Waterloo Better Beginnings as a Transformative Prevention Project: Impacts on Children, Parents, and the Community.

Better Beginnings Waterloo (BBW) is an ecological, community-driven, prevention program for children aged 4-8 and their families. BBW was implemented in two low-income communities with high percentages of visible minorities. Data on Grade 1-2 children and their parents (the baseline comparison group) were gathered through parent interviews (n = 34) and teacher reports (n = 68) in 2015, prior to BBW programs, and in the period 2018-2019, the same data were collected through parent interviews (n = 47) and teacher reports (n = 46) for children and parents participating in programs (the BBW group). As well, qualitative, open-ended individual interviews with parents (n = 47) and two focus groups were conducted in the period 2018-2019. Children in the BBW cohort were rated by their teachers as having a significantly lower level of emotional and behavioural problems than those in the baseline sample; parents in the BBW cohort had significantly higher levels of social support than parents in the baseline cohort; BBW parents rated their communities significantly more positively than parents at baseline. The qualitative data confirmed these findings. The quantitative and qualitative short-term findings from the BBW research showed similar positive impacts to previous research on program effectiveness, thus demonstrating that the Better Beginnings model can be successfully transferred to new communities.

Knowledge translation and implementation of housing first in Canada: A qualitative assessment of capacity building needs for an evidence-based program.

We examined communities' expressed needs for capacity building in the implementation of Housing First (HF) for persons experiencing homelessness. The findings are based on thematic analyses of qualitative data obtained from participants (n = 77) in 11 focus groups conducted in seven Canadian cities. We identified capacity building needs in the areas of training (e.g., HF principles, clinical services, landlord engagement) and technical assistance (e.g., intake coordination, client prioritization, fidelity assessment). These findings were used to tailor training and technical assessment (TTA) to the stages of HF implementation in these cities. Limitations and implications for future theory, research, and practice are discussed.

Systems change in the context of an initiative to scale up Housing First in Canada.

In this study, we examine changes in the homeless-serving system in the context of a training and technical assistance initiative to scale up Housing First (HF) in 6 Canadian communities. Based on qualitative data from focus groups and individual interviews with key stakeholders (k = 7, n = 35) and field notes gathered over a 3-year period (n = 146), we found 2 main system changes: (a) changes in the capacity of the service delivery system at multiple levels of analysis (from individual to policy) to implement HF, and (b) changes in the coordination of parts of the service delivery system and collaboration among local stakeholders to enhance HF implementation. These changes were facilitated or constrained by the larger context of evidence, climate, policy, and funding. The findings were discussed in terms of systems change theory and implications for transformative systems change in the mental health and homelessness sectors.

Navigating Complex Implementation Contexts: Overcoming Barriers and Achieving Outcomes in a National Initiative to Scale Out Housing First in Canada.

The scaling out of Housing First (HF) programs was examined in six Canadian communities, in which a multi-component HF training and technical assistance (TTA) was provided. Three research questions were addressed: (a) What were the outcomes of the TTA in terms of the development of new, sustained, or enhanced programs, and fidelity to the HF model? (b) How did the TTA contribute to implementation and fidelity? and (c) What contextual factors facilitated or challenged implementation and fidelity? A total of 14 new HF programs were created, and nine HF programs were sustained or enhanced. Fidelity assessments for 10 HF programs revealed an average score of 3.3/4, which compares favorably with other HF programs during early implementation. The TTA influenced fidelity by addressing misconceptions about the model, encouraging team-based practice, and facilitating case-based dialogue on site specific implementation challenges. The findings were discussed in terms of the importance of TTA for enhancing the capacities of the HF service delivery system-practitioners, teams, and communities-while respecting complex community contexts, including differences in policy climate across sites. Policy climate surrounding accessibility of housing subsidies, and use of Assertive Community Treatment teams (vs. Intensive Case Management) were two key implementation issues.

Understanding Systems Change in Early Implementation of Housing First in Canadian Communities: An Examination of Facilitators/Barriers, Training/Technical Assistance, and Points of Leverage.

We present interim findings of a cross-site case study of an initiative to expand Housing First (HF) in Canada through training and technical assistance (TTA). HF is an evidence-based practice designed to end chronic homelessness for consumers of mental health services. We draw upon concepts from implementation science and systems change theory to examine how early implementation occurs within a system. Case studies examining HF early implementation were conducted in six Canadian communities receiving HF TTA. The primary data are field notes gathered over 1.5 years and evaluations from site-specific training events (k = 5, n = 302) and regional network training events (k = 4, n = 276). We report findings related to: (a) the facilitators of and barriers to early implementation, (b) the influence of TTA on early implementation, and (c) the "levers" used to facilitate broader systems change. Systems change theory enabled us to understand how various "levers" created opportunities for change within the communities, including establishing system boundaries, understanding how systems components can function as causes of or solutions to a problem, and assessing and changing systems interactions. We conclude by arguing that systems theory adds value to existing implementation science frameworks and can be helpful in future research on the implementation of evidence-based practices such as HF which is a complex community intervention. Implications for community psychology are discussed.

Dominant Cultural Narratives, Racism, and Resistance in the Workplace: A Study of the Experiences of Young Black Canadians.

Although many studies have examined lived experiences of racism and resistance in various contexts, relatively little research has examined such experiences among Black youth within the workplace-particularly in the Canadian context. In this study I use qualitative analyses of narrative interviews with 24 Black Canadian youth and young adults (aged 16-35) to examine the impact of dominant cultural narratives on lived experiences of workplace racism and resistance. Findings are presented using theatrical games as a central conceptual metaphor, suggesting that: (a) dominant cultural narratives have a major impact on relational dynamics of oppression in the workplace; (b) identity performance is a critical strategy for negotiating dominant cultural narratives in the workplace; and (c) panopticism (the internalized gaze) is a significant aspect of internalized oppression. Implications for future research and action are discussed.

Exploring outcomes through narrative: the long-term impacts of Better Beginnings, Better Futures on the turning point stories of youth at ages 18-19.

This study examined the long-term effects of the Better Beginnings, Better Futures project, a community-based early childhood development program, on 18-19 year-old youths' narratives about turning points in their lives. The sample consisted of youth who participated in Better Beginnings from ages 4-8 (n = 62) and youth from a comparison community who did not participate in Better Beginnings (n = 34). Controlling for covariates, significant differences favoring youth from the Better Beginnings sites were found on several dimensions of the turning point stories: ending resolution, personal growth, meaning-making, coherence, and affect transformation. Effect sizes ranged from .45 to .76 for these outcome dimensions, indicating moderate to large effects. Also, turning point story dimensions were found to be significantly correlated with two standardized measures of well-being: youths' self-esteem and community involvement. Youths' self-esteem was directly related to story ending resolution, personal growth, and meaning making, and youths' community involvement was directly related to story specificity, meaning making, and coherence. Family functioning was also examined in relation to these narrative dimensions but was not found to be significantly related to them. The findings suggest the utility of a narrative approach for the evaluation of the long-term outcomes of early childhood development programs.