Improving Group Programs

Through Feedback and

Reflection

Centretown Community Health Centre

Quality Improvement

QI is based on understanding:

• The current system/environment • The complexity working with people

• How the environment and complexity creates variations

AND HOW to ….

• Use knowledge/information to influence outcomes.

Quality Improvement – With Group Programs

The system/environment • Many different health education groups, • Each with different specific objectives

Complexity of working with people• Different populations (age, gender, culture, socio-economic status)• Different modes of delivery• Different levels of literacy/knowledge of English

Lots of Different Groups ….

Children’s Self Esteem

Women of All Cultures

Living with Stress

Walking Group

Senior’s Tea

Breastfeeding Drop-in

Challenge of How to assess these

groups and implement change

in a consistent manner

Not your typical health careQI setting …

• Non-clinical

• “soft” interventions/outcomes – i.e. improve self esteem

• Difficult to measure change/impact with limited resources

Evaluation And QI Issues

in Health Promotion and Community Development Unit of Focus Individual OR

Group, community, system

Type of evaluation

Outcome OR

Include process and context

Indicators Biomedical OR

Community capacity; social health

Evidence Rational & “scientific”; valid/reliable OR

Theory-based, practice-based

How to evaluate

Standardized tools; quantitative OR

Participatory & capacity building; qualitative

Quality Improvement

1. Plan – Group Logic ModelsInputs Staffing, supplies etc.

Activities Sessions, activities etc.

Target Groups Who the group is being targeted for

Outputs # of sessions, # of participants

Outcomes (short term)

What is hoped to happen by the time the group is complete

Outcomes (long term)

What is hoped to happen if the impact/knowledge/skills are maintained

Goal Macro level – (e.g.. decrease in chronic conditions) (but not full influence)

2. Do – Carry Out Group

3. Study – Feedback FormsGroup Feedback Form

Name of the Group: Date: (Day/Month/Year)

Number of sessions attended:

1. How satisfied were you with the group program? (Circle the number that best expresses your opinion.)1 2 3 4 5

Not at all Somewhat Very satisfied satisfied satisfied

2. What have you found useful about the group program?

3. How much have you learned as a result of participating in the group program? 1 2 3 4 5

Little or A moderate A great nothing amount deal

4. What, specifically, have you learned?

5. How much change have you made as a result of participating in the group program? 1 2 3 4 5

Little or A moderate A great none amount deal

6. In what ways, specifically, have you changed?

1. Specific question to your program2. Specific question for your program3. Specific question for your program

10. What suggestions do you have for improving the group program?

Group Feedback Form

Name of the Group: Date: (Day/Month/Year)

Number of sessions attended:

1. How satisfied were you with the group program? (Circle the number that best expresses your opinion.)1 2 3 4 5

Not at all Somewhat Very satisfied satisfied satisfied

2. What have you found useful about the group program?

3. How much have you learned as a result of participating in the group program? 1 2 3 4 5

Little or A moderate A great nothing amount deal

4. What, specifically, have you learned?

5. How much change have you made as a result of participating in the group program? 1 2 3 4 5

Little or A moderate A great none amount deal

6. In what ways, specifically, have you changed?

1. Specific question to your program2. Specific question for your program3. Specific question for your program

10. What suggestions do you have for improving the group program?

Review feedback and observations

Reflect

Write up summary

3. Study – Feedback Forms

4. Act Recommend changes to group structure

Children’s Self Esteem

Teaching participants about the importance of both children’s and their own “emotional tank” and how to “fill it up” to have high self esteem.

9 participants, from catchment area (6 new immigrants)

2 sessions. Childcare provided

Children’s Self Esteem Group

What was trying to be accomplished?

Importance of Self Esteem

Skills and techniques to develop self esteem.

How did we know if intervention was an improvement?

Participants listed techniques they were now using “physical touch/positive talking”

What changes can we make that will result in an improvement?

Moving location of parent’s session so they will have fewer interruptions from the children

Women of All Cultures Program designed to decrease isolation and increase knowledge of

Canadian system and services

Intended population: newcomer women 8 sessions average 14 participants/session

Intended short term outcomes (from logic model):– Participants have increased knowledge of topics.– Participants are more aware of Canadian systems.– Participants are more aware of community services.

Women of All CulturesWhat was trying to be accomplished?

More awareness of Canadian systems and community resources

Decreased isolation

How did we know if intervention was an improvement?

Participants listed “information, knowledge and friendship” and change in “nutrition habits and knowledge about health”

What changes can we make that will result in an improvement?

Develop a program specifically for immigrant seniors.

Focus on informal reciprocity

Limit amount of printed material

Living With Stress Stress reduction workshop designed for use in

community with marginalized populations Intended population: women on low income,

homeless or at risk of homelessness, unemployed or underemployed, social isolation.

5 sessions, 9 unique participants Intended short term outcomes (from logic model):

– Increased knowledge/awareness of: what our stressors are; how we react to stress (in the body, behaving, thoughts); healthy ways to respond to stress; link between stress and chronic diseases

– Gain skills in relaxation/stress reduction skills & techniques to calm the body/mind/breath

Living with StressWhat was trying to be accomplished?

Stress reduction training for marginalized populations

How did we know if intervention was an improvement?

“exploratory” group – what did we learn?

What changes can we make that will result in an improvement?

Less focus on the body

Focus on specific stressors – not generalized

Improve general poverty advocacy within the Centre

Factors for Success

• Commitment from staff to complete the summaries

• Investment in evaluation resources within the Community Health Promotion/Early Years Programs

• Increased interest in results when there are similar comparisons between groups.

• Centre philosophy of group service delivery

How we could do this better?

•Repeat for similar groups

•Working database developed for input and automated summaries of feedback form data.

•Reports back in a timely manner so that facilitators can use the results in planning and evaluation

•Ensuring each group has specific questions linked directly to the group’s logic model

Thank you – Questions?