Peter's Mental Notes
Wednesday, September 03, 2008
Way behind in my PhD work
Life has a way of letting things get further and further away from you. It is like hoping that the oar you dropped in the water is going to float back to you but instead it heads out to the ocean. I feel that way about my PhD thesis proposal at the moment.
Last November and December, I spent quite a bit of time of putting a proposal together: Experiencing youth mental health: podcasting as a method of reducing the stigma associated with mental health difficulties. It got shredded by my committee and despite my stated wishes to substantially revise it, I have been so busy with work and family that it has sat on my desk - untouched and almost abandoned.
After all the hard work that put into the course work and comprehensive exams, it would be a real shame to abandon this project. So here is my plan.
I will submit and defend my proposal by December 15, 2008.
I will dedicate at least 10 hours a week to putting this together until it is ready to go.
Last November and December, I spent quite a bit of time of putting a proposal together: Experiencing youth mental health: podcasting as a method of reducing the stigma associated with mental health difficulties. It got shredded by my committee and despite my stated wishes to substantially revise it, I have been so busy with work and family that it has sat on my desk - untouched and almost abandoned.
After all the hard work that put into the course work and comprehensive exams, it would be a real shame to abandon this project. So here is my plan.
I will submit and defend my proposal by December 15, 2008.
I will dedicate at least 10 hours a week to putting this together until it is ready to go.
Labels: mental health, phd, thesis proposal
¶ 1:35 p.m. 0 comments
Monday, May 29, 2006
Comprehensive Dates and Guidelines
Students from the 2005 Cohort and Thesis Supervisors,
In November 2006 students from the Doctoral program in Population Health, cohort 2005, will be completing their comprehensive examination. You will find enclosed the guidelines.
On Wednesday, November 1, a paper copy of the three questions will be available from the PhD in Population Health program office, 1 Stewart Street , room 302B, Roseline Savage, as of 09:00 a.m. Each student must pick up their questions in person. Your signature will be required to confirm that you have received the questions. Please note that the questions will not be sent by email. You will have 14 days to respond to the questions.
On the 14th day, Tuesday, November 14, you will submit 4 copies of your paper by 16:00 to Roseline Savage. Please do not submit your responses by email. This year there will be 12 students completing their comprehensive exams. At the last PhD in Population Health program meeting, April 12, the committee agreed that there will be 2 days of presentations, 2 sets of jury members and one chair for both sessions. Members of the jury will be determined at a later date. There will be 6 students presenting on Monday, November 27 and the other 6 on Tuesday, November 28. See attached schedule.
(I am at 9:00 am on November 28th)
The oral presentations will be held at the Institute of Population Health , room 223. An LCD projector and a laptop will be available.
__________________________________________________________
PhD IN POPULATION HEALTH
COMPREHENSIVE EXAMINATION GUIDELINES
Prerequisites
Completion of three core courses for Population Health Program; POP 8910, POP8920 and POP8930.
Background - Program Objectives
The objective of the Population Health PhD program is to prepare graduates with the skills needed to:
· Generate new knowledge for, and thus advance the science of population health.
· Undertake transdisciplinary analyses of complex population health problems.
· Apply rigorous scientific methods to studies of population health.
· Function as effective members of transdisciplinary research and implementation teams.
On program completion, graduates are expected to have acquired analytic, research and behavioral skills to:
· Assemble, synthesize and analyze complex data from diverse sources to provide a comprehensive description of a population health problem and its causes or determinants.
· Draw valid conclusions from multiple sources of evidence to formulate clear and appropriate recommendations for research, practice and/or policy.
· Demonstrate insight as to the ways in which various disciplines may contribute to the analysis of complex population health issues.
· Demonstrate a repertoire of research skills applicable to population health problems in one or more domains for the framework.
· Demonstrate advanced use of research skills appropriate to the in-depth study of a population health issue in one domain of the framework.
· Articulate strengths and limitations of qualitative and quantitative research methods for investigating different types of population health problems.
· Perform in-depth analyses of, and describe interactions among, one or more of the following: determinants of health, intervention components, or intersectoral policies.
· Effectively contribute as a member of a transdisciplinary team.
· Appropriately summarize complex ideas and research findings for policy-makers and health professionals.
Overview of Comprehensive Exams
Students in the Population Health PhD program are expected to demonstrate a breadth of knowledge in the field of population health (as defined by the PhD program framework). Your mastery of this breadth of knowledge is evaluated through two distinct mechanisms: a set of questions and an oral defense of your answers to these.
Objectives
The specific objectives for the comprehensive exams are:
1. To assess your knowledge and application of core competencies in the field of population health.
2. To assess your ability to select, critique, interpret and synthesize relevant data and quality evidence to address population health problems.
3. To determine your ability to articulate and defend orally your written responses to questions pertaining to population health issues.
4. To assess your competence as a critical consumer of interdisciplinary qualitative and quantitative research in the field of population health.
Comprehensive Exam Components
Comprehensive exams have been designed based on the following principles:
· Several domains of competence will be evaluated: a) core competencies in the field of population health, b) problem-solving and critical analysis of population health issues requiring intervention and c) ability to formulate and orally defend written answers to specific sets of questions.
· In order to test the breadth of your knowledge in the field of population health, problems selected for the comprehensive exam will be independent of your thesis topic.
· Examining juries will be comprised of an interdisciplinary team of faculty.
Trajectory
The two evaluation mechanisms used for comprehensive examinations are outlined below.
· A set of three questions with a two-week deadline to respond to all of them..
· An oral defense of written responses two weeks after the submission of your written answers.
1. The set of three questions (provided in both French and English) is designed to assess fundamental competencies for the field of population health. These questions will focus on:
- the learning objectives of the scientific paradigms, investigative methods and population health intervention core courses, and
- the five core knowledge areas of the program.
You will have 14 days to respond.
During this period, you are not permitted to consult with your thesis supervisor or any members of the examination jury regarding your written responses or the oral defense of your answers.
Your answers should have a maximum of 3-4 pages in 1.5 spacing, 12 point-font pages per question (excluding references and appendix). You may write them in English or in French, but only one language must be used throughout. Quotations should follow this definition: A passage taken verbatim from a source text and entered on a terminology record, with reference to the source. Also refer to the University rules on plagiarism www.uOttawa.ca/plagiarism.pdf.
On the 14th day you will submit four copies of your paper to Roseline Savage, Academic Assistant, by 16:00. Roseline will then submit the copies to the jury members and chair. If you wish you can also send your paper by email to the jury members (please note that this is not compulsory).
This component of the comprehensive exam will be worth 80%.
2. An oral defense of the three questions will take place fourteen days following submission of your written answers.
- You will have 20 minutes to present a formal and polished oral defense of your written answers.
- A 20 to 30 minute period of questioning by the examining jury will follow.
- You will choose your preferred language for the questions asked during the oral presentation. Both English and French may be used but must not be mixed in the same sentence.
This component of the comprehensive exam will be worth 20% (oral presentation 5%; defense of written responses 15%).
Following the submission of the written answers and the oral defense the examining jury will submit a grade (satisfactory/not satisfactory) to the Academic Assistant. You will be advised of this grade through an e-mail from the Academic Assistant.
Timing of Comprehensive Exams
Comprehensive examinations will be offered once a year, normally in October/November, and should be completed during the second year of the program.
Comprehensive Examination Jury
The membership of the jury is determined as follows:
- The jury will be chaired by the Director of the Population Health PhD Program, except if he/she is your Thesis Supervisor. In such case, the jury will be chaired by a faculty member appointed by the Graduate Program Committee.
- Your thesis supervisor may not sit on the jury for your comprehensive exam. The Program Director will not be present for the examination of his/her students.
- Two jury members will be selected by the Graduate Program Committee.
- Potential supervisors in the Population Health program are eligible as jury members.
- Jury members will be from two different disciplines and from two different faculties.
- For each component of the exam, there will be one jury member with a qualitative research background and a second jury member with a quantitative research background.
- Normally, at least one member of the written questions jury will be common to all of the students.
- One jury member will have active language ability in French; the other will have active language ability in English. Both will have passive language ability in the other official language (as defined by the University of Ottawa).
- The chair of the jury will cast the deciding vote where the two voting jury members are unable to agree on a pass or failure for an exam component.
Failures
Students must pass both components of the comprehensive exam.
The oral portions of the exams will be taped in the case of an appeal for a failure.
All Faculty of Graduate and Postdoctoral Studies regulations regarding comprehensive exams apply (http://www.grad.uottawa.ca/regulations/examinations_grading/comprehensive_examination.html). ¶ 1:10 p.m. 0 comments
In November 2006 students from the Doctoral program in Population Health, cohort 2005, will be completing their comprehensive examination. You will find enclosed the guidelines.
On Wednesday, November 1, a paper copy of the three questions will be available from the PhD in Population Health program office, 1 Stewart Street , room 302B, Roseline Savage, as of 09:00 a.m. Each student must pick up their questions in person. Your signature will be required to confirm that you have received the questions. Please note that the questions will not be sent by email. You will have 14 days to respond to the questions.
On the 14th day, Tuesday, November 14, you will submit 4 copies of your paper by 16:00 to Roseline Savage. Please do not submit your responses by email. This year there will be 12 students completing their comprehensive exams. At the last PhD in Population Health program meeting, April 12, the committee agreed that there will be 2 days of presentations, 2 sets of jury members and one chair for both sessions. Members of the jury will be determined at a later date. There will be 6 students presenting on Monday, November 27 and the other 6 on Tuesday, November 28. See attached schedule.
(I am at 9:00 am on November 28th)
The oral presentations will be held at the Institute of Population Health , room 223. An LCD projector and a laptop will be available.
__________________________________________________________
PhD IN POPULATION HEALTH
COMPREHENSIVE EXAMINATION GUIDELINES
Prerequisites
Completion of three core courses for Population Health Program; POP 8910, POP8920 and POP8930.
Background - Program Objectives
The objective of the Population Health PhD program is to prepare graduates with the skills needed to:
· Generate new knowledge for, and thus advance the science of population health.
· Undertake transdisciplinary analyses of complex population health problems.
· Apply rigorous scientific methods to studies of population health.
· Function as effective members of transdisciplinary research and implementation teams.
On program completion, graduates are expected to have acquired analytic, research and behavioral skills to:
· Assemble, synthesize and analyze complex data from diverse sources to provide a comprehensive description of a population health problem and its causes or determinants.
· Draw valid conclusions from multiple sources of evidence to formulate clear and appropriate recommendations for research, practice and/or policy.
· Demonstrate insight as to the ways in which various disciplines may contribute to the analysis of complex population health issues.
· Demonstrate a repertoire of research skills applicable to population health problems in one or more domains for the framework.
· Demonstrate advanced use of research skills appropriate to the in-depth study of a population health issue in one domain of the framework.
· Articulate strengths and limitations of qualitative and quantitative research methods for investigating different types of population health problems.
· Perform in-depth analyses of, and describe interactions among, one or more of the following: determinants of health, intervention components, or intersectoral policies.
· Effectively contribute as a member of a transdisciplinary team.
· Appropriately summarize complex ideas and research findings for policy-makers and health professionals.
Overview of Comprehensive Exams
Students in the Population Health PhD program are expected to demonstrate a breadth of knowledge in the field of population health (as defined by the PhD program framework). Your mastery of this breadth of knowledge is evaluated through two distinct mechanisms: a set of questions and an oral defense of your answers to these.
Objectives
The specific objectives for the comprehensive exams are:
1. To assess your knowledge and application of core competencies in the field of population health.
2. To assess your ability to select, critique, interpret and synthesize relevant data and quality evidence to address population health problems.
3. To determine your ability to articulate and defend orally your written responses to questions pertaining to population health issues.
4. To assess your competence as a critical consumer of interdisciplinary qualitative and quantitative research in the field of population health.
Comprehensive Exam Components
Comprehensive exams have been designed based on the following principles:
· Several domains of competence will be evaluated: a) core competencies in the field of population health, b) problem-solving and critical analysis of population health issues requiring intervention and c) ability to formulate and orally defend written answers to specific sets of questions.
· In order to test the breadth of your knowledge in the field of population health, problems selected for the comprehensive exam will be independent of your thesis topic.
· Examining juries will be comprised of an interdisciplinary team of faculty.
Trajectory
The two evaluation mechanisms used for comprehensive examinations are outlined below.
· A set of three questions with a two-week deadline to respond to all of them..
· An oral defense of written responses two weeks after the submission of your written answers.
1. The set of three questions (provided in both French and English) is designed to assess fundamental competencies for the field of population health. These questions will focus on:
- the learning objectives of the scientific paradigms, investigative methods and population health intervention core courses, and
- the five core knowledge areas of the program.
You will have 14 days to respond.
During this period, you are not permitted to consult with your thesis supervisor or any members of the examination jury regarding your written responses or the oral defense of your answers.
Your answers should have a maximum of 3-4 pages in 1.5 spacing, 12 point-font pages per question (excluding references and appendix). You may write them in English or in French, but only one language must be used throughout. Quotations should follow this definition: A passage taken verbatim from a source text and entered on a terminology record, with reference to the source. Also refer to the University rules on plagiarism www.uOttawa.ca/plagiarism.pdf.
On the 14th day you will submit four copies of your paper to Roseline Savage, Academic Assistant, by 16:00. Roseline will then submit the copies to the jury members and chair. If you wish you can also send your paper by email to the jury members (please note that this is not compulsory).
This component of the comprehensive exam will be worth 80%.
2. An oral defense of the three questions will take place fourteen days following submission of your written answers.
- You will have 20 minutes to present a formal and polished oral defense of your written answers.
- A 20 to 30 minute period of questioning by the examining jury will follow.
- You will choose your preferred language for the questions asked during the oral presentation. Both English and French may be used but must not be mixed in the same sentence.
This component of the comprehensive exam will be worth 20% (oral presentation 5%; defense of written responses 15%).
Following the submission of the written answers and the oral defense the examining jury will submit a grade (satisfactory/not satisfactory) to the Academic Assistant. You will be advised of this grade through an e-mail from the Academic Assistant.
Timing of Comprehensive Exams
Comprehensive examinations will be offered once a year, normally in October/November, and should be completed during the second year of the program.
Comprehensive Examination Jury
The membership of the jury is determined as follows:
- The jury will be chaired by the Director of the Population Health PhD Program, except if he/she is your Thesis Supervisor. In such case, the jury will be chaired by a faculty member appointed by the Graduate Program Committee.
- Your thesis supervisor may not sit on the jury for your comprehensive exam. The Program Director will not be present for the examination of his/her students.
- Two jury members will be selected by the Graduate Program Committee.
- Potential supervisors in the Population Health program are eligible as jury members.
- Jury members will be from two different disciplines and from two different faculties.
- For each component of the exam, there will be one jury member with a qualitative research background and a second jury member with a quantitative research background.
- Normally, at least one member of the written questions jury will be common to all of the students.
- One jury member will have active language ability in French; the other will have active language ability in English. Both will have passive language ability in the other official language (as defined by the University of Ottawa).
- The chair of the jury will cast the deciding vote where the two voting jury members are unable to agree on a pass or failure for an exam component.
Failures
Students must pass both components of the comprehensive exam.
The oral portions of the exams will be taped in the case of an appeal for a failure.
All Faculty of Graduate and Postdoctoral Studies regulations regarding comprehensive exams apply (http://www.grad.uottawa.ca/regulations/examinations_grading/comprehensive_examination.html). ¶ 1:10 p.m. 0 comments
Urban Health: Bryant, Raphael, Travers
Bryant, T., Raphael, D., & Travers, R. Identifying and strengthening the
structural roots of urban health: Participatory policy research and the
Canadian urban health agenda
http://tinyurl.com/pz2ha ¶ 11:01 a.m. 0 comments
structural roots of urban health: Participatory policy research and the
Canadian urban health agenda
http://tinyurl.com/pz2ha ¶ 11:01 a.m. 0 comments
School-based Mental Health Projects
Position Open
Department of Psychology
Miami University
The Coordinator of School Mental Health Projects will support and provide technical assistance for the Evidence-Based Practices for School-Wide Prevention Programs project. Duties include evaluation planning; needs/resource assessment; school-community partnership and capacity building; supervision of graduate research assistants; possible teaching of graduate or undergraduate courses and clinical supervision of psychology graduate students; opportunities to pursue research and practice interests related to school mental health practices; involvement in other regional initiatives.
Qualifications: Require: Masters degree in psychology, public health, evaluation or related field; three years of relevant experience; proficiency with statistics and research methods; excellent oral and written communication skills; ability to form strong working relationships with diverse groups. Desire: Ph.D.; specific experience working with prevention in schools, organizations focused on prevention, community coalitions, or collaborative partnerships. Position is contingent upon receipt of funding.
Contact Information: Send application, curriculum vitae and three letters of recommendation to Dr. Paul Flaspohler, Department of Psychology. Contact phone number is 513-529-2469; email is flaspopd@muohio.edu. Screening of applications begins June 1, 2006 and will continue until the position is filled. Women and minorities are especially encouraged to apply along with all other qualified applicants. Miami University is an EOE/AA employer. Campus Crime and Safety Report – www.muohio.edu/righttoknow . Hard copy upon request.
--------------------------------------------------------------------------------
Paul D. Flaspohler, Ph.D.
Assistant Professor
Department Of Psychology &
Center for School-Based Mental Health Programs
Miami University
Oxford, OH 45056
(O) 513.529.2469
(F) 513.529.1786 ¶ 10:07 a.m. 0 comments
Department of Psychology
Miami University
The Coordinator of School Mental Health Projects will support and provide technical assistance for the Evidence-Based Practices for School-Wide Prevention Programs project. Duties include evaluation planning; needs/resource assessment; school-community partnership and capacity building; supervision of graduate research assistants; possible teaching of graduate or undergraduate courses and clinical supervision of psychology graduate students; opportunities to pursue research and practice interests related to school mental health practices; involvement in other regional initiatives.
Qualifications: Require: Masters degree in psychology, public health, evaluation or related field; three years of relevant experience; proficiency with statistics and research methods; excellent oral and written communication skills; ability to form strong working relationships with diverse groups. Desire: Ph.D.; specific experience working with prevention in schools, organizations focused on prevention, community coalitions, or collaborative partnerships. Position is contingent upon receipt of funding.
Contact Information: Send application, curriculum vitae and three letters of recommendation to Dr. Paul Flaspohler, Department of Psychology. Contact phone number is 513-529-2469; email is flaspopd@muohio.edu. Screening of applications begins June 1, 2006 and will continue until the position is filled. Women and minorities are especially encouraged to apply along with all other qualified applicants. Miami University is an EOE/AA employer. Campus Crime and Safety Report – www.muohio.edu/righttoknow . Hard copy upon request.
--------------------------------------------------------------------------------
Paul D. Flaspohler, Ph.D.
Assistant Professor
Department Of Psychology &
Center for School-Based Mental Health Programs
Miami University
Oxford, OH 45056
(O) 513.529.2469
(F) 513.529.1786 ¶ 10:07 a.m. 0 comments
Sunday, May 21, 2006
Tips on Comprehensive Exams
This was collected by Vivien Runnels:
Here are the E-mail responses from previous cohort Pop Health Students concerning Comprehensive Examinations (these are edited slightly)
Gail Webber suggests:
1. Don't worry too much, they are not exceedingly difficult.
2. Prepare in small groups - more fun for everyone. , don’t start until after the courses are all complete. Review the course material and you should be well prepared
3. We prepared by each taking two classes material and summarizing them. I think this is a good approach. We met weekly starting in Sept. (for 2 months). That was enough time.
4. Any key documents from the course should be discussed.
5. Think of applying the knowledge (i.e. how does it apply to current government policy, or how would you design an intervention).
And wishes us all “Good luck!”
Gail has also offered to communicate with students via email if there are further questions.
P.S. Our cohort all did fine.
Nadia Hamel wrote:
Bonjour Je suis de la cohorte 2003. Je pense que la meilleure façon de vous préparer est d'échanger vos opinions après avoir identifié les articles que vous considérez "essentiels". You have plenty of time to prepare yourself from Sept-Nov. I'm at the Institute on Thursdays if you want to chat about it.
Mary Lysyk wrote: I am part of Christine's cohort, but due to a sudden illness in my family, I could not join my group when they met in September - October, in fact I was unable to prepare at all. Although I do not recommend this approach, my
point is not to worry too much. We all did very well and as Christine had said, the process was very relaxed.
I cannot give strategies on how to prepare, but what helped me was organizing my course notes and articles/references the night before (at least I managed to do that!) and debriefing with my cohort the morning we received the questions. The moral support (as well as additional notes and articles) from a friend in the cohort ahead also helped a lot (Thank you Theresa!) Please let me know if I can help in any way. I know you'll do very well! Mary
From Christine Faubert who….would give the same advice as Gail based on the experience of our cohort. Concentrate on your courses first. When these are completed, you can review the course material covered and make sure you have a good
understanding of it. We met 6 times during September and October as a group to discuss key concepts and generate a list of what we thought were the most important references/resources. There is no need to worry about it this year. We also all did well and the defence was actually very relaxed. I would also be happy to answer any question you may have.
Other students have indicated willingness to chat too when they are available. ¶ 10:36 p.m. 0 comments
Here are the E-mail responses from previous cohort Pop Health Students concerning Comprehensive Examinations (these are edited slightly)
Gail Webber suggests:
1. Don't worry too much, they are not exceedingly difficult.
2. Prepare in small groups - more fun for everyone. , don’t start until after the courses are all complete. Review the course material and you should be well prepared
3. We prepared by each taking two classes material and summarizing them. I think this is a good approach. We met weekly starting in Sept. (for 2 months). That was enough time.
4. Any key documents from the course should be discussed.
5. Think of applying the knowledge (i.e. how does it apply to current government policy, or how would you design an intervention).
And wishes us all “Good luck!”
Gail has also offered to communicate with students via email if there are further questions.
P.S. Our cohort all did fine.
Nadia Hamel wrote:
Bonjour Je suis de la cohorte 2003. Je pense que la meilleure façon de vous préparer est d'échanger vos opinions après avoir identifié les articles que vous considérez "essentiels". You have plenty of time to prepare yourself from Sept-Nov. I'm at the Institute on Thursdays if you want to chat about it.
Mary Lysyk wrote: I am part of Christine's cohort, but due to a sudden illness in my family, I could not join my group when they met in September - October, in fact I was unable to prepare at all. Although I do not recommend this approach, my
point is not to worry too much. We all did very well and as Christine had said, the process was very relaxed.
I cannot give strategies on how to prepare, but what helped me was organizing my course notes and articles/references the night before (at least I managed to do that!) and debriefing with my cohort the morning we received the questions. The moral support (as well as additional notes and articles) from a friend in the cohort ahead also helped a lot (Thank you Theresa!) Please let me know if I can help in any way. I know you'll do very well! Mary
From Christine Faubert who….would give the same advice as Gail based on the experience of our cohort. Concentrate on your courses first. When these are completed, you can review the course material covered and make sure you have a good
understanding of it. We met 6 times during September and October as a group to discuss key concepts and generate a list of what we thought were the most important references/resources. There is no need to worry about it this year. We also all did well and the defence was actually very relaxed. I would also be happy to answer any question you may have.
Other students have indicated willingness to chat too when they are available. ¶ 10:36 p.m. 0 comments
Data Abstraction Worksheets
Irwin Schweitzer passed along this website that you will find useful in appraising different study designs on your data abstraction forms. Look under the “BETs CA worksheets” under the Resources tab on the left-hand side.
The website is: http://www.bestbets.org/index.html ¶ 10:10 p.m. 0 comments
The website is: http://www.bestbets.org/index.html ¶ 10:10 p.m. 0 comments
Context, the only peer-reviewed electronic journal for health professional students engaged in their communities
Health Students Taking Action Together (HealthSTAT) has announced the debut of the inaugural issue of the only peer-reviewed electronic journal for health professional students engaged in their communities. Context connects students across the nation working to improve the health of our communities. In addition, the journal recognizes insightful, well-designed evaluations of student initiated programs from a variety of perspectives.
The journal's management team is accepting rolling manuscript submissions and applications for editors and peer reviewers. The journal is being published bi-annually. To submit a manuscript or to sign up for a free subscription, visit www.contextjournal.org
A rigorous peer review process ensures that articles meet high standards in terms of theoretical and methodological rigor. As an open access journal, Context offers the health professional community the opportunity to make research results freely available immediately on publication, and permanently available in public archives. Subscribers to Context benefit from the e-journal's multimedia capabilities and all articles and transcripts will be available for download.
The inaugural Editorial Board includes six health professional students representing four disciplines and six institutions: Carmen Patrick, Editor-in-Chief, Emory University School of Medicine (and member of the board of directors, Community-Campus Partnerships for Health); Hugo Javier Aparicio, University of Pennsylvania School of Medicine; Euna M. August, MPH, University of South Florida (USF), PhD candidate, Department of Community & Family Health; John R. Casey, Edward Via Virginia College of Osteopathic Medicine, DO candidate; Cheryl Hunchak, M.D. Harvard School of Public Health, MPH candidate Department of International Health; Pamela Valera, MSW, University of South Carolina, PhD candidate College of Social Work.
For more information, contact Dana M. Lee, Publisher, 678-637-6923 dana@contextjournal.org or visit
http://www.contextjournal.org ¶ 9:45 p.m. 0 comments
The journal's management team is accepting rolling manuscript submissions and applications for editors and peer reviewers. The journal is being published bi-annually. To submit a manuscript or to sign up for a free subscription, visit www.contextjournal.org
A rigorous peer review process ensures that articles meet high standards in terms of theoretical and methodological rigor. As an open access journal, Context offers the health professional community the opportunity to make research results freely available immediately on publication, and permanently available in public archives. Subscribers to Context benefit from the e-journal's multimedia capabilities and all articles and transcripts will be available for download.
The inaugural Editorial Board includes six health professional students representing four disciplines and six institutions: Carmen Patrick, Editor-in-Chief, Emory University School of Medicine (and member of the board of directors, Community-Campus Partnerships for Health); Hugo Javier Aparicio, University of Pennsylvania School of Medicine; Euna M. August, MPH, University of South Florida (USF), PhD candidate, Department of Community & Family Health; John R. Casey, Edward Via Virginia College of Osteopathic Medicine, DO candidate; Cheryl Hunchak, M.D. Harvard School of Public Health, MPH candidate Department of International Health; Pamela Valera, MSW, University of South Carolina, PhD candidate College of Social Work.
For more information, contact Dana M. Lee, Publisher, 678-637-6923 dana@contextjournal.org or visit
http://www.contextjournal.org ¶ 9:45 p.m. 0 comments
Grants for Community-Based Research on Income and Income Distribution - Letters of Intent Due June 30
LETTERS OF INTENT DUE JUNE 30, 2006
Continuing in its commitment to support innovation in community-based research (CBR) on the Social Determinants of Health, the Toronto-based Wellesley Institute will award 4 grants of up to $80,000 to support CBR on the impact of income distribution on health.
They are looking for research that focuses on community level interventions and/or approaches for addressing these issues. Priority is given to research projects that meaningfully involve community members in all aspects of the research process, are policy-relevant and are methodologically rigorous.
They encourage applications that are submitted in partnerships between community agencies, policy makers and academics. They ask that grantees be willing to engage in constructive conversations with policy advisors at the municipal, provincial and/or federal levels.
Examples of relevant research questions might include:
How have disadvantaged neighborhoods or communities built up their own resources and networks to lessen the adverse effects of inequality? What factors contribute to the health disparities experienced by comparably disadvantaged neighborhoods? (i.e. Why do some low-income neighborhoods do better than others?)
Community Health Centres, neighborhood agencies and other providers address the health impact of poverty in their service delivery. What have been the most promising policy and program directions that put social determinants of health perspective into practice? How do you measure success?
What are successful models for reducing barriers to health care access for low-income people?
How do capacity building programs (e.g. job skills training, social enterprises, etc) affect individual and/or community health? What are the relevant explanatory pathways?
They also welcome other innovative CBR proposals focusing on alleviating the impacts of poverty and income inequality on health.
Advanced Community-Based Research Awards are available for projects of up to two years in length. Letters of intent are no more than 5 pages.
For more information on this granting program and how to apply, please visit
http://www.wellesleycentral.com/advancedgrants.csp ¶ 9:44 p.m. 0 comments
Continuing in its commitment to support innovation in community-based research (CBR) on the Social Determinants of Health, the Toronto-based Wellesley Institute will award 4 grants of up to $80,000 to support CBR on the impact of income distribution on health.
They are looking for research that focuses on community level interventions and/or approaches for addressing these issues. Priority is given to research projects that meaningfully involve community members in all aspects of the research process, are policy-relevant and are methodologically rigorous.
They encourage applications that are submitted in partnerships between community agencies, policy makers and academics. They ask that grantees be willing to engage in constructive conversations with policy advisors at the municipal, provincial and/or federal levels.
Examples of relevant research questions might include:
How have disadvantaged neighborhoods or communities built up their own resources and networks to lessen the adverse effects of inequality? What factors contribute to the health disparities experienced by comparably disadvantaged neighborhoods? (i.e. Why do some low-income neighborhoods do better than others?)
Community Health Centres, neighborhood agencies and other providers address the health impact of poverty in their service delivery. What have been the most promising policy and program directions that put social determinants of health perspective into practice? How do you measure success?
What are successful models for reducing barriers to health care access for low-income people?
How do capacity building programs (e.g. job skills training, social enterprises, etc) affect individual and/or community health? What are the relevant explanatory pathways?
They also welcome other innovative CBR proposals focusing on alleviating the impacts of poverty and income inequality on health.
Advanced Community-Based Research Awards are available for projects of up to two years in length. Letters of intent are no more than 5 pages.
For more information on this granting program and how to apply, please visit
http://www.wellesleycentral.com/advancedgrants.csp ¶ 9:44 p.m. 0 comments
Discussion paper on Reducing Health Disparities in Canada - Roles of the Health Sector
Reducing Health Disparities -Roles of the Health Sector Discussion Paper
Prepared by the Health Disparities Task Group of the Federal/Provincial/Territorial Advisory Committee on Population Health and Health Security, Canada
Available online [PDF file 43p.] at:
http://www.phac-aspc.gc.ca/ph-sp/disparities/pdf06/disparities_discussion_paper_e.pdf
Health disparities are avoidable and can be successfully addressed. This paper explores the role of the health sector in addressing health disparities in Canada by:
Presenting some facts of health disparities - how and why they occur and persist, the nature, extent and costs of health disparities in Canada and, where possible, comparisons between Canada and other countries;
Reviewing how Canadian and international thinking on health disparities has evolved and current Canadian and international strategies for reducing health disparities;
Suggesting policy directions and actions for the health sector to take to reduce health disparities, both within its sphere of direct control and through partnerships and promotion, knowledge development and exchange.
Health disparities are a term central to the discussion in this paper. Health disparities refer to differences in health status that occur among population groups defined by specific characteristics. For policy purposes, the most useful categorizations are those consistently associated with the largest variations in health status. The most prominent factors in Canada are socio-economic status (SES), Aboriginal identity, gender and geographic location. ¶ 9:41 p.m. 0 comments
Prepared by the Health Disparities Task Group of the Federal/Provincial/Territorial Advisory Committee on Population Health and Health Security, Canada
Available online [PDF file 43p.] at:
http://www.phac-aspc.gc.ca/ph-sp/disparities/pdf06/disparities_discussion_paper_e.pdf
Health disparities are avoidable and can be successfully addressed. This paper explores the role of the health sector in addressing health disparities in Canada by:
Presenting some facts of health disparities - how and why they occur and persist, the nature, extent and costs of health disparities in Canada and, where possible, comparisons between Canada and other countries;
Reviewing how Canadian and international thinking on health disparities has evolved and current Canadian and international strategies for reducing health disparities;
Suggesting policy directions and actions for the health sector to take to reduce health disparities, both within its sphere of direct control and through partnerships and promotion, knowledge development and exchange.
Health disparities are a term central to the discussion in this paper. Health disparities refer to differences in health status that occur among population groups defined by specific characteristics. For policy purposes, the most useful categorizations are those consistently associated with the largest variations in health status. The most prominent factors in Canada are socio-economic status (SES), Aboriginal identity, gender and geographic location. ¶ 9:41 p.m. 0 comments
2e Forum national de recherche sur la santé des communautés francophones en situation minoritaire
Le Consortium national de formation en santé (CNFS) vous invite au 2e Forum national de recherche sur la santé des communautés francophones en situation minoritaire qui aura lieu les 23 et 24 novembre 2007, à l’Hôtel Crowne Plaza d’Ottawa.
Vous aurez alors l’occasion de prendre connaissance des pas qui ont été franchis depuis le 1er Forum national. Vous verrez comment les chercheurs ont su traduire les besoins de recherche des communautés en projets et en résultats. Vous saurez dans quelle mesure les gens des milieux ont commencé à tirer parti des leçons apprises pour mettre en œuvre les meilleures pratiques.
Le Forum national de recherche a pour objectif de diffuser les nouveaux savoirs. Il vise également à permettre les échanges et le réseautage sur les trois thématiques prioritaires : la santé et ses déterminants; la gouvernance, la gestion et la prestation des services de santé en français; et, enfin, les liens entre la langue, la culture et la santé.
Nous vous ferons parvenir plus d’informations dans les mois à venir. Nous vous invitons à consulter le site Internet du CNFS (http://www.cnfs.ca/pages/colloques.html) pour connaître l’avancement des préparatifs du 2e Forum national.
Caroline Mercier
Adjointe à la recherche
Consortium national de formation en santé
#400-260, Dalhousie
Ottawa (Ontario) K1N 7E4
(613) 244-7837 ¶ 8:02 p.m. 0 comments
Vous aurez alors l’occasion de prendre connaissance des pas qui ont été franchis depuis le 1er Forum national. Vous verrez comment les chercheurs ont su traduire les besoins de recherche des communautés en projets et en résultats. Vous saurez dans quelle mesure les gens des milieux ont commencé à tirer parti des leçons apprises pour mettre en œuvre les meilleures pratiques.
Le Forum national de recherche a pour objectif de diffuser les nouveaux savoirs. Il vise également à permettre les échanges et le réseautage sur les trois thématiques prioritaires : la santé et ses déterminants; la gouvernance, la gestion et la prestation des services de santé en français; et, enfin, les liens entre la langue, la culture et la santé.
Nous vous ferons parvenir plus d’informations dans les mois à venir. Nous vous invitons à consulter le site Internet du CNFS (http://www.cnfs.ca/pages/colloques.html) pour connaître l’avancement des préparatifs du 2e Forum national.
Caroline Mercier
Adjointe à la recherche
Consortium national de formation en santé
#400-260, Dalhousie
Ottawa (Ontario) K1N 7E4
(613) 244-7837 ¶ 8:02 p.m. 0 comments
Tentative Comprehensives Schedule
The dates for the "dreaded" comprehensive exams have not been set but they look like the following:
At this time I am still working on scheduling and to find jury members. But it looks like the questions will be distributed on November 1, responses to be submitted on November 14 and the oral defense on November 27 and November 28. Please note that this information is not confirmed. This will all depends on the availability of the jury members.
I will send an email to all of you very soon! ¶ 7:55 p.m. 0 comments
At this time I am still working on scheduling and to find jury members. But it looks like the questions will be distributed on November 1, responses to be submitted on November 14 and the oral defense on November 27 and November 28. Please note that this information is not confirmed. This will all depends on the availability of the jury members.
I will send an email to all of you very soon! ¶ 7:55 p.m. 0 comments
Thursday, May 11, 2006
Marks
It has been a while since I posted. I guess I have been resting from the marathon of the last semester. What a crazy time. I never thought I would say this but turning 40 and doing a PHD is a rough way to go.
I passed all my seminars but not with the A's and A+'s that had been the norm at the Master's level. However, I feel like I have learned lots about using a Population Health perspective when looking at knowledge exchange, especially within the context of child and youth mental health.
Despite some of the gripes from my colleagues, I feel the program at the University of Ottawa is excellent - challenging and diverse. It is difficult however, to balance all the disciplinary perspectives and to focus on a particular subject matter. In fact, this experience points directly to the difficulty of multi-disciplinary work.
Now, on to a reading course and getting ready for the dreaded comprehensive exams.
Oy! ¶ 9:43 a.m. 0 comments
I passed all my seminars but not with the A's and A+'s that had been the norm at the Master's level. However, I feel like I have learned lots about using a Population Health perspective when looking at knowledge exchange, especially within the context of child and youth mental health.
Despite some of the gripes from my colleagues, I feel the program at the University of Ottawa is excellent - challenging and diverse. It is difficult however, to balance all the disciplinary perspectives and to focus on a particular subject matter. In fact, this experience points directly to the difficulty of multi-disciplinary work.
Now, on to a reading course and getting ready for the dreaded comprehensive exams.
Oy! ¶ 9:43 a.m. 0 comments
Monday, April 10, 2006
CAYARAC Motion
Susan Hess, who is on the Centre of Excellence's Consumer Advisory Reference Group (CARG) sent this along. She says that it would be great if "all agencies (School Boards etc.) involved with Education, Health and Children and Youth Services worked together to seek support from the Provincial government on this pressing issue"
I agree that it would be great if all parties worked together. The challenge of working together often has to do with having the resources to work together and the ability to share the rewards (credit, recognition - otherwise "the profits").
CAYARAC (Children and Youth at Risk Advisory Committee) MOTION re: MENTAL HEALTH ADVOCACY
Whereas
" The lack of mental health care for children and youth is creating a health care crisis" 1 in which it is estimated that 1 in 5 Canadians will experience a mental health problem during their lifetime; and almost one in five Ontario children and youth has at least one mental-health disorder (Offord, 1989) and of the children in need, only one in six receives any therapeutic treatment in the formal care system (CMHO, 2001).2
Whereas
Increasingly, younger students in elementary school (Kindergarten to Grade 6) are being diagnosed with mental illness. Suicide, depression, eating disorders (such as bulimia and anorexia), drug and alcohol dependence, and self-harm (deliberately injuring the body in ways that are not life-threatening) are becoming the epidemics of adolescence.(Stigma and Teens, 2002).3
Whereas
Many people in need of mental health care are not able to access needed services and supports and there are increasing numbers of people with addictions and mental illness living lives of poverty and isolation in the "community" or living in prisons . Despite increasing emphasis on community-based care, many services continue to be delivered within an institutional framework, fostering dependency rather than recovery. 4
Whereas
The mandate of the OCDSB’s (Ottawa Carleton District School Board) Children and Youth At Risk Advisory Committee is
to address the factors and circumstances that impact on the children and youth and their families that may increase their vulnerability to school failure and limit the likelihood of success and to provide feedback, advice and recommendations
to the board of trustees of the OCDSB on the effectiveness and efficiencies of programs and services within the context of the Board’s resources
to reflect in discussions and comments to the OCDSB on the multitude of factors in our broader community that may negatively impact the family and increase the vulnerability of our children and youth;
Therefore be it resolved that:
CAYARAC encourage the Board of the OCDSB to write to and meet with the Minister of Education to seek solutions to the current challenges facing the Board with respect to meeting the mental health needs of its students. These solutions include but are not limited to:
a) Encouraging more direct partnerships with community agencies;
b) Where possible increasing direct mental health services to children , youth and their families in OCDSB schools by increasing the number of service staff (e.g.Social Workers, mental health workers, public health nurses etc.) available per school;
c) Raising the issue of the effects of unmet mental health needs upon the Education system at the next OPSBA AGM in June 2006
d) Encouraging the OCDSB to investigate the provision of free evening parenting classes (provided either by OCDSB staff or community partners), with daycare to be provided by students requiring Community Service volunteer hours.
e) Advocating with the Ministry of Education:
to increase school board funding to meet the increased mental health service needs of children and youth
to seek opportunities for increased integration between the Ministry of Education, the Ministry of Health and the Ministry of Children and Youth Services.
References
1 Davidson, S., (2006) CAYARAC Committee meeting minutes. March 28, 2006, Ottawa Carleton District School Board.
2 CMHO Prebudget Submission February 2004: Wright, 1996
3 Coulman, J.A. (2003) Education in Ontario: Education Resources and the Mental Health of Children and Youth. CAMH http://www.ontario.cmha.ca/content/mental_health_system/children_and_youth.asp?cID=3986
4. Joint Submission to the Standing Committee on Social Policy on Bill 36: Local Health System Integration Act. Karen McGrath,Chief Executive Officer, Canadian Mental Health Association Ontario, Paul Garfinkel,President & Chief Executive Officer,Centre for Addiction and Mental Health, David Kelly,Executive Director, Ontario Federation of Community Mental Health and Addictions Program ¶ 3:19 p.m. 0 comments
I agree that it would be great if all parties worked together. The challenge of working together often has to do with having the resources to work together and the ability to share the rewards (credit, recognition - otherwise "the profits").
CAYARAC (Children and Youth at Risk Advisory Committee) MOTION re: MENTAL HEALTH ADVOCACY
Whereas
" The lack of mental health care for children and youth is creating a health care crisis" 1 in which it is estimated that 1 in 5 Canadians will experience a mental health problem during their lifetime; and almost one in five Ontario children and youth has at least one mental-health disorder (Offord, 1989) and of the children in need, only one in six receives any therapeutic treatment in the formal care system (CMHO, 2001).2
Whereas
Increasingly, younger students in elementary school (Kindergarten to Grade 6) are being diagnosed with mental illness. Suicide, depression, eating disorders (such as bulimia and anorexia), drug and alcohol dependence, and self-harm (deliberately injuring the body in ways that are not life-threatening) are becoming the epidemics of adolescence.(Stigma and Teens, 2002).3
Whereas
Many people in need of mental health care are not able to access needed services and supports and there are increasing numbers of people with addictions and mental illness living lives of poverty and isolation in the "community" or living in prisons . Despite increasing emphasis on community-based care, many services continue to be delivered within an institutional framework, fostering dependency rather than recovery. 4
Whereas
The mandate of the OCDSB’s (Ottawa Carleton District School Board) Children and Youth At Risk Advisory Committee is
to address the factors and circumstances that impact on the children and youth and their families that may increase their vulnerability to school failure and limit the likelihood of success and to provide feedback, advice and recommendations
to the board of trustees of the OCDSB on the effectiveness and efficiencies of programs and services within the context of the Board’s resources
to reflect in discussions and comments to the OCDSB on the multitude of factors in our broader community that may negatively impact the family and increase the vulnerability of our children and youth;
Therefore be it resolved that:
CAYARAC encourage the Board of the OCDSB to write to and meet with the Minister of Education to seek solutions to the current challenges facing the Board with respect to meeting the mental health needs of its students. These solutions include but are not limited to:
a) Encouraging more direct partnerships with community agencies;
b) Where possible increasing direct mental health services to children , youth and their families in OCDSB schools by increasing the number of service staff (e.g.Social Workers, mental health workers, public health nurses etc.) available per school;
c) Raising the issue of the effects of unmet mental health needs upon the Education system at the next OPSBA AGM in June 2006
d) Encouraging the OCDSB to investigate the provision of free evening parenting classes (provided either by OCDSB staff or community partners), with daycare to be provided by students requiring Community Service volunteer hours.
e) Advocating with the Ministry of Education:
to increase school board funding to meet the increased mental health service needs of children and youth
to seek opportunities for increased integration between the Ministry of Education, the Ministry of Health and the Ministry of Children and Youth Services.
References
1 Davidson, S., (2006) CAYARAC Committee meeting minutes. March 28, 2006, Ottawa Carleton District School Board.
2 CMHO Prebudget Submission February 2004: Wright, 1996
3 Coulman, J.A. (2003) Education in Ontario: Education Resources and the Mental Health of Children and Youth. CAMH http://www.ontario.cmha.ca/content/mental_health_system/children_and_youth.asp?cID=3986
4. Joint Submission to the Standing Committee on Social Policy on Bill 36: Local Health System Integration Act. Karen McGrath,Chief Executive Officer, Canadian Mental Health Association Ontario, Paul Garfinkel,President & Chief Executive Officer,Centre for Addiction and Mental Health, David Kelly,Executive Director, Ontario Federation of Community Mental Health and Addictions Program ¶ 3:19 p.m. 0 comments
Podcasts Hitting Mainstream
My colleague David Zavitz sent this email about podcasts:
EXECUTIVE SUMMARY
Podcasts have hit the mainstream consciousness but have not yet seen widespread use. One-quarter of online consumers express interest in podcasts, with most interested in time-shifting existing radio and Internet radio channels. Companies that are interested in using podcasts for their audio should focus not only on downloads but also on streaming audio as a means to get their content and ads to consumers.
blog entry: http://blogs.forrester.com/charleneli/2006/04/forrester_podca_1.html
http://www.forrester.com/Research/Document/Excerpt/0,7211,38761,00.html ¶ 3:15 p.m. 0 comments
EXECUTIVE SUMMARY
Podcasts have hit the mainstream consciousness but have not yet seen widespread use. One-quarter of online consumers express interest in podcasts, with most interested in time-shifting existing radio and Internet radio channels. Companies that are interested in using podcasts for their audio should focus not only on downloads but also on streaming audio as a means to get their content and ads to consumers.
blog entry: http://blogs.forrester.com/charleneli/2006/04/forrester_podca_1.html
http://www.forrester.com/Research/Document/Excerpt/0,7211,38761,00.html ¶ 3:15 p.m. 0 comments
Tuesday, February 28, 2006
Minor Paper: What are the different roles of law in promoting and preventing health?
The following paper was submitted to Nancy Edwards and Michelle Giroux in the context of my Population HEalth 8930 seminar.
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This paper briefly discusses the concept of health, the legal powers of the State to promote health, and considers one notable example in the area of mental health, where the State may be preventing health.
The World Health Organization’s 1948 definition of health is “…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”[i] While this definition has not been amended since its creation almost six decades ago, there has been considerable debate and discussion of how health is promoted or prevented.
Both public and population health are based on collective actions, including, but not restricted to policies, programmes, and perspectives, which are needed to create the conditions for a “state of health”. The Institute of Medicine (USA) has proposed the statement that “Public Health is what we, as a society, do collectively to assure the conditions for people to be healthy.”[ii] Much of what “we do” as a society is carried out by the State, thus it is important that there be considerable alignment between the concepts of “state of health” and “State in health”.
The “State” in Canada has several fundamental characteristics. First, it is a democracy: a government controlled (ideally) by the greater part of the people.[iii] Second, it has a (theoretically) representative government, with delegated authority to elected representatives who act on behalf of the bulk of the population and speak in their name.[iv] The government is also responsible, with close relationships between the executive (Cabinet) and the legislative (Parliament) branches of the government. The Prime Minister and Cabinet are at all times responsible to the House of Commons.[v] The fourth characteristic is that Canadian government is a federation with the broad powers of government distributed between a central government and provincial governments. [vi]
Next, the government of Canada accepts the principle known as the “rule of law”, which connotes that all acts “of government must be based on a law and not on the whim or caprice of the officials who may happen to be in authority.”[vii] The rule of law is protected by the sixth characteristic: the independence of the judiciary. All citizens have the right of appeal to the courts for protection, with the assurance that there will be assurance of finding justice.[viii] Finally, Canada is a sovereign independent state associated with others of equal status in the Commonwealth of Nations. [ix]
Health has been consistently listed as a major concern of Canadians.[x] It is within this complex and interdependent context that individuals pursue health goals - their actions, histories, and genetics; their elected representatives; the executive, legislative, and administrative branches of several tiers of government; the judiciary, and; external bodies and governments in an international context – are all part of the creation of health.
Professor Lawrence O. Gostin defines public health law as: “The study of the legal powers and duties of the State to assure the conditions for people to be healthy and the limitations on the power of the state to constrain autonomy, privacy, liberty, proprietary, or other legally protected interests of individual for the protection or promotion of community health.”[xi] In Canada however, health is not a topic specifically enumerated in the Constitution Act, 1867, and both the federal and provincial levels of government exercise legal authority in regard to public health concerns.[xii] This shared responsibility has led to considerable functional and jurisdictional confusion. This lack of clarity and friction can cause disputes between levels of governments, which can impede the speed of action in difficult situations. Given the complexity of health as a concept, the role of any partner/stakeholder/participant in the health of Canadians appears to shift according to the roles played by other players. It is not clear whether this appearance of shifting is based in reality or the perception of the observer.
The Supreme Court of Canada with regards to RJR-MacDonald Inc. v Canada, [xiii] limited the concept of “freedom of expression” and stated that the Charter was essentially enacted to protect individuals, not corporations. “At times it may be necessary to protect the rights of corporations so as to protect the rights of the individual. The courts must ensure that the Charter not become simply an instrument of better situated individuals to roll back legislation which has as its object the improvement of the condition of less advantaged persons.”
Given the “shifting sands” found around the roles of the various players in the promotion of health, some clarity has been offered by Gostin, via a taxonomy of legal powers to protect and promote the public’s health[xiv]:
· tax and spend – e.g., tobacco taxes and health care spending
· alter the informational environment – e.g., restrictions on advertising
· alter the built environment – e.g., zoning, occupational safety, and housing codes
· alter the socioeconomic environment – decrease disparities
· direct regulation – e.g., quarantine, licenses, and inspections
· indirect regulation through the tort system – e.g., tobacco and firearm litigation
· deregulation – e.g., legalise distribution and possession of drug injection equipment
In the same document, Gostin has also listed the core values of the field of public health law as collective responsibility for health and well-being, a focus on population, the involvement of the community, an orientation towards prevention, and social justice. Elsewhere, he describes the characteristics of public health law as: a special responsibility of government, a focus on populations, a relationship between the State and the population, the provision of population-based services grounded on scientific methodologies, and, the power to regulate individuals and business for the protection of the community.[xv]
The examples offered by Gostin are all connected to health promotion. Yet ironically these are, examples where laws actually prevent health. This is never so apparent as within the realm of mental health. While those affected by a mental disorder are often accommodated by provisions which state that someone is unfit to stand trial. Or are spared by a verdict of “not criminally responsible due to a mental disorder”, the criminal justice system has in many ways contributed to a public mental health crisis. “Portions of our jails are now the “new asylums” but without many of the psychiatric resources available to mental health hospitals. A 1999 Alberta study found that a full 34% of male inmates in provincial jails suffer a serious form of mental disorder like schizophrenia or bipolar disorder and 22% have attempted suicide. Suicide is now the number one cause of death for Canadians in Correctional facilities.”[xvi] The situation in the United States is worse…each year about 700,000 adults with a serious mental illness come into contact with the criminal justice system …about 70% of those admitted to correctional facilities have active symptoms of serious mental illness.[xvii]
While cancer and diseases of the heart account for over half of deaths in Canada[xviii] most of these deaths happen in the latter part of life.[xix] According to Statistics Canada[xx], suicide and mental disorders tend to happen earlier in life and are thus associated with a greater loss of potential. There were 3,692 deaths reported as suicides in 2001, up 2.4% from 2000. Suicide rates differ between men and women, young and old. Men are more likely to commit suicide than women, with 3.5 suicides among men for every suicide among women in 2001. For men, the risk of suicide was greatest between the ages of 40 and 44. For women, the risk peaked at ages 45 to 49. Young people who report high levels of depression, anxiety or low self-esteem are more likely to report suicidal thoughts. In 2001, there were 234 teenage deaths reported as suicide. Since the 1980s, the suicide rate—12.2 per 100,000 people in 1999—has remained fairly constant for teens aged 15 to 19. For both sexes, suicide was the second-leading cause of teen death, surpassed only by motor vehicle accidents.
When one examines Gostin’s taxonomy of legal powers within the context of the WHO definition of health, is it reasonable to wonder whether one can assert that a hierarchy of priorities exists between the physical, mental and social aspects of health. This is clearly something to be examined. The confusion of roles and the multiplicity of legal actors is clearly shown in a 2001 study that found “clinically significant differences among the provinces and territories on all major components of their mental health acts.”[xxi] The study concluded that some Canadian mental health acts include provisions that prevent patients receiving appropriate clinical care.
Alternate provisions that support appropriate clinical care, that respect the human rights and personal dignity of patients, and that are consistent with the Canadian Charter of Rights and Freedoms can be found in the legislation of other jurisdictions. These differences may be in part due to what Hunsley describes as an approach by most psychologists and other mental health professionals towards the realm of public policy and law as perhaps best characterized as one of benign neglect.[xxii] Mental health is an important aspect of the overall health of Canadians and it is time to move beyond neglect to a serious, action-oriented investigation of the role of law in the provision of mental health services. At what point does benign neglect become criminal negligence?
[i] Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948 [cited 2006 Feb 5] . Available from: http://www.who.int/about/definition/en/
[ii] Institute of Medicine. The future of the public’s health in the 21st century. Washington, D.C.: National Academy Press, 2003.
[iii] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 3.
[iv] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 5.
[v] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 6.
[vi] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 9.
[vii] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 11-12.
[viii] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 13.
[ix] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 14.
[x] Standing Committee on Health: Health Canada - Main Estimates. Opening remarks for A. Anne McLellan, Minister of Health. Ottawa, May 7, 2002 [cited 2006 Feb 5]; Available from: http://www.hc-sc.gc.ca/ahc-asc/minist/health-sante/speeches-discours/2002_05_07_e.html
[xi] Gostin LO. Health of the people: The highest law? The Journal of Law, Medicine & Ethics 2004; 32(3): 509-515.
[xii] Ries NM. Legal foundations of public health in Canada. In: Bailey TM, Caulfield T and Ries NM, editors. Public health law and policy in Canada. Markham: LexisNexis Canada Inc.; 2005. p. 8.
[xiii] RJR-MACDONALD INC. c. CANADA (P.G.), [1995] 3 R.C.S. 199
[xiv] Gostin LO. The core values of public health law and ethics. In: Bailey TM, Caulfield T and Ries NM, editors. Public health law and policy in Canada. Markham: LexisNexis Canada Inc.; 2005. p. xi.
[xv] Gostin LO. Health of the people: The highest law? The Journal of Law, Medicine & Ethics 2004; 32(3): 509-515.
[xvi] Canadian Mental Health Association, Alberta Division, as quoted by Renke WN. Criminal justice and public health. In: Bailey TM, Caulfield T and Ries NM, editors. Public health law and policy in Canada. Markham: LexisNexis Canada Inc.; 2005. p. 464.
[xvii] Redding RE as quoted by Renke WN. Criminal justice and public health. In: Bailey TM, Caulfield T and Ries NM, editors. Public health law and policy in Canada. Markham: LexisNexis Canada Inc.; 2005. p. 464.
[xviii] Statistics Canada. The people: Major causes of death. [updated 2004, Sep 10]. In: The Canada e-Book [cited 2006, Feb 6] Available from: http://142.206.72.67/02/02b/02b_003_e.htm#t01
[xix] Center for Disease Control. HIST290 Death Rates for Selected Causes by 10-Year Age Groups, Race, and Sex: Death Registration States, 1900-32, and United States, 1933-98. [updated 2005, Aug 23]. Hyattsville, Maryland: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Available from: http://www.cdc.gov/nchs/datawh/statab/unpubd/mortabs/hist290.htm#Tables
[xx] Statistics Canada. The people: Major causes of death. [updated 2004, Sep 10]. In: The Canada e-Book [cited 2006, Feb 6] Available from: http://142.206.72.67/02/02b/02b_003_e.htm#t01
[xxi] Gray JE and O’Reilly RL. Clinically significant differences among Canadian mental health acts. Can J Psychiatry 2001;46:315-321.
[xxii] Hunsley, J. Review: Gray JE, Shone MA. and Liddle PF. Canadian mental health law and policy. Markham: Butterworths, 2000. Canadian Psychology Aug 2001. ¶ 10:30 a.m. 0 comments
-------------------------------------------
This paper briefly discusses the concept of health, the legal powers of the State to promote health, and considers one notable example in the area of mental health, where the State may be preventing health.
The World Health Organization’s 1948 definition of health is “…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”[i] While this definition has not been amended since its creation almost six decades ago, there has been considerable debate and discussion of how health is promoted or prevented.
Both public and population health are based on collective actions, including, but not restricted to policies, programmes, and perspectives, which are needed to create the conditions for a “state of health”. The Institute of Medicine (USA) has proposed the statement that “Public Health is what we, as a society, do collectively to assure the conditions for people to be healthy.”[ii] Much of what “we do” as a society is carried out by the State, thus it is important that there be considerable alignment between the concepts of “state of health” and “State in health”.
The “State” in Canada has several fundamental characteristics. First, it is a democracy: a government controlled (ideally) by the greater part of the people.[iii] Second, it has a (theoretically) representative government, with delegated authority to elected representatives who act on behalf of the bulk of the population and speak in their name.[iv] The government is also responsible, with close relationships between the executive (Cabinet) and the legislative (Parliament) branches of the government. The Prime Minister and Cabinet are at all times responsible to the House of Commons.[v] The fourth characteristic is that Canadian government is a federation with the broad powers of government distributed between a central government and provincial governments. [vi]
Next, the government of Canada accepts the principle known as the “rule of law”, which connotes that all acts “of government must be based on a law and not on the whim or caprice of the officials who may happen to be in authority.”[vii] The rule of law is protected by the sixth characteristic: the independence of the judiciary. All citizens have the right of appeal to the courts for protection, with the assurance that there will be assurance of finding justice.[viii] Finally, Canada is a sovereign independent state associated with others of equal status in the Commonwealth of Nations. [ix]
Health has been consistently listed as a major concern of Canadians.[x] It is within this complex and interdependent context that individuals pursue health goals - their actions, histories, and genetics; their elected representatives; the executive, legislative, and administrative branches of several tiers of government; the judiciary, and; external bodies and governments in an international context – are all part of the creation of health.
Professor Lawrence O. Gostin defines public health law as: “The study of the legal powers and duties of the State to assure the conditions for people to be healthy and the limitations on the power of the state to constrain autonomy, privacy, liberty, proprietary, or other legally protected interests of individual for the protection or promotion of community health.”[xi] In Canada however, health is not a topic specifically enumerated in the Constitution Act, 1867, and both the federal and provincial levels of government exercise legal authority in regard to public health concerns.[xii] This shared responsibility has led to considerable functional and jurisdictional confusion. This lack of clarity and friction can cause disputes between levels of governments, which can impede the speed of action in difficult situations. Given the complexity of health as a concept, the role of any partner/stakeholder/participant in the health of Canadians appears to shift according to the roles played by other players. It is not clear whether this appearance of shifting is based in reality or the perception of the observer.
The Supreme Court of Canada with regards to RJR-MacDonald Inc. v Canada, [xiii] limited the concept of “freedom of expression” and stated that the Charter was essentially enacted to protect individuals, not corporations. “At times it may be necessary to protect the rights of corporations so as to protect the rights of the individual. The courts must ensure that the Charter not become simply an instrument of better situated individuals to roll back legislation which has as its object the improvement of the condition of less advantaged persons.”
Given the “shifting sands” found around the roles of the various players in the promotion of health, some clarity has been offered by Gostin, via a taxonomy of legal powers to protect and promote the public’s health[xiv]:
· tax and spend – e.g., tobacco taxes and health care spending
· alter the informational environment – e.g., restrictions on advertising
· alter the built environment – e.g., zoning, occupational safety, and housing codes
· alter the socioeconomic environment – decrease disparities
· direct regulation – e.g., quarantine, licenses, and inspections
· indirect regulation through the tort system – e.g., tobacco and firearm litigation
· deregulation – e.g., legalise distribution and possession of drug injection equipment
In the same document, Gostin has also listed the core values of the field of public health law as collective responsibility for health and well-being, a focus on population, the involvement of the community, an orientation towards prevention, and social justice. Elsewhere, he describes the characteristics of public health law as: a special responsibility of government, a focus on populations, a relationship between the State and the population, the provision of population-based services grounded on scientific methodologies, and, the power to regulate individuals and business for the protection of the community.[xv]
The examples offered by Gostin are all connected to health promotion. Yet ironically these are, examples where laws actually prevent health. This is never so apparent as within the realm of mental health. While those affected by a mental disorder are often accommodated by provisions which state that someone is unfit to stand trial. Or are spared by a verdict of “not criminally responsible due to a mental disorder”, the criminal justice system has in many ways contributed to a public mental health crisis. “Portions of our jails are now the “new asylums” but without many of the psychiatric resources available to mental health hospitals. A 1999 Alberta study found that a full 34% of male inmates in provincial jails suffer a serious form of mental disorder like schizophrenia or bipolar disorder and 22% have attempted suicide. Suicide is now the number one cause of death for Canadians in Correctional facilities.”[xvi] The situation in the United States is worse…each year about 700,000 adults with a serious mental illness come into contact with the criminal justice system …about 70% of those admitted to correctional facilities have active symptoms of serious mental illness.[xvii]
While cancer and diseases of the heart account for over half of deaths in Canada[xviii] most of these deaths happen in the latter part of life.[xix] According to Statistics Canada[xx], suicide and mental disorders tend to happen earlier in life and are thus associated with a greater loss of potential. There were 3,692 deaths reported as suicides in 2001, up 2.4% from 2000. Suicide rates differ between men and women, young and old. Men are more likely to commit suicide than women, with 3.5 suicides among men for every suicide among women in 2001. For men, the risk of suicide was greatest between the ages of 40 and 44. For women, the risk peaked at ages 45 to 49. Young people who report high levels of depression, anxiety or low self-esteem are more likely to report suicidal thoughts. In 2001, there were 234 teenage deaths reported as suicide. Since the 1980s, the suicide rate—12.2 per 100,000 people in 1999—has remained fairly constant for teens aged 15 to 19. For both sexes, suicide was the second-leading cause of teen death, surpassed only by motor vehicle accidents.
When one examines Gostin’s taxonomy of legal powers within the context of the WHO definition of health, is it reasonable to wonder whether one can assert that a hierarchy of priorities exists between the physical, mental and social aspects of health. This is clearly something to be examined. The confusion of roles and the multiplicity of legal actors is clearly shown in a 2001 study that found “clinically significant differences among the provinces and territories on all major components of their mental health acts.”[xxi] The study concluded that some Canadian mental health acts include provisions that prevent patients receiving appropriate clinical care.
Alternate provisions that support appropriate clinical care, that respect the human rights and personal dignity of patients, and that are consistent with the Canadian Charter of Rights and Freedoms can be found in the legislation of other jurisdictions. These differences may be in part due to what Hunsley describes as an approach by most psychologists and other mental health professionals towards the realm of public policy and law as perhaps best characterized as one of benign neglect.[xxii] Mental health is an important aspect of the overall health of Canadians and it is time to move beyond neglect to a serious, action-oriented investigation of the role of law in the provision of mental health services. At what point does benign neglect become criminal negligence?
[i] Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948 [cited 2006 Feb 5] . Available from: http://www.who.int/about/definition/en/
[ii] Institute of Medicine. The future of the public’s health in the 21st century. Washington, D.C.: National Academy Press, 2003.
[iii] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 3.
[iv] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 5.
[v] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 6.
[vi] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 9.
[vii] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 11-12.
[viii] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 13.
[ix] Dawson RM and Dawson WF (revised by Ward N). Democratic government in Canada 3rd ed. Toronto: University of Toronto Press; 1971. p. 14.
[x] Standing Committee on Health: Health Canada - Main Estimates. Opening remarks for A. Anne McLellan, Minister of Health. Ottawa, May 7, 2002 [cited 2006 Feb 5]; Available from: http://www.hc-sc.gc.ca/ahc-asc/minist/health-sante/speeches-discours/2002_05_07_e.html
[xi] Gostin LO. Health of the people: The highest law? The Journal of Law, Medicine & Ethics 2004; 32(3): 509-515.
[xii] Ries NM. Legal foundations of public health in Canada. In: Bailey TM, Caulfield T and Ries NM, editors. Public health law and policy in Canada. Markham: LexisNexis Canada Inc.; 2005. p. 8.
[xiii] RJR-MACDONALD INC. c. CANADA (P.G.), [1995] 3 R.C.S. 199
[xiv] Gostin LO. The core values of public health law and ethics. In: Bailey TM, Caulfield T and Ries NM, editors. Public health law and policy in Canada. Markham: LexisNexis Canada Inc.; 2005. p. xi.
[xv] Gostin LO. Health of the people: The highest law? The Journal of Law, Medicine & Ethics 2004; 32(3): 509-515.
[xvi] Canadian Mental Health Association, Alberta Division, as quoted by Renke WN. Criminal justice and public health. In: Bailey TM, Caulfield T and Ries NM, editors. Public health law and policy in Canada. Markham: LexisNexis Canada Inc.; 2005. p. 464.
[xvii] Redding RE as quoted by Renke WN. Criminal justice and public health. In: Bailey TM, Caulfield T and Ries NM, editors. Public health law and policy in Canada. Markham: LexisNexis Canada Inc.; 2005. p. 464.
[xviii] Statistics Canada. The people: Major causes of death. [updated 2004, Sep 10]. In: The Canada e-Book [cited 2006, Feb 6] Available from: http://142.206.72.67/02/02b/02b_003_e.htm#t01
[xix] Center for Disease Control. HIST290 Death Rates for Selected Causes by 10-Year Age Groups, Race, and Sex: Death Registration States, 1900-32, and United States, 1933-98. [updated 2005, Aug 23]. Hyattsville, Maryland: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Available from: http://www.cdc.gov/nchs/datawh/statab/unpubd/mortabs/hist290.htm#Tables
[xx] Statistics Canada. The people: Major causes of death. [updated 2004, Sep 10]. In: The Canada e-Book [cited 2006, Feb 6] Available from: http://142.206.72.67/02/02b/02b_003_e.htm#t01
[xxi] Gray JE and O’Reilly RL. Clinically significant differences among Canadian mental health acts. Can J Psychiatry 2001;46:315-321.
[xxii] Hunsley, J. Review: Gray JE, Shone MA. and Liddle PF. Canadian mental health law and policy. Markham: Butterworths, 2000. Canadian Psychology Aug 2001. ¶ 10:30 a.m. 0 comments
What If Project
My friend, colleague, and mentor from the UK, Dr. Joyce Liddle (who will be taking a new position as Associate Professor of Public Policy, Nottingham Policy Centre, School of Sociology and Social Policy, University of Nottingham, this spring) sent me this very interesting blog link - Whatifproject.
Run by Stuart Smith BSc MSc (DIC), his biography says that he is the Director of Consultancy at Wood Holmes Group, and has several years experience of working in environmental, regeneration and strategy development. He is particularly interested in understanding complexity in regeneration and the knowledge sharing processes that are vital to regeneration success. Stuart has pioneered community centric approaches to regeneration and future visioning.
I really like the recent inputs on randomness. Try this:
- Keep a dictionary somewhere where you will normally see it.
- Open the dictionary at a random place and select a random word.
- Does this word generate any ideas? ¶ 10:18 a.m. 0 comments
Run by Stuart Smith BSc MSc (DIC), his biography says that he is the Director of Consultancy at Wood Holmes Group, and has several years experience of working in environmental, regeneration and strategy development. He is particularly interested in understanding complexity in regeneration and the knowledge sharing processes that are vital to regeneration success. Stuart has pioneered community centric approaches to regeneration and future visioning.
I really like the recent inputs on randomness. Try this:
- Keep a dictionary somewhere where you will normally see it.
- Open the dictionary at a random place and select a random word.
- Does this word generate any ideas? ¶ 10:18 a.m. 0 comments
Monday, January 30, 2006
Meeting the Challenges in Implementing Evidence-Based Practices and Treatments
Jane Tallim and I have the opportunity to deliver a series of workshops across Ontario, on implementing evidence-based practice.
These workshops are organized and hosted by Safeguards: Children's Services Training.
The description of the workshops is below:
The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO is committed to facilitating your use of evidence-based practices and treatments. In this workshop, Peter Levesque and Jane Tallim explore evidence-based practice and treatment and how it relates to child and youth mental health. They also discuss the challenges encountered by service providers in implementing these in their daily practice and provide strategies for overcoming these challenges.
Learning Outcomes:
In this practical interactive workshop, participants will learn to enhance their current work by better understanding the tools, methods, and supports available for implementing evidence-based and evidence-informed practices and treatments. Some of the issues to be addressed include: What is evidence? Why is it important to meeting the mental health care needs of children, youth and families? How do I find out about evidence-based practices and treatments? How do I judge their quality? How do I select the most appropriate ones to introduce in my work? What does my organization need to do to increase the chances of successfully introducing new practices and treatments? Finally, the workshop will also ask what the Centre can do to further facilitate your use of evidence-based practices and treatments. ¶ 9:42 a.m. 0 comments
These workshops are organized and hosted by Safeguards: Children's Services Training.
The description of the workshops is below:
The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO is committed to facilitating your use of evidence-based practices and treatments. In this workshop, Peter Levesque and Jane Tallim explore evidence-based practice and treatment and how it relates to child and youth mental health. They also discuss the challenges encountered by service providers in implementing these in their daily practice and provide strategies for overcoming these challenges.
Learning Outcomes:
In this practical interactive workshop, participants will learn to enhance their current work by better understanding the tools, methods, and supports available for implementing evidence-based and evidence-informed practices and treatments. Some of the issues to be addressed include: What is evidence? Why is it important to meeting the mental health care needs of children, youth and families? How do I find out about evidence-based practices and treatments? How do I judge their quality? How do I select the most appropriate ones to introduce in my work? What does my organization need to do to increase the chances of successfully introducing new practices and treatments? Finally, the workshop will also ask what the Centre can do to further facilitate your use of evidence-based practices and treatments. ¶ 9:42 a.m. 0 comments
Wednesday, January 18, 2006
Preliminary Research Questions
In the Methodology seminar (POP8920), we have been assigned three linked projects that will lead to a fully formed dissertation proposal. The first part is a one page preliminary draft that outlines the issue of interest and some questions associated to this issue.
Here is my draft:
To: Dr. Lise Dubois, Dr. Maurice Lévesque
From: Peter Levesque, 424540
Date: 2005-01-17
Re: POP8920 Preliminary version of research question
----------------------------------------------------------
Mental health problems and illnesses (MHPI) affect approximately one in five children and youth in Canada . Yet only about one in six of these individuals receive any service from a mental health professional.(1) Many MHPI can be prevented and all can be treated. (2)
In the context of schools, mental health problems contribute significantly to class disruption and dropping out. When in school, students cannot optimize their learning if their mental health needs are not met. This leads to other behaviors that are manifested in other areas such as physical health, youth justice, and child welfare. More troubling is not just removal from school but from life, by committing suicide. Statistics Canada reports suicide as the second leading cause of youth death, after fatal motor vehicle accidents. (3)
Given that children and youth have an almost universal access to school in Canada, what does child and youth mental health mean for school principals, administrators, and teachers? They are often in an excellent position to promote mental health and to assist in the detection of mental illnesses. They receive almost no training or support in this area.
School is identified by youth as both the most positive aspect of their life and the most stressful. The 1992 Canadian Psychiatric Association’s Canadian Youth and Mental Health & Illness Survey demonstrated that for youth, school was seen as the most positive aspect of their life. The same survey also identified school as the most stressful aspect of their life. When it comes to discussing mental health concerns however, teachers, principals, school health workers appear to be left out of the loop. When youth are ready to seek help, they go to their family doctor first, family and friends next, almost never to a school worker. Why not?
• What is the prevalence of mental health problems and illnesses (MHPI) in Canada compared to other countries?
• What is the relationship between MHPI and socioeconomic status?
• What is the relationship of access to treatment and SES?
• What are the current barriers, gaps, and resource needs for schools to be a “first line” of detection and treatment of MHPI?
• How can school professionals be effectively developed to support CYMH?
• What issues are preventing the development of an integrated system for CYMH?
• How can mental health be viewed as a component in the holistic health of a population?
• What is the cost of non-treatment of MHPI versus the potential gains in productivity from early and adequate treatment?
1) Davidson, S. & Manion, I.G. (1996). Facing the challenge: mental health and illness in Canadian youth. Psychology, Health & Medicine 1, (1), 41-56.
2) World Health Organization. Fact sheet No. 265, Mental and neurological disorders. December 2001. Available from: http://www.who.int/mediacentre/factsheets/fs265/en/print.html
3) Statistics Canada (2005). Major Causes of Death. Available online at: http://142.206.72.67/02/02b/02b_003_e.htm ¶ 9:33 a.m. 0 comments
Here is my draft:
To: Dr. Lise Dubois, Dr. Maurice Lévesque
From: Peter Levesque, 424540
Date: 2005-01-17
Re: POP8920 Preliminary version of research question
----------------------------------------------------------
Mental health problems and illnesses (MHPI) affect approximately one in five children and youth in Canada . Yet only about one in six of these individuals receive any service from a mental health professional.(1) Many MHPI can be prevented and all can be treated. (2)
In the context of schools, mental health problems contribute significantly to class disruption and dropping out. When in school, students cannot optimize their learning if their mental health needs are not met. This leads to other behaviors that are manifested in other areas such as physical health, youth justice, and child welfare. More troubling is not just removal from school but from life, by committing suicide. Statistics Canada reports suicide as the second leading cause of youth death, after fatal motor vehicle accidents. (3)
Given that children and youth have an almost universal access to school in Canada, what does child and youth mental health mean for school principals, administrators, and teachers? They are often in an excellent position to promote mental health and to assist in the detection of mental illnesses. They receive almost no training or support in this area.
School is identified by youth as both the most positive aspect of their life and the most stressful. The 1992 Canadian Psychiatric Association’s Canadian Youth and Mental Health & Illness Survey demonstrated that for youth, school was seen as the most positive aspect of their life. The same survey also identified school as the most stressful aspect of their life. When it comes to discussing mental health concerns however, teachers, principals, school health workers appear to be left out of the loop. When youth are ready to seek help, they go to their family doctor first, family and friends next, almost never to a school worker. Why not?
• What is the prevalence of mental health problems and illnesses (MHPI) in Canada compared to other countries?
• What is the relationship between MHPI and socioeconomic status?
• What is the relationship of access to treatment and SES?
• What are the current barriers, gaps, and resource needs for schools to be a “first line” of detection and treatment of MHPI?
• How can school professionals be effectively developed to support CYMH?
• What issues are preventing the development of an integrated system for CYMH?
• How can mental health be viewed as a component in the holistic health of a population?
• What is the cost of non-treatment of MHPI versus the potential gains in productivity from early and adequate treatment?
1) Davidson, S. & Manion, I.G. (1996). Facing the challenge: mental health and illness in Canadian youth. Psychology, Health & Medicine 1, (1), 41-56.
2) World Health Organization. Fact sheet No. 265, Mental and neurological disorders. December 2001. Available from: http://www.who.int/mediacentre/factsheets/fs265/en/print.html
3) Statistics Canada (2005). Major Causes of Death. Available online at: http://142.206.72.67/02/02b/02b_003_e.htm ¶ 9:33 a.m. 0 comments
Thursday, January 12, 2006
Computer Supported Cooperative Work
Dr. Melanie Barwick, at SickKids Hospital in Toronto, a Canadian leader in knowledge exchange and translation for children and youth mental health, sent me this very interesting conference link:
Computer Supported Cooperative Work 2006, Banff, AL, Nov 4-8 2006
CSCW 2006, the ACM Conference on Computer Supported Cooperative Work, is the premier venue for presenting research and development achievements in the design, introduction, and use of technology that affect groups, organizations, communities and societies. Although work is an important area of focus for the conference, technology is increasingly supporting a wide range of recreational and social activities. As more and more people in all regions of the globe are able to interact online we are rapidly moving toward a Computer Supported Collaborative World.
Appropriate topic areas for CSCW 2006 include all contexts in which technology is used to mediate human activities such as communication, coordination, cooperation, competition, entertainment, education, medicine, art, and music. The technology may include: email, instant
messaging, blogs, shared workspaces, teleconferencing, games, co-located systems, robotics, haptics, and much more.
I think I will submit something based on my current systematic review work.
(Thanks Melanie) ¶ 4:06 p.m. 0 comments
Computer Supported Cooperative Work 2006, Banff, AL, Nov 4-8 2006
CSCW 2006, the ACM Conference on Computer Supported Cooperative Work, is the premier venue for presenting research and development achievements in the design, introduction, and use of technology that affect groups, organizations, communities and societies. Although work is an important area of focus for the conference, technology is increasingly supporting a wide range of recreational and social activities. As more and more people in all regions of the globe are able to interact online we are rapidly moving toward a Computer Supported Collaborative World.
Appropriate topic areas for CSCW 2006 include all contexts in which technology is used to mediate human activities such as communication, coordination, cooperation, competition, entertainment, education, medicine, art, and music. The technology may include: email, instant
messaging, blogs, shared workspaces, teleconferencing, games, co-located systems, robotics, haptics, and much more.
I think I will submit something based on my current systematic review work.
(Thanks Melanie) ¶ 4:06 p.m. 0 comments
Wednesday, January 11, 2006
Rewarding Work
Last semester, I worked on a student consulting project with Dr. Yolande Chan at the Queen's University School of Business. The students in her knowledge management class produced three excellent consulting projects that will soon be posted on the COE of CYMH website.
Yesterday, I received a nice thank you email from one of the students - Miriam. Besides the pleasure of receiving a thank you, I know that she will soon be graduating and I want to let anyone who reads this that her work is first-class and she is a joy to work with. I don't she will mind if employers - in business, government, or public agencies - contact her with enquiries.
_______________________
Hi Mr. Levesque,
Just wanted to sincerely thank you for the acknowledgment letter and your offer of acting as a reference in the future. Your time and efforts in supporting us throughout the project is very much appreciated. Many thanks!
Regards,
Mariam
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Mariam Ghiacy
Co-Chair,
Queen's Management Consulting Association (QMCA)
School of Business,
Queen's University ¶ 9:30 a.m. 0 comments
Yesterday, I received a nice thank you email from one of the students - Miriam. Besides the pleasure of receiving a thank you, I know that she will soon be graduating and I want to let anyone who reads this that her work is first-class and she is a joy to work with. I don't she will mind if employers - in business, government, or public agencies - contact her with enquiries.
_______________________
Hi Mr. Levesque,
Just wanted to sincerely thank you for the acknowledgment letter and your offer of acting as a reference in the future. Your time and efforts in supporting us throughout the project is very much appreciated. Many thanks!
Regards,
Mariam
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Mariam Ghiacy
Co-Chair,
Queen's Management Consulting Association (QMCA)
School of Business,
Queen's University ¶ 9:30 a.m. 0 comments
Sunday, January 08, 2006
60 hours a week?
After a 2005 that almost did me in, I am trying hard to limit my work week this year to 60 hours a week. It is a difficult balance given the needs at the Centre, the 4 seminars that I am taking this semester, the speaking engagements that are already planned, and the inevitable issues that come out of the blue.
This week looks like the following:
POP 8930 - seminar, readings, and assignment - 15 hours
POP 8920 - seminar and readings - 8 hours
EPI 6188 - seminar and readings - 8 hours
Population Health Strategic Area Conference and readings - 9 hours
Implementation Research seminar - 2 hours
KT workshop preparation - 3 hours
CU Case studies - 4 hours
KE Journal editing - 4 hours
Email and correspondence - 4 hours
That looks like all that I can get done this week. Hopefully, I can keep to this agenda and not get too many unexpected issues popping up. ¶ 7:17 p.m. 0 comments
This week looks like the following:
POP 8930 - seminar, readings, and assignment - 15 hours
POP 8920 - seminar and readings - 8 hours
EPI 6188 - seminar and readings - 8 hours
Population Health Strategic Area Conference and readings - 9 hours
Implementation Research seminar - 2 hours
KT workshop preparation - 3 hours
CU Case studies - 4 hours
KE Journal editing - 4 hours
Email and correspondence - 4 hours
That looks like all that I can get done this week. Hopefully, I can keep to this agenda and not get too many unexpected issues popping up. ¶ 7:17 p.m. 0 comments
Population Health Interventions
Tomorrow, I start POP 8930, Population Health Interventions.
"This course examines approaches to influence population health. Contextual influences on and interactions between individual and population health approaches for health promotion, disease prevention and risk management. Process for establishing transdisciplinary teams and intersectoral partnerships. Sustainable systems change, including health care reform and policy development."
"Overall course objectives are described in this section. Additional objectives are defined for each of the three blocks in the course.
1. To analyze the theoretical foundations for and underlying assumptions of population health interventions.
2. To examine the evidence base supporting population health interventions.
3. To review and critique alternative strategies for identifying population health needs.
4. To consider population health interventions that may reduce inequity gaps.
5. To identify pertinent multi-jurisdictional and intersectoral influences on population health interventions.
6. To debate the relative contributions (immediate and sustained) of alternative population health interventions to achieve improvements in health."
Faculty: Nancy Edwards, Michelle Giroux, and invited guests
This appears to be a very structured seminar with a "killer" amount of readings. The readings that had to be done before Monday's seminar included the following:
Baba A, Cook DM, McGarity TO, Bero LA. Legislating “sound science”: The role of the tobacco industry. Am J Public Health. 2005;Suppl 1: 95;S1: S20-S27.
Bal DG, Lloyd JC, Roeseler A, Shimizu R. California as a model. J Clin Oncology. 2001;19;18s:69s-73s.
Bauer JE, Hyland A, Li Q, Steger C, Cummings M. A longitudinal assessment of the impact of smoke-free worksite policies on tobacco use. Am J Public Health. 2005;95(6):1024-9.
Berryman, J. Canadian reflections on the tobacco wars: some unintended consequences of mass tort litigation. International & Comparative Law Quarterly. 2004; (53 ICLQ 579)
Callard C, Thompson D, Collishaw N. Transforming the tobacco market: Why the supply of cigarettes should be transferred from for-profit corporations to non-profit enterprises with a public health mandate. Tob Control. 2005;14:278-83.
Friedman LC, Daynard RA, Banthin CN. Learning from the tobacco industry about science and regulation. How tobacco-friendly science escapes scrutiny in the courtroom. Am J Public Health. 2005;95;S1: S16-S20.
Gostin LO. “ ¶ 7:05 p.m. 0 comments
"This course examines approaches to influence population health. Contextual influences on and interactions between individual and population health approaches for health promotion, disease prevention and risk management. Process for establishing transdisciplinary teams and intersectoral partnerships. Sustainable systems change, including health care reform and policy development."
"Overall course objectives are described in this section. Additional objectives are defined for each of the three blocks in the course.
1. To analyze the theoretical foundations for and underlying assumptions of population health interventions.
2. To examine the evidence base supporting population health interventions.
3. To review and critique alternative strategies for identifying population health needs.
4. To consider population health interventions that may reduce inequity gaps.
5. To identify pertinent multi-jurisdictional and intersectoral influences on population health interventions.
6. To debate the relative contributions (immediate and sustained) of alternative population health interventions to achieve improvements in health."
Faculty: Nancy Edwards, Michelle Giroux, and invited guests
This appears to be a very structured seminar with a "killer" amount of readings. The readings that had to be done before Monday's seminar included the following:
Baba A, Cook DM, McGarity TO, Bero LA. Legislating “sound science”: The role of the tobacco industry. Am J Public Health. 2005;Suppl 1: 95;S1: S20-S27.
Bal DG, Lloyd JC, Roeseler A, Shimizu R. California as a model. J Clin Oncology. 2001;19;18s:69s-73s.
Bauer JE, Hyland A, Li Q, Steger C, Cummings M. A longitudinal assessment of the impact of smoke-free worksite policies on tobacco use. Am J Public Health. 2005;95(6):1024-9.
Berryman, J. Canadian reflections on the tobacco wars: some unintended consequences of mass tort litigation. International & Comparative Law Quarterly. 2004; (53 ICLQ 579)
Callard C, Thompson D, Collishaw N. Transforming the tobacco market: Why the supply of cigarettes should be transferred from for-profit corporations to non-profit enterprises with a public health mandate. Tob Control. 2005;14:278-83.
Friedman LC, Daynard RA, Banthin CN. Learning from the tobacco industry about science and regulation. How tobacco-friendly science escapes scrutiny in the courtroom. Am J Public Health. 2005;95;S1: S16-S20.
Gostin LO. “ ¶ 7:05 p.m. 0 comments
Thursday, January 05, 2006
Workshop on Strategic Directions for Population Health
STRATEGIC DIRECTIONS FOR POPULATION HEALTH
AT THE UNIVERSITY OF OTTAWA
Workshop 10 January 2006
Your participation in our workshop is greatly valued. This document has been designed to initiate reflections and prompt informal exchange and discussion.
In 2006, the University of Ottawa finds itself in an environment that differs significantly from that in which it created IPH/IRSP in 2000. First, the University has ratified Vision 2010, in which it has reaffirmed its commitment to research excellence, high-quality learning, passion for knowledge and innovation, leadership on language issues, and openness to diversity. Second, there is even greater recognition of the significant opportunities arising from our unique geographic location to partner with government departments and national and provincial agencies. Third, findings of the IPH/IRSP review conducted in 2004 provide an informed critique of strengths and weaknesses of current structures in Population Health. Fourth, development of administrative and governance structures to better promote interdisciplinarity at the University of Ottawa is underway. Fifth, organisational expansion continues to create designated positions for research chairs and Faculty appointments pertinent to Population Health. Sixth, a smooth change of leadership in IPH/IRSP itself was achieved in 2005. Seventh, other Canadian universities now are creating innovative enterprises in Population Health with similar if not identical mandates as originally afforded IPH/IRSP to promote research and training.
By reaffirming Population Health within HEALTH as a Strategic Area of Development, the University of Ottawa is inviting its renewal and seeking a clear statement of strategic direction. At its meeting on 12 September 2005, the College of Principal Scientists of IPH/IRSP recognised this opportunity and many other challenges requiring thoughtful, timely and incisive analysis and response. Dialogue instigated during the 2005 summer reinforced the breadth of unrealised potential at the University of Ottawa beyond IPH/IRSP in Population Health research and training. Subsequent investigations revealed a positive readiness to broaden the scope of consultation and dialogue to engage a wider community in the development of the future for Population Health in Ottawa.
Hence, the first proposed objective towards which our workshop represents a key step is to articulate the vision, scope, performance and future impact of Population Health.
It then is intended that a framework document will be produced that will convey a contemporary vision, mission, values, objectives, strategies (ie actions for the next five years) and performance indicators for Population Health. This planning framework will enable subsequent decisions about issues such as governance, structures, priorities, resources, capital development and recruitment foci at the University of Ottawa to be informed, timely, enabling and reflective of a shared understanding of Population Health. Through the College of Principal Scientists at IPH/IRSP, it has been proposed that this framework be entitled Opportunities and outcomes: Possibilités et résultantes 2010.
Opportunities and outcomes: Possibilités et résultantes 2010
The following questions that have been generated to provide prompts for reflection ahead of the workshop. Key developments since 2000 also are summarised in a series of ten brief appendices to update all participants.
FOCUS QUESTIONS
POPULATION HEALTH RESEARCH AGENDA
What is it that we have in common? What unites us as Population Health researchers
What is the Population Health research agenda that IPH/IRSP should commit to deliver? How might it differ from other health research agendas?
How should its research be characterised in terms of quality, direction, underpinning values?
What are the advantages of creating designated clusters of research and what should these be?
What expertise is currently missing for IPH/IRSP to be a credible and comprehensive Population Health research enterprise?
How well do the current classifications of association and conditions of employment enable researchers to excel?
What new research agenda emerge from the Health Goals for Canada?
What is our obligation to provide postdoctoral training in Population Health research? How well do we do this now?
What happens once postdoctoral experience is obtained? How should we nurture the careers of junior researchers to ensure that each becomes an outstanding and effective contributor in Population Health?
SIGNIFICANCE AND OPPORTUNITIES AS A STRATEGIC AREA OF DEVELOPMENT
What are the implications of being a designated focus within HEALTH as a Strategic Area of Development (SAD) for the University of Ottawa?
What are our deliverables?
Who is nurturing our development? Who can measure our performance? How are they doing this? How can performance management help us?
How should IPH/IRSP better avail itself of appointment mechanisms, new initiatives and time-limited opportunities such as CRCs, ORCs, etc?
What might be done that is new, bold and builds upon our first five years?
TRAINING AND TEACHING
What is the Population Health training agenda that IPH/IRSP should deliver? Should it be research-only training at PhD level?
What is the role for IPH/IRSP with respect to the Faculty of Graduate and Postdoctoral Studies?
What have we learned from the development of alternative graduate opportunities such as graduate certificates? What is our future with respect to Masters courses that are vocationally oriented (eg Masters in Health Services Management, Masters in Public Health)
What markets are we trying to reach? How well do we equip our graduates for the positions they seek?
How should our training be characterised in terms of quality, direction, underpinning values?
What expertise is currently missing for IPH/IRSP to be a credible and comprehensive Population Health training enterprise?
What additional resources are needed to deliver this Population Health research training agenda?
How well do the current classifications of association and conditions of employment enable our students to acquire the best learning experience possible?
FUNDING THE FUTURE
What might a more strategic approach to CFI and other funding opportunities look like to ensure longterm stability and infrastructure for Population Health?
How should IPH/IRSP position itself in relation to philanthropic donations, foundations and long-term institutional funding arrangements?
Is there anything we shouldn’t do or any partnerships we ought never progress?
VALUES, ORGANISATIONAL CULTURE and INTERPERSONAL BEHAVIOUR
What are the values that underpin our enterprise?
What behaviour is condoned? What behaviour is unacceptable?
What standards and behaviours will distinguish those who work in IPH/IRSP and what will be unacceptable standards and behaviours?
To what extent do those contributing to Population Health embrace the stated values of the University of Ottawa? What values could be added to these based on our unique perspective, contributing disciplines and vision? What would be distinct about the values we embrace in Population Health?
IDENTITY
What is the ‘essence’ of IPH/IRSP that should distinguish its image, its external communications and its identity within the University of Ottawa?
How should IPH/IRSP market itself in an increasingly ‘noisy’ and competitive environment?
CROSS-CUTTING QUESTIONS
How ‘current’ is the original vision, mission and objectives as envisaged for IPH/IRSP?
How well has this vision been realised?
What might any new vision for the University of Ottawa include?
What are obvious gaps between current capacity and performance and those envisaged?
What are the University’s existing strengths (recognised areas of excellence) and weaknesses? Not only in IPH/IRSP but across the campus in Population Health?What are the greatest opportunities for Population Health? How ready are we? ¶ 7:12 p.m. 0 comments
AT THE UNIVERSITY OF OTTAWA
Workshop 10 January 2006
Your participation in our workshop is greatly valued. This document has been designed to initiate reflections and prompt informal exchange and discussion.
In 2006, the University of Ottawa finds itself in an environment that differs significantly from that in which it created IPH/IRSP in 2000. First, the University has ratified Vision 2010, in which it has reaffirmed its commitment to research excellence, high-quality learning, passion for knowledge and innovation, leadership on language issues, and openness to diversity. Second, there is even greater recognition of the significant opportunities arising from our unique geographic location to partner with government departments and national and provincial agencies. Third, findings of the IPH/IRSP review conducted in 2004 provide an informed critique of strengths and weaknesses of current structures in Population Health. Fourth, development of administrative and governance structures to better promote interdisciplinarity at the University of Ottawa is underway. Fifth, organisational expansion continues to create designated positions for research chairs and Faculty appointments pertinent to Population Health. Sixth, a smooth change of leadership in IPH/IRSP itself was achieved in 2005. Seventh, other Canadian universities now are creating innovative enterprises in Population Health with similar if not identical mandates as originally afforded IPH/IRSP to promote research and training.
By reaffirming Population Health within HEALTH as a Strategic Area of Development, the University of Ottawa is inviting its renewal and seeking a clear statement of strategic direction. At its meeting on 12 September 2005, the College of Principal Scientists of IPH/IRSP recognised this opportunity and many other challenges requiring thoughtful, timely and incisive analysis and response. Dialogue instigated during the 2005 summer reinforced the breadth of unrealised potential at the University of Ottawa beyond IPH/IRSP in Population Health research and training. Subsequent investigations revealed a positive readiness to broaden the scope of consultation and dialogue to engage a wider community in the development of the future for Population Health in Ottawa.
Hence, the first proposed objective towards which our workshop represents a key step is to articulate the vision, scope, performance and future impact of Population Health.
It then is intended that a framework document will be produced that will convey a contemporary vision, mission, values, objectives, strategies (ie actions for the next five years) and performance indicators for Population Health. This planning framework will enable subsequent decisions about issues such as governance, structures, priorities, resources, capital development and recruitment foci at the University of Ottawa to be informed, timely, enabling and reflective of a shared understanding of Population Health. Through the College of Principal Scientists at IPH/IRSP, it has been proposed that this framework be entitled Opportunities and outcomes: Possibilités et résultantes 2010.
Opportunities and outcomes: Possibilités et résultantes 2010
The following questions that have been generated to provide prompts for reflection ahead of the workshop. Key developments since 2000 also are summarised in a series of ten brief appendices to update all participants.
FOCUS QUESTIONS
POPULATION HEALTH RESEARCH AGENDA
What is it that we have in common? What unites us as Population Health researchers
What is the Population Health research agenda that IPH/IRSP should commit to deliver? How might it differ from other health research agendas?
How should its research be characterised in terms of quality, direction, underpinning values?
What are the advantages of creating designated clusters of research and what should these be?
What expertise is currently missing for IPH/IRSP to be a credible and comprehensive Population Health research enterprise?
How well do the current classifications of association and conditions of employment enable researchers to excel?
What new research agenda emerge from the Health Goals for Canada?
What is our obligation to provide postdoctoral training in Population Health research? How well do we do this now?
What happens once postdoctoral experience is obtained? How should we nurture the careers of junior researchers to ensure that each becomes an outstanding and effective contributor in Population Health?
SIGNIFICANCE AND OPPORTUNITIES AS A STRATEGIC AREA OF DEVELOPMENT
What are the implications of being a designated focus within HEALTH as a Strategic Area of Development (SAD) for the University of Ottawa?
What are our deliverables?
Who is nurturing our development? Who can measure our performance? How are they doing this? How can performance management help us?
How should IPH/IRSP better avail itself of appointment mechanisms, new initiatives and time-limited opportunities such as CRCs, ORCs, etc?
What might be done that is new, bold and builds upon our first five years?
TRAINING AND TEACHING
What is the Population Health training agenda that IPH/IRSP should deliver? Should it be research-only training at PhD level?
What is the role for IPH/IRSP with respect to the Faculty of Graduate and Postdoctoral Studies?
What have we learned from the development of alternative graduate opportunities such as graduate certificates? What is our future with respect to Masters courses that are vocationally oriented (eg Masters in Health Services Management, Masters in Public Health)
What markets are we trying to reach? How well do we equip our graduates for the positions they seek?
How should our training be characterised in terms of quality, direction, underpinning values?
What expertise is currently missing for IPH/IRSP to be a credible and comprehensive Population Health training enterprise?
What additional resources are needed to deliver this Population Health research training agenda?
How well do the current classifications of association and conditions of employment enable our students to acquire the best learning experience possible?
FUNDING THE FUTURE
What might a more strategic approach to CFI and other funding opportunities look like to ensure longterm stability and infrastructure for Population Health?
How should IPH/IRSP position itself in relation to philanthropic donations, foundations and long-term institutional funding arrangements?
Is there anything we shouldn’t do or any partnerships we ought never progress?
VALUES, ORGANISATIONAL CULTURE and INTERPERSONAL BEHAVIOUR
What are the values that underpin our enterprise?
What behaviour is condoned? What behaviour is unacceptable?
What standards and behaviours will distinguish those who work in IPH/IRSP and what will be unacceptable standards and behaviours?
To what extent do those contributing to Population Health embrace the stated values of the University of Ottawa? What values could be added to these based on our unique perspective, contributing disciplines and vision? What would be distinct about the values we embrace in Population Health?
IDENTITY
What is the ‘essence’ of IPH/IRSP that should distinguish its image, its external communications and its identity within the University of Ottawa?
How should IPH/IRSP market itself in an increasingly ‘noisy’ and competitive environment?
CROSS-CUTTING QUESTIONS
How ‘current’ is the original vision, mission and objectives as envisaged for IPH/IRSP?
How well has this vision been realised?
What might any new vision for the University of Ottawa include?
What are obvious gaps between current capacity and performance and those envisaged?
What are the University’s existing strengths (recognised areas of excellence) and weaknesses? Not only in IPH/IRSP but across the campus in Population Health?What are the greatest opportunities for Population Health? How ready are we? ¶ 7:12 p.m. 0 comments
Wednesday, January 04, 2006
Systematic reviews and meta-analysis
Tomorrow I start the "Systematic reviews and meta-analysis" seminar series with David Moher and Dean Fergusson.
The course outline is very interesting as were the first set of readings.
The evaluation is along 3 lines:
Protocol 30% - Must be handed in by 27th February
Final report 50% - Must be handed in by 21st April
Class participation 20%
Compulsory Text
· “Systematic reviews to support evidence-based medicine: how to review and apply findings of healthcare research” by Khan, Kunz, Kleijnen and Antes.
Optional Text
· “The Cochrane Handbook”, freely downloadable http://cochrane.mcmaster.ca/manuals.asp
· “Undertaking systematic reviews of researh on effectiveness. CRD’s guidance for carrying out or commissioning reviews”. CRD Report.
After reading the texts I went poking around the Cochrane Library again. There is not enough work in producing systematic reviews and meta-analyses for mental health issues, especially for children and youth. The work that Howard Schacter is doing with the COE is helping to close the gap but there is still so much that need to be done.
Here is the outline and first week's readings:
For the first session please review the following readings:
· Bhandari M, Devereaix PJ, Montori V, Cinà C, Tandan V, Guyatt GH, for the Evidence-Based Surgery Working Group. Users’ guide to the surgical literature: how to use a systematic review and meta-analysis. Canadian Journal of Surgery. 2004; 47:60-67.
· Pai M, McCulloch, Gorman JD, Pai N, Enanoria W, Kennedy G, Tharyan P, Colford JM. Systematic reviews and meta-analyses: an illustrated, step-by-step guide. National Medical Journal of India. 2004; 17:86-95.
Atkins D, Fink K, Slutsky J. Better information for better health care: the evidence-based practice center program and the Agency for Healthcare Research and Quality. 2005;142:1035-1041.
· Bero L, Rennie D. The Cochrane Collaboration. Preparing, maintaining, and disseminating systematic reviews of the effects of health care. JAMA 1995; 274: 1935-8.
· Moher D, Cook DJ, Eastwood S. Olkin I, Rennie D, Stroup D, for the QUOROM group. Improving the quality of reporting of meta-analysis of randomized controlled trials: the QUOROM statement. The Lancet 1999;354:1896-1900
Session 1(5th January):
Overview of systematic reviews
What is a systematic review; types of systematic reviews; systematic review programs; where do systematic reviews fit in the EBM framework; decision maker and policy maker needs; and how good are we conducting systematic reviews.
Session 2 (12th January):
Question and Protocol development
Any research project, including a systematic review, requires a road map to answer a specific question. In this session we will work on developing and refining the research question; developing a template for a protocol and beginning to populate it. We will also discuss time management for completing a systematic review. We will also consider issues surrounding development data collection forms, extraction and discuss qualitative data synthesis.
Session 3 (19th January):
Refining the research question and Searching the literature I
An early and essential part of conducting a systematic review involves identifying and retrieving the individual studies. This combines both electronic and manual methods: the students will have the opportunity to develop various search strategies tailored to their protocols during this session.
Session 4 (26th January)
Searching the literature II
Computer Lab, using Reference Manager and RevMan
This lab will be devoted to helping students become familiar with the various bibliographical and statistical programs available to complete quantitative data synthesis. This software includes ‘Revman’ produced by the Cochrane Collaboration. Revman can be downloaded from “http://hiru.mcmaster.ca/cochrane/default.htm”. The lab will take place in the Children’s Hospital of Eastern Ontario
Session 5 (2nd February):
Refining the protocol and conducting systematic reviews – process issues I
Computer lab, using RevMan
Specification of the question(s) to be addressed by a systematic review often arise(s) through debate and exploration of issues surrounding a general health problem. Precise and detailed formulation of the question is important to ensure that the review will produce answers that are meaningful to health care professionals and others. The lab will take place in the Children’s Hospital of Eastern Ontario
Session 6 (9th February):
Conducting systematic reviews – process issues II
Computer Lab, Mastering RevMan
To be systematic criteria outlining the characteristics of studies eligible for inclusion in the review should be developed and stated a priori. This session will consider the form and scope of these criteria, how they relate to the research question, and how they are best operationalized. The session will also discuss issues in the development of data abstraction forms. The lab will take place in the Children’s Hospital of Eastern Ontario
Session 7 (16th February):
Methodological issues in systematic reviews I
This session will concentrate on quality assessment, including approaches that have been developed to assess quality. Students will participate in a informal debate.
Session 8 (2nd March):
Methodological issues in systematic reviews II
The validity of a systematic review depends, in part, on several characteristics beyond simply ‘quality’. This session will concentrate on other characteristics, such as language publication, publication status, duplicate publications, and sponsorship.
Session 9 (9th March):
Statistical issues in systematic reviews I
This session will focus on the analytical issues required to synthesis data from a single primary study and will include examples for dichotomous and continuous outcomes.
Session 10 (16th March)
Statistical issues in systematic reviews II
This session will focus on the analytical issues required to synthesis data from multiple studies together and will include examples for dichotomous and continuous outcomes. The session will also discuss issues involved in detecting, describing and explaining both the clinical and statistical heterogeneity found in systematic reviews.
Session 11 (23rd March):
Statistical issues in systematic reviews III
This session will focus on publication bias: prevention, detention and adjustment.
Session 12(30th March):
Hot topics in systematic reviews
This session will include the following topics: what is evidence; use of non-randomized evidence in systematic review; updating systematic reviews; incorporating qualitative information into systematic reviews; patient safety/quality improvement and registering systematic reviews.
Session 13 (6th March):
Limitations of systematic reviews
The session will review themes concerning the limitations of systematic reviews, such as responding to policy makers needs; the labor-intensive methods of conducting a systematic review. This session will also review limitations in light of emerging methodology literature.
Session 14 (13th April):
Reporting systematic reviews
Reporting EMB, including systematic reviews, is currently undergoing ‘standardization’. These developments will be discussed and student reports will be discussed in light of these developments. We will also discuss how to prepare your manuscript of publication submission. ¶ 10:40 p.m. 0 comments
The course outline is very interesting as were the first set of readings.
The evaluation is along 3 lines:
Protocol 30% - Must be handed in by 27th February
Final report 50% - Must be handed in by 21st April
Class participation 20%
Compulsory Text
· “Systematic reviews to support evidence-based medicine: how to review and apply findings of healthcare research” by Khan, Kunz, Kleijnen and Antes.
Optional Text
· “The Cochrane Handbook”, freely downloadable http://cochrane.mcmaster.ca/manuals.asp
· “Undertaking systematic reviews of researh on effectiveness. CRD’s guidance for carrying out or commissioning reviews”. CRD Report.
After reading the texts I went poking around the Cochrane Library again. There is not enough work in producing systematic reviews and meta-analyses for mental health issues, especially for children and youth. The work that Howard Schacter is doing with the COE is helping to close the gap but there is still so much that need to be done.
Here is the outline and first week's readings:
For the first session please review the following readings:
· Bhandari M, Devereaix PJ, Montori V, Cinà C, Tandan V, Guyatt GH, for the Evidence-Based Surgery Working Group. Users’ guide to the surgical literature: how to use a systematic review and meta-analysis. Canadian Journal of Surgery. 2004; 47:60-67.
· Pai M, McCulloch, Gorman JD, Pai N, Enanoria W, Kennedy G, Tharyan P, Colford JM. Systematic reviews and meta-analyses: an illustrated, step-by-step guide. National Medical Journal of India. 2004; 17:86-95.
Atkins D, Fink K, Slutsky J. Better information for better health care: the evidence-based practice center program and the Agency for Healthcare Research and Quality. 2005;142:1035-1041.
· Bero L, Rennie D. The Cochrane Collaboration. Preparing, maintaining, and disseminating systematic reviews of the effects of health care. JAMA 1995; 274: 1935-8.
· Moher D, Cook DJ, Eastwood S. Olkin I, Rennie D, Stroup D, for the QUOROM group. Improving the quality of reporting of meta-analysis of randomized controlled trials: the QUOROM statement. The Lancet 1999;354:1896-1900
Session 1(5th January):
Overview of systematic reviews
What is a systematic review; types of systematic reviews; systematic review programs; where do systematic reviews fit in the EBM framework; decision maker and policy maker needs; and how good are we conducting systematic reviews.
Session 2 (12th January):
Question and Protocol development
Any research project, including a systematic review, requires a road map to answer a specific question. In this session we will work on developing and refining the research question; developing a template for a protocol and beginning to populate it. We will also discuss time management for completing a systematic review. We will also consider issues surrounding development data collection forms, extraction and discuss qualitative data synthesis.
Session 3 (19th January):
Refining the research question and Searching the literature I
An early and essential part of conducting a systematic review involves identifying and retrieving the individual studies. This combines both electronic and manual methods: the students will have the opportunity to develop various search strategies tailored to their protocols during this session.
Session 4 (26th January)
Searching the literature II
Computer Lab, using Reference Manager and RevMan
This lab will be devoted to helping students become familiar with the various bibliographical and statistical programs available to complete quantitative data synthesis. This software includes ‘Revman’ produced by the Cochrane Collaboration. Revman can be downloaded from “http://hiru.mcmaster.ca/cochrane/default.htm”. The lab will take place in the Children’s Hospital of Eastern Ontario
Session 5 (2nd February):
Refining the protocol and conducting systematic reviews – process issues I
Computer lab, using RevMan
Specification of the question(s) to be addressed by a systematic review often arise(s) through debate and exploration of issues surrounding a general health problem. Precise and detailed formulation of the question is important to ensure that the review will produce answers that are meaningful to health care professionals and others. The lab will take place in the Children’s Hospital of Eastern Ontario
Session 6 (9th February):
Conducting systematic reviews – process issues II
Computer Lab, Mastering RevMan
To be systematic criteria outlining the characteristics of studies eligible for inclusion in the review should be developed and stated a priori. This session will consider the form and scope of these criteria, how they relate to the research question, and how they are best operationalized. The session will also discuss issues in the development of data abstraction forms. The lab will take place in the Children’s Hospital of Eastern Ontario
Session 7 (16th February):
Methodological issues in systematic reviews I
This session will concentrate on quality assessment, including approaches that have been developed to assess quality. Students will participate in a informal debate.
Session 8 (2nd March):
Methodological issues in systematic reviews II
The validity of a systematic review depends, in part, on several characteristics beyond simply ‘quality’. This session will concentrate on other characteristics, such as language publication, publication status, duplicate publications, and sponsorship.
Session 9 (9th March):
Statistical issues in systematic reviews I
This session will focus on the analytical issues required to synthesis data from a single primary study and will include examples for dichotomous and continuous outcomes.
Session 10 (16th March)
Statistical issues in systematic reviews II
This session will focus on the analytical issues required to synthesis data from multiple studies together and will include examples for dichotomous and continuous outcomes. The session will also discuss issues involved in detecting, describing and explaining both the clinical and statistical heterogeneity found in systematic reviews.
Session 11 (23rd March):
Statistical issues in systematic reviews III
This session will focus on publication bias: prevention, detention and adjustment.
Session 12(30th March):
Hot topics in systematic reviews
This session will include the following topics: what is evidence; use of non-randomized evidence in systematic review; updating systematic reviews; incorporating qualitative information into systematic reviews; patient safety/quality improvement and registering systematic reviews.
Session 13 (6th March):
Limitations of systematic reviews
The session will review themes concerning the limitations of systematic reviews, such as responding to policy makers needs; the labor-intensive methods of conducting a systematic review. This session will also review limitations in light of emerging methodology literature.
Session 14 (13th April):
Reporting systematic reviews
Reporting EMB, including systematic reviews, is currently undergoing ‘standardization’. These developments will be discussed and student reports will be discussed in light of these developments. We will also discuss how to prepare your manuscript of publication submission. ¶ 10:40 p.m. 0 comments
Implementation Research Methods
My supervisor, Dr. Jeremy Grimshaw has offered to teach his students the basics of Implementation Research Methods through a series of workshops this semester. I am looking forward to it.
_____________________________________________________
Hello Everyone,
Please note the dates of the Implementation Research Methods Sessions:
Session #1 January 11th, 2006 5:00 - 6:30 C4 Conf. Room
Session #2 Feb 2nd, 2006 5:00 -6:30 C4 Conf. Room
Session #3 Feb 13th, 2006 5:00 -6:30 C4 Conf. Room
Session #4 March 9th, 2006 5:00 -6:30 C4 Conf. Room
Session #5 March 23rd, 2006 5:00 -6:30 C4 Conf. Room
Please let me know if you have any further questions.
Regards,
Karen McPherson
Research Administrative Assistant to
Dr. Jeremy M. Grimshaw
Director, Clinical Epidemiology Program
Ottawa Health Research Institute ¶ 7:32 p.m. 0 comments
_____________________________________________________
Hello Everyone,
Please note the dates of the Implementation Research Methods Sessions:
Session #1 January 11th, 2006 5:00 - 6:30 C4 Conf. Room
Session #2 Feb 2nd, 2006 5:00 -6:30 C4 Conf. Room
Session #3 Feb 13th, 2006 5:00 -6:30 C4 Conf. Room
Session #4 March 9th, 2006 5:00 -6:30 C4 Conf. Room
Session #5 March 23rd, 2006 5:00 -6:30 C4 Conf. Room
Please let me know if you have any further questions.
Regards,
Karen McPherson
Research Administrative Assistant to
Dr. Jeremy M. Grimshaw
Director, Clinical Epidemiology Program
Ottawa Health Research Institute ¶ 7:32 p.m. 0 comments
Tuesday, January 03, 2006
What is Population Health
The question of what is population health was only partly answered by the two required readings.
Contandriopoulos, C. How Canada's health care system compares with that of other countries: an overview. In: Forum national de la santé. Le secteur de la santé au Canada et ailleurs. Sainte-Foy, Qc: Editions MultiMondes; 1998.
Evans RG (2000). Canada. Journal of Health Politics, Policy and Law, 25 (5): 890-897.
This appears to be normal due to the emerging nature of this area of study and the complex nature of the questions addressed. The historical shift from medicine to public health and health promotion, to population health is interesting and led me to further readings. These include David Mechanic’s ”Who Shall Lead: Is There a Future for Population Health?”, the Charter of Transdisciplinarity, the Ottawa Charter, Higginbotham et al.’s “Health Social Science”, and the Lalonde Report.
Reflecting on how these readings apply to the area of children and youth mental health, it is clear to me that although mental health is sometimes mentioned, it is a under-developed (or under-used) perspective. A search on PUBMED using the terms: population health, mental health, children, youth, adolescent, produced only six papers, the most useful being McLennan et. al.’s, “Canada’s programs to prevent mental health problems in children: the research-practice gap. This theme of addressing the research-practice gap was picked up in the Kickbusch paper under knowledge transfer. The relationship between knowledge transfer/exchange and population health appears strong but insufficiently researched and implemented. This would be an interesting paper.
What surprised me most from the readings from week two was the Evans paper. His demonstration that the Canadian health system is, for the most part, private but that insurance coverage is mainly public caused me to revisit my own preconceptions about what the Canadian health system is. The focus in my knowledge exchange work has been on incentives and infrastructure to support behavior from these incentives leading to more and more effective knowledge exchange. If, as Evans presents, most of the actors are private then my assumptions about their interactions within institutions and with the policies of various governments will have to be reworked.
The social determinants reading was a useful reference point for thinking about the complexity of factors which need to be addressed however; I need more information about how they interact with each other and what are the relative weights of each factor in differing circumstances. Again, mental health is mentioned in several places, with manifestations such as stress, suicide, and work satisfaction pointed to directly however, I do not have a clear sense of how to apply each of these determinants to an examination of the child and youth mental health system/context in Ontario. This is another interesting possibility for a paper.
The Contandriopoulos paper (NTS: met both father and son during the J.L Denis CHSRF evaluation in 2005-01, Montreal) provided a very useful view of where Canada places within the OECD. The cross-border competition for personnel and resources caused by the USA was clear. The outrageous costs incurred by the USA is a possibility of what costs could have been in Canada without the stabilizing effect that Medicare introduced in the late 1960’s.
It would have been interesting if the author had also analyzed the unit cost of service per person and looked at the distribution across the population. I presume that the USA and Mexico would start to look even more similar, with enormous differences in access across the population. I found the social determinant evidence linking relative population wealth to better health and longer life is very interesting and supported by what Contandriopoulos presented.
From the perspective of child and youth mental health, it could be an interesting study to look at what the expenditure comparisons are. I will have to look for more details of how the numbers presented can be broken down by treatment area. ¶ 10:08 p.m. 0 comments
Contandriopoulos, C. How Canada's health care system compares with that of other countries: an overview. In: Forum national de la santé. Le secteur de la santé au Canada et ailleurs. Sainte-Foy, Qc: Editions MultiMondes; 1998.
Evans RG (2000). Canada. Journal of Health Politics, Policy and Law, 25 (5): 890-897.
This appears to be normal due to the emerging nature of this area of study and the complex nature of the questions addressed. The historical shift from medicine to public health and health promotion, to population health is interesting and led me to further readings. These include David Mechanic’s ”Who Shall Lead: Is There a Future for Population Health?”, the Charter of Transdisciplinarity, the Ottawa Charter, Higginbotham et al.’s “Health Social Science”, and the Lalonde Report.
Reflecting on how these readings apply to the area of children and youth mental health, it is clear to me that although mental health is sometimes mentioned, it is a under-developed (or under-used) perspective. A search on PUBMED using the terms: population health, mental health, children, youth, adolescent, produced only six papers, the most useful being McLennan et. al.’s, “Canada’s programs to prevent mental health problems in children: the research-practice gap. This theme of addressing the research-practice gap was picked up in the Kickbusch paper under knowledge transfer. The relationship between knowledge transfer/exchange and population health appears strong but insufficiently researched and implemented. This would be an interesting paper.
What surprised me most from the readings from week two was the Evans paper. His demonstration that the Canadian health system is, for the most part, private but that insurance coverage is mainly public caused me to revisit my own preconceptions about what the Canadian health system is. The focus in my knowledge exchange work has been on incentives and infrastructure to support behavior from these incentives leading to more and more effective knowledge exchange. If, as Evans presents, most of the actors are private then my assumptions about their interactions within institutions and with the policies of various governments will have to be reworked.
The social determinants reading was a useful reference point for thinking about the complexity of factors which need to be addressed however; I need more information about how they interact with each other and what are the relative weights of each factor in differing circumstances. Again, mental health is mentioned in several places, with manifestations such as stress, suicide, and work satisfaction pointed to directly however, I do not have a clear sense of how to apply each of these determinants to an examination of the child and youth mental health system/context in Ontario. This is another interesting possibility for a paper.
The Contandriopoulos paper (NTS: met both father and son during the J.L Denis CHSRF evaluation in 2005-01, Montreal) provided a very useful view of where Canada places within the OECD. The cross-border competition for personnel and resources caused by the USA was clear. The outrageous costs incurred by the USA is a possibility of what costs could have been in Canada without the stabilizing effect that Medicare introduced in the late 1960’s.
It would have been interesting if the author had also analyzed the unit cost of service per person and looked at the distribution across the population. I presume that the USA and Mexico would start to look even more similar, with enormous differences in access across the population. I found the social determinant evidence linking relative population wealth to better health and longer life is very interesting and supported by what Contandriopoulos presented.
From the perspective of child and youth mental health, it could be an interesting study to look at what the expenditure comparisons are. I will have to look for more details of how the numbers presented can be broken down by treatment area. ¶ 10:08 p.m. 0 comments
Science of Population Health
The discussion of how to approach a science of population health seems to be not unlike the science of making a stew or a casserole. Each of the ingredients are of their own particular nature and “flavour”, yet when they are added together, spiced, and simmered, the result is something quite different from what one started with. Preference for one method or another appears to be one of taste. I could not distinguish a clear method to determine how to best judge what is most effective approach, yet I could see value in most views presented in the readings.
This also brings to mind the difference between complicated and complex. It appears impossible to pull apart the interconnected elements of population health without destroying the powerful framework in which to study the health of populations. Not that population health is the “Holy Grail” of a unified theory. It seems to approach however, the necessary level of completeness to arrive at a more effective; perhaps more efficient, understanding of how to reduce harm to individuals within populations as well as improving the macroscopic conditions which “manufactures” health.
The pulling apart of Evans & Stoddart and to a lesser extent Frank & Mustard by Labonte, Robertson, Poland and colleagues is “normal” behavior found in most fields of research. The setting of boundaries and the dismantling of other frameworks are regular exercises of influence and power. With tongue in cheek, whenever I read any article, I am looking for actionable alternatives that are applicable, feasible, sustainable, and transferable to other contexts. Most of the critiques did not provide this and thus I find them in some respects, to be of limited utility.
Each of the articles however, provided interesting points to consider, the following being what I consider highlights:
Friedman:
A good introduction to models of population health “…it is important to acknowledge that no single widely accepted definition of population health exists.”
Evans & Stoddart:
“There are always unmet needs.”
“…most of the public and political debate over health policy continues to be carried on in the rhetoric of “unmet needs” for health care.”
“Once we recognize the importance and potential controllability of factors other than health care in both the limitation of disease and the promotion of health, we simultaneously open for explicit consideration the possibility that the direct positive effects of health care on health resources may be outweighed by its negative effects through competition for resources with other health-enhancing activities.”
(This is of particular interest to my thinking on examining the models of mental health service delivery and looking for alternatives outside the current framework which has been subject to gross under-funding for decades.)
Frank & Mustard:
“It is not lack of access to health care that is setting this gradient but the underlying social economic factors (unemployment, income, and education) as in Marmot’s study…”
Dunn and colleagues:
“A population health framework situates the importance of social relations centre-stage…Many dimensions of social relations are simultaneously involve in shaping our health experience – global capitalism, gender, ethnicity, religion, identity, power, housing, telecommunications, etc.”
Frank:
“The major determinants of human health status…are not medical care inputs and utilization, but cultural, social and economic factors – at both the population and individual level.”
Labonte:
“Population health arguments are largely silent on ecological issues.”
Poland and colleagues:
“the rhetoric of community-based care…the burden of health care is not being removed from society, but simply shifted from the public domain to the private (domestic) sphere.”
Robertson:
“…what counts as data depends on what we judge to be important to notice in the first place, and them to measure.”
Mechanic:
“If the field of population health is to have sustained policy influence, it requires a persistent constituency, a strong organizational base both within and outside of government, and academic respectability.”
“Population health is most basically about aggregates and not about individuals.”
“Population health policy is different from medical care policy…”
Wilkinson and Marmot:
“…the common causes of ill health that affects populations are environmental: they come and go far more quickly than the slow pace of genetic change because they reflect the changes in the way we live.”
“People further down the social ladder usually run at least twice the risk of serious illness and premature death as those near the top.”
“People who have more control over their work have better health.”
As I move towards an idea for a paper, what is emerging is an examination of child and youth mental health service delivery in Ontario rated against a population health perspective rather than a health care perspective.
Most of these readings address mental and psychological issues but almost exclusively from an adult perspective. I would appreciate suggestions for readings that may show population health from a child and youth perspective – beyond what I can infer from what I have currently read. ¶ 10:05 p.m. 0 comments
This also brings to mind the difference between complicated and complex. It appears impossible to pull apart the interconnected elements of population health without destroying the powerful framework in which to study the health of populations. Not that population health is the “Holy Grail” of a unified theory. It seems to approach however, the necessary level of completeness to arrive at a more effective; perhaps more efficient, understanding of how to reduce harm to individuals within populations as well as improving the macroscopic conditions which “manufactures” health.
The pulling apart of Evans & Stoddart and to a lesser extent Frank & Mustard by Labonte, Robertson, Poland and colleagues is “normal” behavior found in most fields of research. The setting of boundaries and the dismantling of other frameworks are regular exercises of influence and power. With tongue in cheek, whenever I read any article, I am looking for actionable alternatives that are applicable, feasible, sustainable, and transferable to other contexts. Most of the critiques did not provide this and thus I find them in some respects, to be of limited utility.
Each of the articles however, provided interesting points to consider, the following being what I consider highlights:
Friedman:
A good introduction to models of population health “…it is important to acknowledge that no single widely accepted definition of population health exists.”
Evans & Stoddart:
“There are always unmet needs.”
“…most of the public and political debate over health policy continues to be carried on in the rhetoric of “unmet needs” for health care.”
“Once we recognize the importance and potential controllability of factors other than health care in both the limitation of disease and the promotion of health, we simultaneously open for explicit consideration the possibility that the direct positive effects of health care on health resources may be outweighed by its negative effects through competition for resources with other health-enhancing activities.”
(This is of particular interest to my thinking on examining the models of mental health service delivery and looking for alternatives outside the current framework which has been subject to gross under-funding for decades.)
Frank & Mustard:
“It is not lack of access to health care that is setting this gradient but the underlying social economic factors (unemployment, income, and education) as in Marmot’s study…”
Dunn and colleagues:
“A population health framework situates the importance of social relations centre-stage…Many dimensions of social relations are simultaneously involve in shaping our health experience – global capitalism, gender, ethnicity, religion, identity, power, housing, telecommunications, etc.”
Frank:
“The major determinants of human health status…are not medical care inputs and utilization, but cultural, social and economic factors – at both the population and individual level.”
Labonte:
“Population health arguments are largely silent on ecological issues.”
Poland and colleagues:
“the rhetoric of community-based care…the burden of health care is not being removed from society, but simply shifted from the public domain to the private (domestic) sphere.”
Robertson:
“…what counts as data depends on what we judge to be important to notice in the first place, and them to measure.”
Mechanic:
“If the field of population health is to have sustained policy influence, it requires a persistent constituency, a strong organizational base both within and outside of government, and academic respectability.”
“Population health is most basically about aggregates and not about individuals.”
“Population health policy is different from medical care policy…”
Wilkinson and Marmot:
“…the common causes of ill health that affects populations are environmental: they come and go far more quickly than the slow pace of genetic change because they reflect the changes in the way we live.”
“People further down the social ladder usually run at least twice the risk of serious illness and premature death as those near the top.”
“People who have more control over their work have better health.”
As I move towards an idea for a paper, what is emerging is an examination of child and youth mental health service delivery in Ontario rated against a population health perspective rather than a health care perspective.
Most of these readings address mental and psychological issues but almost exclusively from an adult perspective. I would appreciate suggestions for readings that may show population health from a child and youth perspective – beyond what I can infer from what I have currently read. ¶ 10:05 p.m. 0 comments
Accepted Submission to the Society for Applied Anthropology Annual Meeting, Vancouver
Dear Peter Levesque:
Congratulations! Your abstract submission has been accepted for the SfAA 2006 Annual Meeting at the Hyatt Regency Hotel in Vancouver, British Columbia, March 28-April 2.
Information on the date and time of your presentation is below. If you have more then one presentation scheduled, all will be listed below.
Within the next few weeks, we will have an electronic version of the preliminary program posted on the SfAA annual meeting web site. You will receive another e-mail notice when the preliminary program is ready for review. Please review the posted preliminary program carefully, as presentation dates and times may change.
You may visit the annual meeting web site at: http://www.sfaa.net/sfaa2006.html
You will also find information about the annual meeting hotel, travel, and Vancouver attractions. Make your hotel and travel arrangements soon! We have added an entire day (March 28) to the meetings. This day will be devoted to sessions, tours, and other activities that highlight the region we are visiting.
We look forward to seeing you in Vancouver!
Sincerely,
Orit Tamir and Bruce Miller
SfAA 2006 Program Co-Chairs
_______________________
Presentation Day, Date, and Time:Fri, March 31
_______________________
Submission:
Sessions Abstract
Multi-Level Community-Based Culturally Situated Intervention Science (Sessions I and II)
Jean J. Schensul
Change efforts in health have argued for multilevel approaches that can include advocacy for policy change, campaigns, community mobilization models, norms change through peer influence, dyads and small group interventions combined with targeted individual change efforts. Multilevel intervention studies are substantial, and multisectoral. They are simultaneously theoretically driven and locally situated. They utilize unconventional research design and evaluation strategies and though costly in the short run, may offer the best hope for sustainability. This two-part session will consider strategic, methodological and political implications of multilevel community based interventions with illustrated examples of work conducted by anthropologist-led interdisciplinary teams. Session I: Theory, Method, and
Political Infrastructure
Introduction: Jean Schensul
Paper I: Community intervention theory: a shift from ‘program’ thinking to ‘system’ thinking
Penny Hawes, Ph.D., University of Calgary
Overly technological ways of viewing interventions dominate in population health, affecting how intervention integrity is defined and implementation measured. Non compromising rules on adaptation may affect sustainability. A newly funded International Collaboration on Complex Interventions links an interdisciplinary group of investigators in Canada, USA, UK and Australia in a six year program to explore these issues. The collaboration addresses key program areas - ethics and community engagement; intervention theory; intervention x context interaction; and the economic valuation of social benefits that accrue at levels higher than the individual. Thinking of interventions as “events” in systems helps to recast methodological assumptions.
Paper II: Multi-Level Community Interventions: Ecological Considerations of Design and Implementation
Edison J. Trickett and Susan Ryerson Espino, University of Illinois at Chicago
Multilevel community-based interventions pose conceptual and pragmatic questions related to design and implementation. This paper applies an ecological framework to such interventions. It highlights (a) the development of local knowledge as prelude to intervention; (b) the value of collaborative relationship building; and (c) community development or enhancing local social capital as a prime intervention objective. Embedded is the importance of creating alternative designs to randomized controlled trial and new intervention roles to document the ripple effects of such interventions. We include an analysis of existing multi-level interventions to assess the degree to which they fulfill these ecological criteria.
Paper III: Do multilevel interventions increase sustainability of effects?
Jean J. Schensul, ICR
This presentation addresses the critical interface between multilevel collaborative or participatory interventions and sustainability. Multilevel interventions are designed to bring about changes in health status, health access and health disparities at the individual, social and societal levels. A major challenge in prevention or intervention research is sustainability of intervention results over time. Sustainability involves both immediate and long term outcomes, and the ability to adapt interventions to changing conditions. We explore the question of whether and under what conditions multilevel interventions can improve intervention sustainability and whether embedding an intervention in local culture can achieve sustainability without broader structural changes.
Political Will: Promoting Multilevel Intervention Community Based Partnership Research at the National Level
Levesque, Peter (Institute for Population Health, University of Ottawa)
The conditions that sustain international efforts at CBR include active adjusting of incentives and infrastructure within university, government, and civic organizations. As Deputy Director (Knowledge Mobilization) and program officer (CURA) at SSHRC, I engaged in knowledge brokering, incentive and infrastructure adjustment, and policy entrepreneurship to support the conditions that allowed for the development and growth of CBR in Canada and Europe. An active discursive process between disciplines such as Anthropology, Economics, and Sociology, with leaders in policy, community, and business, is necessary for successful on-going political support of multilevel CBR efforts.
Discussant: Anthony Davis
Session II: Theory driven illustrations
V.I.P. Vaccinate for Influenza Prevention, a multilevel empowerment intervention to increase flu vaccination uptake in older minority adults.
McElhaney, Janet, Radda, Kim, and Schensul, J.
Vaccine acceptance is promoted via changes in national and international policies, campaigns and targeted vaccination through primary health care and community situated clinics. Factors affecting vaccination decisions and rates include availability (production, supply and distribution), acceptability (belief in efficacy versus risk), and affordability (whether cost is bearable). In the United States, a country without a coordinated national health care system, disparities in these areas are notable among poor and ethnic minority populations. This paper describes a theory-driven comprehensive multilevel model to reach and empower older low-income adults in senior housing to activate and sustain efforts to obtain influenza vaccine annually.
Changing Drug-users’ Risk Environments: Peer Health Advocates as Multi-level Community Change Agents
Margaret Weeks, Julia Dickson-Gomez, Maria Martinez, Mark Convey
Peer driven, social oriented HIV prevention and other interventions conducted with networks of high-risk groups are increasingly popular for addressing broader contexts of health risk beyond individual factors. To the degree that these models take on multiple levels of risk and change, they become more effective mechanisms to support sustained health improvement. The Risk Avoidance Partnership, conducted with drug users in Hartford, CT, builds on individual identity of trained Peer Health Advocates as social change agents, group processes of norm modification for harm reduction, and community engagement in advocacy for broad health enhancement.
A Site-Based Social Marketing Intervention to Prevent Party Drug Use
Diamond, Sarah and Bermudez, Rey, ICR
This presentation provides an overview of a theoretically-driven, multi-level substance use intervention model that combines social marketing, entertainment-education and cognitive behavior change methodologies. We have developed an innovative site-based drug prevention program to address environmental and social influences of party culture in promoting drug use. Through organizing and promoting drug-free parties, which incorporate drug prevention messages into the entertainment, this intervention aims to create new social contexts, networks, and motivations to support non-drug use among hard-to-reach urban youth. Some of the challenges in evaluation design will also be addressed.
Cultural, Community, And Health System Approaches To The Prevention Of Hiv/Sti In Mumbai, India.
Schensul, Stephen L. and Mekki-Berrada, Abdelwahed (U of Connecticut Hlth. Ctr.)
This paper reports on the results of formative research and intervention conducted through a five-year, NIMH-funded, Indo-US project in economically marginal, migrant communities in Mumbai. The project utilizes a multilevel intervention focusing on culturally-based sexual health concerns centered on performance dysfunctions (gupt rog) as a means of engaging men in health services. The intervention involves the training and support of non-allopathic providers in one community and an allopathic male health clinic in a governmental primary care facility in another community. The study utilizes a quasi-experimental design to test the efficacy of the intervention at the community, provider and patient levels.
Discussant: Edison Trickett ¶ 2:09 p.m. 0 comments
Congratulations! Your abstract submission has been accepted for the SfAA 2006 Annual Meeting at the Hyatt Regency Hotel in Vancouver, British Columbia, March 28-April 2.
Information on the date and time of your presentation is below. If you have more then one presentation scheduled, all will be listed below.
Within the next few weeks, we will have an electronic version of the preliminary program posted on the SfAA annual meeting web site. You will receive another e-mail notice when the preliminary program is ready for review. Please review the posted preliminary program carefully, as presentation dates and times may change.
You may visit the annual meeting web site at: http://www.sfaa.net/sfaa2006.html
You will also find information about the annual meeting hotel, travel, and Vancouver attractions. Make your hotel and travel arrangements soon! We have added an entire day (March 28) to the meetings. This day will be devoted to sessions, tours, and other activities that highlight the region we are visiting.
We look forward to seeing you in Vancouver!
Sincerely,
Orit Tamir and Bruce Miller
SfAA 2006 Program Co-Chairs
_______________________
Presentation Day, Date, and Time:Fri, March 31
_______________________
Submission:
Sessions Abstract
Multi-Level Community-Based Culturally Situated Intervention Science (Sessions I and II)
Jean J. Schensul
Change efforts in health have argued for multilevel approaches that can include advocacy for policy change, campaigns, community mobilization models, norms change through peer influence, dyads and small group interventions combined with targeted individual change efforts. Multilevel intervention studies are substantial, and multisectoral. They are simultaneously theoretically driven and locally situated. They utilize unconventional research design and evaluation strategies and though costly in the short run, may offer the best hope for sustainability. This two-part session will consider strategic, methodological and political implications of multilevel community based interventions with illustrated examples of work conducted by anthropologist-led interdisciplinary teams. Session I: Theory, Method, and
Political Infrastructure
Introduction: Jean Schensul
Paper I: Community intervention theory: a shift from ‘program’ thinking to ‘system’ thinking
Penny Hawes, Ph.D., University of Calgary
Overly technological ways of viewing interventions dominate in population health, affecting how intervention integrity is defined and implementation measured. Non compromising rules on adaptation may affect sustainability. A newly funded International Collaboration on Complex Interventions links an interdisciplinary group of investigators in Canada, USA, UK and Australia in a six year program to explore these issues. The collaboration addresses key program areas - ethics and community engagement; intervention theory; intervention x context interaction; and the economic valuation of social benefits that accrue at levels higher than the individual. Thinking of interventions as “events” in systems helps to recast methodological assumptions.
Paper II: Multi-Level Community Interventions: Ecological Considerations of Design and Implementation
Edison J. Trickett and Susan Ryerson Espino, University of Illinois at Chicago
Multilevel community-based interventions pose conceptual and pragmatic questions related to design and implementation. This paper applies an ecological framework to such interventions. It highlights (a) the development of local knowledge as prelude to intervention; (b) the value of collaborative relationship building; and (c) community development or enhancing local social capital as a prime intervention objective. Embedded is the importance of creating alternative designs to randomized controlled trial and new intervention roles to document the ripple effects of such interventions. We include an analysis of existing multi-level interventions to assess the degree to which they fulfill these ecological criteria.
Paper III: Do multilevel interventions increase sustainability of effects?
Jean J. Schensul, ICR
This presentation addresses the critical interface between multilevel collaborative or participatory interventions and sustainability. Multilevel interventions are designed to bring about changes in health status, health access and health disparities at the individual, social and societal levels. A major challenge in prevention or intervention research is sustainability of intervention results over time. Sustainability involves both immediate and long term outcomes, and the ability to adapt interventions to changing conditions. We explore the question of whether and under what conditions multilevel interventions can improve intervention sustainability and whether embedding an intervention in local culture can achieve sustainability without broader structural changes.
Political Will: Promoting Multilevel Intervention Community Based Partnership Research at the National Level
Levesque, Peter (Institute for Population Health, University of Ottawa)
The conditions that sustain international efforts at CBR include active adjusting of incentives and infrastructure within university, government, and civic organizations. As Deputy Director (Knowledge Mobilization) and program officer (CURA) at SSHRC, I engaged in knowledge brokering, incentive and infrastructure adjustment, and policy entrepreneurship to support the conditions that allowed for the development and growth of CBR in Canada and Europe. An active discursive process between disciplines such as Anthropology, Economics, and Sociology, with leaders in policy, community, and business, is necessary for successful on-going political support of multilevel CBR efforts.
Discussant: Anthony Davis
Session II: Theory driven illustrations
V.I.P. Vaccinate for Influenza Prevention, a multilevel empowerment intervention to increase flu vaccination uptake in older minority adults.
McElhaney, Janet, Radda, Kim, and Schensul, J.
Vaccine acceptance is promoted via changes in national and international policies, campaigns and targeted vaccination through primary health care and community situated clinics. Factors affecting vaccination decisions and rates include availability (production, supply and distribution), acceptability (belief in efficacy versus risk), and affordability (whether cost is bearable). In the United States, a country without a coordinated national health care system, disparities in these areas are notable among poor and ethnic minority populations. This paper describes a theory-driven comprehensive multilevel model to reach and empower older low-income adults in senior housing to activate and sustain efforts to obtain influenza vaccine annually.
Changing Drug-users’ Risk Environments: Peer Health Advocates as Multi-level Community Change Agents
Margaret Weeks, Julia Dickson-Gomez, Maria Martinez, Mark Convey
Peer driven, social oriented HIV prevention and other interventions conducted with networks of high-risk groups are increasingly popular for addressing broader contexts of health risk beyond individual factors. To the degree that these models take on multiple levels of risk and change, they become more effective mechanisms to support sustained health improvement. The Risk Avoidance Partnership, conducted with drug users in Hartford, CT, builds on individual identity of trained Peer Health Advocates as social change agents, group processes of norm modification for harm reduction, and community engagement in advocacy for broad health enhancement.
A Site-Based Social Marketing Intervention to Prevent Party Drug Use
Diamond, Sarah and Bermudez, Rey, ICR
This presentation provides an overview of a theoretically-driven, multi-level substance use intervention model that combines social marketing, entertainment-education and cognitive behavior change methodologies. We have developed an innovative site-based drug prevention program to address environmental and social influences of party culture in promoting drug use. Through organizing and promoting drug-free parties, which incorporate drug prevention messages into the entertainment, this intervention aims to create new social contexts, networks, and motivations to support non-drug use among hard-to-reach urban youth. Some of the challenges in evaluation design will also be addressed.
Cultural, Community, And Health System Approaches To The Prevention Of Hiv/Sti In Mumbai, India.
Schensul, Stephen L. and Mekki-Berrada, Abdelwahed (U of Connecticut Hlth. Ctr.)
This paper reports on the results of formative research and intervention conducted through a five-year, NIMH-funded, Indo-US project in economically marginal, migrant communities in Mumbai. The project utilizes a multilevel intervention focusing on culturally-based sexual health concerns centered on performance dysfunctions (gupt rog) as a means of engaging men in health services. The intervention involves the training and support of non-allopathic providers in one community and an allopathic male health clinic in a governmental primary care facility in another community. The study utilizes a quasi-experimental design to test the efficacy of the intervention at the community, provider and patient levels.
Discussant: Edison Trickett ¶ 2:09 p.m. 0 comments
