner reserve.

Each group developed their own plans and timelines for specific ongoing activities. Regular monitoring has occurred through qualitative process evaluations (e.g. focus groups) and

quantitative measures as appropriate (e.g. attendance at events). Impact measures and evaluation are discussed below. Results and outcomes A comprehensive Evaluation Plan has been developed for the project which is reported on to the Department of Health annually. A range of baseline and process data has been gathered over the last 5 years and an interim evaluation in 2010 revealed the following improvements:

• Increase (5%) in the number of local women walking in the past week at the time of survey. The sample was from women attending settings involved in the project in February 2007 and 2010 (not the same group of women);

• Increase (41%) in the number of women reporting an increase in walking over the last year (time period and settings as above);

• Increased understanding of the link between walking and cycling and community/social connectedness by mothers directly involved in the project. (focus group and interviews) and;

• Improved sense of social belonging and connection for mothers directly involved in the project (focus group and interviews)

A range of other outcomes have been experienced in terms of changes in the environment and community life in Bayswater including:

• Streetscape beautification and traffic calming in the Bayswater Hub area to encourage walking and cycling;

• Identification of other infrastructure requirements for further planning/funding by local council;

• A calendar of family-oriented outdoor community events with a social inclusion focus (low cost, accessible, culturally appropriate).

Final evaluation will occur in 2012.Mothers/community residents will be supported to evaluate outcomes in partnership with residents, schools, traders, groups and other local stakeholders. Status and sustainability The project is in its final phase of building sustainability. To this end, different structures have established in both project arms, with a steering committee for Bayswater shopping area and a quarterly forum for the Bayswater West Community Hub with monthly action group meetings. They are all led by members of the local community including residents and organisations such as Interchange and Bayswater West Primary school. Plans for the gradual withdrawal of KCHS’s facilitation and staffing have been in place since early 2011 and our substantive involvement will cease at the completion of evaluation in 2012 as we transition to total community facilitation. Budget Resources were primarily from the KCHS HP budget, totalling approximately $120,000 per year for staff, on-costs and minor operational costs. Additional funding has been obtained including:

� $80,000 grant from TravelSmart; � $20,000 from KCC; � ‘Streets4Living’ project in Bayswater West was co-funded by DOT and KCC ($80,000 for

streetscape, art installations and traffic calming). The annual Welcoming Bayswater Social Inclusion Street party is entirely self funded ($7,000 per year) and has a very large list of local sponsors including politicians, real estate agencies, RACV, Multi-cultural commission, small retailers etc. The Bendigo bank has recently provided a $3000 grant to buy a computer for the Bayswater Buzz production. Other organisations now take a lead in applying for grants to fund further actions, such as the expansion of the Street party.

Achieving excellence in health MLW has taken a deliberate “upstream” approach utilising a very broad range of interconnected and evidence-based interventions (led by the community rather than the health service) to create environmental change where health and wellbeing can improve, rather than relying on isolated interventions such as walking groups. As such it has received recognition and positive feedback from both the local community and from other organisations interested in replicating the model. It recently received a KCC Environment Award for Community Engagement. Local mothers have disseminated their learning’s in a number of ways, most recently presenting at a Walkable Communities forum (2011). Its strength is in the highly collaborative approach and strong leadership that has been developed in local women (and men) to continue the actions. Organisations have reoriented to take on a role in sustaining the project aims, for example Interchange are now the publishers of the Bayswater Buzz community newspaper and Bayswater West Primary school auspice a mobile community cafe run by local mothers for mothers. The project therefore provides a significant return for investment with outcomes that will be felt into the future.

Referees Mandy Roche – Coordinator, Community Strengthening, Knox City Council 511 Burwood Highway, Wantirna South, 3152 Mandy.Roche@knox.vic.gov.au (03) 9298 8377 Peter DeWacht – Principal, Bayswater West Primary School Phyllis St, Bayswater, 3153 dewacht.peter.w@edumail.vic.gov.au (03) 9729 3394 References Bostock, L 2000 ‘Pathways of disadvantage? Walking as a mode of transport among low-income mothers’ Health and Social Care in the Community, vol. 9, no. 1, pp. 11-18.

Department of Transport 2011, Five step travel Planning process . Accessed on 20/8/2011. http://www.transport.vic.gov.au/projects/sustainable/travelsmart/travel-planning/travel-planning-in-five-steps

Kavanagh, A, Goller, J, Kind, T, Jolley, D, Crawford, D, & Turrell, G 2005. ‘Urban area disadvantage and physical activity: a multilevel study in Melbourne Australia’, Journal of Epidemiology and Community Health, vol. 59, pp. 934-940.

Lime Management Group 2010 Department of Tranport and Knox community Health service: Mothers Living Well, A Bayswater community project - Evaluation Report, . accessed on 24/8.2011 http://www.kchs.org.au/healthpromotion.shtml

Minkler, M & Wallerstein, N Eeds 2003, Community-Based Participatory Research for Health. San Francisco: Jossey-Bass.

Semenza, JC & Krishnasamy, PV 2007 ‘Design of a Health-Promoting Neighborhood Intervention’, Health Promotion Practice, vol. 8, p. 243.

Whitzman, C 2007 ‘Stuck at the front door: gender, fear of crime and the challenge of creating safer space’, Environment and Planning, vol 39, pp. 2715-2732.

Whitzman, C & Pike, L 2007 From Battery-Reared to Free Range Children: Institutional Barriers and Enablers to Children’s Independent Mobility in Victoria, Aust, Australasian Centre for Governance and Management of Urban Transportation (GAMUT). Yantzi, NM, Rosenberg, MW & McKeever, P 2006,. ‘Getting out of the house: the challenges mothers face when their children have long-term care needs’, Health and Social Care in the Community, vol. 15, no. 1, pp/: 45-55. 9. Word count

1380

Conditions of entry Your submission must meet the Awards entry requirements, otherwise it may be declared ineligible. Entry requirements are available from the website at: www.health.vic.gov.au/healthcareawards/ Supporting material You can supply one support document up to three single-sided A4 pages, which may include graphs, charts tables or other illustrative material. A high quality photo is required with your entry. Entry presentation Use Arial font, size 11 in black text. Before you submit, delete the grey shaded descriptions and check the spelling and grammar of your entry.

Evidence of Community Wide Sustainable Health Impacts Mothers Living Well (MLW) shows strong evidence that it has been successful in achieving its objectives: across two levels: First, level of impact are the results showing improvements in both mothers’ sense of belonging and in walking behaviour, even at this early stage of community implementation. Secondly (and in terms of long term change, equally importantly), MLW has successfully created both strong structures of community partnerships and local environmental improvements which will ensure that the improvements to mothers wellbeing and active transport behaviour will continue.

Early data showing increased mothers’ active transport and increased social Connectedness by mothers as a result of Mothers Living Well

Measurement is being taken of mothers’ uptake of walking / cycling & social connectedness over time using a Snapshot Survey.

Mothers have been surveyed using this tool at a range of destination points including shopping centres, maternal child health, schools

etc.in both Feb 2007 and then April 2010. Survey questions include social belonging and walking and cycling behaviour based on

other standardised tools. Changes in Walking behaviour is shown in Summary data as summarised in figures 1, figure 2, and figure 3.

Figure 1: Mothers who had walked or cycled in the past week (2007 and 2010)

79%84%

11%5%

0%

20%

40%

60%

80%

100%

2007 2010

Walked

Cycled

41%

16%

43%

Increased

Decreased

Same

24%

24%

52%

Increased

Decreased

Same

MLW Tree The outcomes and impacts of

MLW over time is represented here in a tree

diagram. The trunk shows the research

phase which generated leadership &

partnerships & identified local needs. These

led into the branches which represent the

implementation stage of the project since

2008. Projects have been implemented in 2

branches representing 2 settings: Bayswater

West and Welcoming Bayswater at Central

Bayswater Shopping Area. Projects run in

these settings led by mothers/ partners are

generating increases at neighbourhood

levels in community connection & active

transport for mothers. The tree reflects the

longevity of outcomes as environments &

leadership strengthens & more projects

develop

Table 1: Table showing changes in mothers’

walking/Cycling over time as captured by

Snapshot Survey in 2007/2010. This data

suggests, at this early stage of the community’s

implementation of actions that there is a small

increase in mothers walking to local

destinations (but no increase in cycling).

(n= 173) (N=50)

Figures 2 & 3: Pie diagrams showing results from 2010 Snapshot Survey from the question asking if mothers have

increased walking cycling in the last year. This data suggests mothers have increased their amount of active transport

(walking and cycling) in the past year. Figures 4 and 5 show the results to these questions with 41 % noted an increase in

their frequency of walking while 24% increased cycling.

Environmental improvements which contribute to long term sustainable increases in mothers’ wellbeing

Evidence of Mothers’ increased leadership in and involvement in creating neighbourhood improvements

Environmental improvements at Bayswater West Resulting from the Bayswater Community Hub Project (one of the action branches of Mothers Living Well

• A pause point (a seat, drinking fountain, fruit tree and children’s seats/steps designed and decorated in liaison with community hub action group and other residents including mothers and children from MLW).

• Colored line markings on roads to signify this is a community hub precinct where children and diverse people cross to encourage slower driving.

• Sculpture art work on the streets also as signals of being in a community hub, to slow traffic and create a pleasing, welcoming spaces for mothers and children to walk, cycle and connect to others.

• Community Notice Board: for residents, groups etc. to regularly promote local activities at the hub.

• Updating and greater access created for the school disability car spot.

• More welcoming entrance (including lower fenceline) at the local children’s services building which mothers had previously suggested as ugly.

• Improved footpath surface at the entry to Guy Turner Reserve

• Knox Council has allocated a budget for a pathway through Guy Turner Reserve and for a fully integrated master planning process at the reserve which will engage residents & groups around the hub in designing Guy Turner as a welcoming, supportive place for diverse people including as a place for mothers to Walk/Cycle and connect.

• Signage with maps has been placed in the hub to encourage people to meet, walk and cycle and to know where paths lead and what facilities exist.

• The Bowling Club has cut down foliage to allow people to see inside their facility based on children’s interest in better connecting to that space.

“I know I can change my world personally, but I didn’t

know you could actually make a physical difference in what

the area looks like. And the kinder, it’s like there are things

we can do there to make it friendlier for mums to talk and

interact, and I actually have more personal power to

change things than I ever thought, not just for me”

“It’s given me the skills to consider, ok, by my little actions

I can actually influence how my school community

operates”

“I think I am still just a suburban mum but now I am a

suburban mum who can make a difference. I always thought

I only had my own personal power to change my own

relationships and suddenly I have discovered that I can

actually make a change on in the community”

“Previously I wouldn’t have known who to talk to at

Council; I wouldn’t have known the Department of

Transport. I wouldn’t have known that you can actually talk

to these people and put up an idea. I wouldn’t have known

where to start previously”

Quotes taken from Mothers who have become leaders in The

Action Projects of Mothers Living Well 2010

Outcomes in strengthening mothers leadership of local Community improvements:

• Mothers (community Leaders) now leading both the

Community Café and the Welcoming Bayswater

Street party (both ongoing social connection events

Which will continue in Bayswater)

• Mothers are now leading in the community Hub Action

In Bayswater West.

• Mothers have led in a major workshop in Outer East

Letting other health agencies know about Mothers Living

Well

• MLW Mothers have led and facilitated in a consumer

Participation Forum at Knox Community Health Services,

and presented at 2 Melbourne based conferences.

• One Mother has received for her volunteer work in MLW

the award of Knox Citizen of the Year (2010).

• One mother from MLW was part of creating and formatting

Bayswater Buzz, the first community paper

in Bayswater to support celebrate and encourage

social connection locally.

• Mothers have spoken at 2 launches, presented at

Council Budget meetings and are now involved in

Discussions with councils over the need for a pedestrian crossing in the hub area.

Resources produced as part of the Mothers Living Well