According to a Scale-up document provided by the PHAC, five conditions enhance opportunities for scaling up; our Phase 3 proposition has considered these items:
- Common agenda: The focus of the program on cultural knowledge is closely aligned with community priorities making the intervention attractive to communities. Our Phase 3 scale-up plan will engage regional Indigenous regional Health, Education and Social Service Centres, which are mandated to provide culturally relevant mental health promotion services, so that the intervention remains closely aligned with their priorities.
- Continuous communication: We have maintained close communication with a complex array of partners at multiple levels throughout Phase 2, mainly through telephone and teleconference contact, as well as an internet website, blog and periodic face-to-face meetings. We will extended these same methods of maintaining ongoing communication to the wider network planned for Phase 3.
- Mutually reinforcing activities: The intervention is consistent with other cultural knowledge and mental health literacy programs delivered by the regional centers and community partners so that the messaging of the intervention is strengthened by these ongoing activities. We will seek to maximize these by working with the regional Centres to identify and reinforce links across the range of their activities.
- Sharing measurement systems and knowledge exchange: The tools we have developed throughout Phase 2 will facilitate common use of measures and ongoing knowledge exchange that will provide value-added to the participating centres.
- Backbone support organization: Engagement of regional centres will position the program in ways that can maximize the likelihood of sustainability and policy exchange.
Evidence from Phase 2:
- A Wide Range of Communities Can Be Engaged: Five First Nations from four provinces, within communities situated in very different geographical and social contexts have successfully delivered the program. The intervention was given to various types of families: nuclear, extended, reconstituted, foster families.
- A Balance Between Flexibility and Fidelity Can Be Achieved: The program engages communities in cultural adaptation and allows a high degree of creative innovation regarding specific activities, scheduling (once or twice a week), location (safe place: sometimes outdoors on weekends); but fidelity at the level of specific program targets was achieved when the overall the objectives associated to each session were monitored on a weekly basis during the delivery of the program or in a post-delivery focus group.
- Results from the full quantitative evaluation are not yet available since there are still several cohorts completing the intervention and data are still being collected. The final report is due in May 2015. However, qualitative reports collected as part of the ongoing evaluation from participants, facilitators and coordinators regarding the program's impact indicate strong positive outcomes in all five First Nations. The recurrent themes include: increases in family bonding, communication skills, parenting skills, as well as increased interest in, and enthusiasm for learning about their own cultures. There is evidence for substantial spill-over effects both for other children and family members and for wider community solidarity and social capital.
- Evidence in terms of cultural relevancy: Although after Year 1, communities were supposed to have completed the adaptation of the program, the positive participants’ reaction about this aspect stimulates facilitators to integrate more cultural items (Summer 2014: Mi’gmaq/ videos, Anishinabe/ board game, Secwepemc/ Theatre Play).
- Cost effectiveness evidence (prevention program vs treatment cost): The program is relatively inexpensive: $10,000 per community, which includes a meal per session to both youth and parent participants (10 families). Contrastingly, years of declining mental health might equate to use of health services and costly travel to access these services that are generally not offered close by.
