aohc hp and cd ple july 16, 2013

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Changing the way welook at clients: options

and opportunities tobuild resilience

Ron Shore, MPA

www.shoreconsulting.ca

AOHC HP and CD

Strategic Annual Professional Learning Event

Toronto, ON., July 16, 2013
http://www.shoreconsulting.ca/http://www.shoreconsulting.ca/


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Abstract.

Taking a resiliency lens, this presentation argues

for the creation ofopportunities for communities

to actively engage in navigating, networking and

negotiating for their own health. This involves

improving the way in which we provide options andopportunities for people to participate in altering

and improving their social environment rather than

looking at individuals as clients to whom we

provide service.


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Order of events

Thinking about thinking

Uncovering clients as people

Exploring resilience Creating social ecology


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Conjecture(s)

Rate of growth of information = pace of

historical memory loss

At risk, identify of what it is to be CHC

True change lies in transforming social

processes which mediate the way we are

with each other: relationships (Im tired of

our youth killing each other) Project of now: trace the conceptual roots

of CHCs


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Thinking aboutthinking

Part One


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Building dwelling thinking

What it means to be reflexive


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Shadow side of the moon

The binary push: this or that

(a lesson in ontology, perception andreality)

Simplify, simplify, simplify

The imperative to categorize

Cognitive biases are culturally rooted We murder to dissect


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Wordsworth.

One impulse from a vernal wood

May teach you more of man, Of moral evil andof good,

Than all the sages can.

Sweet is the lore which Nature brings; Ourmeddling intellect

Mis-shapes the beauteous forms of things:--We murder to dissect.

The Tables Turned, 1888


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The masters tools will never dismantlethe masters house (Audre Lorde)

What we lose in this binary thinking are

the relationships, the interconnectivities,the networks, the motion, the fluidity, thechange, the potential..

reification.the fallacy of making concretesomething that is abstract, or fluidto makesomething into a thing


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A little softer

Relational/dialogical/dialectical thinking

Ecological thinking

Importance of differentiation, diversity andnetworks

Its all about relationships!

What this requires: mindfully hold your

tendency to affix a bar code to people,processes, events, things (things can bemany things/never give up on people)


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Uncovering clientsas people

Part Two


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What do we mean?

client (n.) late 14c., from Anglo-Frenchclyent (c.1300), from Latin clientem(nominative cliens) "follower, retainer,"

perhaps a variant of present participle ofcluere "listen, follow, obey" (see listen);or, more likely, from clinare "to incline,bend," from suffixed form of PIE root

*klei- "to lean" (see lean (v.)).www.etymonline.com
http://www.etymonline.com/index.php?term=client&allowed_in_frame=0http://www.etymonline.com/index.php?term=listen&allowed_in_frame=0http://www.etymonline.com/index.php?term=lean&allowed_in_frame=0http://www.etymonline.com/index.php?term=lean&allowed_in_frame=0http://www.etymonline.com/index.php?term=listen&allowed_in_frame=0http://www.etymonline.com/index.php?term=client&allowed_in_frame=0


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The banking model

Viewing the student, participant or clientas a passive object to be filled, fixed orshaped (tabula rasa)

Roots in critical educational philosophy

"it transforms students into receivingobjects. It attempts to control thinking andaction, leads men and women to adjust tothe world, and inhibits their creative power"(Freire, Pedagogy of the Oppressed, 1970)


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Another model: conscientization

The process of developing a critical awarenessof ones social reality through reflection andaction. Action is fundamental because it is theprocess of changing the reality. Paulo Freire

says that we all acquire social myths which havea dominant tendency, and so learning is a criticalprocess which depends upon uncovering realproblems and actual needs.

- See more at:http://www.freire.org/conscientization/#sthash.RtLPNeaI.dpuf


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Praxis

Again, Freire

"reflection and action upon the world inorder to transform it.


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Will you join the client list

Etymologically, another interpretation ofthe origins of client is

one who listens to be called

What are we being called to?


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So, in this context

Importance of CD work

Chronic disease managementsomewhat flips the traditional medical

power structure as do group visits

The origins of Community HealthCentres are in mobilizing, organizing

and providing opportunities for people topotentiate via their social actions


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The new language

Navigate

Negotiate

Network Herein lie opportunities to create

change: all three are action oriented,view clients as activating, and all three

are dialogical


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The social orientation of CHCs isprecisely what differentiates them fromFamily Health Teams

1. Analysis of social determinants ofhealth; individual health is rooted inneighbourhoods, families, society

2. Commitment to the marginalized 3. Role of social action in obtaining

health


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ExploringResilience

Part three:


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The myth of resilience

when life throws you curveballs, hitthem out of the park

Return of the ol bootstraps

Deserving vs. undeserving poor ahistory of charity

Proviso: there is a role for personal

agency, its just not the only dimension


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Resilience: A social ecologymodel

Recognizes that people potentiate theirresilience within time and space

via opportunities

in social relationships with each other

when they have valued social roles

when there is social cohesion


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2 models of human behaviour

Individualist Ecologist

Complete autonomy Shared governance (ethics)

Sovereign Democratic

Self-determined Agency in context (team)

Alone Community

Responsible Relational


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There is free will

Human agency matters, its just not theonly dimension

Think of a team

Individual performance still matters

Interrelated performances

Accountable to each other

Even in individual sport, competition with andalong side others is what leads toimprovement


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Performance Domains

Decision making

Hardiness

Will, commitment, strength, determination

Flexibility

Creativity

Emotional regulation Goal-setting


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Individual Qualities Associated with Resiliency

Self efficacy (Bandura, 1977)

Sense of coherence (Antonovsky, 1987)

Self esteem (Brown & Lohr, 1987) Prosociality (Dovidio, Piliavin, Schroeder

& Penner, 2006)


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Resilience does not occur in isolation. It is aninteractive process that requires someone orsomething to interact with. It is dependent uponcontext or environment, including our most

important relationships. How are individualsand their brains resilient in their socialenvironment? The short answer is that ourneurophysiological constitutions find viable

ways of being in our worlds. (Martha Kent,From Neuron to Social Context, in The SocialEcology of Resilience, Ch. 11, 2012)


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Creating Socialecology

Part Four


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Integrative thinking

Epigenetics

Nature and nurture

Individual in community.. Social determinants of health or social

ecology of health?

Relational

Dynamic

Importance of networks and relationships


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Mirror neurons

The roots of empathy

What does this tell us about beinghuman?


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Harm Reduction 2.0: Moving to The

Social Ecology Model

Harm ReductionModel Social Ecology Model

disease control positive health outcomes

risk minimization protective factorsindividual

behaviour social relations

needs based asset based

public health

primary and community

health

Marginal enriching environments

Outreach diffusion

Advocacy

informed care, practice &

policy

social inclusion people-centred

Survival resiliency


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A telling example

Citizens of Roseto, Pennsylvania (pop.2000), have a death rate from heartdisease of less than of that in the US

and a 1/3 of comparable townsSimilar diet, exercise, family hx

Difference? A powerful protective socialstructure

Egalitarian, 22 separate civic organizations,multigenerational homes, social cohesion, lots ofvisiting


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Take home messages

Recognize cognitive biases

Hold your tendency to reify

Relate, honestly and authentically topeople, holding yourself beside notabove or ahead of them

Listen for opportunities to create

opportunities: multiplier effect


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Further reading

The Social Ecology of Resilience, A Handbookof Theory and Practice, Michael Unger Ed., 2012

Pedagogy of the Oppressed, Paulo Freire, 1970

The Opposable Mind, Roger Martin, 2007

Drug, Set and Setting, Norman Zinberg, 1984

Outliers: The Story of Success, MalcolmGladwell, 2008


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Contact info

[email protected]

www.shoreconsulting.ca

Follow me on twitter.@ronshore4

Thanks, and take care of each other
mailto:[email protected]://www.shoreconsulting.ca/http://www.shoreconsulting.ca/mailto:[email protected]

aohc hp and cd ple july 16, 2013

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