Creating Change Leaders

Introduction

Creating Change Leaders to promote maximum growth starts with establishing a community of practice

Vision Statement:

All adults serving youth will collaborate to create environments & interactions that will promote and support the mental health and well-being of all children and youth.

One of the goals of Every Moment Counts (EMC) is to create change leaders who are committed to promoting the positive mental health of all children and youth. Shared learning and work within a community of practice is essential to creating interdisciplinary mental health promoters.

Change leaders are school or community providers with the knowledge and confidence needed to change practice based on current evidence in the Community of practice is one that supports positive mental health occupational therapy strategies areas of mental health promotion, prevention, and intervention.

Since 2011, EMC has been committed to building capacity of school personnel to be mental health promoters. Our building capacity process involves bringing together school providers who commit to shared learning and work over time (Communities of Practice, CoPs) in order to embed mental health promotion and prevention strategies throughout the day. Outcome research indicates positive changes in knowledge, beliefs, and actions related to addressing the mental health needs of children and youth.¹

Learn about the components of the building capacity process:

Knowledge translation (KT)
Within Communities of Practice (CoP)
Strategic Planning for implementation and change

Consider how you and your colleagues can work together over time as a community of practice to be mental health promoters and implement the Every Moment Counts' initiatives.

¹Bazyk, S., Demirjian, L., LaGuardia, T., Thompson-Repas, K., Conway, C., & Michaud, P. (2015). Building capacity of occupational therapy practitioners to address the mental health needs of children and youth: Mixed methods study of knowledge translation. American Journal of Occupational Therapy, 69, 6906180060p1–6906180060p10.

About: Building Capacity within a Community of Practice

Knowing is not enough. We need to move from 'knowing' to 'doing'.

Attending workshops and reading literature may not always result in the application of new knowledge to practice. Based on an understanding of knowledge translation, the building capacity process was developed in 2011 and implemented extensively nationally and internationally.

(Definition) The building capacity process is a systematic approach aimed at integrating new knowledge and research into a community of practitioners so that situated learning takes place over time resulting in innovative practice.¹

The building capacity process involves knowledge translation over time within a community of practitioners. Keep reading to learn more!

Knowledge translation (KT)

All school personnel, families and students need to develop an understanding of positive mental health and mental health promotion, prevention and intervention based on current best evidence.

Problem: It is estimated that is takes more than 17 years to translate evidence to practice¹ and that only about 14% of new knowledge is believed to enter daily practice.²

What? Knowledge translation is a process:

Involving a complex set of activities including a combination of face-to-face interaction, reading, reflection, and discussion
Promoting a dynamic and collaborative process
Between diverse stakeholders - practitioners, frontline personnel, researchers, and decision-makers
Resulting in mutual learning, application of new knowledge, problem-solving, and strategic planning on how to implement change specific to the context. The focus of the change is to make things better.

How to promote knowledge translation?
Create systematic opportunities for meaningful, focused interaction or exchange between people that share a desire to improve a common practice.^4,5

Read → Reflect → Dialogue → Plan → Make Changes

Communities of Practice (CoP) can serve as a mechanism for promoting knowledge translation.⁶ Read about Communities of Practice in the next section!

References:
¹ Balas EA, Boren SA. (2000). Managing clinical knowledge for health care improvement. In: Bemmel J, McCray AT, editors. Yearbook of Medical Informatics 2000: Patient-Centered Systems. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH; 2000:65-70.
² Westfall, J.M., Mold, J., & Fagan, L. (2007). Practice-based research – "Blue Highways" on the NIH Roadmap. JAMA, 297(4), 403-406.
⁴ Canadian Institutes of Health Research (CIHR) CIHR. (2004). Knowledge translation strategy 2004–2009: Innovation in action. Ottawa, ON: Canadian Institutes of Health Research. Retrieved from www.cihr.ca
⁵ Lowe, M, Rappolt, S, Jaglal, S., & Macdonald, G. (2007). The role of reflection in implementing learning from continuing education to practice. Journal of Continuing Education in Health Care Practice, 27, 143-148.
⁶ Barwick M., Peters J., Boydell KM. (2009). Getting to Uptake: Do Communities of Practice Support the Implementation of Evidence-Based Practice? Journal of the Canadian Academy of Child and Adolescent Psychiatry, 18(1), 16-29.

Communities of Practice (CoP)

Communities of Practice (CoP) can serve as a mechanism for promoting knowledge translation.

A Community of Practice (CoP) is simply a group of people who share a concern for an area of practice and interact regularly to problem solve, share resources and develop new ways of doing.¹
Examples:
Shared area of interest = children's mental health
Diverse stakeholders = parents, teachers, para-educators, occupational therapy practitioners (OT & OTAs), speech language pathologists, PE teachers, cafeteria and recess supervisors, principals, counselors, physical therapy practitioners (PT & PTAs), school nurses, etc.

Who is invited to belong to a Community of Practice? A diverse group of stakeholders who care about and are influenced by the topic and potential work can belong to a community of practice. Their shared work results in greater impact than if the work is completed by a small number of stakeholders.

What does a Community of Practice do?

Meets routinely (e.g. once per month either in-person or virtually)
Commits to community-building based on trusting relationships
Shares knowledge, perspectives and resources
Engages in dialogue
Engages in strategic planning and changes in practice

Involving diverse stakeholders leads to — greater collective impact!

¹ Wenger, E., McDermott, R., & Snyder, W. M. (2002). Cultivating communities of practice: A guide to managing knowledge. Boston: Harvard Business School Press. 
² Cashman, J., Linehan, P., Purcell, P., Rosser, M., Schultz, S., & Skalski, S. (2014). Leading by convening: A blueprint for authentic engagement. Alexandria: VA: National Association of State Directors of Special Education.

Steps for implementing a Building Capacity Process

Refer to the Building Capacity template for detailed instructions.
© Bazyk, S. (2011)

Steps for implementing a building capacity process:
1. Gearing up process (~2-3 months)

Develop a leadership team of 2-3 people who will organize and lead the building capacity process (i.e. send out emails, facilitate meetings, etc.)
Decide on the approximate number of participants you’d like to be a part of your CoP. Starting small the first time is good (10-15 participants)
Develop a timeline for the process. We have found that 5-6 months works well. Starting in August or September also seems to be a good starting time for school teams.
Determine if you will need funding to finance the initiative. Generally, this can be done with little or no funds if the facilitators agree to lead the process as volunteers. Identify if there are any internal funds from your school or facility that can support the facilitators’ time and pay for refreshments and any copying costs.
Identify a venue/location for in-person meetings.
Decide how you will communicate with the group (email?) and what platform you will use for online discussions (e.g. google groups? Blackboard? Canvas?).
Determine if you will collect data on the building capacity outcomes. Refer to Bazyk et al. (2015) for information on pre-post surveys and obtaining qualitative data.
Apply for CEUs (continuing education units) if possible. Providing CEUs has been a strong motivator for professionals to participate in the CoP.
Recruit community of practice participants. Make the ‘invitation’ to participate clear and upbeat.
Plan the kick-off meeting which can be virtual or in-person.

2. The Building Capacity Process. This process allows for flexibility based on the group and setting.

Kick-off meeting (2-3 hours). This meeting is critical for welcoming participants, creating a sense of shared learning and shared work, and orienting participants to what will be done over the 5-6 month period. Being organized is essential.
Monthly readings, webinars, and online discussions. Provide readings about the public health approach to mental health and Every Moment Counts.1 Provide a schedule of the readings and due dates for online posts. Give 1-2 questions for each online discussion to foster reflection and application.
Over a 6-month period of time, consider having 3 face-to-face or virtual meetings to connect in real time for review and sharing. These sessions are important for community-building.
During the entire process, encourage participants to identify gaps in service provision. Have participants complete strategic planning for implementation by the 3rd or 4th month.
Final meeting is a time for celebrating the shared learning and work. It is also a time to reflect on next steps.

¹ Bazyk, S. (Ed.). (2011). Mental health promotion, prevention, and intervention for children and youth: A guiding framework for occupational therapy. Bethesda, MD: AOTA Press.

Research Outcomes: Building Capacity within a Community of Practice

The Building Capacity Process
Developed by: Susan Bazyk, PhD, OTR/L, FAOTA

The first building capacity process was envisioned and implemented in 2011.¹ Since then, it has been replicated throughout Ohio seven times between 2012-2015 as a part of an Ohio Department of Education funded grant. This process was so successful, that it has been replicated in other states (New Hampshire, North Dakota, Colorado, Wyoming, Minnesota, Pennsylvania, etc.) and countries (New Zealand). The process can be adapted based on the CoP's specific needs. For example, it was modified (shortened and implemented virtually) with Level 2 OT Fieldwork students across the USA in 2017.²

Summary of Research Outcomes

Participant quote: I am more confident in my role in addressing mental health… and initiate conversations about mental health issues with administrators, counselors, teachers, and parents.

¹ Bazyk, S., Demirjian, L., LaGuardia, T., Thompson-Repas, K., Conway, C., & Michaud, P. (2015). Building capacity of occupational therapy practitioners to address the mental health needs of children and youth: Mixed methods study of knowledge translation. American Journal of Occupational Therapy, 69, 6906180060p1–6906180060p10.

In order to reduce the gap between new knowledge and action, the six month building capacity process was developed and implemented throughout Ohio to foster knowledge translation (KT) and implementation of a public health approach to mental health among occupational therapy practitioners participating in a Community of Practice (CoP). A one-group (n=117) mixed methods design using quantitative (pretest-posttest survey) and qualitative methods (phenomenological analysis of written reflections) was used to explore the meaning and outcomes of participation in the building capacity process involving reading, discussion (in-person and online), practice reflection and community building. Results: Statistically significant improvements (p<.02) in pretest-posttest scores of knowledge, beliefs and actions related to a public health approach to mental health were found. Four major themes reflecting the meaning and impact of the building capacity process emerged from the qualitative data:
1) The building capacity process was both meaningful and enjoyable;
2) New knowledge regarding mental health resulted in a change in thinking about the term ‘mental health’ to include promotion and prevention;
3) The experience evoked strong emotions regarding participants’ occupational therapy identity reconnecting them to our ‘OT roots’; and
4) Changes in practice occurred: Greater confidence empowered practitioners to actively advocate for and address mental health in big and small ways.
Conclusion: Occupational therapy practitioners need to create opportunities for expanding new knowledge, strategically reflect on and apply new knowledge to practice in order to articulate, advocate for, and implement practice changes reflecting occupational therapy’s role in addressing children’s mental health in everyday practice.

OT student quote: One of the best strategies that will help reframe mental health is to begin to openly discuss mental health with the children, their parents, and other faculty members. I hope this will help reduce stigma ... mental health needs to be talked about as easily as something like a broken leg.

² Bazyk, S., Pataki, K., & DeBoth, K. (2020). Building Capacity of Occupational Therapy Students to Address the Mental Health Needs of Children and Youth during a Level II Fieldwork in a School Setting, Journal of Occupational Therapy, Schools, & Early Intervention, DOI: 10.1080/19411243.2020.1776186

The purpose of this study was to explore the meaning and outcomes of a virtual building capacity process designed to promote knowledge translation of a public health approach to mental health with children and youth by occupational therapy students completing a Level II Fieldwork experience in school settings.
Method: A one-group (n=19) mixed design using quantitative (pretest-posttest survey) and qualitative methods (phenomenological analysis of written reflections) was used to explore the meaning and outcomes of participation in the virtual building capacity process.
Results: Statistically significant improvements (p<.00) in pretest-posttest scores of knowledge, beliefs and actions related to addressing mental health were found in 7 of the 9 categories. Four themes emerged from the data: New thinking regarding ‘mental health’; Gearing up for change; Planning led to implementation; and the Building capacity process was meaningful and enjoyable.
Conclusion: The building capacity process expanded student knowledge of a public health approach to mental health resulting in increased awareness and application of embedded strategies to address the mental health needs of students during a Level II Fieldwork experience in school settings.

How you can create change leaders using Communities of Practice (CoPs)

Consider implementing a building capacity process in your setting!

How?
1) Facilitate a CoP using the online building capacity course, "Building Capacity of School Personnel to Promote Positive Mental Health in Children and Youth" developed by Sarah Nielsen, PhD, OTR/L and Susan Bazyk, PhD, OTR/L, FAOTA. This was developed for the Mountain Plains MHTTC (Mental Health Technology Transfer Center), funded by SAMHSA (Substance Abuse and Mental Health Services Administration) in 2019. To access this online course go to the Healtheknowledge website and create a login account (free).

This is a 5-6 month building capacity process that includes:
1) Five 1-hour webinars covering: Foundations of EMC, embedding strategies that focus on mental health promotion, Calm Moment Cards, Refreshing Recess & Comfortable Cafeteria, Making Leisure Matter, and Comprehensive MH Literacy.
2) Facilitation Guides for five sessions
Creating change leaders in schools by forming a trusted community of practice to promote positive mental health occupational therapy strategies for students. 3) Readings

This online course can be taken individually or used to facilitate a Community of Practice. Refer to this Information Brief

2) Contact Every Moment Counts to seek assistance in implementing the building capacity process. Virtual coaching is provided by the Every Moment Counts team.

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