
The search for models that addressed the issue at hand led to identifying a concept that could be adapted and enhanced to better meet this community's needs. In community development, there is a need not only to be innovative, but also to look at what others have already done from a new perspective. This combination of awareness of what has been done, along with the creativity to think outside the box, has the potential to meet the unique needs of a community. It is not feasible to take a program or initiative that seems successful in one community and parachute it into another and expect the same results.
The previous data and concepts provide a very important clue to an all-important asset in youth mental health promotion. Quite simply, it is the youth themselves. Recognizing the critical role and potential of youth themselves, the Community Resource Centre and West Carleton Secondary School, in partnership with the Positive Futures for Youth Committee, launched an innovative program called Community Helpers.
The Community Helpers Program is based on the Natural Helpers® program from Washington D.C. The Canadian Community Helpers Program was adopted by the National Stay-In-School Initiatives with funding from Human Resources Development Canada and was written by Dave Redekopp (1993). The original intent of the Canadian model was for career development and targeted youth at risk for dropping out of school.
The underlying philosophy of the Community Helpers Program promotes the principles of capacity building. "In every community there are people to whom others naturally turn when they need help. They are people from all walks of life and all ages. The one thing that they have in common is that they are considered by others to be helpers" (Redekopp, 1993).
The program becomes a key mechanism for capacity building as it highlights the existing strengths in the community and not what is missing. The Community Helpers Program does not create volunteers to work with youth but finds a way to discover the community members, the "natural helpers," who youth already relate to when they have a mental health problem. Not only is the glass always viewed as half full, but there are many people in the community who can top up the glass.
The program helps communities to identify its natural helpers. Community helpers could be anyone associated with youth, including friends, team-mates, coaches, neighbours, teachers, clergy. This program has advantages over traditional peer helper programs in that it reduces the inequalities among youth. Traditional models may leave many youth with a sense that the helpers, albeit youth themselves, are out of touch of the types of issues that they actually face in their peer groups. In community helpers, youth who already connect with youth are identified. Their own capacity to support others is increased, as is their knowledge of what other resources exist to support their friends.
The objectives of the Community Helpers Program are to:
Community Helpers are identified through an anonymous survey that is distributed throughout an entire school population. The survey asks youth to identify those in the community who they feel they could turn to for help if they had a personal problem. The youth are asked to name two of their peers and two adults. As well, youth have the option to indicate if they feel there is no one in the community who they could turn to. Utilizing trained student leaders (existing peer helpers or students' council reps), the survey process takes place over a two-day period.
A user-friendly survey was designed through a partnership with Nortel Networks. The goal was to engage youth in both the data collection and inputting the information. Once again, this demonstrates how resources exist in a community that may not even have been considered to be relevant to mental health issues. This hightech community partner was able to participate in a way that capitalized on its own strengths. This enabled them to feel that they could also contribute instrumentally (not just financially) to the health and well-being of community members, many of whom are also employees in this company.
The survey was administered by extending a homeroom for a few minutes in the morning, so that we were assured that most youth were reached. This survey is administered every year so that new community helpers are identified and their numbers are kept relatively constant.
On the first day, the students who were administering the survey visited the homeroom and described for the students what Community Helpers was all about. They also requested that the students think about who their natural helpers are and to come back the next day with as much contact information as possible. As well, resource lists were distributed to remind youth of the more formalized helpers in the community if they felt they had no one to turn to.
On the second day, the surveys were handed out and completed in homeroom. Students were reminded that the surveys were anonymous; they were gathered into a central location so homerooms could not be identified.
The surveys took several days to input (based on a high school of 1000 youth). This became an ongoing task for co-operating students. An unexpected result was that the computer skills of the youth inputting the data increased.
Community helpers were named if their name appeared two or more times in the database. The key points to remember in the selection of community helpers are:
Community Helpers were notified by a letter to indicate that they had been named in the survey results. They were invited to attend an orientation session to talk further about the program and about their potential involvement. Being a voluntary program, there was no requirement for a person named as a community helper to participate. The only thing requested was that they take a mental health resource package in case they or their friends were ever in need of support.
Those who attended the information session were introduced to representatives from the formal youth-serving agencies and given resource materials. They were also asked to brainstorm the types of topics for future workshops that would assist them in helping their friends.
The results of the brainstorming activity are different for every school. For example, one school named four key areas:
Some of the schools that have implemented Community Helpers host seminars on school time or during lunch hours. Others prefer to take all the named helpers away on a "camp" experience covering many topics at one time. At these camps, the formal youth-serving agencies are invited to make presentations so that the youth further engage with them.
The flexibility with which the model accommodates these different approaches demonstrates the importance of respecting how different communities (in this case, schools) need to do things in a way that makes sense for them. Such respect is essential to enlist community buy-in.
One of the interesting and not so surprising characteristics of the community helpers is that they are thought of as good listeners and are actively sought out by their peers. This "caregiver" personality of the community helpers also has a downside - if they are always helping all their friends, who is listening to them? As a result of the feedback and observations of the community helpers, each training session now starts with a self-care component.
One of the key benefits of the Community Helpers Program is that it is inclusive. First, it enables a cross section of an entire student population and allows those who may be on the periphery of the school community to name their own support people. As well, it is not an identified club. Anyone can be a community helper. The survey does offer a good starting point in finding the natural helpers in a community. However, many helpers will self-identify and need to be included as well. Community helpers are the people who youth already turn to when they have a personal problem. If someone is perceived as being in that role, it is not challenged, but celebrated.
If the Community Helpers Program achieves a bridge between the formal and informal networks, it is a valuable mental health promotion tool. The first goal is to reach out to community helpers to provide them with accurate resources about youth mental health issues. Both adult and youth helpers receive mental health information packages on substance abuse, dating violence, parent-teen conflict, eating disorders, sexual health issues and suicide prevention. The youth helpers are formally introduced to the youth service providers in the school to put a personal name to an organization.
Adult helpers are also made aware of the youth-serving agencies in the community. After one tragedy a coach reported, "I feel that sometimes youth on my team are really struggling but I didn't even know you people existed" (referring to the youth counselling agency). When this coach was named as a community helper, he went back to his sporting association and arranged for a presentation on youth mental health issues to the entire group of volunteer coaches. It becomes very empowering for the adults when they are named as a community helper by the youth. It positively validates the significant role that they play in a young person's life.
As discussed earlier, the professionalization of helping has not reached youth who tell us that they will turn to professionals only 1 percent of the time. The people who are named as community helpers come from all parts of the community they include - friends, team-mates, sports coaches, dance teachers, neighbours, and even a waitress at a local coffee shop "hang out."
"I know through personal experience how hard it is to seek help from strangers or outside services. The Community Helpers Program trains youth to recognize mental health issues so that they may help within their own peer groups. In my case, it was my friend who identified that I may have had an eating disorder. My friend was a person involved in the Community Helpers Program and was able to recognize and help me access the services I needed. Now that I have recovered, I have become involved in making sure that this type of program continues for youth in my school and other schools in the community. I am now a Community Helper and am more comfortable with my abilities to help my friends deal with their problems and know where to direct them if the issues are serious."
17-year-old female student at
West Carleton Secondary School
The Community Helpers Program does not advocate that all community members become professional counsellors but that a bridge be built between informal and formal youth support systems. It is essential that the community have the tools to recognize and respond to mental health issues. The community is seen as the first point of contact. A community that can challenge the stigma and shame of mental health issues becomes a much healthier community not only for the youth but also for everyone.
Even if youth do not immediately access support, the link can begin with the helper. Very often community helpers, when they are concerned about a youth, will consult the formal youth service agencies. The helpers may be more likely to appreciate the role of more formal helping agencies and individuals because, through their role as community helpers, they have been able to "put a face" to many of these helping professionals. This in turn helps to decrease the stigma associated with accessing help. Many times, a helper has brought someone in counselling because he or she plays a key role in bridging at-risk youth. Subsequently, community helpers become the promotional tool for youth helping agencies in the community. "The targets of such education must include the general public and adolescents themselves. The medium by which this information is provided will be as important as the message, as youth are clearly likely to listen to some people better than others" (Davidson and Manion, 1996).
The Community Helpers Program is also an invaluable tool because it simply makes sense to the community. In West Carleton, there has been significant buy-in' because of the characteristics of the program. It is both cost-effective and youth-friendly, something that appealed to everyone, including the business community and the youth themselves. The business community, youth and the service providers became very passionate about not only the Community Helpers Program but also the ultimate concept of destigmatizing mental health issues for the next generation in the community. When a community becomes enthusiastic, capacity building and mobilization naturally follow. People want to be part of the solution.
"A partnership is defined as a relationship where two or more parties, having compatible goals, form an agreement to do something together. Partnerships are about people working together in a mutually beneficial relationship, oftentimes doing things together that might not be able to be achieved alone."
(HRDC, 2000)
Community capacity building and mobilization depends upon the development and maintenance of strong partnerships. From a community perspective, the numbers and types of partners are quite far reaching, and can include youth themselves, their parents, the school system, service providers, the police, business, government and the media. In each case, it is important to identify the potential roles of partners, as well as how to sustain them in these roles. Roles cannot be completely independent but must be overlapping and exemplify mutual appreciation and respect for what each has to offer.
As the community began to appreciate the possibilities of being able to make a difference, their collective voices began to be heard. These voices developed into a network of partnerships between the Community Resource Centre, West Carleton Secondary School, businesses, the youth and the community. Each partner at the table was viewed as having their own expertise and strengths. The capacities of both the individual and the community were utilized to address the shared vision of youth mental health promotion. At the centre of this network were the youth themselves. The key focus of any vision was that the developed strategies had youth involvement, were youth friendly and were accessible to the rural population.
"Schools are, or should be, important agencies of child welfare. Institutions, which children attend for five hours a day for two thirds of the year, should know children well, should care for them as individuals, and should have a fundamental concern for their welfare"
(Bagley and Ramsey, 1997)
West Carleton Secondary School played a fundamental role in the capacity building of the community. It embraced the role of school as community and continually created opportunities to engage youth and school personnel in the process. The staff of West Carleton Secondary believe in thinking "outside of the box". Barriers were seen as challenges and opportunities.
West Carleton is a large, rural community and every student relies on the bus (or vehicle) to attend the school. It can be difficult to address the mental health needs of youth who live in a rural environment. Accessing confidential supports is very challenging for teens who do not have means of transportation. Although living in a small rural community can create a sense of belonging, it can conversely take away any sense of privacy. It feels, at times, that everyone knows everyone else's business.
Capacity building and partnership development also had to occur at the professional level. There has been an emergence of "specialty fields" in addressing youth mental health issues. While specialization may be practical for service delivery in both understanding and treating complex mental health issues such as substance abuse, eating disorders, depression etc., it unwittingly places barriers for youth to access support. At times, an agency's mandate becomes the focus, not the needs of the community. Community development may not have been the catalyst for an organization's strategic planning. Funding streams dictate where and how an organization operates and also can initiate "turf" wars.
Service providers often get only one chance to engage a youth. The youth (or their parents) will take the initiative to call for support and may get a response that they have called the wrong agency. In building the community capacity for youth, it was essential that those tasked with helping youth with mental health issues had both shared vision and established partnerships.
In identifying and accepting that the school was indeed the "community," for the youth, the capacity to support those youth had to occur within the school environment. It was not enough to engage in youth mental health promotion and talk about services to support youth if they were completely inaccessible. As the partnerships with key youth service providers were established they were assimilated into the community vision. There are now many agencies providing on-site support to youth at West Carleton Secondary School to complement the existing school support staff. These include: a Teen Sexual Health Centre; Rideauwood Addictions and Family Services; Youth Services Bureau counselling; Community Resource Centre staff including an intake worker, Gay/Lesbian Outreach Worker and a Community Helpers Coordinator; Youth Net/Reseau Ado mental health promotion; Ottawa Police School Resource Officer, and the Royal Ottawa Hospital Early Intervention Program.
Too often the police are the first responders to a crisis, they do their job and then move on to the next crisis. The capacity of police in youth mental health promotion is often overlooked. Police are often the first point of contact for youth who are engaging in risk-taking behaviours. Parents often call police with serious concerns about their youth. Police know first hand the devastation that occurs in a community when a young person is struggling with mental health issues. In a small community, it is commonly the same few officers who attend the calls for service. Officers were faced with the same question as other service providers: Why was this happening?
A parent information program was being developed in 1996 by the Community Resource Centre and the Ontario Provincial Police entitled "You've Had Pre-Natal, Now Get Pre-Teen." Although in its pilot stages before the tragedies, it became an extensive source of support for parents seeking information. You've Had Pre-Natal, Now Get Pre-Teen is an early identification and intervention program that targets parents in addressing youth mental health and youth crime issues.
The program advocates for the police and community agencies to be "partners with parents" to increase the community capacity to understand the connection between mental health and risk-taking behaviours. Similar to the concept of prenatal education, the seminar is hosted throughout the community and is led by both a police officer and personnel from the Community Resource Centre.
An accompanying book of the same title was released in 1999 with funding from a local service club. This comprehensive, easy-to-read book is a compilation of normal teen behaviour, behaviours and issues to be concerned about, various legal rights and responsibilities related to parenting and youth, substance abuse, mental health issues and resources in the community.
This partnership is an example of positive community capacity building. Parents are able to access one-stop shopping' from community agencies serving youth. The program originators were also able to foster understanding and respect for the professional differences in the way police and social service agencies both perceive and address youth issues. The partnership also became the first step in enhancing the affiliation of police addressing youth mental health issues. The officers generally became better informed of the services available for families and would make referrals to mental health agencies much earlier.
Engaging government in community mobilization efforts is a natural progression as politicians are elected to represent the concerns and visions of their constituents. In the broad definition of community, it is important to engage everyone in the vision and long-term action plan. Getting support, both stated and financial from government sources, promotes the credibility of community mobilization efforts. There is danger, however, in relying solely on government financing to sustain an initiative. Having many partners and connections interested in the action plan builds capacity and empowers mobilization.
Early in the process, a presentation on youth mental health issues was made to the West Carleton mayor and municipal council members. This presentation was initially a request for funding, yet became an important opportunity for youth mental health promotion. The presentation was not only from the Community Resource Centre but also a representative from the business community. This was an unusual concept for council. Businessmen were more likely to approach council for zoning amendments or site approval, not to appeal for youth mental health funding. The municipal government representatives not only agreed to provide matching grants to the fund-raising efforts but also promised to encourage others to do so as well. They also became very informed about youth mental health issues and resources. Over the next few years, they created many forums to engage in a dialogue about youth mental health promotion. Some even highlighted their support of these initiatives in their bid for re-election.
After the tragedies became known, the media descended upon the school and community looking for the story. Youth were being stopped in the parking lot of the school and asked why youth were killing themselves in their community. This was very upsetting to the students and they did not know how to respond. To combat this, the youth committee members were "media trained" and invited the media to attend a press conference prior to the community forum. The youth were given key messages to respond to the reporters' questions, (e.g. suicide is a complex issue; one suicide is one too many; suicide is preventable; and, suicide is about pain, and ending pain). Instead of restricting media access to the youth and the initiatives, the partnerships actually assisted them. There was recognition of the capacity that the media have in disseminating the key messages to a wider audience.
Losing many young people in such a short period of time was considered news in the community. The media, like the general public, had limited information about youth mental health issues. They also needed to be educated on what role they could play in the community mobilization endeavour. There was a conscious decision on behalf of the key partners to involve the media as much as possible. The local papers were read by almost every resident and thus they became an important medium for the sharing of youth mental health material, and the promotion of key initiatives and fund raising. The establishment of a recognized partnership with the media benefited the community mobilization efforts and the media themselves. Since community mobilization is about inclusiveness, it resulted in the media feeling as if they were part of the solution. The payoff was many teachable moments in youth mental health promotion.
"It takes leadership, time and effort to build capacity."
(HRDC, 1999)
Capacity building does not happen without intentional effort. A critical element in both capacity building and mobilization is the leadership required to bring the key community players together, to capture their imagination and to energize them to action. Such leadership need not come from established hierarchies, but can emerge from the community itself. It could be a service provider, an educator, a parent, a member of the business community, or even a youth. Often, it is the personal qualities of an individual that enable that person to connect with the diverse groups that make up a community. These individuals must be supported by the more formal systems so they can put in the time to play this all important leadership role. Fostering and maintaining partnerships is a time-consuming activity that requires the appropriate allocation of resources.
In mental health promotion, particularly with youth, strong leadership can be both an essential component and a potential barrier to sustainability and replicability. Without the leadership, community capacity building and mobilization do not occur. Leadership without the development of a solid foundation and a mechanism for succession planning can leave a health-promoting initiative vulnerable once that leader departs. It is the balance between leading and recruiting the next generation of leaders that must be considered throughout a program's development and evolution.
The unique role of the youth community development position that the Community Resource Centre created provided continuity and cohesiveness in the community vision. This position provided the communication link between the youth, the Teen Assistance Fund, the school, the service providers, government and the community at large. This leadership role became recognized by the community as a common thread and provided a means whereby their ideas and their questions could converge. Having someone take on such a leadership role does not preclude the emergence of other leaders. In fact, the best leaders empower others to step up and take on significant roles.
Community mobilization places an emphasis on the grassroots leadership inherent in a community. The very nature of the Community Helpers Program promotes the concept of stability in developing potential youth leaders. The program is designed to reach all youth so that even the youngest members of a school community can be named as helpers. In this way, the community does not have to wait for the leadership abilities of youth to become apparent, as the annual survey identifies the capacities of youth. As each group of youth move on to adulthood, a wave of youth comes up behind them to create new visions and achieve new goals in youth mental health promotion. The program is constantly evolving with the focus on the capacities of the youth population in any given year. The key to community mobilization efforts in youth mental health promotion becomes flexibility and creativity and a willingness to continually modify initiatives.
One of the biggest challenges in mental health promotion is the sustainability of initiatives that emerge at a community level. This includes maintaining the momentum once the acute crisis has passed, as well as "passing on the torch" beyond the initial leaders who facilitated the mobilization of a community. Youth initiatives present their own challenges as, by definition, youth leaders grow older and move on with their lives. For these reasons, one must consider sustainability from the onset.
Audra Kneiper (1999), in an article about grief related to survivors of suicide, used a quote by Henry David Thoreau that feels especially relevant to this concept:
"If you have built castles in the air,
Your work need not be lost;
That is where they should be.
Now put the foundations under them."
The community had come together with the realization that the tools already existed in the community to build the castle, including a shared blueprint for what it would look like. There was also consensus about the importance of a solid foundation not only to sustain the existing efforts but also to develop a long-term plan. There was also an emerging sense of "looking down the road" to anticipate both obstacles and opportunities to explore.
Sustainability must recognize the ebb and flow of community involvement. Some individuals join only for a short time, perhaps a special event, while others are on board for the long journey. No matter what the involvement, all are recognized as contributing their own capacity and ultimately building a lasting foundation.
Capacity building recognizes the need for resources to sustain the shared vision and action plan. The stigma and shame associated with mental health issues can create considerable barriers in mobilizing a community to adopt youth mental health promotion as "a cause." Public education, programming and fund-raising activities had been left to those directly affected by this issue, usually survivors of suicide or those in the helping professions. It feels, at times, that we have to "bake sale" our way to positive mental health.
Fund raising opportunities are a way not only to secure much needed financial resources but are also a valuable tool in youth mental health promotion. Any event or activity was deliberately transformed into public education. The Teen Assistance Committee members became eloquent spokespersons for youth mental health issues. It was now not the "experts" delivering the message but community members from all walks of life, including the youth. An illustration of the progress made in community capacity building can be seen in the example of an accountant giving a speech to a local Chamber of Commerce on the concepts of earache vs. psychache and youth mental health promotion.
Community mobilization presents a continuing challenge. Traditionally, given the lack of core funding for community capacity building and mobilization, it is essential to continuously look beyond the immediate situation. This is where the community action plan becomes absolutely necessary. This plan, for West Carleton, spoke of the need for sustainability both in human and financial terms. An example of this was seen when the partners, including the Brady Burnette Teen Assistance Fund, West Carleton Secondary School and the Community Resource Centre, took the risk and jointly applied to the Ontario Trillium Foundation for core funding. The community mobilization had moved beyond community fund raising and into "big picture" type of funding. Even the exercise of applying for funding contributed to both community capacity building and mobilization as it propelled the community partnerships to develop a comprehensive strategic plan for youth mental health promotion. Clear, measurable outcomes also had to be established. When the program successfully received a significant grant from the Ontario Trillium Foundation, it gave a huge elevation to the partnerships.
The systemic implications for youth mental health that result from community capacity building and mobilization are numerous. The community not only shares in the ownership of youth mental health issues, but also recognizes the unique role that they play in establishing and maintaining a shared vision in creating a safe and healthy community. The underlying assumption that only professionals can assist youth and engage in youth mental health promotion is challenged. A new understanding emerges whereby communities begin to envision a continuum of mental health supports, both at the formal and informal levels. Youth themselves, and the full range of community members, become active in helping to shape the system that is intended to meet their needs. To accomplish this, there must be a mutual respect between service providers and community members, as well as between formal and informal support systems.
Formal systems must understand and appreciate the importance of community input. Opportunities must be built into formal systems to include the community voice, particularly the voice of youth. The formal system's accountability must also extend to the community which, in many ways, is the ultimate judge of what is working for it. The community in turn must be prepared to advocate and actively lobby for those services, be they health promoting, preventive, or interventional - that serve youth all along the continuum of need. Systems that simply look at one aspect of this continuum are likely to miss opportunities for true partnerships that better serve the mental health needs of youth.
The mental health system also becomes more proactive than reactive. Community mobilization involves an improved relationship between the formal and informal networks in a community. The Community Helpers Program unites the formal youth-serving agencies with the informal support systems that youth are known to utilize. This creates an extensive community safety net in not only identifying youth that may be at risk, but also linking those youth with the appropriate support.
Policy implications also need to include the realization that it is youth themselves who may be the most influential mental health promoters. If youth "buy in" to the concepts of youth mental health and well-being, and are invested in reducing the stigma and shame at an early age, the stage is set for them to carry this throughout their adult lives. Policy makers and mental health professionals need to find ways to engage youth in both meaningful and youth-friendly ways. True engagement reaches far beyond the tokenism often seen in systems that include some youth membership without true participation or empowerment. Such participation must be legitimized and formalized at a policy level.
At a fundamental level, policy needs to reflect the fact that youth mental health promotion is, in and of itself, a valuable undertaking. In the current climate of focusing on the early years, prevention efforts have, for the most part, been defined as relating to 0-6 year-olds. Policy needs to appreciate that prevention and health promotion, particularly mental health promotion, can occur throughout the life span. A psychache can occur at any point in a person's life and thus should be reflected both in the planning of services and the allocation of resources.
Mental health promotion is a process, the outcomes of which are potentially measurable over extended periods of time. Accordingly, it takes a concerted, long-term commitment to this process to foster real change. Policy needs to recognize that this process takes time. Furthermore, mental health promotion through community capacity building is everyone's business, even though it is rarely delineated explicitly in the mandate, policy and procedures of many organizations. Policy needs to reflect that these activities are integral parts of the role of such organizations. This includes those organizations/systems involved in education, law enforcement, specialized mental health service delivery, and child welfare, among others. It is also relevant to other organizations with less obvious roles in health promotion (e.g. business community). By acknowledging this at a policy level, the contributions of individual members of these organizations to community capacity building and mobilization can be recognized and validated.
Initiatives can move from the local level to having a far-reaching impact. The Community Helpers model, for example, has been presented at numerous provincial and national conferences, with significant interest being expressed in replicating the model in communities across the country. When the systems that exist within a community can acknowledge that the need truly exists and that it is time to try to do things in a different way, the value of having well articulated mental health promotion programs becomes evident. We do not have to reinvent the wheel, but rather be willing to consider models that have been tested in other communities and have the flexibility to be adapted to meet our own needs.
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