Ron Shore, MPA www.shoreconsulting.ca AOHC HP and CD Strategic Annual Professional Learning Event Toronto, ON.

, July 16, 2013

Changing the way we look at clients: options and opportunities to build resilience

Abstract.
Taking

a resiliency lens, this presentation argues for the creation of opportunities for communities to actively engage in navigating, networking and negotiating for their own health. This involves improving the way in which we provide options and opportunities for people to participate in altering and improving their social environment rather than looking at individuals as clients to whom we provide service.

Order of events
Thinking

about thinking

Uncovering clients as people Exploring resilience Creating social ecology

Conjecture(s)
Rate

of growth of information = pace of historical memory loss At risk, identify of what it is to be CHC True change lies in transforming social processes which mediate the way we are with each other: relationships (Im tired of our youth killing each other) Project of now: trace the conceptual roots of CHCs

Part One

Thinking about thinking

Building dwelling thinking

What it means to be reflexive

Shadow side of the moon

The binary push: this or that (a lesson in ontology, perception and reality) Simplify, simplify, simplify The imperative to categorize Cognitive biases are culturally rooted We murder to dissect

Wordsworth.
One impulse from a vernal wood May teach you more of man, Of moral evil and of good, Than all the sages can. Sweet is the lore which Nature brings; Our meddling intellect Mis-shapes the beauteous forms of things:-We murder to dissect. The Tables Turned, 1888

The masters tools will never dismantle the masters house (Audre Lorde) What we lose in this binary thinking are the relationships, the interconnectivities, the networks, the motion, the fluidity, the change, the potential..
reification.the fallacy of making concrete

something that is abstract, or fluidto make something into a thing

And on the bright side

The

Opposable Mind

The ability to face constructively the tension of

opposing ideas and, instead of choosing one at the expense of the other, generate a creative resolution of the tension in the form of a new idea that contains elements of the opposing ideas but is superior to each.
The importance of integrative thinking Roger Martin: The Opposable Mind: How

Successful Leaders Win Through Integrative Thinking, 2007

A little softer
Relational/dialogical/dialectical

thinking

Ecological thinking Importance of differentiation, diversity and networks Its all about relationships! What this requires: mindfully hold your tendency to affix a bar code to people, processes, events, things (things can be many things/never give up on people)

Part Two

Uncovering clients as people

What do we mean?

client (n.) late 14c., from Anglo-French clyent (c.1300), from Latin clientem (nominative cliens) "follower, retainer," perhaps a variant of present participle of cluere "listen, follow, obey" (see listen); or, more likely, from clinare "to incline, bend," from suffixed form of PIE root *klei- "to lean" (see lean (v.)).
www.etymonline.com

The banking model

Viewing the student, participant or client as a passive object to be filled, fixed or shaped (tabula rasa) Roots in critical educational philosophy
"it transforms students into receiving

objects. It attempts to control thinking and action, leads men and women to adjust to the world, and inhibits their creative power" (Freire, Pedagogy of the Oppressed, 1970)

Another model: conscientization

The

process of developing a critical awareness of ones social reality through reflection and action. Action is fundamental because it is the process of changing the reality. Paulo Freire says that we all acquire social myths which have a dominant tendency, and so learning is a critical process which depends upon uncovering real problems and actual needs. - See more at: http://www.freire.org/conscientization/#sthash.Rt LPNeaI.dpuf

Praxis

Again, Freire "reflection and action upon the world in order to transform it.

Will you join the client list

Etymologically, another interpretation of the origins of client is

one who listens to be called What are we being called to?

So, in this context

Importance of CD work Chronic disease management somewhat flips the traditional medical power structure as do group visits The origins of Community Health Centres are in mobilizing, organizing and providing opportunities for people to potentiate via their social actions

The new language

Navigate Negotiate Network Herein lie opportunities to create change: all three are action oriented, view clients as activating, and all three are dialogical

The social orientation of CHCs is precisely what differentiates them from Family Health Teams 1. Analysis of social determinants of health; individual health is rooted in neighbourhoods, families, society 2. Commitment to the marginalized 3. Role of social action in obtaining health

Part three:

Exploring Resilience

The myth of resilience

when life throws you curveballs, hit them out of the park Return of the ol bootstraps Deserving vs. undeserving poor a history of charity Proviso: there is a role for personal agency, its just not the only dimension

Resilience: A social ecology model

Recognizes that people potentiate their resilience within time and space
via opportunities in social relationships with each other when they have valued social roles when there is social cohesion

2 models of human behaviour

Individualist Ecologist

Complete autonomy Sovereign Self-determined Alone Responsible

Shared governance (ethics) Democratic Agency in context (team) Community Relational

There is free will

Human

agency matters, its just not the only dimension Think of a team
Individual performance still matters Interrelated performances Accountable to each other Even in individual sport, competition with and

along side others is what leads to improvement

Performance Domains
Decision

making

Hardiness Will, commitment, strength, determination Flexibility Creativity Emotional regulation Goal-setting

Individual Qualities Associated with Resiliency

Self

efficacy (Bandura, 1977)

Sense of coherence (Antonovsky, 1987) Self esteem (Brown & Lohr, 1987) Prosociality (Dovidio, Piliavin, Schroeder & Penner, 2006)

 Resilience

does not occur in isolation. It is an interactive process that requires someone or something to interact with. It is dependent upon context or environment, including our most important relationships. How are individuals and their brains resilient in their social environment? The short answer is that our neurophysiological constitutions find viable ways of being in our worlds. (Martha Kent, From Neuron to Social Context, in The Social Ecology of Resilience, Ch. 11, 2012)

Part Four

Creating Social ecology

Integrative thinking

Epigenetics Nature and nurture Individual in community.. Social determinants of health or social ecology of health?
Relational Dynamic Importance of networks and relationships

Mirror neurons The roots of empathy What does this tell us about being human?

Harm Reduction 2.0: Moving to The Social Ecology Model

Harm Reduction Model disease control risk minimization individual behaviour needs based public health Marginal Outreach Advocacy social inclusion Survival

Social Ecology Model positive health outcomes protective factors social relations asset based primary and community health enriching environments diffusion informed care, practice & policy people-centred resiliency

A telling example

Citizens of Roseto, Pennsylvania (pop. 2000), have a death rate from heart disease of less than of that in the US and a 1/3 of comparable towns
Similar diet, exercise, family hx Difference? A powerful protective social

structure

Egalitarian, 22 separate civic organizations,

multigenerational homes, social cohesion, lots of visiting

Take home messages

Recognize cognitive biases Hold your tendency to reify Relate, honestly and authentically to people, holding yourself beside not above or ahead of them Listen for opportunities to create opportunities: multiplier effect

Further reading
The

Social Ecology of Resilience, A Handbook of Theory and Practice, Michael Unger Ed., 2012 Pedagogy of the Oppressed, Paulo Freire, 1970 The Opposable Mind, Roger Martin, 2007 Drug, Set and Setting, Norman Zinberg, 1984 Outliers: The Story of Success, Malcolm Gladwell, 2008

Contact info

ronshore4@gmail.com www.shoreconsulting.ca Follow me on twitter.@ronshore4 Thanks, and take care of each other