5.3 Analyses: How This Initiative Illustrates The  Mobilization Of Population Health

5.3.1 How the determinants of health are addressed

The focus of this initiative is on father involvement as a supportive condition for heathy child development. It began in 1997 with an analysis of the risk and support factors for father involvement using a literature review (1A). This review examined the role of fatherhood from a population health perspective, linking father disinvolvement to risk factors for healthy child development including low self-esteem, behaviour disorders, depressive symptoms, violence, delinquency and arms-carrying, early sexual activity, teenage pregnancy, substance abuse, child poverty, school drop-out, and sexual abuse. The range of supportive and risk factors was also identified for father involvement, and an ecological model was used to develop a framework for understanding their actions and interactions (1B). The review also developed a taxonomy for the types of intervention which could be developed.

During Phase II, this review was complemented by a consultation process within eight communities in Eastern Ontario. Based on the research content of the prior review, surveys of the vision, values, attitudes, behaviours, existing projects and interests, and barriers and opportunities related to father involvement were carried out with 46 agencies and community groups and in 15 focus groups with mothers and fathers (1B). The results of this investigation confirmed the findings of the literature review, and led to the identification of areas and levels of needed action.

5.3.2 How the focus is placed on the health of populations

This initiative, aimed in the long term at supporting healthy child development, targets Ontario fathers of all backgrounds and types of family status (1A). Although the connections in some communities with CPNP has meant that there are some activities specifically targeting first-time fathers, the communities involved have been very broad and inclusive in responding to needs throughout the span of fatherhood.

The types of factors identified in the literature review and confirmed by stakeholders as important in father involvement are (1B):

• factors related to the education, values and experiences of the father (for example, attitudes toward gender roles, perceived parental competence)

• factors related to the immediate environment and living conditions of the father (for example, quality of parents' relationship, family financial status)

• factors related to the relationship between the family and the work environment, and between the father and his social environment (for example, social support, family-work balance)

• factors related to activities, services and organizations in the community (for example, professionals' attitudes, service delivery modes)

• factors related to the ideology and culture of society (for example, social policies for parental leave).

5.3.3 How upstream investment has occurred

The findings from both the literature and the community surveys emphasize the need for strategies to address social and community environments in order to reduce barriers and strengthen support for father involvement. Accordingly, the FII-ON employs several upstream strategies:

• First, the work with communities is centred on consolidating existing fathering assets and capacities and channeling those energies toward consensually developed goals. This community development approach provides a solid infrastructure, anchored within the community, on which specific initiatives can grow and flourish.

• Second, the Initiative has emphasized development of local expertise and capacity as an upstream investment in the ability of communities to advance the work on their own, and to seek out their own opportunities and resources. The training program for managers, front-line staff, volunteers and community leaders interested in the healthy development of children and families aims to entrench the population health approach in the ways in which father involvement is understood and supported, with a focus on social and environmental determinants.

• Supportive environments for father involvement are also created and reinforced through action toward policy changes. An important example of this is found in the emphasis that several communities have placed on the creation of family-friendly workplace policies with specific recognition of fathers' roles. More subtly but also importantly, the Initiative attempts to raise awareness about the benefits of changing verbal and visual imagery of parenting resources to be more inclusive of fathers.

• Finally, it is important to reiterate that the entire fathering initiative is in itself an upstream strategy to foster healthy child development.

5.3.4 What accomplishments are anticipated in the short, medium and long term

In the short to medium term, the Initiative expects to create a pro-father involvement movement through both its social marketing efforts and its community coalitions. The main short-term goal for the Initiative is therefore to increase sensitivity to father involvement issues, especially about systemic barriers that thwart involvement.

In the medium term, the Initiative expects to create more favorable environments for father involvement, as well as improved access to supports for involvement in its participating communities. It is expected that this will lead to more involvement, reflected in both the nature and the amount of parent-child interaction as well as in fathers' and community attitudes and expectations about fathers' roles in healthy child development. As one respondent expressed: "Fathers will come to understand that they have an important role in their children's lives, will find resources to help them assume their role, and find their voice for positive involvement."

In the long term, the Initiative expects to contribute to better outcomes for children, in terms of their global development. These outcomes include increased resiliency and improved self-esteem, social skills and achievement. However, as one respondent noted, this is a very long-term outlook: "It's a shift that will happen in 2020!"

5.3.5 How multiple strategies are applied

The FII-ON has deliberately set out to use a balanced mix of interconnected strategies in its work to promote father involvement. This mixed approach is used so that the multiple strategies can become mutually intermeshed and mutually reinforcing, and so that fathers on their way to increased involvement find supports and do not encounter barriers at any step in their journey.

The main categories of strategies used are:

• individual level: training and education
• family level: provision and receipt of support
• community level: community capacity building
• sectoral level: collaborating with other sectors
• societal level: influencing policy and programs.

Each of these strategies may be used in multiple settings, although in practice community-level activities have tended to focus on community-based and recreational settings, workplaces, health and human service agencies, and family resource centres. One of the tools used by community coalitions in the Initiative is a matrix with health determinants on the vertical axis and the settings listed above on the horizontal axis. This tool is used to illustrate how each of the settings may in fact be linked to actions on each of the determinants, which then has implications for the range of settings that can be targeted. The population health promotion cube model is also used as a planning tool, helping to relate health promotion strategies, health determinants and levels of intervention.

5.3.6 How collaboration across levels and sectors has occurred

5.3.6.1 Nature and implications of collaboration by specific sectors (5C, 5D)

This initiative has several layers, each with its own set of collaborating partners and sectors:

• At the provincial level, project coordination has been provided through a steering group partnership between Health Canada and the Peterborough Family Resource Centre, which has acted as host organization for the project funds. The background work and support system development and delivery has been carried out by Health Canada and a contractor working in partnership. The governance of the project is now evolving toward an executive structure with 50% representation from fathers.

• At the regional level (although moving toward a provincial scope), the Father Involvement Initiative Network includes collaborators from a variety of sectors representing community-level initiatives as well as service agency representatives.

• At the community level, mobilization is carried out through coalitions or networks representing various local sectors. For example, in the Peterborough Fathering Community Network, the following organizations are represented:

  • Peterborough Family Resource Centre
  • Five Counties Children's Centre
  • Ontario Works
  • Kawartha Pine Ridge District School Board
  • Lovesick Lake Native Women's Association
  • Peterborough Mediation Centre
  • family counselling service providers
  • medical/pediatric service providers
  • Peterborough County Public Health Unit
  • Peterborough Regional Health Centre
  • Kawartha Midwives
  • Learning Disabilities Association of Peterborough
  • Cogeco

Within the local coalitions, the locus of leadership seems to depend on the credibility and natural leadership patterns within the community. However, it is often located outside the health sector, and those interviewed suggest that coalitions may in fact be most effective when they are situated within community development stakeholders. However, those community partners interviewed emphasized that Health Canada has been a constant source of expertise, resources and support, providing a sense of continuity during a period of change.

The relationship between the local and the macro level is described as symbiotic: there is information flow and learning in both directions at all times. In addition, the approach taken to relationship building is inclusive: there is father involvement at all levels, and careful attention is paid to methods of integrating new network members, as well as to cultural sensitivity.

The relationship with the provincial government and the health system varies from community to community, according to the opportunities that have presented themselves and the orientations of the local coalition. Some participating communities have links with Early Years pilot sites.

5.3.6.2 Resources brought by partners (5B)

Health Canada has provided funds in each year of the initiative to support the background work (for example, literature review, community surveys, training development and delivery). In many of the participating communities, local Family Resource Centres contribute staff time and infrastructure support; these centres may receive funds from several sources, including Health Canada. For example, Family Resources for Victoria County receives funding from CAPC and CPNP, the municipal government, United Way, Trillium and the National Child Benefit.

5.3.6.3 Gains and challenges from intersectoral collaboration

All those interviewed report that the intersectoral collaboration that has emerged from the mobilization of the population health approach in this initiative has been extremely valuable. It has provided heretofore unheard-of opportunities to network and become aware of promising strategies to promote and support father involvement. This has brought concrete, hands-on benefits to the local level.

Effective intersectoral collaboration presents several challenges to its participants. First, it is important that partners become aware of their differences in terms of organizational culture, and be able to accommodate these. Underlying these differences, it is essential that partners develop and work from a common value base. This can serve as a reference point when conflicts or difficulties arise, and may attract more people to the initiative.

Leadership in an intersectoral context requires special skills, notably the ability to "drive from the back seat," to maintain accountability and to stay with the work plan, while at the same time not appearing to be controlling the agenda.

5.3.6.4 Sustainability (5E)

According to some of those interviewed, both the community-level projects and the broader network are sustainable to the extent that they come with ground-level buy-in from all sectors. However, sustainability will require continued access to financial and other forms of resources, in order to support the collaborative work. Although individual organizations and groups are willing to continue to invest staff time in the Initiative, effective coordination will require access to resources in support of the mobilization process.

See Table 3 in section 10 for a summary of the contribution of each sector/partner to the Initiative.

5.3.7 How mechanisms for citizen engagement have been employed

Citizen engagement in this initiative has been built in part through the partnership role of community-based groups, in addition to public consultations and activities at the local level.

LEVEL OF ENGAGEMENT	CITIZEN ENGAGEMENT
	Population at large	Target group	Community-based organizations	Advisory committee	Other
Level 1: Inform, educate
Level 2: Gather information, views		Consulted in development stages.	Consulted in development stages.
Level 3: Public involvement through discussion or formal consultation		Formal consultation with fathers and mothers in Phase I.	Formally consulted in Phase I.
Level 4: Engagement of public/social marketing		Participate in focus groups, community coalitions, provincial initiative and Steering Committee.	Participate in local and provincial coalitions.
Level 5: Facilitate capacity building		Participate in capacity- building exercises for community- based organizations.	Participate in capacity-building exercises.

5.3.8 How accountability for health outcomes is increased

In Phase III of its activities, the FII-ON began developing a community-based evaluation model which would develop collaborations with existing initiatives, notably the ProsPère project in Quebec, and with the academic environment, notably the Centre for Health Promotion at the University of Toronto. In a series of face-to-face and telephone meetings which began in April 2000, the Initiative has begun to develop a framework for the evaluation process and tools. Initial meetings have identified the need to address a wide range of issues, from community capacity to father-child interactions.

It is intended that this evaluation model contribute to the learnings from the Initiative, and remain responsive to information needs as the Initiative evolves. An example of this approach is found in the ongoing development of a baseline readiness instrument. This tool applies lessons learned from the first cluster of communities to the concept of a longitudinal monitoring approach, in which the evolution of mobilization and its impacts can be followed over time. Other evaluation tools being considered include a process evaluation for the network development and community mobilization processes, and the implementation of a generic participant satisfaction instrument for fathers and staff.

It is important to note that in the context of intersectoral partnership, accountability has to be maintained both sectorally and intersectorally. Network members are not only accountable to the plenary, but they also must be able to validate network actions against the desires of their local constituents.

The Web site that is being developed for the project is intended to be an archive of all activities, events and milestones at all levels. It can also serve as a tool for the documentation of project processes.

5.3.9 How knowledge development has occurred

The FII-ON has identified many lessons learned over the course of its mobilization, intersectoral collaboration and capacity-building activities:

• A crucial success factor is building the local initiative from a foundation of pre-existing support, rather than trying to coax involvement from disinterested or resistant parties. Without the lubricant provided by existing concern about the issue and willingness to do something about it, mobilization becomes rather like pushing a large wooden crate up a gravelly hill.

• The identification and utilization of credible gateways into the local community resource and influence networks can greatly facilitate the entry process and quickly establish a network of affinities and allies. In case of the FII-ON, CAPC projects have often provided the gateways, but others are possible as well.

• To be successful, mobilization must be community-activated and animated by community development practices. Within this framework, for intersectoral collaboration to be successful, it is critical to identify and work with partners who are collaboratively minded and who have the necessary skills to be comfortable in this approach. This applies to informal and formal community leaders, as well as to fathers themselves. At the same time, working from a conceptual framework such as the population health approach is an unfamiliar experience to many in the community. Individuals with both conceptual and operational skills are required to allow for adequate translation between the two types of functioning, and to ensure that tasks are appropriately matched to skills and interests.

• The stepped approach to bringing communities on board has several advantages. Lessons learned can be progressively applied as the deployment advances; at the same time, earlier groups can become sources of positive models and support for newer groups.

• It is important to produce milestone documents so that participants can follow the "roadmap of progress" in the initiative and feel that it is making a difference.

Supports needed for the mobilization efforts to take root within communities have also been identified. According to the Phase II report as well as those interviewed, these include:

• Access to a minimal level of resources, including a mobilization process leader or coordinator. In addition, while many communities support organizations that provide communication links to men who are fathers, entities do not exist for men as fathers. A challenge for the Initiative, and an important step in the sensitization process, is to help make this distinction clear and create a space for fatherhood among the resources and activities that reach men. Small seed funding is helpful for taking potential interest to the next level, with the organization of initial activities and the identification and recruitment of community members who will become mobilized.

• Supports to communication mechanisms are also very valuable, including mechanisms for regular communications with leaders and champions in interested local communities, as well as fora or networking opportunities to facilitate communication across communities.

Those interviewed feel that the mobilization model developed in this initiative can be franchised, i.e., can be adapted to other health issues (such as teen pregnancy, fetal alcohol syndrome/effect). In this sense, the Initiative is making an ongoing contribution to knowledge development by ensuring that its learnings are applied as broadly as possible, in order to maximize the benefits from population health mobilization.

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