Around the Kitchen Table

Programming Connection

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January 2, 2012

Chee Mamuk Aboriginal Program, BC Centre for Disease Control

What is the Program?

Around The Kitchen Table (ATKT) trains Aboriginal women to be leaders and educators within their communities, reclaiming traditions and increasing awareness of HIV, STIs and hepatitis. ATKT follows a traditional Aboriginal approach to education, recognizing that traditional knowledge and skills are passed on through informal day-to-day activities. ATKT draws on a theory of community change called the “Community Readiness Model,” which integrates a community’s culture, resources and readiness for change to effectively address an issue, such as HIV prevention. See below for more information on this model.

ATKT identifies organizations within Aboriginal communities willing to participate and recruits local women to be facilitators, providing them with training and support. Peer-led ATKT workshops combine information about HIV, STIs and hepatitis prevention and treatment with traditional cultural activities, with each community tailoring its own approach.

ATKT is designed to create a ripple effect in each community whereby ideas and concepts are passed on beyond those immediately involved. By participating as facilitators, Aboriginal women leaders reclaim tradition, helping to keep their community and culture alive and healthy. After training, the women leaders are able to facilitate peer support in their own communities and become active in efforts to slow the spread of HIV. Participating communities are encouraged to network with each other to provide ongoing support.

What is the Community Readiness Model?

The Community Readiness Model is a model for community change. To effectively address an issue, such as HIV, this model integrates a community’s culture, resources and level of readiness to address that issue. ATKT utilizes assessment questions from this model to determine how ready a community is for HIV programming.

For more information on the process for using the Community Readiness Model, please see Other Useful Resources.

Why Was the Program Developed?

Aboriginal people, particularly women, are disproportionately affected by HIV/AIDS. According to the BC Centre for Disease Control, while Aboriginal people make up approximately 5% of the total BC population, Aboriginal women represented 24% of all new HIV infections in 2009.

Given the legacy of colonialism and the history of subjugation of Aboriginal communities, Aboriginal women face many challenges and barriers to health. Poverty, inadequate nutrition, low levels of education and a high level of sexual, emotional and physical abuse make Aboriginal women one of the most vulnerable populations. Aboriginal women also have the least access to support services, putting them at elevated levels of risk for contracting HIV.

In this context, Chee Mamuk engages local community organizations and educates Aboriginal women (often local health and social service staff) about HIV, STIs and hepatitis in a way that is not only culturally relevant but that actually strengthens the women’s sense of their cultural identities as well as their ability to serve within their traditional communities as educators and role models.

ATKT has been implemented in two rounds to date (2004-2007 and 2008-2010). In both rounds, ATKT staff conducted culturally appropriate training of local facilitators who then reached out to their communities across British Columbia, both in Vancouver and in remote communities. ATKT is currently being run a third time with five additional communities being trained and supported in 2010-2011.

Six communities were involved in the first round of the project. Four of those communities continue to facilitate activities. The second round of the project included five communities, three from the northwest area of BC, one from the interior and one in Vancouver’s Downtown Eastside. The third round of the project includes two communities from Vancouver Island, one from northern BC, one from southeast BC and one from the interior.

Initially all finances for community implementation were handled centrally by Chee Mamuk. However, due to the difficulties associated with the remoteness of some of the participating communities, such as quickly receiving financial resources when needed, each community now receives a small budget ($2,500) under their local control. Communities then report back on how the funds were utilized. Chee Mamuk continues to promote the project, train and support the community facilitators and distributes the training and promotional materials.

How Does the Program Work?

Location

ATKT training and workshops can be conducted anywhere that is suitably private, comfortable, well lit and quiet enough to facilitate confidential participation in discussion and activities. ATKT events are most frequently held in meeting rooms at local community centres.

Recruitment and engagement

Templates for many of the documents referred to in this section are available in the Program Materials section.

ATKT Facilitators and Local Organizations

To implement ATKT in a community, one local health or social service organization and at least two of its staff members must sign on to the project. A local organization is needed to provide institutional support, a work space, access to a photocopier and fax machine, and two staff people who have some background in providing health services.

The ATKT Project Coordinator begins recruitment by sending a letter of invitation and information package to all of the First Nations communities in the province. Packages are sent out to key community workers, leaders and role models through several networks, including First Nations and Inuit Health, Community Health Associates, Friendship Centres and Aboriginal Organizations.

The letter of invitation introduces the recipients to the ATKT project and Chee Mamuk, explaining that this innovative yet traditional project can help service providers further their training, build skills and learn from other women. The letter also outlines the application process for participation, indicating that interested groups can contact the Project Coordinator for support.

In filling out the application, interested communities must provide a letter of support from a Health Director or Director of a community-based organization (CBO) who is dedicated to the project and able to allocate staff to support its implementation. In addition, each community must identify at least four women to be trained as facilitators— two women employed in health or social services (such as a community health representative or a drug and alcohol counselor) and two volunteer community representatives (such as an elder and a youth worker) who are willing to commit to participate in the four-day facilitator training. It is also preferable that communities provide additional funding to the project, as this helps with the sustainability of the project in the community over time.

The application also asks if sufficient resources (staff time, meeting space, community support, people to lead cultural activities, etc.) are available to facilitate the sessions that will take place in the community.

The application process itself is designed to indicate the community’s capacity to undertake the project. By completing the application within the deadline, a community demonstrates team work and local support for the project. Communities that demonstrate limited capacity may be supported by Chee Mamuk to implement the project. Communities that are not selected will be referred to other Aboriginal AIDS service organizations that can provide community education and help build readiness for a project like ATKT.

The Project Coordinator and the ATKT working group review the applications and send letters of acceptance to those selected, following up to arrange a time to speak with community representatives by telephone. During these conversations, each woman is asked to think about and discuss strengths and challenges in their communities, especially as they relate to readiness to discuss HIV, STIs and hepatitis. The ATKT working group is comprised of Chee Mamuk staff, the Evaluator, a representative from the funding organization from First Nations Inuit Health, and a street nurse from Chee Mamuk’s partner program. The working group helps guide major decisions of the project, such as selecting communities, reviewing evaluation results and making recommendations for future ATKT projects.

During a follow-up planning call any specific issues that the community representatives decide need to be addressed during the training are identified.

Training

The four-day facilitator training prepares community representatives to become leaders who will organize and implement the ATKT program within their communities. Participants from different communities are trained together in one central location, allowing the women to be away from their communities during training to more fully immerse themselves in the ATKT training. This also offers the opportunity to meet women from other communities with whom they can share ideas and begin networking.

Training is focused around modeling the ATKT program that the women will implement in their home communities. The future facilitators first act as participants in the same type of sessions they will lead in their own communities. The trainers then explain how to facilitate these sessions through traditional teaching techniques, providing tips for facilitating a successful workshop.

Topics covered include: the context for HIV and Aboriginal communities; healthy self-esteem; the basics of HIV, STIs and hepatitis; how people can stay safer with drug and alcohol use; and healthy sexuality.

Trainees are provided with project planning tools, session guides, instructional aids and a free-standing table chart. The table chart is used instead of a PowerPoint presentation to give a more intimate, informal feeling to the visual instruction component of each workshop they will be leading. For more information on these materials, please contact Chee Mamuk.

Facilitators in training are also given six different lesson plans (see “Community Implementation,” below, for titles of sessions), which are helpful to the women when it comes to delivering ATKT sessions in their communities. Each lesson plan clearly outlines a session’s objectives, assessment of the group’s familiarity with the topic, activities, timeline and materials needed. The lesson plan also provides instructions to the facilitator about when to refer to the table chart to help illustrate a portion of the material being discussed.

Finally, the facilitators are given steps and guidance for creating, implementing and facilitating an ATKT program tailored to the needs of their own community. They are supported as they begin creating their community implementation plan, which includes dates for the sessions, location(s), which ATKT facilitator will be the lead on the team, and who will be responsible for various tasks (arranging food, communicating with the Project Coordinator). The training concludes with a traditional ceremony to celebrate the women’s completion of the training and honours their strength to bring these challenging teachings back to their home communities.

Community implementation

Though ATKT follows a specific organizational structure, sessions can easily be tailored to the needs of each specific community as determined by the participants and local facilitators.

Facilitators begin by deciding when it will be best to hold their sessions—in the afternoon or evening, on weekdays or weekends—to attract the most participants. Anywhere from 10 to 35 women may attend each session; the optimal number of participants has varied by community. Based on previous experiences with implementing ATKT in a community, Chee Mamuk recommends holding the ATKT sessions once every two weeks, as one session per month proved too infrequent to develop group cohesion and one per week may be challenging to prepare for.

Recruitment of community participants

Participants are recruited primarily by word of mouth, especially in smaller, more remote communities. Facilitators are encouraged to tell their family and friends, advertise in newsletters and newspapers, provide personal invitations and/or make announcements at community gatherings and meetings.

Recruitment is typically far more successful when communities promote ATKT as a “women’s wellness group” involving traditional culture and health topics such as healthy self-esteem, drugs and alcohol, healthy sexuality and HIV. One community initially promoted the program as an “HIV women’s group” and no one signed up. When this community advertised as a women’s wellness group with HIV as one of the many topics, they were able to recruit a good-sized group.

Groups have ranged in size from 11 to 35 participants. In communities that identified the need for more focused programming, recruitment was limited to a specific population, such as younger women or women who were at a particularly high risk for contracting HIV, STIs and/or hepatitis.

Sessions

The project is generally organized into six sessions of approximately three hours in length. A typical ATKT session consists of women gathering together to share a meal, followed by an hour of facilitated learning activities on the scheduled topic using the table chart and other visual aids. Then, the group participates in the cultural activity while continuing to casually discuss the topic of the evening. Each session covers a different topic: