aohc hp and cd ple july 16, 2013
TRANSCRIPT
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Changing the way welook at clients: options
and opportunities tobuild resilience
Ron Shore, MPA
www.shoreconsulting.ca
AOHC HP and CD
Strategic Annual Professional Learning Event
Toronto, ON., July 16, 2013
http://www.shoreconsulting.ca/http://www.shoreconsulting.ca/ -
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Abstract.
Taking a resiliency lens, this presentation argues
for the creation ofopportunities for communities
to actively engage in navigating, networking and
negotiating for their own health. This involves
improving the way in which we provide options andopportunities for people to participate in altering
and improving their social environment rather than
looking at individuals as clients to whom we
provide service.
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Order of events
Thinking about thinking
Uncovering clients as people
Exploring resilience Creating social ecology
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Conjecture(s)
Rate of growth of information = pace of
historical memory loss
At risk, identify of what it is to be CHC
True change lies in transforming social
processes which mediate the way we are
with each other: relationships (Im tired of
our youth killing each other) Project of now: trace the conceptual roots
of CHCs
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Thinking aboutthinking
Part One
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Building dwelling thinking
What it means to be reflexive
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Shadow side of the moon
The binary push: this or that
(a lesson in ontology, perception andreality)
Simplify, simplify, simplify
The imperative to categorize
Cognitive biases are culturally rooted We murder to dissect
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Wordsworth.
One impulse from a vernal wood
May teach you more of man, Of moral evil andof good,
Than all the sages can.
Sweet is the lore which Nature brings; Ourmeddling intellect
Mis-shapes the beauteous forms of things:--We murder to dissect.
The Tables Turned, 1888
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The masters tools will never dismantlethe masters house (Audre Lorde)
What we lose in this binary thinking are
the relationships, the interconnectivities,the networks, the motion, the fluidity, thechange, the potential..
reification.the fallacy of making concretesomething that is abstract, or fluidto makesomething into a thing
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A little softer
Relational/dialogical/dialectical thinking
Ecological thinking
Importance of differentiation, diversity andnetworks
Its all about relationships!
What this requires: mindfully hold your
tendency to affix a bar code to people,processes, events, things (things can bemany things/never give up on people)
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Uncovering clientsas people
Part Two
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What do we mean?
client (n.) late 14c., from Anglo-Frenchclyent (c.1300), from Latin clientem(nominative cliens) "follower, retainer,"
perhaps a variant of present participle ofcluere "listen, follow, obey" (see listen);or, more likely, from clinare "to incline,bend," from suffixed form of PIE root
*klei- "to lean" (see lean (v.)).www.etymonline.com
http://www.etymonline.com/index.php?term=client&allowed_in_frame=0http://www.etymonline.com/index.php?term=listen&allowed_in_frame=0http://www.etymonline.com/index.php?term=lean&allowed_in_frame=0http://www.etymonline.com/index.php?term=lean&allowed_in_frame=0http://www.etymonline.com/index.php?term=listen&allowed_in_frame=0http://www.etymonline.com/index.php?term=client&allowed_in_frame=0 -
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The banking model
Viewing the student, participant or clientas a passive object to be filled, fixed orshaped (tabula rasa)
Roots in critical educational philosophy
"it transforms students into receivingobjects. It attempts to control thinking andaction, leads men and women to adjust tothe world, and inhibits their creative power"(Freire, Pedagogy of the Oppressed, 1970)
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Another model: conscientization
The process of developing a critical awarenessof ones social reality through reflection andaction. Action is fundamental because it is theprocess of changing the reality. Paulo Freire
says that we all acquire social myths which havea dominant tendency, and so learning is a criticalprocess which depends upon uncovering realproblems and actual needs.
- See more at:http://www.freire.org/conscientization/#sthash.RtLPNeaI.dpuf
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Praxis
Again, Freire
"reflection and action upon the world inorder to transform it.
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Will you join the client list
Etymologically, another interpretation ofthe origins of client is
one who listens to be called
What are we being called to?
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So, in this context
Importance of CD work
Chronic disease managementsomewhat flips the traditional medical
power structure as do group visits
The origins of Community HealthCentres are in mobilizing, organizing
and providing opportunities for people topotentiate via their social actions
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The new language
Navigate
Negotiate
Network Herein lie opportunities to create
change: all three are action oriented,view clients as activating, and all three
are dialogical
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The social orientation of CHCs isprecisely what differentiates them fromFamily Health Teams
1. Analysis of social determinants ofhealth; individual health is rooted inneighbourhoods, families, society
2. Commitment to the marginalized 3. Role of social action in obtaining
health
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ExploringResilience
Part three:
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The myth of resilience
when life throws you curveballs, hitthem out of the park
Return of the ol bootstraps
Deserving vs. undeserving poor ahistory of charity
Proviso: there is a role for personal
agency, its just not the only dimension
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Resilience: A social ecologymodel
Recognizes that people potentiate theirresilience within time and space
via opportunities
in social relationships with each other
when they have valued social roles
when there is social cohesion
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2 models of human behaviour
Individualist Ecologist
Complete autonomy Shared governance (ethics)
Sovereign Democratic
Self-determined Agency in context (team)
Alone Community
Responsible Relational
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There is free will
Human agency matters, its just not theonly dimension
Think of a team
Individual performance still matters
Interrelated performances
Accountable to each other
Even in individual sport, competition with andalong side others is what leads toimprovement
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Performance Domains
Decision making
Hardiness
Will, commitment, strength, determination
Flexibility
Creativity
Emotional regulation Goal-setting
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Individual Qualities Associated with Resiliency
Self efficacy (Bandura, 1977)
Sense of coherence (Antonovsky, 1987)
Self esteem (Brown & Lohr, 1987) Prosociality (Dovidio, Piliavin, Schroeder
& Penner, 2006)
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Resilience does not occur in isolation. It is aninteractive process that requires someone orsomething to interact with. It is dependent uponcontext or environment, including our most
important relationships. How are individualsand their brains resilient in their socialenvironment? The short answer is that ourneurophysiological constitutions find viable
ways of being in our worlds. (Martha Kent,From Neuron to Social Context, in The SocialEcology of Resilience, Ch. 11, 2012)
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Creating Socialecology
Part Four
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Integrative thinking
Epigenetics
Nature and nurture
Individual in community.. Social determinants of health or social
ecology of health?
Relational
Dynamic
Importance of networks and relationships
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Mirror neurons
The roots of empathy
What does this tell us about beinghuman?
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Harm Reduction 2.0: Moving to The
Social Ecology Model
Harm ReductionModel Social Ecology Model
disease control positive health outcomes
risk minimization protective factorsindividual
behaviour social relations
needs based asset based
public health
primary and community
health
Marginal enriching environments
Outreach diffusion
Advocacy
informed care, practice &
policy
social inclusion people-centred
Survival resiliency
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A telling example
Citizens of Roseto, Pennsylvania (pop.2000), have a death rate from heartdisease of less than of that in the US
and a 1/3 of comparable townsSimilar diet, exercise, family hx
Difference? A powerful protective socialstructure
Egalitarian, 22 separate civic organizations,multigenerational homes, social cohesion, lots ofvisiting
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Take home messages
Recognize cognitive biases
Hold your tendency to reify
Relate, honestly and authentically topeople, holding yourself beside notabove or ahead of them
Listen for opportunities to create
opportunities: multiplier effect
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Further reading
The Social Ecology of Resilience, A Handbookof Theory and Practice, Michael Unger Ed., 2012
Pedagogy of the Oppressed, Paulo Freire, 1970
The Opposable Mind, Roger Martin, 2007
Drug, Set and Setting, Norman Zinberg, 1984
Outliers: The Story of Success, MalcolmGladwell, 2008
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Contact info
www.shoreconsulting.ca
Follow me on twitter.@ronshore4
Thanks, and take care of each other
mailto:[email protected]://www.shoreconsulting.ca/http://www.shoreconsulting.ca/mailto:[email protected]