Community and Health Issue
The community chosen for this strategy is children with learning disabilities and their families. The health issue is children's mental health and self-confidence when in-class learning is not designed for them or is unsuitable and appropriate accommodations and support for their learning styles are not forthcoming. Although the target population is children under 12 years of age, it is not limited because a learning disability is usually a lifelong challenge.
Children with learning disabilities are more likely to develop mental health disorders than their neurotypical peers (Vedi & Bernard, 2012). The comorbidity of mental illness among children with learning disabilities is in the range of 30-50% as compared to 8-18% for neurotypical children (Vedi & Bernard). There are also social and contextual challenges associated with learning disabilities with children so diagnosed being more likely to have other health issues, lack social support and live in poverty (Vedi & Bernard). Exasperating the situation are the facts that only a small number of these children use mental health services to mitigate against some of the implications of living with a mental illness and emotional distress is extremely common in the families of these children due to their complex needs (Vedi & Bernard).
Research has indicated that there has been a rise in the number of specific learning disabilities since 1975. In the United States, learning disabilities affect 2.7 million children and the onset of a learning disability has been associated with special health care needs, sociodemographic status and family structure (Altarac & Saroha, 2007). According to Statistics Canada, Nova Scotia has one highest rates in Canada of mild-moderate disabilities in children; however, the province has a relatively low rate of special education classes compared to other provinces (Statistics Canada, 2008). In addition, children in Nova Scotia are 19% less likely to receive special education services than the national average (Statistics Canada). This lack of programming has resulted in literacy differences between disabled and non-disabled students, especially those with cognitive disabilities (Statistics Canada). Research has determined that children's self-perception of their learning disability is associated with self-esteem and academic achievement (Heyman, 1990). This is indicative of the challenges associated with learning disabilities in that they may create issues related to mental health, academics and achievements in later years (Heyman).
The community organization I will be working with is Chisholm for Children (Chisholm). My contact is Rebecca Levick, the Program Manager of the LINKS Children's Literacy Program that Chisholm provides. She has expressed the need for a strategy that will help kids with learning disabilities thrive in both the classroom and other social settings and I will be collaborating with her throughout the term.
During our initial discussions, Levick opined that addressing learning disabilities would be a good issue to focus on, in particular how they relate to mental health in the classroom and the stress that goes with falling behind in a classroom designed for neurotypical learners (Levick, personal communication, October 4, 2018). She suggested an electronic resource due to its effectiveness, feasibility and generalizability (Levick).
The LINKS literacy program is designed for elementary school students who are at least one year behind in reading/writing or need extra support due to a learning disability or other difficulty(s) (Chisholm Services for Children , 2018). Chisholm provides services and a safe and supportive environment for children 12 and under who have complex needs by working with them to cultivate self-worth and life skills such as compassion, respect, hope, belonging, collaboration and respect (Chisholm Services for Children , 2018). Examples of these services are employees of the program working with these children to improve their reading comprehension, writing and spelling.
The LINKS literacy program has had a tremendous amount of success with past LINKS families stating “I used to fight with him to read, and now he really enjoys going to LINKS and reading every day!, She has so much confidence and is happy at school because of LINKS!, and our children are so proud of their reading accomplishments!” (Chisholm Services for Children , 2018). The Research cited above indicates that increased self-esteem and mental health in children with learning disabilities may improve future health outcomes.
Other initiatives in Nova Scotia for children with learning disabilities include online resources such as eMental Health.ca which provides information, support and external links to resources. One of the recommended resources is the IWK Mental Health and Addictions Center for Psychological Counselling and Therapy. However, as many of the children involved with LINKS and Chisolm are in foster homes, they are unable to use this resource as it is based on a family centre care approach and is not available to them. Further, organizations such as the Canadian Mental Health Association, Learning Disabilities Association of Canada and Nova Scotia ADHD can all be resources for children and families, but their programs are often not learning disability specific or are out of province. For example, the Learning Disability Association of Canada is based in Ottawa and does not seem to offer services in the Halifax area.
Levick and I have been emailing regularly throughout the development of this strategy and had one thirty-minute meeting on October 23, 2018 to discuss its direction and theoretical basis. After the first draft was submitted to Levick, we discussed approaches moving forward and made changes for the final draft. Levick has suggested a health education-awareness based strategy. During our meeting, we discussed the lack of knowledge of, and resources for, families with children with learning disabilities. We discussed how to transfer knowledge to this population to ensure affected children receive the support and resources they need to excel in education. Health awareness and education can also develop community connections that can mobilize and create social support networks that may be lacking (Austen, 2003).
During our more recent discussion, Levick commented that the strategy must be engaging, useful and a reliable resource for the target population (Levick). Levick also stated that she has wanted to update the resources offered on her website but has been challenged by the theoretical basis of the importance and efficacy of this type of online platform. We came to the conclusion that a health education awareness campaign or knowledge translation would be useful to convey the information to the target audience (Levick).
The strategy I intend to use is a health education awareness and resource campaign facilitated by, and disseminated via, Chisolm's website. This campaign will be an online webpage that will provide knowledge, guidance and resources to parents and guardians of children who may be struggling with their schoolwork or have a diagnosed learning disability.
Rationale and Purpose
The goal of this strategy is to provide information and resources for these children but targeted to their parents and guardians. Levick is of the opinion that the website should be a source of information for families to help guide and further their understanding of learning disabilities and their implications on mental health (Levick, Personal Communication, 2018). One of the goals of this education and awareness strategy is to improve the mental health and self-confidence of children with learning disabilities and those who experience challenges in the typical classroom by developing their personal and life skills. This project has three objectives: to increase knowledge surrounding learning disabilities, to improve the mental health of children with learning disabilities and to provide resources to improve self-esteem and mental health. Research indicates that children with disabilities have poorer health outcomes, which emphasizes the need for a strategy.
Health education approaches involve providing information and knowledge to communities to increase their capacity to adopt healthy behaviours. This learning can be put into practice and therefore can help people with disabilities understand and take control of their health (Kumar & Preetha, 2011). A health education approach will encourage parents and guardians to obtain assistance for their children and enable access to helpful community resources to help children and their families engage and develop a network and build social capital. This will also help community members understand and learn about learning disabilities. Ultimately, this knowledge will help children build their self-efficacy, leadership and self-confidence. Providing resources for children will help them learn from experience, acquire knowledge and potentially improve their mental health and self-confidence.
The LINKS page on the Chisholm website informs parents and guardians of programs, but currently provides little information about what a disability is, how to know if your child has a disability and community resources that can provide support. This strategy will provide facts and statistics about disabilities, discuss the types of disabilities and provide a questionnaire or framework to do a preliminary test with your child to see if they are exhibiting some of the characteristics of certain disorders such as dyslexia or dysgraphia. Further, if a child seems to be have difficulty, parents will be directed to contact accredited assessment resources/facilities that can help them to obtain a diagnosis. An example of a learning disability center in Halifax is Green Leaf Psychological that has a variety of services such as assessments for ADHD and other learning disorders and therapy (Green Leaf Psychological Services , 2018).
The resources listed on the website will help children achieve the sense of belonging and inclusion that is associated with health and wellbeing (Sharpe, Mair , & Yuen, 2016). Social and community connections have been found to be important for mental health and mental well being (McAneney, et al., 2015). For example, children who experience bullying at school are at risk for mental health challenges (Rigby, 2000) and children with disabilities are more likely to have mental health challenges and therefore do not receive adequate support at school. This resource can assist families in the community connect with each other so that they are able to get the support they need from people in similar situations.
Online communities are becoming common resources for information about health issues. Increasingly, people use group forums to collaborate, share information and provide support (Institute of Medicine (US) Committee on Assuring the Health of the Public in the 21st Century., 2002). On the website, there will be links to forums and support groups that can help parents navigate the challenges they face and possibly will face. For example, there is a national forum in Canada for people with learning disabilities and a National Valuing Families forum, both of which would be useful to families. Research done on forums have concluded that they increase social capital and promote helpful social networking; however, people have difficulty finding forums and so helping people find one that is correct for their needs is important to this strategy (Pendrya & Salvatore, 2015). Having the possible forums listed for parents/guardians on the website will increase their chances of participating in them. Further, online forums promote development that can be applied to offline engagement related causes (Pendrya & Salvatore).
Through this strategy, there will be questionnaires for children to complete, resources that children can use at home, recommended apps and assisted technology. Some of the apps recommended for students are Dyslexia Toolbox, News-o-Matic and Stop, Breathe, Think. These applications, that parents or guardians might be unaware of, are useful resources for children. In addition, there will be information about community groups and programming such as those put on at Halifax's IWK hospital, school programming and at the Halifax Public Library. Many libraries in the Halifax area currently have free weekly homework help for kids that can provide some of the one-on-one support they need. In addition, the libraries often have family drop-in sessions to get parents and children involved with stories, rhymes, songs, crafts and other activities that may help improve reading and comprehension abilities. Programs like these are also an opportunity for parents and guardians to receive social support as meet others experiencing the same difficulties. These programs have the potential to increase the mental health and self-esteem of children by providing the extra support they need in a safe environment.
Besides content, it is also important that an online page be easy to use, well organized and visually appealing. Web aesthetics are often associated with increased service and satisfaction of an online resource (Wang, Hernandez, & Minor, 2010). Websites with low aesthetic appeal are held to be mediocre or provide sub-standard information (Wang, Hernandez, & Minor). This highlights the need for a visually appealing and well-designed web page.
Social Marketing Theory
Social marketing theory will be used to show how the intended strategy will be effective. This theory postulates that tools and techniques can promote social change and help address social problems (Wood, 2008). Social marketing can be more complex than just knowledge translation and behavior changes (Wood). The first aspect of social marketing theory is the exchange of knowledge, the exchange in this case being an exchange between Chisholm and the target: children with learning disabilities and their families. The product would be information about learning disabilities to create a positive shift in behaviour through understanding and knowledge (Wood). Next is the social price, which in terms of this strategy would be the cost to provide this resource to families and community members. This will lead to the distribution of the product or information through Chisolm's website. This knowledge will be disseminated, and the users of this resource should be able to easily access it. Websites and other forms of media are effective promotion strategies because they are interactive, readily available and easily accessible (Wood).
Marketing is particularity effective when societal goals may not reflect the same ideologies (Grier & Bryant , 2005). In this case, there is a tremendous amount of stigmatization and marginalization associated with learning disabilities. This type of health education can make the environment supportive to changes by providing more support for students with these challenges (Grier & Bryant). In addition, this type of knowledge exchange will help the target population understand the implications of having a learning disability and how it affects mental health. This strategy can affect societal change because this media/resource, although target to a specific audience, is accessible to everyone and is not confined by geography or location.
In addition to the use of social marketing theory, knowledge translation (KT) will also function to ensure the information is accessible, effective and be useful in real life. It is based on the premise that research and academia fail to present and use evidence optimally.
In other words, knowledge is not put into action (Straus, Tetore, & Graham, 2009). The first component of KT is synthesis of information, which includes collecting common research related to a topic or a phenomenon. This research must be good quality information and consistent with other research in the field (Straus, Tetore, & Graham). The next step is dissemination which refers to knowledge uptake or diffusion; this is actually making the research available for the public (Straus, Tetore, & Graham). After dissemination, the exchange occurs, and this is referred to as “the interaction between the knowledge user and the researcher, resulting in mutual learning.” (CHIR, 2015). The final step is the application of the process which will be consistent with the research findings and ethical principles to ensure appropriate knowledge can be applied and used in real life (Straus, Tetore, & Graham).
Much of the research used in the background of this paper refers to the poor health outcomes associated with having a learning disability in a society designed for neuro-typical people. In Nova Scotia, children with learning disabilities are not receiving the support they need and accordingly they are more likely to experience mental health and self-esteem issues. However, this research is not always public knowledge, and most people are unaware of the magnitude of this issue. KT will put this research into practice via the Chisolm for Children website and social marketing theory will underlie how the target population will adopt and use the research and supports available.
Health Promotion is becoming increasingly relevant due to the emerging discourse related to the acceptance of factors that determine health in that they are not merely lifestyle choices (Kumar & Preetha, 2011). Although this strategy will not directly affect underlying social determinants of health, it will promote community health and, if successful, have a positive influence on future public policy and stakeholders. Increasingly, there is a need for comprehensive health approaches to address learning disabilities in children, which is why the use of multiple strategies will empower people to take action, get involved and build community capacity (Kumar & Preetha). Social marketing theory and KT align with health education and awareness approaches because when knowldege is put into practice it can create positive social changes. The strengths of both theories will be used to ensure the strategy's success.
This program will be evaluated by goals based evaluation. Goals based evaluation is used to determine the extent pre-determinted goals have been achieved (Sherry Jarvis, 2018). The goal of this strategy is to provide information and resources for these children though targeted to their parents and guardians. In addition to the goals, the objectives mentioned above are to increase knowledge surrounding learning disabilities, to improve the mental health of children with learning disabilities and to provide resources to increase their self-esteem and mental health. A goals-based evaluation will help determine if social marketing theory and KT are effective bases for this strategy. Questions related to how the goals were established, whether the goals are specific, measurable, achievable, relevant and time-based, and whether the goals should be revised, will give us a more quantitative understanding of our progress. In addition, because this strategy is electronic, it can be reviewed and modified to best serve the community.
When Levick and I discussed the evaluation plan, she liked the idea of goals-based evaluation but suggested that another type of evaluation might also be useful. LINKS wants to ensure children and their families are getting the most out of the program, so Levick thought that an evaluation more inclusive of the community members would also be useful (Levick, Dec 1).
Community Contact Evaluation
After submitting my CHPS draft to Levick, I received feedback about the research and actual implementation of the strategy. Levick advised that it might be useful to do a needs assessment prior to the implementation of the strategy (Levick, Dec 1). She indicated that she would be able to speak to some of the parents involved in the LINKS program and find out any resources that might be helpful to them and their children. The needs assessment will help guide the specifics of the strategy if it was to be implemented. The rationale for doing a needs assessment is to make sure the resources are being used and that the community supports the strategy.
When I presented Levick with my draft, though she was excited about the online resources, she did want more input from the community and comfort that if this strategy is applied, it reflects the needs of the community. The theory and strategy portion of this assignment focuses mostly on research and literature, which sometimes are not feasible or effective in practice.
Working with the Organization and Contact
I initially got in contact with Levick because I work as a tutor for the LINKS literacy program. As a member of this community, I thought it would a good match. As Levick and I had already developed a relationship, the process of creating a strategy was efficient as we were both familiar with the target audience and specifics of the children in learning-based settings. Levick herself has dysgraphia (a learning disability associated with visual spatial skills) which gives her a unique perspective as she is able to draw from her own experiences of being educated in a system not designed for her needs. In fact, this experience is what inspired her to become involved in the organization. She has worked for the company for a number of years and has strong relationships with the client children and their parents. At the beginning of this project, I was nervous about how it would develop. However, as I continued to work with Levick, I was reassured that it was moving in the right direction.
I submit that my CHPS will be useful to Chisolm with Children, even if they do not implement the strategy. Health promotion strategies are very comprehensive and collaborative and draw on multiple disciplines to ensure the effectiveness. I feel that this strategy looks beyond the individuals and addresses challenges within the community that can be associated with learning disabilities/challenges. Levick's preliminary comments suggested that this strategy would be useful to the updating and development of their website even if they do not implement all of it. She said that she has been wanting to expand the website and online resources offered to children and parents. This strategy can help inform this change.
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