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Literature Review by Linzi Williamson

Literature Review Jessies The June Callwood Centre for Young Women

Completed by Linzi Williamson (Summer Student Intern) May 2012-September 2012

Literature Review by Linzi Williamson Table of Contents Literature Review for Jessies The June Callwood Centre for Young Women Research on Teen Mothers Individuals who become teen mothers Poverty Race and poverty Role of education Mental health Physical health Negative outcomes for mothers and children The Typical View of Young Mothers: Stigma and Discrimination Examples of relevant research Innate Versus Social Conditions The Social Determinants of Health Socio-economic status and poverty Public policy Challenges with addressing the social determinants of health Drop-in Models of Help Approaches to service Defining drop-in services Other drop-in models Theoretical frameworks 5 5 5 6 6 6 7 7 8 9 10 14 16 19 21 22 24 25 25 26 27

Literature Review by Linzi Williamson Role of drop-in centres Research on Anti-oppressive Practices Research on the Strengths-based Perspective Resiliency and Healthy Development of Young Families Potential Long-term Impacts on Young Mothers and Their Children Evidence-Based Literature and Research Studies Effective Tools for Helping Young Mothers Basic needs, education, and housing Social supports Sexual health Specific research 28 29 30 35 40 42 43 43 43 44 44

Jessies The June Callwood Centre for Young Women: A Different Perspective on a Prevalent Issue Historical Summary of Jessies The June Callwood Centre for Young Women 46 47

Jessies The June Callwood Centre for Young Women Mission Statement, Mandate, and Service Delivery Principles Mission Statement Mandate Service Delivery Principles Services Provided by Jessies Centre Counselling Program Swap Shop Housing Program 49 49 49 50 53 53 54 54

Literature Review by Linzi Williamson Heath Program Parent-Child Centre Parenting Groups Respite Program Food Program Community Education Program Toronto Board of Education School Program References 55 55 56 56 57 57 58 58

Literature Review by Linzi Williamson Literature Review for Jessies The June Callwood Centre for Young Women Research on Teen Mothers

Teen pregnancy is defined as an event where a young woman gives birth to a child before the age of 20, whether or not she is married (Meade, Kershaw, & Ickovics, 2008). Canada calculates teen pregnancy rates as the sum of recorded live births, induced abortions, and miscarriages per 1,000 of the population of women aged 15 to 19 (McKay, 2006). Between 1974 and 2003, the teen pregnancy rate declined from about 54% to 32% and this decline was greater among younger (15 to 17) than older teens (18 to 19) (McKay, 2006). In Canada and other Western countries, teen pregnancy rates are viewed as a general indicator of community and socio-economic status as well as adolescent sexual and reproductive health (McKay, 2006). The increase in young womens ability and opportunities to control their sexual and reproductive health has a lot to do with the declines in teen pregnancies (McKay, 2006). Individuals who become teen mothers. Teens who are more likely to become parents at a young age are those who experience family poverty, family dysfunction and violence, academic problems and those who drop-out, high aggression, favourable views about pregnancy and early parenthood, negative peer associations, and limited economic opportunities (Dilworth, 2006; Easterbrooks, Chauhuri, Bartlett, & Copeman, 2010;United Way of Calgary and Area, 2011). Also, teen pregnancy rates are highest among teens coming from low-income families with low self-esteem, low expectations for the future, and a history of family dysfunction, poor parenting, or child abuse (Dilworth, 2006; Easterbrooks et al., 2010; United Way of Calgary and Area, 2011). Some other reasons cited for teenage women becoming pregnant and giving birth include the fact that more teens are sexually active, fewer are using contraception, and many simply have the desire to become pregnant (Dilworth, 2006) Aboriginal teen women have the

Literature Review by Linzi Williamson highest birth rates in all of Canada, while immigrant girls and women are less likely to become

teenage mothers than Canadian-born girls and women (United Way of Calgary and Area, 2011). Poverty. Almost 92% of young mothers under the age of 25 are living in poverty (Women Moving Forward Canada, 2010). The majority have an annual income of less than $20,000 a year and 75% cannot meet basic needs of food, housing, and childcare (United Way of Calgary and Area, 2011). Furthermore, the children of these mothers are at a higher risk of becoming impoverished as adults and facing various social, economic, and health issues (e.g., alcohol abuse, become smokers, have less access to physicians, suffer low self-esteem and selfmaster, etc.) (Women Moving Forward Canada, 2010). There are three main reasons why teen mothers are at a greater risk of experiencing long-term poverty. The first is that most are single parents and are more likely to have a lower income. The second is that they are less likely to get married and stay married and tend to have more children because they started having them earlier. Finally, the third reasons is that they are less likely to complete high school, are more likely to be unemployed, and are less likely to get higher paying jobs (Dilworth, 2006, United Way of Calgary and Area, 2011). Race and poverty. Due to intersections between race/ethnicity and poverty, there are some low-income adolescent mothers (e.g., African Americans, Aboriginals) who face a unique set of risks, including race-related social, economic, and political marginalization. In addition to marginalization and/or exclusion from societal resources, personal experiences with racial discrimination can often result in poorer physical and mental health outcomes (Williams, Neighbors, & Jackson, 2003). Role of education. Without a high school education, teen mothers are likely to have lower earnings, have a higher risk of losing their job, receive fewer benefits, and have a low level

Literature Review by Linzi Williamson of savings (United Way of Calgary and Area, 2011). About three quarters of single mothers without a high school degree, about 50% with non-university post-secondary degrees, and 30%

with a university degree live in poverty live in poverty (United Way of Calgary and Area, 2011). However, teen mothers who actually complete high school and post-secondary education are just as likely to live in poverty as adult single mothers (United Way of Calgary and Area, 2011), suggesting that education alone is not the sole determinant of poverty for this group. Mental health. Over a third of teen mothers experience mental health issues, relationship conflict, and family violence (United Way of Calgary and Area, 2011). Post-partum and longterm depression are experienced by most teen mothers. Other common issues, which also put teen mothers at risk for post-partum, include depression during pregnancy, stressful life events during pregnancy or after birth, low levels of social support, and a previous history of depression. Children who have depressed mothers are at risk for developing insecure attachment, emotional and self-regulation problems, poor self-control, internalizing and externalizing problems, difficulties in cognitive functioning and social interaction, conduct disorders, affective disorders, anxiety disorders, ADHD, and learning disabilities (United Way of Calgary and Area, 2011). Poverty, family conflict, and stressful life events can all greatly increase a mothers depression and childs behavioural problems. Physical health. Young mothers are more likely to smoke, be overweight as they get older, and suffer poorer health than women who become parents as adults. Because adolescents and teens are still developing and growing they often experience more health risks during their pregnancy, including anaemia, high blood pressure, pre-term birth, inadequate weight gain, vitamin deficiencies, and Caesarean births (United Way of Calgary and Area, 2011). Most teens do not plan their births, nor do they seek prenatal care so overall their health and their babys

Literature Review by Linzi Williamson health during the pregnancy can suffer (United Way of Calgary and Area, 2011). Other reasons why many teen mothers do not seek prenatal care include beliefs that they already know about pregnancy and birth, concealing pregnancy because of fear of judgement, difficulty scheduling and appointment with a clinic or physician, domestic violence, exhaustion and fatigue, fear of health care providers, feeling sick, financial restrictions, isolation, lack of support, language and cultural barriers, literacy, living in substandard housing, location of health facility and unfamiliarity with area, no access to childcare, no transportation, stress and depression, as well as discomfort with health facilities (Planned Parenthood of Toronto, 2005). Negative outcomes for mothers and children. The potential negative outcomes for the children of young mothers include health, behaviour, learning, and social problems. Teenage women who become pregnant and have children are at an increased risk of having a low birth weight baby (Dilworth, 2006). Sadly, low birth weight babies are more likely to die in their first month of life and those who do survive are likely to have health problems and birth defects (Dilworth, 2006). There are social and personal risk factors that increase this risk including poverty, single parent status, being a teenage parent, little or no prenatal care, living with a violent partner, stressful life events, poor workplace conditions, type and amount of work, smoking, use of alcohol and other drugs, poor nutrition before and during pregnant, and limited stress-relief coping mechanisms (Dilworth, 2006). Many children from low-income families

display increased levels of aggression, have delayed vocabulary development, experience vision, hearing, speech, or mobility issues, live in problem neighbourhoods, rarely participate in organized sports, live in substandard housing, and live in poorly functioning families (Dilworth, 2006).

Literature Review by Linzi Williamson The Typical View of Young Mothers: Stigma and Discrimination

Adolescent and teen mothers are often described in terms of their deficits as poor, undereducated, unlikely to find stable employment, and lacking emotional development and problemsolving skills (Black & Ford-Gilboe, 2004). They are also viewed negatively for their early sexual activity and single status (Black & Ford-Gilboe, 2004). There are, however, some qualitative studies that have shown that not all adolescent mothers struggle as parents. Many embrace their parenting responsibilities with optimism and determination (Black & Ford-Gilboe, 2004). Ford-Gilboe (2000) found that single mothers personal strengths were stronger predictors of family health promotion efforts than external resources (i.e., social support, community services and finances), which suggests that the personal strengths of single mothers is important to health family outcomes. Teen pregnancy has not always been considered a social problem, particularly when it involved married teens (Sex Information and Education Council of Canada (SIECCAN), 2007). It only became a concern and an area of social stigma when greater numbers of young single mothers began raising children on their own and when life expectancies increased (Turney, Conway, Plummer, Adkins, Hudson, McLeod, & Zafaroni, 2011). When a pregnancy is unintended and/or unwanted, concerns about teen pregnancy increase (SIECCAN, 2007). These concerns are linked to socio-economic issues, particularly because there are high pregnancy rates within economically disadvantaged and marginalized segments of the population (SIECCAN, 2007). However, in some ethno-cultural communities teen pregnancy and child birth is much more accepted than in others as there as many cultural beliefs about the appropriateness of early pregnancy (McKay, 2006). For many teens there is a strong personal desire to become pregnant and they often find it to be a transformative experience (SIECCAN, 2007).

Literature Review by Linzi Williamson In general, teenage women who become pregnant and have children are blamed for causing adult poverty, welfare dependence, and other various other social problems (Dilworth, 2006). The reality is that these beliefs are untrue as most teen mothers are poor before they become pregnant. These beliefs are harmful for two main reasons: they have led to the development of policies that punish teen mothers who already face hardships and they take the

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focus away from the real issues that cause poverty (e.g., problems in educational systems, lack of health care, decreased labour market opportunities, absence of reliable childcare, and inadequate housing) (Dilworth, 2006). Many teen parents decide to become pregnant at a young due to their individual desire to become pregnant and many young parents say that their children are a great source of joy in their lives (Dilworth, 2006). It was previously assumed that most teen pregnancies were the result of inadequate sex education as well as lack of access to contraception and sexual health services (SIECCAN, 2007). This line of evidence lead to efforts of improving sex education and providing better access to health services as a means of lowering teen pregnancy rates (SIECCAN, 2007). More recently though, the focus has shifted to the underlying socio-economic and cultural factors associated with teen pregnancy, including growing inequity in rich countries, lack of opportunities for disadvantaged youth, cultural norms, and alienation from school (SIECCAN, 2007). Examples of relevant research. Kearney and Levine (2012) set out to understand why the teen birth rate is so high in the United States and also understand why it matters (teens in the United States are far more likely to give birth than in any other industrialized country in the world). They argued that the explanations that economists have generally provided in the past are unable to account for any sizable share of the variation in teen childbearing rates around the

Literature Review by Linzi Williamson world. They described recent empirical work that demonstrates that variation in income

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inequality across the United States and developed countries can explain much of the geographic variation in teen childbearing. With income inequality being associated with a lack of economic opportunity and heightened social marginalization for those at the bottom of the distribution (e.g., teen mothers), this empirical finding may be consistent with the ideas that have been promoted by other social scientists. Kearney and Levine (2012) concluded that being on a low economic trajectory in life leads many teen women to have children while they are young and unmarried and that poor outcomes seen later in life are simply the continuation of the original low economic trajectory (so being a teen mother is not the cause of poverty). The researchers suggest that to effectively address teen childbearing in America, difficult social problems (e.g., perceived and actual lack of economic opportunity among those in lower SES categories) must first be addressed (Kearney & Levine, 2012). Eshbaugh (2011) examined positivity toward teen mothers among college students. Students responded positively to some items regarding teen mothers, but there were also some who showed endorsements of stereotypes. Positivity toward teen mothers was positively associated with empathy. Those who did not report having a teen mother in their family had higher levels of positivity than those who reported having a teen mother in their family. The researchers suggested that the positivity toward teen mothers amount professionals should be explored in the future (Eshbaugh, 2011). Much of the research on teenage pregnancy has focused on incidence and prevalence rates and factors that increase the risk for becoming pregnancy (e.g., family structure and function, socio-economic status, parent-child communication, ethnicity, religiosity, sexual attitudes and behaviours) (Spear, 2001). There are also studies that have focused on the outcomes

Literature Review by Linzi Williamson of teenage pregnancy (e.g., incomplete education, poverty, excessive fertility, delayed goal attainment) (Spear, 2001), but few studies have employed qualitative methods to examine the experiences and perspectives of young mothers after they have given birth (Spear, 2001). Similarly, few studies have examined the personal experiences of pregnant adolescents (Spear, 2001). Spear (2001) conducted a qualitative study exploring the experience of pregnant,

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adolescent females. Participants expressed a sense of optimism and confidence in their abilities to manage single parenthood, achieve educational goals, and maintain supportive relationships with the fathers of their babies. The findings suggested that some women may become more motivated academically, more goal-oriented, and more responsible as they contemplate motherhood (Spear, 2011). Darisi (2007) conducted a study in response to the predominant view of research literature and popular media about single young motherhood being a social problem. She posited that the problem characterization of young mothers enables negative identity inferences about those who might feel they belong to that category. A discussion of the ways in which members of this problematic social category construct the meaning and relevance of the category to their own identities was provided by Darisi (2007). She used recorded focus groups of young mothers revealed discursive practices by which young mothers construct the category, resist negative inferences, and establish more positive category associations. The young women were able to establish identities for themselves that allowed for an evaluation of good mother that entailed a reworking of the cultural repertoire for understanding motherhood. Despite facing poverty and stigmatization, the mothers in this study demonstrated the desire to do the best for their children (Dasiri, 2007).

Literature Review by Linzi Williamson Breheny and Stephens (2010) noted that in medical and nursing journals, teenage motherhood is framed as a cause for concern and a social problem. The researchers examined

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four discourses for how teenage mothers were defined. The Public Health discourse understood early motherhood as a disease requiring surveillance and a public health response. The Economic discourse understood teenage mothers as a financial drain on society and early motherhood as a cost to the mothers themselves. The Ethnicity discourse classified young mothers into specific ethnic groups and explained that the different fertility rates among groups was due to resistance of reproductive technology among some minority group members. Finally, the Eugenics discourse defined parenting as a biological priority and stated that young mothers were unsuitable as parents. The authors concluded from this examination that the wrong sort of young women becoming mothers and mothering too soon were both of equal concern within the medical community (Breheny & Stephens, 2010). Herrman and Waterhouse (2010) examined teens thoughts on the costs and rewards of teen parenting using the Thoughts on Teen Parenting Survey (TTPS: Herrman, 2006, 2007, 2008; Herrman & Nandankumar, 2010). While teen pregnancy rates have decreased in recent years, the issues of teen pregnancy and prevention are still of great concern to many groups. As well, these issues are further complicated by ethnic, socioeconomic, geographic, and racial disparities. Interventions and policies to address teen pregnancy are often designed on the beliefs of adults and young parents. Herrman and Waterhouse (2011) felt that the perceptions of nonparenting, adolescents are largely unknown and might positively benefit the development of interventions and policies related to teen pregnancy, especially since many interventions are designed to target the sex practices of teens. This study found that lower income youth had significantly more positive perceptions regarding the impacts of teen pregnancy. The researchers

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believed that because low-income youth have little realistic educational and career opportunities and goals that messages about the negative impact of a teen birth may not have an impact on them. Those individuals who had a parent or a sibling who was a teen parent also had more positive perceptions of teen parenting. Ethnic or racial group was also found to be significantly related to perceptions, with African American and Hispanic teens have more positive perceptions than White and Asian youth. The researchers felt that this might have reflected family values and norms in specific ethnic groups (Herrman & Waterhouse, 2011). Duncan (2007) reviewed research evidence and found that the age that pregnancy occurs has little effect on social outcomes for the individual. Many teen mothers have stated how motherhood makes them feel stronger and signifies a change for the better for them. As well, many fathers try to remain connected with their children. Parenting seems to provide motivation for both young mothers and fathers to seek out education, training, and employment. Duncan (2007) concludes that parenting may be more of an opportunity than a catastrophe for many young parents. This evidence is an important, but stark contrast, to the prevailing view of society that teenage motherhood is a social problem that will inevitably cause suffering for mothers, their children, and society at large (Duncan, 2007). Innate Versus Social Conditions Using Bronfenbrenners (1979) conceptual framework of an ecological systems model, Corcoran, Franklin, and Bennett (2000) compared non-pregnant or non-parenting teens with pregnant and/or parenting teens on factors organized by the following main systems of interacting categories of variables: 1) the microsystem, consisting of the psychological variables of self-esteem, depression, and stress levels experienced, and the social psychological variables of alcohol and drug abuse; 2) the mesosystem, consisting of family structure, family functioning,

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problems with friends, the neighbourhood, and the school, as well as enacted social support; and 3) the macrosystem, consisting of household income, parents occupations, and race. They found that factors from the macrolevel (income and race), mesolevel (communication problems within the family, a positive relationship with school), and microlevel (age, high stress, and few problems with alcohol) acted in combination to predict teenage pregnancy and parenting status. The researchers concluded that there was a need for interventions to go beyond sex education and health information and to focus as well on improving coping with stress, communication skill building with the family, and improved resources attainment and opportunities (Corcoran, Franklin, & Bennett, 2000). Recent estimates indicate that about 1 in 10 children live in poverty (Best Start Resource Centre, 2010). Working with families living in poverty is not easy as the individuals needs are often complex (Best Start Resource Centre, 2010). Service providers can have a profoundly positive impact on childrens healthy development, as well as improving wellbeing (Best Start Resource Centre, 2010). The Best Start Resource Centre (2010) outlined several important qualities that service providers should have in order to be effective in meeting the challenges that families and children face as a result of living in poverty: 1) Have a broad understanding of the issues facing families living in poverty, 2) Develop an ability to see the intersections between these challenges, 3) Reflect on what this means for the service provider, 4) Have the ability to review examples of effective practices on an ongoing basis, and 5) Be able to care for themselves as well as consider creative solutions to the pressing problems of families living in poverty (Best Start Resource Centre, 2010). Morgan and Miller (2011) worked in cooperation with the Jane/Finch Community and Family Centre in Toronto, Ontario to produce a guide for helping young mothers succeed.

Literature Review by Linzi Williamson Within this guide they presented some important statistics: 1) In 2005, 43.8% of all children living in poverty across the country live in Ontario, 2) Sole-support mothers and their children are at a higher risk of poverty due to the costs of raising children, reduced labour market opportunities, and lack of affordable housing and childcare, 3) The number of sole-support female-led families has increased in Toronto, 4) The majority of jobs available to low-income

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mothers are low income jobs with high rates of employee turnover, 5) Many young mothers have not completed high school due to pregnancy and a lack of support within school systems, 6) Many young women who leave social assistance for low-wage positions have to return to the welfare system, 7) Many women are unaware about what resources are available to them, and 8) Many women lack a social support system, have a low sense of self, and are involved in physically, sexually, emotionally, and/or verbally abusive relationships. In Canada, female-led, sole-support parent families are generally misunderstood and are an underestimated family structure. As a result, many researchers have failed to recognize the strength, resiliency, and determination of many sole-support mothers (Morgan & Miller, 2011). Marra, McCarthy, Lin, Ford, Rodis, and Frisman (2009) examined the impact of conflict and social support on parenting behaviours among a sample of homeless mothers. They found that those women who reported high emotional and instrumental social support reported greater improvements in parenting consistency over time than those who reported lower levels of support. These results suggested that social support may enhance homeless mothers ability to provide consistent parenting (Marra, McCarthy, Lin, Ford, Rodis, & Frisman, 2009). The Social Determinants of Health Health inequity refers to the health inequalities considered to be unfair or unjust and modifiable while health equity refers to the absence of unfair systems and policies that cause

Literature Review by Linzi Williamson health inequalities (Public Health Agency of Canada, 2011). Health inequalities are the differences in the health status of individuals and groups and are linked to various personal,

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social, economic, and environmental factors called determinants of health (Public Health Agency of Canada, 2011). Determinants of health include income and social status, employment and working conditions, education and literacy, childhood experiences, physical environments, social supports and coping skills, healthy behaviours, access to health services, biology and genetic endowment, gender, and culture (Public Health Agency of Canada, 2011). Others include housing situations, immigration status, and the perception that one can make a meaningful contribution and participate fully in ones community (Planned Parenthood of Toronto, 2005 article).The World Health Organization (WHO) cites five main causes of health inequalities including different levels of power and resources, different levels of exposure to health hazards, different impacts of exposure to health hazards, different impacts of being sick, and different experiences in early childhood (Public Health Agency of Canada, 2011,). Individuals who are most vulnerable to health inequalities are people living on low income, Aboriginal peoples (First Nations, Inuit, Metis), Canadians living in rural parts of Canada, immigrant groups, and vulnerable men and women (Public Health Agency of Canada, 2011). Social determinants of health are a set of specific socio-economic factors within the broader determinants of health (i.e., personal, social, economic, and environmental factors) that relate to a persons place within society (i.e., income, education, or employment) (Public Health Agency of Canada, 2011). There are a variety of models outlining the social determinants of health. One developed at a conference in Toronto at York University in 2002 identified 14 social determinants of health which included Aboriginal status, disability, early life, education, employment and working conditions, food insecurity, health services, gender, housing, income

Literature Review by Linzi Williamson and income distribution, race, social exclusion, social safety net, and unemployment and job security (Mikkonen & Raphael, 2010). Michael Marmot (2005) outlined three major strategies for decreasing the gross health

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inequalities in health between countries. The first is to better control major diseases and improve health systems, the second is to decrease poverty, and the third is to take action on the social determinants of health. Taking action of the social determinants of health can both relieve poverty and improve peoples life and working conditions. However, in order for action to be taken on the social determinants of health, public policy at both the national and global level must change so that effective interventions and policies can be put in place (Marmot, 2005). Some of the policy objectives that Michael Marmot suggests should be met are to give every child the best start in life, enable all children young people, and adults to maximise their capabilities and have control over their lives, create fair employment and good work for all, ensure a health standard of living for all, create and develop healthy and sustainable places and communities, and finally strengthen the role and impact of ill health prevention (Marmot, 2012). There are various groups that pregnant women can come from with a wide range of abilities and challenges that service providers must consider when attempting helping these women. Some of the groups include pregnant teens, women living in poverty, women living in rural areas, new immigrants, women with low levels of literacy, the working poor, unemployed women, single parents, women with little social support, women living in violent situations, women struggling with substance use, homeless women, and women in poor housing conditions (Best Start Resource Centre, 2002). Some specific determinants of health for women can include income and social status, social support networks, education, employment and working conditions, social environments, physical environments, personal health practices and coping

Literature Review by Linzi Williamson skills, health child development, culture, health services, gender, as well as biological and

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genetic endowment (Best Start Resource Centre, 2002). Also included in that list is the impact of economic and social policies on health, which may be even more important to health than access to medical care (Best Start Resource Centre, 2002). Socio-economic status and poverty. Socio-economic status is a clear determinant of health and can be defined by a persons income, level of education, occupation, housing, cultural background, material possessions, and having a perception of a meaningful role in social life (Best Start Resource Centre, 2002). Those with high levels of education and income tend to have better states of health than those with low income and less education (Best Start Resource Centre, 2002). More specifically, pregnant women of low socio-economic status have a higher chance of being negatively affected by social and other determinants of health, women are more likely to live in poverty than men, single mothers with young children have the highest rate of poverty in Canada, and single mothers under 18 have the greatest depth of poverty in Canada (Best Start Resource Centre, 2002). A Manitoba study found that the use of hospital days for treating pregnancy-related complications was about four times greater for women in the lowest income group compared to those in the highest income group (Best Start Resource Centre, 2002). Pre-natal, newborn, and maternal health is negatively affected by low socio-economic status. Factors that contribute to poor birth outcomes include discrimination, lack of food security, stress, violence, lack of support, and alcohol and drug use (Best Start Resource Centre, 2002). These factors in addition to low socio-economic status increase the risks for infants and mothers. Culture and geographic isolation are other demographic factors that can lead to increased infant mortality. Furthermore, low income pregnant women experiencing distressed life circumstances (i.e., poor housing conditions, substance use, high stress levels, lack of social

Literature Review by Linzi Williamson support, mistrust of professionals, lack of childcare and transportation) are less likely to seek

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prenatal care, which is an essential component to healthy pregnancy and positive birth outcomes (Best Start Resource Centre, 2002). Unfortunately, many low income pregnant women who do overcome the barriers they face to getting prenatal care will receive less than adequate service. Prejudices around these women include the belief that they do not value prenatal care and many service providers do not look to the actual reasons for the lack of access. Low-income pregnant women are more likely to experience high levels of stress, depression, and substance use and most face issues with food security. High levels of stress are associated with low levels of social support (i.e., family and friends). The health and wellbeing of mothers and their children are also negatively affected by lack of emotional support and high levels of social isolation. Women who become pregnant are in a heightened state of vulnerability with respect to domestic abuse and violence and many women do not leave such situations due to the potential for increased financial hardship if they leave the relationship. Low socio-economic status and disadvantaged situations increase the likelihood that a pregnant woman will experience depression. The use of alcohol, tobacco, and other drugs is highly associated with distressed life circumstances and the use of such substances during pregnancy can contribute to distress life circumstances and negative birth outcomes. The majority of low-income pregnant women do not have access to affordable, high quality, nutritious food to keep themselves and their baby healthy (Best Start Resource Centre, 2002). There are a myriad of misconceptions surrounding pregnancy and poverty, including the idea that low-income people do not know how to budget. The truth is that most low-income individuals receive less money than is required for the basic necessities in life. Pregnant teen women living in poverty face the same distressed life circumstances as pregnant adult women,

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however they are unique in that they also face discrimination and blame for their irresponsible behaviour (Best Start Resource Centre, 2002). Some believe that teens get pregnant so that they will receive enough money through assistance programs to get their own apartment. The truth is that most teens do not intend to get pregnant, and those trying to move out their own are often leaving difficult home situations or abuse. There are also some who believe that supporting teens condones sexual activity and teen pregnancy. Providing supports to pregnant teens actually helps them raise healthier children. It has not been shown that increasing supports to pregnant teens or improving access to birth control increases rates of sexual activity or teen pregnancy (Best start Resource Centre, 2002). Public policy. Working on the social determinants of health and addressing healthy and/or unhealthy societal conditions is central to overall public health (Borisch, 2012). The term social determinants of health is meant to encompass the social, economic, political, cultural, and environmental determinants of health. Discussions on the social determinants of health generally focus on ill-health or unfavourable societal conditions. Public health work contributes to broader societal goals by turning unfavourable into favourable societal conditions. However, the lack of necessary governance and systems to implement the policies that create favourable societal conditions are considered major barriers to progress in this area. Because both problems and solutions are systemic, public policies are extremely important. The ability to decrease health inequities is most effective when it is undertaken at varying levels and by targeting policies and policymakers. For example, transport and housing policies are generally most effective at local levels; fiscal, environmental, educational, and social policies work best at the national level for most countries; and financial, trade, and agricultural policies have the greatest impact at the global level (Borisch, 2012).

Literature Review by Linzi Williamson Effective public health needs to tackle both the biomedical domain which addresses diseases and the socio-economic and political domain which addresses the structural

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determinants of health (Borisch, 2012). Unfortunately, less attention has been paid to providing public health practitioners with the necessary skills to address the socio-economic and political domain. In order to address the structural determinants of population wellbeing, a new approach to inter-sectoral collaboration is required where public health professionals participate early in policy processes. New responsibilities for public health practitioners might include: 1) understanding the political agendas and administrative imperatives of other sectors, 2) creating regular platforms for dialogue and problem solving with other sectors, 3) and working with other arms of government to achieve their goals, and thus advancing health and wellbeing (Borisch, 2012). There are many different articles published regarding what Marmot first described in 1978 as the causes of the causes of disease (Hunter, Neiger, & West, 2011). Social gradients have been found in health outcomes according to education, social status, income, and zip code (Hunter et al., 2011). The social gaps between and within countries are large. It is now clear that addressing social determinants is key to reducing the disparities found throughout the world and many organizations have increased their focus on them (Hunter, et al., 2011). The World Health Organization (WHO) has created a global commission on the social determinants of health and will include working on the social determinants of health as one of the objectives of Healthy People 2020 (Krisberg, 2008). Challenges with addressing the social determinants of health. There are many difficulties associated with addressing the social determinants of health. Hunter et al. (2011) reviewed the literature to find manageable solutions for addressing the social determinants of

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health at the local level. Effective action at the local level requires intersectoral collaboration and long-term, mainstream funding. Also, increasing social capital can help mitigate the effects of the social determinants of health and help individuals function more fully in their society (Marmot, 2006). Longitudinal studies have shown that with time, increases in social capital are associated with improvements in health (Hunter et al., 2011). One study found that individuals who maintain high levels of trust or social participation within their communities reported better health in 2005 than they reported in 1999, while those who had low levels of trust, met less often with friends, or dissolved their marriage were more likely to report poorer health over the same time period (Giordano & Lindstrom, 2010). Social determinants can affect the kinds of opportunities that are available to individuals through their effect on peoples allocation of social capital (Hunter et al., 2011). Based on the evidence linking social capital, health, and social determinants, Hunter et al. (2011) stated that poorer health may be an outcome due to a lack of social capital, which is a result of social determinant gradients. Focusing on reducing disparities in social capital may be the most reasonable and manageable option for reducing the negative effects of the social determinants of health (Hunter, et al., 2011). Most of the previous efforts to address social determinants have focused only on national programs and policies whose aim was to reduce health disparities within communities. Moore, Haines, Hawe, and Shiell (2006) supported the improvement of social capital by focusing on social networks and argued that future work in public health should look at social capital through a social network lens and how the networks influence the health of individuals and communities. The evidence provided by Hunter et al. (2011) shows that approaches for addressing social determinants should be within the control of local health

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departments and that the approaches can increase social capital and lead to improved community health and wellbeing. Drop-in Models of Help The Toronto Drop-in Network (TDIN; 2008) identified three distinct models of drop-ins: the spiritual/missionary approach, the social work approach, and the community work approach. The spiritual/missionary approach expects little of the participants, provides sanctuary at the drop-in centre, and has minimal paid staff supplemented by volunteers. The social work approach provides a drop-in centre for rehabilitation and change, participants are encouraged to actively work to change their lives with the help of the centre, and targeted, professional interventions are offered. The community work approach provides a centre that is a place of empowerment, there is less reliance on professional intervention, and individuals are supported in making changes in their lives by using their own and their peers resources (TDIN, 2008). Combining both the social work and community approaches is most supported by the literature (TDIN, 2008). Most of the literature on drop-in programs is qualitative in nature and many studies are based on interviews and surveys completed with program staff and participants (City of Toronto, 2006). Typical questions of these studies are why do people use drop-ins, what type of people use drop-in services, what is the nature and scope of services, and what are the different models and approaches to drop-in programs (City of Toronto, 2006). With regards to drop-in programs tackling homelessness, it has been shown that these programs are an important service component in a network of non-housing supports that people need to help them find and maintain housing (City of Toronto, 2006). These drop-in programs also play an important role in supporting people after they are housed (City of Toronto, 2006). Homeless people in particular

Literature Review by Linzi Williamson have issues that make it difficult for them to secure and maintain their own homes, including

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health and personal care issues, mental health problems, drug or alcohol dependency, and a lack of financial resources (City of Toronto, 2006). Recognizing that there is a need for support services as part of the effort to end homelessness also involves recognizing the importance of structural factors that cause homelessness, including lack of affordable housing and unemployment (City of Toronto, 2006). Jones and Pleace (2005) noted that if affordable housing is not available then there is little use for interventions designed to enhance social support and improve access to education and training (City of Toronto, 2006). Approaches to service. Once again with regards to homelessness, a multi-service, integrated approach to services that combines drop-in programs with outreach and engagement, individual support (i.e., case management), treatment programs for mental health and addictions, group activities, or housing initiatives increases the chances for homeless people to find and maintain housing (City of Toronto, 2006). Some researchers have proposed that the integration of services should be considered at the level of client and service integration as well as the level of systems integration. Service integration should be aimed at improving the quality of life or specific outcomes for individuals. Some strategies for service integration could include case management and conferencing, individual service planning, assertive community treatment, wrap-around service, flexible funds at the disposal of the front-line worker, and case monitoring and outcome monitoring City of Toronto, 2006). Services can be delivered by one agency with a multi-service approach or by a range of agencies that coordinate their services (City of Toronto, 2006). Defining drop-in services. The flexible and responsive nature of drop-in services makes them difficult to define (City of Toronto, 2006). Drop-in services are generally developed in

Literature Review by Linzi Williamson response to problems identified by service users, so they are not always developed within a framework. Drop-ins can differ in their mandates that guide daily operations and the

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development of policies, their philosophical approach, their mission statement, the services they offer, the environments they create, their governance structures, the populations they serve, and the kinds of staff or volunteers they recruit (Toronto Drop-In Network (TDIN), 2007). Despite the differences between drop-ins, there are some common characteristics. Services are generally responsive and flexible where services and practices are changed depending on the needs of the population; they respect the autonomy of service users and their ability to make their own decisions; and they adopt a holistic approach, recognizing that one particular need is usually bound up with many other needs (TDIN, 2007). Generally, the role of drop-in programs can be organized into four clusters: 1) providing for basic needs (e.g., food, clothing, shelter, etc.), 2) providing opportunities for social contact, 3) providing support for wellbeing (e.g., provide help with housing, debt problems, rent arrears, physical and mental health concerns, social assistance issues, and substance abuse), and 4) providing the opportunity for change (e.g., build skills, motivation, confidence, and self-esteem) (TDIN, 2007). Other drop-in models. There are a number of models that drop-ins can operate from including the faith-based model, the clubhouse model, the health-focused model, and the community development model. A faith-based model extends services from a church, ministry, or spiritual group and focuses on providing basic needs and provides a space for marginalized people where they can build community and be respected (TDIN, 2007). A clubhouse model restricts membership and use of the drop-in based on age, gender, or another characteristic, is intended to foster a sense of belonging to, and ownership of, the drop in, and focuses on basic needs and recreational activities (TDIN, 2007). A health-focused model offers health services

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from staff with medical training to people who might have difficulty accessing such services and they help service users by treating their illnesses, helping them overcome addictions, and assisting them with accomplishing their goals for positive change. A drop-in working from this model differs from a walk-in clinic by focusing on socially marginalized populations and by meeting needs that go beyond a purely medical or physical health model (TDIN, 2007). A community development model focuses mostly on peer support and capacity building by providing a welcoming, informal space that is intended to foster the development of supportive relationships where staff work to empower service users to become advocates on their own behalf and on behalf of their community (TDIN, 2007). Theoretical frameworks. Social inclusion and social justice, health promotion and the determinants of health, harm reduction, and community development are all concepts and theoretical frameworks that help drop-ins build the foundation for their work and articulate the rationale behind their approach (TDIN, 2007). Social inclusion refers to the approach taken by drop-in workers to help people become active participants in their community in economic, social, psychological, and political terms. Social exclusion is an alternative term for poverty. Poverty focuses only on finances and ignores the social marginalization that people with minimal resources experience. Describing someone as poor can obscure systemic and structural oppression. Social justice is linked to social inclusion and aims for full and equal participation of all groups in a society that is shaped to meet everyones needs. Many drop-ins try to create an environment where relationships between people are organized according to the principles of fairness, rationality, consideration, and kindness. They also work to create an environment of social justice with within the drop in while also working with participants to advocate for more social justice within the community outside of the drop-in. Health promotion is seen as a way of

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emphasizing social and personal resources as well as physical capacities, and is a responsibility of the health sector, society in general, and individuals. The social and economic environment (income, education, social status, access to health care, support networks, employment, and working conditions), the physical environment (rural, urban, industrial, tropical, in a war zone, in overcrowded housing), and a persons individual characteristics and behaviours (genetics, gender, culture, age, hygiene practices, smoking habits, exercise, nutritional intake) are all determinants of health that affect peoples health. Health promotion takes each of these factors into account as it enables people to increase control over and to improve their health by building health public policy, creating supportive environments, strengthening community actions, developing personal skills, and reorienting health services. Harm reduction is an approach that takes into account the effects of potentially harmful behaviour in a persons life as well as the impact on the wider community. This approach also takes into account the fact that people have many needs related to their personal health and safety. Community development is made possible through concrete and effective community action that builds on a communitys strength, sustainability and capacity to set priorities, and make decisions on issues that affect its health and well-being (TDIN, 2007). Role of drop-in centres. Measuring Success (Toronto Drop-In Network (TDIN), 2010) found that drop-in centres play a key role in the development of three core competencies for participants: personal health and safety, personal identity, and social connection. Drop-in services are a place where service users can obtain a sense of personal wellbeing, access basic health and safety tools, and make use of strategies to assist with personal health and safety on a long-term basis. Drop-in centres support participants in developing a positive personal identity by providing a non-judgemental setting with flexible and accommodating norms, supporting

Literature Review by Linzi Williamson autonomy and allowing participants to make choices, and providing a place where participants

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can contribute and feel valued (TDIN, 2010). Drop-in centres also provide participants with the opportunity to form and maintain social connections and relationships by being flexible to accommodate a broad range of behaviours, mandating staff to make supportive and positive interactions with participants, and supporting participants to learn and develop their social skills. Research on Anti-oppressive Practices Corneau and Stergiopoulos (2012) conducted a literature review to summarize how antiracism and anti-oppression frameworks of practice are being increasingly advocated for in efforts to address racism and oppression embedded in mental health and social services. They identified strategies that are being applied to services targeted toward racialized and oppressed groups. Eight main categories of strategies were identified: 1) empowerment, 2) education, 3) alliance building, 4) language, 5) alternative healing strategies, 6) advocacy, 7) social justice/activism, and 8) fostering reflexivity. It was concluded that despite the limitations and critiques of antiracism and anti-oppression philosophies of practice, they each have the potential to bring positive changes to mental health service delivery (Corneau & Stergiopoulos, 2012). Barnoff and Moffatt (2007) discuss the contradictory tensions that are present in antioppression practice within feminist social services. They contend that anti-oppression practice can only be well understood if one understands the historical and social conditions that create inequity and also understand the conflicting desires of agency service providers. Some service providers want organizational change that reflects the social ideal of rectifying all relations of oppression that are based on race, gender, class, ability, and sexual orientation, while those individual who have personally experienced marginalization and oppression are more concerned that their experience of oppression continues to be silenced and made invisible in the anti-

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oppression model. The authors believe that the kind of approach that can balance between these opposing viewpoints is one that factors in social location, prejudicial relations, historical mistreatment, and the lack of inclusion of marginalized groups on both the individual and groupbased, power-oriented levels. The researchers concluded that an anti-oppressive approach to practice is integral for social work to live up to the fields value of equity, inclusion, transformation, and social justice (Barnoff and Moffatt, 2007). McLaughlin (2005) outlined the rise and rationale for anti-racist and anti-oppressive practices, which are considered to be essential components of social work education and practice. Practitioners and students are expected to have both an awareness of the construction and perpetuation of social divisions as well as be able to demonstrate in the practice how they have changed the norms, assumptions, and behaviours that result from them. The International Federation of Social Workers has stated that the main aim of social work is to alleviate poverty, liberate vulnerable and oppressed people, and promote social inclusion. Social work is said to be both political and personal in that social works are gatekeepers to societal resources and have power over their clientele and also are committed to fostering individual personal change and enforcing a new moral consensus (McLaughlin, 2005). Research on the Strengths-based Perspective A strengths perspective is one that shifts the focus of community agencies with clients from being based on their deficits to being based on their assets or strengths (MacArthur, Rawana, & Brownlee, 2011). Laursen (2003) noted that practices with youth that are deficitsfocused can have many unintended effects including interfering with achievement and excellence, demoralizing the individual and eroding self-confidence, reduce motivation and aspiration to excel, focus on past failures and set up negative expectancies, stigmatize and

Literature Review by Linzi Williamson stereotype youth, and also alienate youth from belonging in the community. Strengths-based practices focus instead on helping individuals increase achievements and live more fulfilling lives (Laursen, 2003). Many agencies have begun to adopt the strengths-perspective as an alternative to the problem orientation and pathology offered by the medical and mental health fields (Laursen, 2003).

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Previously, the strengths-based perspective was seen as more of a values-driven approach to interacting with clients than a model that interventions could be based on (MacArthur et al., 2011). Because of this view, strengths-based interventions were not really developed or operationalized. The development and use of strengths-based interventions has also been limited with many groups associating strengths with only difficult situations. Strengths were often defined as personal qualities, traits, and virtues that people possess and are often forged by trauma and loss. The connection between strength and adversity is very clear, but it is important to recognize that people can also find strength in mundane, everyday environments (MacArthur et al., 2011). Rawana and Brownlee (2009) developed a strengths-based model that draws on a wide spectrum of strengths not limited to those linked to adversity. They developed it with children and youth ages 10 to 18 and focused on helping them explore and find positive characteristics, knowledge, and assets that they could develop and apply in their daily experiences. The strengths, assessment, and treatment model includes a strengths-focused assessment stage that evaluates personal agency and the strengths in the individuals environment. The development of the individual is focused on, taking into account their functioning, strengths, and their environment. This model is also based on the development of a therapeutic relationship with clients and their support network. This approach allows for a more complete conceptualization of

Literature Review by Linzi Williamson a persons strengths that they can use to overcome issues in order to make positive change (Rawana & Brownlee, 2009). Laursen (2000) outlined four factors that he found most contributed to positive

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therapeutic outcomes when using a strengths-based perspective. The first is developing strengths, supports, and successful coping with random events with the individual. The second is forming and maintaining a positive therapeutic alliance. The third is developing a spirit of hope and positive expectations within the individual. Finally, the fourth is using methods respectful of the clients values and needs. Sieta and Brondtro (2002) found evidence of positive youth development with the use of these four principles in many youth educational and treatment programs. Within the field of social work, strengths-based practice is rooted in the belief that everyone has a wide range of talents, abilities, skills, resources, and aspirations (Hill, 2008). When these strengths are identified, recognized, and developed they can drive human growth and growth is inhibited when a persons problems and deficits are focused on (Hill, 2008). The strengths-based perspective has changed social works focus to one where the emphasis on client strengths and a belief in the capacity for growth is balanced (Lietz, 2011). Applying this approach in social work practice at the micro, meso, or macro level puts the stories of the target population, their community, cultural identity, and institutions at the centre of practice (Hill, 2008). By assessing past successes, looking for exceptions to problems, and locating resources within a person and their communities, practitioners can better help clients (Lietz, 2011). Allowing clients to define the areas of focus for intervention and the desired goals and outcomes of an intervention is another crucial component to this approach (Hill, 2008). Strengths-based practice is also relational in that it occurs within the context of relationships formed between

Literature Review by Linzi Williamson clients and social workers and it also works with the naturally occurring connections within social networks in families and communities (Lietz, 2011). Plasticity, empowerment, membership resilience, healing, wholeness, dialogue, and collaboration are key terms and

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concepts that are part of the core values of the strengths perspective of social work practice (Hill, 2008). The strengths-based approach is also hopeful, relational, and responsive (Lietz, 2011). Rapp, Pettus, and Goscha (2006) outlined six principles to strengths-based social policy. The first is that policy should be congruent with the experience and agenda of the target population. The second is that policy should put problems in their place. The third is that policy should emphasize equal membership and a positive perception of the environment. The fourth is that policy should be voluntary for beneficiaries. The fifth is that policy should emphasize choice. Finally, the sixth is that policy should provide a wellbeing incentive structure for clients (Rapp et al., 2006). Lindsey (2000) compared the use of a strength-based social work practice and a solutionfocused practice when assisting homeless women and their children, citing how they each help clients become empowered yet differ when they are operationalized in practice. The strengthsbased approach focuses on helping people become empowered to make the changes in their lives that they desire. These changes are made possible by drawing on existing internal and external resources and developing new resources as required. The strengths-based approach also involves helping people understand the effect that institutions, agencies, ideologies, and public policy have on their lives so that they can begin to remove any stigma or self-blame they might associate with their life situation. Thus the crucial aspect of this perspective is that it helps people understand the role that society plays in their ability to care for themselves and their families (Lindsey, 2000).

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With regards to crisis intervention, Greene, Lee, Trask, and Rheinsheld (2000) defined a strengths-based approach as a chance to develop new coping skills with the client and leave them with strengths and resources to rely on after the crisis is over. This approach emphasizes active listening, building on inner strengths, and developing new coping skills. In an intervention, it is important that the therapist emphasizes joining and active listening so that they can fully understand the crisis from the clients perspective. Developing a persons inner strengths can enable them to draw on them during a future crisis (Greene et al, 2000). A strengths-based approach to crises has been found to be useful when working with adolescents because the development stage that they are in may cause them to feel more resentful of a problem-focused approach to therapy (OHalloran & Copeland, 2000). Adolescents are more likely to blame themselves for negative outcomes or crises in their lives, so they need help with reducing feelings of self-blame (OHalloran & Copeland, 2000)). Within a therapeutic setting, Rapp (2006) notes that the strengths-based model assists marginalized individuals in accessing the resources that they need and improves treatment linkage, engagement, and final outcomes. There are five principles that guide the strengths-based approach to case management: 1) client strengths, abilities, and assets are emphasized during assessment and planning; 2) clients retain control over goal-setting and the search for needed resources; 3) the relationship between client and case manager is important; 4) the community is viewed as a resources and not a barrier; and 5) case management is conducted as an active, community-based process (Redko, Rapp, Elms, Snyder, & Carlson, 2007). Clients are encouraged to identify skills, interests, and evidence of past successes and positive traits with a strengths assessment (Redko et al., 2007). The theory of self-efficacy (Bandura, 1997) is what forms the basis of the focus on positive attributes. Self-efficacy theory hypothesizes that people

Literature Review by Linzi Williamson are more likely to begin and maintain positive behaviours if they recognize that they have engaged in those behaviours in the past (Bandura, 1977).

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Redko et al. (2007) conducted a qualitative methods study examining how 26 people with substance abuse problems perceived the working alliance they had with case managers who used a strengths perspective. The client narratives showed that two of the strengths-based guiding principles were most important to the relationship clients had with the case managers. The majority of the clients felt that a positive working alliance with their case manager helped them build trust, self-worth, and self-esteem. Overall, the narratives provided support of the adherence to the strengths-based model by case managers (Redko et al., 2007). Resiliency and Healthy Development of Young Families Children of young mothers are more likely to be victims of maltreatment, and their mothers are at a higher risk for perpetrating maltreatment, compared to children of older mothers (Lounds, Borkowski, & Whitman, 2006; Bert, Guner, & Lanzi, 2009). Despite the fact that young mothers and their children are at risk for poor life circumstances, there are many young mothers who thrive and show resilient functioning defined as high adversity and high competence (Luthar, Ciccheti, & Becker, 2000). Easterbrooks et al. (2010) examined resilience in parenting among a sample of young mothers under the age of 21 at childbirth. The focus of the research was to examine the contextual factors associated with resilient functioning in young mothers. They defined resilient functioning as a parent as the lack of perpetration of child maltreatment in the context of risk. Risk factors included family (negative childhood histories in family of origin) and ecological (neighbourhood, poverty, mothers financial stress) levels. Mothers in the resilient groups were less likely to live with their families of origin and to rely on their own mothers as sources of emotional or caregiving support. Resilient functioning as parents

Literature Review by Linzi Williamson was associated with higher rates of depressive symptoms, suggesting a cost or limit to resilient parent functioning in young mothers.

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Resilience can be defined as a personal strength that may help people cope with adversity and may be conceptualized as an aspect of health potential (Black & Ford-Gilboe, 2004). This concept has been developed from three different perspectives personal capacity, process, and outcome. Child and adolescent resilience research has largely used a process perspective and focused on the role of protective factors in buffering the effects of poor environments (Black & Ford-Gilboe, 2004). Most of the resilience research that has focused on adult women has posited that personal capacity is what helps people cope with challenging circumstances (e.g., loss, single-parenting) (Black & Ford-Gilboe, 2004). Health-promoting lifestyles are multidimensional patterns of self-initiated actions and perceptions that serve to maintain or enhance the level of wellness, self-actualization, and fulfilment of individuals (Black and Ford-Gilboe, 2004). Some of the factors that have been positively correlated with health lifestyle practices in adolescent females include positive selfconcept, self-efficacy, social support, quality of the physical and social environment, and parents adoption of health lifestyle practices (Black & Ford-Gilboe, 2004). A study by Black and Ford-Gilboe (2004) examined the relationships among mothers resilience, family health promotion, and mothers health-promoting lifestyle practices in single-parent families led by adolescent mothers. This study was undertaken in response to the majority of research focusing on the negative maternal and child outcomes rather than the capacities of young families. Mothers resilience (personal strength that helps people cope with adversity) and health work (process of active involvement through which families learn ways of coping with health challenges and of using strengths and resources to achieve goals for individual and family

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development) predicted health promoting lifestyle practices, with health work being the strongest unique predictor of health promoting lifestyle practices followed by resilience. Overall, the findings of the study support the idea that resilience is an important resource for single adolescent mothers (Black & Ford-Gilboe, 2004). Looking at more diverse groups of adolescent mothers over time has shown that there is considerable variability in long-term outcomes, which suggests that many adolescent mothers are able to overcome the challenges associated with teenage childbearing (Hurd & Zimmerman, 2010). Additionally, alternative explanations for the negative outcomes faced by adolescent mothers (e.g., unequal access to resources such as education, employment, and safe housing) have been identified, suggesting that researchers and policy makers have ignored pre-existing disadvantage and overstated the negative effects of teenage childbearing (SmithBattle, 2007). In response to these findings, resilience theory has been adopted more frequently as an approach for studying long-term outcomes among teen mothers because this model focuses on factors that promote successful adjustment despite adversity (Hurd & Zimmerman, 2010). Resilience theory is used to explain why some youth who have experienced adversity are able to thrive in the face of risk (Luthar & Cicchetti, 2000). Risk factors increase a persons likelihood of experiencing negative outcomes while promotive factors (e.g., self-efficacy, mentors) contribute positively to outcomes or buffer people from negative outcomes associated with risks. Resilience theory is useful for estimating outcomes among populations that are at risk because the focus can be put on factors that may predict positive development within the populations (Hurd & Zimmerman, 2010). This approach is unique in that it focuses on strengths within an individual and their environment rather than focusing only on deficits and blaming atrisk populations for their own problems (Hurd & Zimmerman, 2010). The presence of strong,

Literature Review by Linzi Williamson supportive relationships has been found to contribute significantly to resilience among African American adolescent mothers (Hurd & Zimmerman, 2010). Using a risk and resilience approach grounded in a multicultural feminist perspective,

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Kennedy (2005) conducted a qualitative study examining adolescent mothers experiences with multiple forms of violence, relationships between violence and school, and their resilience, all within the context of welfare reforms. Resilience has been defined as a dynamic process encompassing positive adaptation within the context of significant adversity (Luther, Cicchetti, & Becker, 2000). Many researchers and theorists examine resilience as a multidimensional, dynamic process that constantly interacts with environmental contexts and changes over time, rather than a static, essential set of characteristics that some possesses (Kennedy, 2005). Resiliency can be shaped by several distinct characteristics, abilities, and protective factors (e.g., temperament, problem-solving abilities, strong attachment to parents, consistent rules and expectations coupled with support within a family, positive peer support, supportive environments). Kennedys (2005) working definition of resilience processes were defined as current, global, positive adaptations or functioning in the realms of intimate relationships and school or work, as well as participants subjective understanding of their adaptation and functioning, given the context of poverty, minority status, and violence exposure. She found that several young women emerged as resilient and there were five distinct individual level protective factors that contributed to their resilience: 1) ability to connect with others for support; 2) problem-solving ability and planfulness as opposed to impulsivity; 3) a strong goal orientation coupled with motivation to succeed; 4) insightful, or the ability to be introspective, interpersonally intelligent, and articulate; and 5) independent, action-oriented, and determined to stand up for herself.

Literature Review by Linzi Williamson McGaha-Garnett (2007) used the Resiliency Model to examine the success factors of

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adolescent mothers who were able to continue in school despite the responsibilities they faced as parents, and defined resiliency as the ability for all youth to have healthy development and successful learning (Benard, 2004). Gonzales (2003) identified three main elements for characterizing resilient youth: 1) risk factors, 2) protective factors, and 3) personal characteristics. Risk factors are stressful situations and adversity (e.g., pregnancy, chronic poverty, abuse, marginality, divorce, violence, stress) (Benard, 2004). Protective factors are variables that reduce the chances of abnormal development (e.g., supportive relationships with adults, family involvement, social training) (McGaha-Garnett, 2007). Personal characteristics that increase a persons chances of being resilient include social competence, problem solving, independence, and motivation (McGaha-Garnett, 2007). Resilience can surface in the face of hardship and denotes the ability of individuals who are able to bounce back from adversity (Hawley, 2000; Collins, 2010). Defining resilience as a construct and not a personality trait or an attribute prevents victim-blaming and the adoption of the idea that people should be blamed for not possessing characteristics that help them function well (Luthar & Cicchetti, 2000). It is important to note that the resiliency of an individual is not invincible, as continuing assaults from changing life circumstances can reduce the resiliency a person possesses. As well, being resilient in one life domain (e.g., education, emotion, behaviour, etc.) does not necessarily mean that a person is resilient in other domains (Luthar et al., 2000). A resilience perspective offers another lens for examining teenage parenting. Resnick (2000) believes that focusing on resilience provides a solutions-orientation which emphasizes hopes and potential instead of only risk and pathology. Studies of resilience have generated new

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perspectives on resilience by focusing on the complexity of peoples experiences and the specific contexts and circumstances of their lives (Ungar, 2003). Collins (2010) reported on young mothers accounts of their lives and how they demonstrated factors associated with resilience. The individual factors associated with resilience among this sample include being motivated and taking responsibility, having goals, aspirations, and pride in achievements, using insights into their past as a means of moving forward, having a strong sense of identity, and seeing their lives in a wider context. Potential Long-term Impacts on Young Mothers and Their Children Evaluating the effectiveness of a program is essential for finding out which programs work and which ones do not work (SIECCAN, 2007). Program evaluations that use a test group and a control group provide the most convincing statistical evidence for successful strategies (SIECCAN, 2007). The effectiveness of a program can be measured in a number of ways. For some, effectiveness is measured by behavioural or outcome changes (e.g., reduction in teen pregnancy and birth rates, delayed age of first intercourse, increased use of condoms) and others by increased knowledge levels or self-reported attitudes (SIECCAN, 2007). Long-term follow up is recommended as a means of gauging the true effectiveness of a program, particularly when it comes to measuring behaviour and attitudes as both of these tend to change constantly during adolescence (SIECCAN, 2007). Long-term participation in comprehensive programs that offer health care, family planning, counselling, education or support for mothers to continue education, social support, and parenting education improves success rates of preventing repeat pregnancies among teens, helping teen mothers continue their education, and improving teen and infant health (United Way of Calgary and Area, 2011). The one-stop shopping approach, access to other services, and the

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relationships developed with program staff in organizations that offer these service components have much to do with the success rates (United Way of Calgary and Area, 2011). Researchers from the Institute of Social and Economic Research at the University Essex (Berthoud, Ermisch, Fransesconi, Liao, Pevalin, & Robson, 2004) used birth cohort and household panel datasets to examine the effects and potential long-term consequences of teenage motherhood. While women from poorer backgrounds and from areas of higher unemployment rates are more likely to become teenage mothers, a new, more rigorous analytical approach showed that the negative consequences of having a child as a teenager are not as wide-ranging as much of the earlier research has suggested. The primary consequence for young mothers is that they fare worse in the marriage market in that they end up with men who are poorly qualified and more likely to suffer unemployment. Teenage mothers suffer from poorer mental health in the first three years after giving birth compared to other mothers, after which they start to converge with the population average. The children of teenage mothers tend to suffer as young adults in terms of lower educational attainment, a higher risk of economic inactivity, and of becoming teenage parents themselves. This may be due to the lower standard of living that their teenage mothers experience. The authors of this report concluded that more efforts should be given to helping teenage mothers, particularly in the first three years that they become mothers when their mental health suffers the most. Koblinsky, Kuvalanka, and Randolph (2006) examined the role of parenting, family routines, family conflict, and maternal depression in predicting the social skills and behaviour problems of low-income African-American preschoolers. They found that mothers who utilized more positive parenting practices and engaged in more family routines had children who displayed higher levels of pro-social skills. More positive parenting and lower levels of maternal

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depressive symptoms predicted fewer externalizing and internalizing child behaviour problems. Lower family conflict was also linked with fewer externalizing problems among the children. The researchers concluded that mothers and children who reside in poor, high-risk neighbourhoods could benefit from culturally sensitive interventions designed to enhance their parenting skills, increase their participation in family routines, reduce family conflict, and improve caregiver and child mental health. More specifically, educators should inform parents of parenting practices that are associated with positive socio-emotional development in preschoolers, as well as effective strategies for managing child behaviour problems (Koblinsky et al., 2006). Whitson, Martinez, Ayala, and Kaufman (2011) examined risk and protective factors and their impact on young, impoverished mothers. Analyses revealed that adolescent mothers with restricted social support have children who are at a higher risk for maltreatment. The researchers suggested that assessing for depression and social support in adolescent mothers and that developing interventions that focus on emotional wellbeing, enhancing social support, and providing parenting education are essential components for social programs targeting these women (Whitson et al., 2011). Evidence-Based Literature and Research Studies The term evidence-based literature comes from the field of health sciences and refers to a wide range of study and research including: studies comparing patterns of service-provision and investigating the most effective approaches for reducing social problems; longitudinal studies following-up on large samples of subjects; systematic reviews bringing together scattered research findings; qualitative studies based on interviews with service users and staff; and investigations of the causes of social problems (City of Toronto, 2006). Evaluation systems

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widely vary in terms of focus and language, but commonalities include certain basic evaluative principles and theoretical underpinnings (TDIN, 2008). The Toronto Drop-in Network reviewed materials related to evaluation systems specific to homeless programs and generally to related social services. For evaluation systems to be effective, the following basic principles of evaluation systems must be considered: 1) The objectives of the project being evaluated must be clearly understood; 2) The purpose of the evaluation must be clear as this is integral in the design of the evaluation system; and 3) The indicators chosen for an evaluation systems must be based on data that is obtainable and meaningful (TDIN, 2008). Effective Tools for Helping Young Mothers Basic needs, education, and housing. The most effective community supports for teen mothers include education, help meeting basic needs (e.g., housing, food security), physical and mental healthcare, parenting instruction and support, as well as social support (United Way of Calgary and Area, 2011). Completing high school and furthering their education greatly reduces a teen mothers chance of living in low income. Other benefits for teen mothers when they increase their education are safer, more nurturing, and more developmentally-appropriate home environments for their children (United Way of Calgary and Area, 2011). Pregnancy has actually been shown to motivate teens to stop unhealthy behaviours and plan for their futures. Housing supports helps to teach teen mothers independence and parenting skills as well as foster attachment between mothers and their children. When teen mothers are securely housed and provided with additional supports then the outcomes are better (United Way of Calgary and Area, 2011). Social supports. A teen mothers psychological state and parenting practices are positively impacted by the social supports that she has in her life (United Way of Calgary and

Literature Review by Linzi Williamson Area, 2011). Depression can be reduced and child outcomes can be improved when a teen mother has good informal and community supports in place (United Way of Calgary and Area,

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2011). The link between social support and better parenting has been shown to lead to increased parental self-confidence (United Way of Calgary and Area, 2011). Sexual health. Comprehensive sexual health and reproduction programs that target teen mothers while they are pregnant and continue to offer education, information, and support around family planning and contraception at least 2 years afterwards are most successful in preventing additional births (United Way of Calgary and Area, 2011). Organizations like Planned Parenthood take an approach to sexual health that supports the health promotion values of optimal health, participation, capacity building, and social change by fostering healthier relationships, promoting safety and freedom from harm, reducing access barriers to accurate primary and sexual health information and services, and working from a perspective that values choice over control (Planned Parenthood of Toronto, 2005). Specific research. When young mothers are offered tools, support, and opportunities to change their circumstances they have a greater chance of becoming more economically selfsufficient, more active in their community, and stronger role models for their children (United Way of Calgary and Area, 2011; Women Moving Forward Canada, 2011). Dr. Gina Browne from McMaster University and her colleagues published results in 2001 from a five-year study that compared services offered to single-parent families. Her findings showed that when single parents are given access to a variety of services in a comprehensive way there are greater savings to the welfare system. After one year, only 10% of parents on welfare who were in control of the services that they used ended up leaving welfare and did not use welfare again the next year. In comparison, 25% of parents who used age-appropriate comprehensive quality child care and

Literature Review by Linzi Williamson recreation, public health, and employment retraining services left the welfare system (Browne, Byrne, Roberts, Gafni, & Whittaker, 2001). Because there are about one million single parent families in Canada and about 83% of those are headed by single women (Women Moving Forward Canada, 2011), these results from Browne provide good evidence for the need of comprehensive, age appropriate, quality services for young mothers. Another study conducted by Coren and Barlow (2001) evaluated the effectiveness of a school-based parenting programme. They found that there were three ways that parents most benefitted from the programme: 1) support they received in their parenting role form other parents, 2) regaining a sense of control in the parental role and through the provision of new

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parenting tools, and 3) an increased ability to empathize, stay calm, identify with their children, and have a better understanding of the factors that motivate their children to behave in a particular way (Coren & Barlow, 2001). An evaluation of the effectiveness of an organization called Second Chance Homes was conducted (Dilworth, 2006). Regarding the implementation of the program and service delivery model, there were seven critical program components that were identified by the evaluators. Educational opportunities were provided, including access to public high schools, technical or vocational training programs, GED programs, and community college systems. Employment services were available, but were limited to teaching about issues such as appropriate dress, job application and resume writing, and interviewing techniques. Child care was provided either through on-site programs at the organization or within the community. Health services were available for teen parents and their children. Life skills and parenting skills training were provided using a varied curriculum based on the skill level of the participants. Housing search assistance was provided, but limited in what could be offered. Finally, follow-up services were

Literature Review by Linzi Williamson also provided and programs attempted to maintain contact with former participants (Dilworth, 2006).

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Domain, Baggett, Carta, Mitchell, and Larson (2010) identified the possible risk factors influencing the ability of mothers perceived to be at the highest risk for maltreating their children. The qualitative content analysis revealed three major themes related to mothers in need of engagement: 1) mothers struggle to meet the emotional needs of themselves and their child, 2) mothers lack familial and social support in navigating stressful life events, and 3) mothers consistency with nursing home visitation program engagement is mediated through a trusting and caring relationship with the nurses. The authors concluded that programs such as the nurse home visitations are important sources of support for mothers so that they can explore and discover self-care strategies and ways to navigate through stressful times. A foundation of trust and caring can thus increase relationship building and program engagement (Doman et al., 2010) Jessies The June Callwood Centre for Young Women: A Different Perspective on a Prevalent Issue Traditionally, there has been a lack of programs and resources for young mothers 18 and under and the vast majority of communities and organizations have viewed teen pregnancy as a serious problem that society must resolve and overcome. Many organizations that have been in operation have worked from a problem-based approach, with the main focuses being the prevention of negative outcomes (i.e., preventing unplanned pregnancy) and on changing the behaviour of the young women (i.e., increasing contraceptive use). Many organizations have also failed to work from a holistic, strength-based approach and to provide services and programs that enhance opportunities for informed problem solving and for breaking through barriers of service. Additionally, some organizations have been inflexible with their service, have been too formal,

Literature Review by Linzi Williamson have not emphasized both emotional and practical assistance, and have not allowed women to voluntarily use only the services that suit their needs.

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Fostering the health and wellbeing of young pregnant women and mothers involves more than just the prevention of negative outcomes and changing the individual because there are many other issues that affect these women. The programs and services at Jessies Centre are designed to foster the development of self-esteem, life skills, parenting ability, independence, and informed choice about decisions impacting the lives of the young mothers and their children. Jessies Centre is also committed to advocating for the societal and political changes to eliminate the policies and practices that adversely affect young families. Teen mothers are less likely to complete high school, more likely to live in poverty, more likely to have low-income jobs, more likely to experience longer periods of unemployment, more likely to receive welfare before and after pregnancy, and more likely to be a single parent. Many communities and researchers have come to realize the complexity of this issue and difficulty of effectively helping young mothers and their children. In order to effectively help young mothers and their families, community organizations must address the two most important factors causing young women stress: relationships with partners and/or families and money. Reducing and preventing poverty is a much more cost-effective method than paying for the consequences, as it has been shown that each dollar spent on preventing teen pregnancy can result in ten dollars saved. Of equal importance to stress prevention is providing appropriate services and support including childcare, recreation services, health services, as well as education and job training. Historical Summary of Jessies The June Callwood Centre for Young Women The June Callwood Centre for Women and Families, founded in 1982 as Jessies Centre, is a non-profit agency in downtown Toronto that serves pregnant youth, young mothers, their

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partners and children. In 1979, June Callwood, a journalist and community activist, became the Chair of the Taskforce on Teenage Pregnancy that was formed to meet the needs of young parents. June Callwood, along with our other founders created Jessies Centre based on the findings of the task force. Their mission from the beginning has been to nurture the healthy development of pregnant youth, young parents and their children. Jessies Centre operates from a commitment to feminism, anti-oppression, accessibility and positive social change in every aspect of our structure and functioning and we offer our clients a pro-choice, supportive, respectful, anti-discriminatory approach to service delivery. Their model of working with young parents and children is unique and has been perfected over the past 27 years. Their programs are geared especially for children and youth, and work well because of their accessibility. They are leaders in the area of working with young families and currently, and they act as consultants for the Ontario Early Years Centres due to the success of their unique model. Jessies Centre is also committed to equity, social justice, inclusiveness, diversity, selfdetermination and choice. They offer comprehensive and holistic care to participants, including counselling, health counselling, housing support, respite care, community education, prenatal and postnatal groups as well as a school program and a parent-child centre. They work very closely with stakeholders and offer programs and services in partnership with agencies such as Toronto Public Health and the Hospital for Sick Children. In 1992, Jessie's Centre moved into its current home, a brand new 6-storey building on Parliament Street. Their programs operate in the first two floors of the building and they provide supportive housing to 16 young families (the majority single mother-led) on the top four floors. This year (2012) they celebrated their30th Anniversary. They now have 20 staff members and
Comment [L1]: Is this still true today?

Literature Review by Linzi Williamson close to 80 volunteers. Along with their generous donors, several community partners and

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supportive neighbouring businesses, they serve over 200 pregnant teenagers and a grand total of 1,100 young parents and their children every year. Jessies The June Callwood Centre for Young Women Mission Statement, Mandate, and Service Delivery Principles Mission Statement (Jessies Centre, May 2012) The mission of Jessies Centre is to nurture the healthy development of pregnant teenagers, young parents and their children. There are several principles that guide their service approach, including a pro-choice stance that supports a womans right to make choices about her sexual health and pregnancy options. Jessies Centre also promotes and endorses the following: Comprehensive, accessible services; Opportunities to exercise individual choice, experience personal empowerment, resolve problems successfully, and move toward adult independence; Commitment to feminism, anti-discrimination, accessibility, anti-oppression, and positive change in every aspect of the organization structure and functioning; Supportive, respectful, anti-discriminatory approach to service delivery; Systemic social change designed to promote equity, fairness, and respect toward children and young parents. Mandate (Jessies Centre, May 2012) In addition to offering a broad range of services for pregnant young women, young parents and their children, Jessies Centre is committed to identifying, challenging, and eliminating the economic, social, political, and individual disadvantages that compromise their development,

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health, and wellbeing. There are several strategies that Jessies Centre employs in order to meet this mandate: Supportive counselling, information delivery, advocacy, and referral services, particularly with regards to health, parenting, educational, employment, housing, financial, and emotional needs. They provide practical assistance with regards to legal forms and documents (e.g., birth certificates, health cards, etc.). They promote, support, and provide opportunities for participants to exercise individual choice, experience personal empowerment, resolve problems successfully, and move toward adult independence. Promoting, supporting, providing opportunities for healthy growth and development for the children of young parents involved with Jessies Centre. Maintaining a welcoming, nonviolent environment and demonstrating an awareness of, and respect for, the diversity found in the Greater Toronto Area (GTA) communities. Challenging individual and systemic discrimination against children and youth and promoting social, political, and economic changes that will contribute to the elimination of such discrimination. Service Delivery Principles (Jessies Centre, July 2012) The organizational structure of Jessies Centre encompasses the following ideals: holistic, comprehensive, and participatory services; a drop-in model of services geared toward meeting the needs of young people; advocacy; a nurturing environment; and adherence to emotional intelligence principles. They offer participants a pro-choice, anti-oppressive, culturally competent, feminist, participant-centered, strength-based, and sex positive environment and
Comment [L2]: This is mentioned as part of the Mission Statement does it need to be repeated under the mandate?

Literature Review by Linzi Williamson promote a reciprocal learning and peer-guided approach to education. The staff members of Jessies Centre also strive to use a supportive, respectful, accessible, anti-discriminatory approach to service delivery. Jessies Centre is committed to the following service delivery principles: Participants are supported with making their own decisions whereby participation is voluntary and counselling and programs are pro-choice.

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o Rationale: Making programs voluntary helps build trust with participants, many of whom have had negative experiences accessing services at other organizations including schools, childrens aid societies, and the police. A drop-in format responds to the complexity and competing priorities of participants. The participants at Jessies Centre are making decisions that can affect the rest of their lives. Through education, advocacy, and promoting a pro-choice culture, the staff members at Jessies Centre strongly supports individuals in developing a critical analysis of the facts to enable them to make informed life choices for themselves and their children. Making responsible decisions by thinking through impacts and developing a plan for action is a key skill that Jessies Centre imparts to young women. Services addressing discrimination based on social location (i.e., gender, age, race, sexual orientation, etc.). o Rationale: Equipping participants to confront discrimination and assert their rights is key in empowering them to building better lives for themselves and their children. The majority of participants have experienced physical, sexual, or other types of abuse. Understanding their rights as women and how to exercise these

Literature Review by Linzi Williamson rights is critical to securing their safety and the safety of their children and accessing public services such as health, education, or private housing with landlords reluctant to rent to young parents living on social assistance. The centre models a respectful, supportive environment for young parents and their children.

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o Rationale: Many participants have had punitive, judgemental, and undermining relationships with other institutions and adult service providers. Jessies Centre staff model respectful interactions in their service delivery approach, which is intended to communicate a standard of service - something that youth and their children have a right to expect in all areas of life. The young woman is the initial and primary participant at Jessies Centre. o Rationale: Jessies Centre acknowledges that mothers are usually the primary caregiver of children and, as such, that children cannot be serviced without first addressing the needs of the mother. The best way to secure the health and wellbeing of a single-parent family led by a mother is to work through the mother. Jessies Centre focuses its resources on establishing trust with mothers and making them comfortable in the centre. Supporting the relationship between the mother and child dyad and balancing their individual needs is critical. Jessies Centre is committed to balancing and supporting the needs of the mother-child dyad. o Rationale: Some children require third party intervention to help them to articulate their needs. Sometimes multiple demands on, or the special life circumstances of the parents, make it difficult for parents to advocate for their

Literature Review by Linzi Williamson child. Jessies Centre ensures that all its programs and services are designed to give voice to the child and act in the childs best interest. Jessies Centre articulates and responds to the voice of the child. o Rationale: Healthy families require numerous things, including safety, health, education, housing, adequate income, positive personal relationships, life skills,

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and the support of an extended family or equivalent for emergencies. In response, Jessies supports and respond to the multiple complex components of family life. Jessies Centre takes an integrated view of participants needs. o Rationale: It is important to provide young parents with the services they need when they need them. The times when youth feel connected enough with a staff member to share a concern or focused enough to be receptive to information, advice, or referral are key moments for immediate attention and action. The cost of not responding in the moment can be a lost opportunity to facilitate an important change in the familys life. Services Provided by Jessies Centre Counselling Program The Counselling Program was developed by Jessies Centre to be an intrinsic component of the overall service. The program is designed to provide participants with access to an individual counsellor, provide counselling from other counsellors as needed, provide them with information regarding program and community resources, and advocate on their behalf as needed. Some of the issues that are addressed in counselling sessions include social and personal issues (e.g., parenting issues, family conflicts, physical and sexual abuse, mental health issues, substance abuse), finances (e.g., information about social assistance programs, budgeting),

Literature Review by Linzi Williamson housing (e.g., referral to Jessies housing counsellor and outside resources (maternity homes, emergency shelters, subsidized housing), and other issues (e.g., education, day care, legal

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problems, birth control). Each woman using Jessie's services has a counsellor who is available to her for personal counselling, information and advocacy. Referrals to internal services (e.g., labour support, housing, on-site high school, well-baby clinic, parenting groups, prenatal programs, parent relief) and external services (e.g., social assistance (Ontario Works), health care, abortion clinics, public health services, legal counsel, residential care programs, shelters, daycare, employment programs) are also provided as needed. Counsellors also provide support with applications and documentation. These may include Statement of Live Birth Birth Certificate Child Tax Benefit, Income Tax, Day Care Application, and Custody & Support documents. Swap Shop The Swap Shop Program was designed to provide young women with access to items that they might not otherwise be able to afford for themselves or their children. The Swap Shop is stocked with baby clothes and equipment, clothes for mothers including maternity clothes and many household items you may need in your kitchen. The program relies on donations from local communities, staff members of the centre, and participants of the centre. Housing Program The Housing Program was developed by Jessies Centre to help young women who are inadequately housed (i.e., homeless, maternity homes, etc.) find suitable and affordable housing to ensure safety and health for themselves and their children. More specifically, housing services include: searching rental listings for appropriate units; contacting landlords to arrange viewings and interviews; accompaniment to viewings and interviews; filling out applications for

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subsidized and specialized priority housing in Toronto and other regions in Ontario; education on tenant rights and responsibilities as well as housing and human rights; advocacy and support when facing housing discrimination; conflict resolution with landlord; eviction prevention; help getting repairs and maintenance done; accompaniment to Landlord and Tenant Board in the event that landlord/tenant dispute results in court proceedings; and referral to other community agencies as needed (for example: Legal Aid Clinics, Centre for Equality Rights in Accommodation, Federation of Metro Tenants Associations). With support from external funders, Jessies developed housing for young parents which includes sixteen two- and threebedroom apartments located in the same building as the centre. Heath Program The Health Program was designed to promote the health of young mothers and their children by providing access to a full-time health counsellor who is available for drop-in visits at Jessies Centre. The health counsellor can also help mothers better understand their childs development and track their growth. The goals of the program include: reducing risk taking behaviours (e.g., smoking, substance abuse, unsafe sex, etc.), promote breastfeeding, enhance positive sexual identify, healthy sexuality and body image, promote regular check-ups for young women and their children, develop awareness of reproductive health, increase awareness and the ability of young women to access and utilize medical care in the community, and have health counselling available to pregnant and parenting young women. Parent-Child Centre The Parent-Child Centre was developed by Jessies Centre to provide an opportunity for children to learn and interact with others and to provide respite to young parents in a nursery setting at the same location as Jessies Centre. The Parent-Child Centre is also a place for

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parenting education and support to take place, for child development and health to be monitored, and for peer teaching a modeling to occur. Parenting Education takes place through structured and unstructured activities at Jessies Centre. Regular groups are offered focused on specific ages and stages of infant and toddler development.The Parent-Child Centre is designed to be a drop-in program that is staffed by three nursery coordinators who are supported by both male and female volunteers, students on placement, and other staff members as needed. Parents are encouraged to come to the centre to play with their children and interact with other parents through a variety of programs and activities such as music circle, mom and child playtime, crafts and sensory activities, gross motor play and special events. Parenting Groups The Parenting Groups were designed to provide young parents the opportunity to become educated on child health and development, labour and delivery, and parenting skills. Participants can choose from a variety of scheduled groups, which vary from time to time as different needs are identified by the centre staff. The groups also give participants the chance to meet other young parents, gain support, and build networks. Respite Program Jessies Centre recognizes that parenting is a challenging and sometimes stressful responsibility. This is true especially for young people who may lack family support and alternate child care options. In response to this, Jessie's Centre offers a Respite Care Program designed to offer a break for young parents under 25 from the responsibilities of caring for their infants and toddlers. This service is particularly important for those who lack family support and alternate child care options. Young parents can make use of the service when they must tend to appointments (i.e., housing, medical care, etc.) or emergencies (i.e., court dates, family illness,
Comment [WL3]: Not sure if you would like each group to be described?

Literature Review by Linzi Williamson funerals, etc.), as well as when they just need a break from the challenges and stresses of parenting. Food Program

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The Food Program was designed to provide young parents access to nutritious food at no cost for themselves and their children as a means of encouraging growth and development and easing the pressure on poverty stricken parents of providing food for their family. They program aims to serve a variety of foods that will give options and promote healthier choices. More specifically, meals are served buffet style, breakfast and lunch are served four days a week, dinner is served on Monday and Tuesday evenings, and snacks are provided for groups during the week. Community Education Program The purpose of the Community Education Program is to educate high school students and to increase the awareness and sensitivity of professionals who work with young women and young parents. The program does so in the following ways:1) Provide insight into the lives and the challenges experienced by young families through pregnancy and parenting, creating awareness of the services offered by Jessie's Centre; 2) Educate youth on the importance of contraceptives and STI prevention; 3) Challenge and reduce stereotypes surrounding young parents; 4) Support informed decision making about personal choices surrounding pregnancy options; 5) Encourage peer-to-peer support and education regarding the issues that impact young families; 6) Promote opportunities for leadership amongst speakers; and 7) Support Jessie's Centre fundraising initiatives and the annual United Way campaign.

Literature Review by Linzi Williamson Toronto Board of Education School Program Jessies Centre has an on-site high school program that is funded by the Ministry of

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Education and Ministry of Children and Youth Services. Many young women who are pregnant or who have children are face difficulties with attending community schools due to discrimination from staff and students or lack of understanding and flexibility with their needs as mothers. Participants are able to earn compulsory and elective secondary school credits from grades 9 to 12 in a full day semester program that is supportive of parenting. Individualized programs of study allow the students to work independently in different courses and at various course levels to meet their needs and future goals. This school program prepares the students for re-integration into community schools, alternative schools and post-secondary education. The program provides:12 seat school, 4 seats for prenatal women, and 8 seats for mother (while their babies are in our nursery); An educational bridge to balance scholastic, emotional, and social needs of young women during the pre and post natal period, in a full day semester after a period of absence from school; Individual programs of study revised to accommodate varying levels of concentration, self-discipline, learning difficulties and well-being to meet the student's needs and future goals; The opportunity to receive secondary school credits from grades 9 to 12; Life Skills program; and Preparation for re-integration into community schools, alternative schools and post-secondary education. References Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215. Barnoff, L. & Moffatt, K. (2007). Contradictory tensions in anti-oppression practice in feminist social services. Journal of Women and Social Work, 22(1), 56-70.

Literature Review by Linzi Williamson Benard, B. (2004). Resiliency: What have we learned? San Francisco:WestED.

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Bert, S. C., Guner, B. M., & Lanzi, R. G. (2009). The influence of maternal history of abuse on parenting knowledge and behavior. Family Relations, 58(2), 176187. Berthoud, R., Ermisch, J., Fransesconi, M., Liao, T., Pevalin, D., & Robson, K. (2004). Longterm consequences of teenage birth for parents and their children. Retrieved from http://www.six.somerset.gov.uk/teenagepregnancy/docs/Publications/Research/Teenage %20Pregnancy%20Briefing%201.pdf Best Start Resource Centre. (2002). Reducing the impact: Working with pregnant women who live in difficult life situations. Retrieved from http://www.beststart.org/resources/anti_poverty/index.html Best Start Resource Centre. (2010). Child and Family Poverty in Ontario. Retrieved from http://www.beststart.org/resources/anti_poverty/pdf/child_poverty_guide_rev.pdf Black, C. & Ford-Gilboe, M. (2004). Adolescent mothers: Resilience, family health work and health-promoting practices. Journal of Advanced Nursing, 48(4), 351-360. Borisch, B. (2012). Working on the social determinants of health is central to public health. Journal of Public Health Policy, 33, 279-284. Breheny, M. & Stephens, C. (2010). Youth or disadvantage? The construction of teenage mothers in medical journals. Culture, Health & Sexuality, 12(3), 307-322. Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press. Browne, G., Byrne, C., Roberts, J., Gafni, A., & Whittaker, S. (2001). When the Bough Breaks: Provider-initiated Comprehensive Care is More Effective and Less Expensive for Solesupport Parents on Social Assistance. Social Science & Medicine, 1, 1-14

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City of Toronto. (2006). Drop-in services sector: Literature review of good practices. Retrieved from http://www.toronto.ca/housing/pdf/drop-in-literature-review-060710.pdf Collins, B. (2010). Resilience in teenage mothers: A follow-up study. Retrieved from http://www.msd.govt.nz/documents/about-msd-and-our-work/publicationsresources/research/sole-parenting/resilience-in-teenage-mothers.pdf Corcoran, J., Franklin, C., & Bennett, P. (2000). Ecological factors associated with adolescent pregnancy and parenting. Social Work Research, 24(1), 29-39. Coren, E. & Barlow, J. (2001). Individual and group-based parenting programmes for improving psychosocial outcomes for teenage parents and their children. Cochrane Database of Systematic Reviews, 3. Corneau, S. & Stergiopoulos, V. (2012). More than being against it: Anti-racism and antioppression in mental health services. Transcultural Psychiatry, 49(2), 261-282. Darisi, T. (2007). It doesnt matter if youre 15 or 45, having a child is a difficult experience. Reflexivity and resistance in young mothers constructions of identity. Journal of the Motherhood Initiative, 9(1), 29-41. Dilworth, T. (2006). Literature review: Poverty, homelessness and teenage pregnancy. Retrieved from http://tamarackcommunity.ca/downloads/vc/SJ_Literature_Review.pdf Doman, E. W., Baggett, K., M., Carta, J. J., Mitchell, S., & Larson, E. (2010). Factors influencing mothers abilities to engage in a comprehensive parenting intervention program. Public Health Nursing, 27(5), 399-407. Duncan, S. (2007). Whats the problem with teenage parents? And whats the problem with policy? Critical Social Policy, 27(3), 307-334.

Literature Review by Linzi Williamson Easterbrooks, M. A., Chauhuri, J. H., Bartlett, J. D., & Copeman, A. (2010). Resilience in

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parenting among young mothers: Family and ecological risks and opportunities. Children and Youth Services Review, 33(1), 42-50. Eshbaugh, E. M. (2011). College students positivity toward teen mothers. Journal of Family Social Work, 14, 237-246. Ford-Gilboe M. (2000). Dispelling myths and creating opportunity: A comparison of the strengths of single-parent and two-parent families. Advances in Nursing Science, 23, 41 58. Giordano G.N. & Lindstrom M. (2010). The impact of changes in different aspects of social capital and material conditions on self-rated health over time: A longitudinal cohort study. Social Science and Medicine, 70, 700710. Gonzales, J. (2003). Cesar Chavez: A case study of a resilient childs adaptation into adulthood. (ERIC Document Reproduction Service No. ED478347). Greene, G. J., Lee, M., Trask, R., & Rheinsheld, J. (2000). How to work with clients strengths in crisis intervention: A solution-focused approach. In A. R. Roberts (Ed.), Crisis Intervention Handbook: Assessment, Treatment, and Research (2nd ed.) (pp. 31-55). New York: Oxford University Press. Hawley, D.R. (2000). Clinical implications of family resilience. American Journal of Family Therapy, 28(2), 101116. Herrman, J. W. (2006). The voices of teen mothers: The experience of repeat pregnancy. MCN: The American Journal of Maternal Child Nursing, 31, 243-249. Herrman, J. W. (2007). Repeat pregnancy in adolescence: Intentions and decision making. MCN: The American Journal of Maternal Child Nursing, 32, 89-94.

Literature Review by Linzi Williamson Herrman, J. W. (2008). Adolescent perceptions of teen births: A focus group study. Journal of Obstetrical, Gynecological, and Neonatal Nursing, 37(1), 42-50. Herrman, J. W., & Nandankumar, R. (2010). Development of a survey to assess adolescent perceptions of teen parenting. Manuscript submitted for publication. Herrman, J. W. & Waterhouse, J. K. (2010). What do adolescents think about teen parenting? Western Journal of Nursing Research, 33(4), 577-592. Hill, K. (2008). A strengths-based framework for social policy: Barriers and possibilities. Journal of Policy Practice, 7(2-3), 106-121. Hopson, L. M. & Kim, J. S. (2004). A solution-focused approach to crisis intervention with adolescents. Journal of Evidence-Based Social Work, 1(2-3), 93-110.

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Hunter, B. D., Neiger, B., & West, J. (2011). The importance of addressing social determinants of health at the local levels: The case for social capital. Health and Social Care in the Community, 19(5), 522-530. Hurd, N. M. & Zimmerman, M. A. (2010). Natural mentoring relationships among adolescent mothers: A study of resilience. Journal of Research on Adolescence, 20(3), 789-809. Jones, A. & Pleace, N. (2005). Daytime Homelessness. Centre for Housing Policy, The University of York; U.K. Kearney, M. S. & Levine, P. B. (2012). Why is the teen birth rates in the United states so high and why does it matter? Journal of Economic Perspectives, 26(2), 141-166. Kennedy, A. C. (2005). Resilience among urban adolescent mothers living with violence. Violence Against Women, 11(12), 1490-1514.

Literature Review by Linzi Williamson Koblinsky, S. A., Kuvalanka, K. A., & Randolph, S. M. (2006). Social skills and behavior problems of urban, African American preschoolers: Role of parenting practices, family

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conflict, and maternal depression. American Journal of Orthopsychiatry, 76(4), 554-563. Krisberg K. (2008) Healthy People 2020: Tackling social determinants of health: input sought from health workforce. The Nations Health, 38(10), 125. Laursen, E. K. (2000). Strength-based practice with children in trouble. Reclaiming Children and Youth, 9(2), 70-75. Laursen, E. K. (2003). Frontiers in strength-based treatment. Reclaiming Children and Youth, 12(1), 12-17. Lietz, C. A. (2011). Theoretical adherence to family centered practice: Are strengths-based principles illustrated in families descriptions of child welfare services? Children and Youth Services Review, 33, 888-893. Lindsey, E. W. (2000). Social work with homeless mothers: A strengths-based solution-focused model. Journal of Family Social Work, 4(1), 59-78. Lounds, J. J., Borkowski, J. G., & Whitman, T. L. (2006). The potential for child neglect: The case of adolescent mothers and their children. Child Maltreatment, 11(3), 281294. Luthar, S. S., & Cicchetti, D. (2000). The construct of resilience: Implications for interventions and social policies. Development and Psychopathology, 12, 857885. Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71, 543562. MacArthur, J., Rawana, E. P., & Brownlee, K. (2011). Implementation of a strengths-based approach in the practice of child and youth care. Relational Child and Youth Care, 24(3), 6-16.

Literature Review by Linzi Williamson Marmot, M. (2005). Social determinants of health inequalities. Public Health, 365, 1099-1104.

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Marmot M. (2006). Status syndrome: A challenge to medicine. Journal of the American Medical Association, 295(11), 13041307. Marmot, M. (2012). Health equity through action on the social determinants of health: The role of national medical associations. Retrieved from http://www.who.int/social_determinants/events/Sir_michael_mamort_presentation_wha6 5_2012.pdf Marra, J. V., McCarthy, E., Lin, H., Ford, J., Rodis, E. & Frisman, L. K. (2009). Effects of social support and conflict on parenting among homeless mothers. American Journal of Orthopsychiatry, 79,(3), 384-356. McGaha-Garnett, V. (2007). Needs assessment for adolescent mothers: Building resiliency and student success towards high school completion. Retrieved from http://counselingoutfitters.com/vistas/vistas_2008_Title.htm Meade, C. S., Kershaw, T. S., & Ickovics, J. R. (2008). The intergenerational cycle of motherhood: An ecological approach. Health Psychology, 27(4), 419429. McKay, A. (2006). Trends in teen pregnancy in Canada with comparisons to U.S.A. and England/Wales. The Canadian Journal of Human Sexuality, 15(3-4), 157-161. McLaughlin, K. (2005). From ridicule to institutionalization: Anti-oppression, the state and social work. Critical Social Policy, 25(3), 283-305. Mikkonen, J. & Raphael, D. (2010). Social determinants of health: The Canadian facts. Retrieved from http://www.thecanadianfacts.org/The_Canadian_Facts.pdf

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Moore S., Haines V., Hawe P. & Shiell A. (2006). Lost in translation: a genealogy of the social capital concept in public health. Journal of Epidemiology and Community Health, 60, 729734. Morgan, T. & Miller, H. (2011). From poverty to prosperity: A proven model helping young mothers succeed. Retrieved from http://www.womenmovingforwardcanada.org/reportsand-publications/ OHalloran, M. S. & Copeland, E. P. (2000). Crisis intervention with early adolescents who have suffered a significant loss. In A. R. Roberts (Ed.), Crisis Intervention Handbook: Assessment, Treatment, and Research (2nd ed.) (pp. 101-130). New York: Oxford University Press. Planned Parenthood of Toronto. (2005). Young parents sexual health consultation report. Retrieved from http://www.ppt.on.ca/pdf/reports/YoungParentsreport.pdf Public Health Agency of Canada. (2011). Reducing health inequalities: A challenge for our times. Retrieved from http://publications.gc.ca/collections/collection_2012/aspcphac/HP35-22-2011-eng.pdf Rapp, R.C. (2006). Strengths-based case management: Enhancing treatment for persons with substance abuse problems. In: D. Saleebey (Ed,) The Strengths Perspective in Social Work Practice, Fourth Ed. Boston: Pearson. Rapp, C. A., Pettus, C. A., & Goscha, R. J. (2006). Principles of strengths-based policy. Journal of Policy Practice, 5(4), 3-18. Rawana, E. & Brownlee, K. (2009). Making the possible probable: A strength-based assessment and intervention framework for clinical work with parents, children and adolescents. Families in

Literature Review by Linzi Williamson Society: The Journal of Contemporary Social Services, 90, 255-260. Redko, C., Rapp, R. C., Elms, C., Snyder, M., & Carlson, R. G. (2007). Understanding the working alliance between persons with substance abuse problems and strengths-based case managers. Journal of Psychoactive Drugs, 39(3), 241-250.

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Resnick, M.D. (2000). Protective factors, resiliency, and healthy youth development. Adolescent Medicine: State of the Art Reviews, 11(1), 157164. Seita, J. & Brondtro, L. (2002). Kids who outwit adults. Longmont, CO:Sopris West. Sex Information and Education Council of Canada (SIECCAN). (2007). Update report on teen pregnancy prevention. Retrieved from http://www.sieccan.org/resources.html SmithBattle, L. (2007). Legacies of advantage and disadvantage: The case of teen mothers. Public Health Nursing, 24, 409420. Spear, H. J. (2001). Teenage pregnancy: Having a baby wont affect me that much. Pediatric Nursing, 27(6), 574-580. Toronto Drop-In Network (TDIN). (2007). Good practices toolkit. Retrieved from http://www.toronto.ca/housing/pdf/toolkit-complete.pdf Toronto Drop-In Network (TDIN). (2008). Evaluation strategies for drop-in settings. Retrieved from http://www.toronto.ca/housing/pdf/measuringsuccessapril7.pdf Toronto Drop-In Network (TDIN). (2010). Drop-in review consultation report. Retrieved from http://www.toronto.ca/housing/pdf/consultation_report.pdf Turney, H. M., Conway, P., Plummer, P., Adkins, S. E., Hudson, G. C., McLeod, D. A., & Zafaroni, A. (2011). Exploring behavioral intentions among young mothers. Journal of Family Social Work, 14, 298-310.

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Ungar, M. (2003). Qualitative contributions to resilience research. Qualitative Social Work, 2(1), 85102. United Way of Calgary and Area. (2011). Seeds of success: Seeking solutions for teen mothers and their children. Retrieved from http://www.calgaryunitedway.org/main/sites/default/files/united_way__teen_mom_report.pdf Whitson, M. L., Martinez, A., Ayala, C., & Kaufman, J. S. (2011). Predictors of parenting and infant outcomes for impoverished adolescent parents. Journal of Family Social Work, 14, 284-297. Williams, D. R., Neighbors, H. W., & Jackson, J. S. (2003). Racial/ethnic discrimination and health: Findings from community studies. American Journal of Public Health, 93, 200 208. Women Moving Forward Canada. (2010). Case for collaboration. Retrieved from http://www.womenmovingforwardcanada.org/reports-and-publications/