Programming Connection

Remote Outreach Project 

Blood Ties Four Directions Centre
Yukon
2010

How Does the Program Work?

Location

The project is delivered in remote First Nations communities in the Yukon, and the project coordinator is based at the Blood Ties office in Whitehorse. While there are 14 remote communities in the territory, due to funding limitations only nine participate in the Remote Outreach Project. The best time for program delivery to the communities served is during the winter; however, this is the time of year when having a person “out on the road” can be the most dangerous.

With input from the steering committee and based on Blood Ties’ experience working in the region, communities most in need of support were chosen first according to conditions of community readiness. Having an agency that already has a record of delivering HIV and hepatitis C programs in each community is very helpful. One community, Old Crow, was included in the project though it was visited only once per fiscal year due to its geographic location with no road access.

Recruitment and Engagement

Outreach to remote communities can be challenging for outsiders. The Blood Ties Coordinator involved in delivering remote outreach is not a member of any of the communities the organization aims to serve. Community Health Representatives (CHRs), meanwhile, who work primarily in First Nation and Métis communities across Canada to deliver health and social services in health promotion, health protection and community advocacy, are often considered insiders. Therefore, forging and maintaining solid relationships with these CHRs, who are often longtime residents of the communities in which they deliver health and social services, or someone in a similar position, is crucial to engaging other community members as participants. 

To encourage local residents to participate in workshops, the Project Coordinator and the CHR work together to plan the date and location of each event. The Coordinator relies heavily on the CHR to do the bulk of community engagement and workshop recruitment work by:

  • advertising the workshop through flyers posted at community centers, coffee shops and other places where locals tend to congregate
  • promoting the project and its coordinator though informal conversations with clients and locals in general

When the Coordinator arrives in the community, she engages the community on an ongoing basis by approaching people in respectful, casual ways to introduce who she is and why she is visiting. Workshops are scheduled at least twice a year to build trust through continuity.

“You really need a Coordinator who is relaxed, easy to approach and not shy about approaching people. You also have to have buy-in from the CHR. If the Coordinator is even a bit abrasive or ignorant, we would not get anywhere. People don’t come out to your workshop unless you’re really good at talking to people during the daytime and convincing them to come out” –Patricia Bacon, Executive Director, Blood Ties

Workshop Structure

In each community, workshops occur at least twice a year, allowing the Coordinator to build trust and rapport. Each visit lasts two to three days and is scheduled in consultation with the CHR around other community activities.

The project was originally designed to bring the Coordinator to each remote community for a one- or two-week visit, with the idea that an extended presence would further help to build trust. After operating the project in this manner for a year and a half, it was recommended that Blood Ties visit communities for shorter periods of time but more frequently to show locals they are being more consistently served over the long run and to reduce Coordinator burnout, which is common when spending extended periods of time in secluded communities. 

Workshop content is based on the Canadian AIDS Society’s HIV Transmission: Guidelines for Assessing Risk and adapted in consultation with the CHR to be accessible to participants at their current level of awareness of HIV and hepatitis C. To translate material to be easily absorbed by locals, the coordinator must have a solid understanding of the learning style of the community. In early sessions, it was discovered that the program did not require a great deal of adaptation from one community to another, as all of the remote communities of the Yukon shared the same basic needs for HIV and hepatitis C information. This realization allowed Blood Ties to focus efforts on more effective standardized programming.

It was also discovered that “capacity building” in the context of these remote communities was best fostered by continuing to deliver the project through the Blood Ties Coordinator rather than through CHRs or other local leaders. Not only did Blood Ties have the necessary expertise, but the communities indicated that they actually preferred to leave the expertise in the hands of Blood Ties and the Project Coordinator rather than taking on HIV and hepatitis C education on their own.

“The CHRs like it when we connect with them because they are very busy and often do not receive training in HIV and hepatitis C information. CHRs address so many health issues that are happening in these communities. Sometimes having someone come into their community and do the HIV work relieves at least part of the burden.” –Patricia Bacon, Blood Ties

As the communities visited by the Coordinator are quite small, interactions with locals can be spontaneous and impromptu. The following six activities serve as a general guideline for program structure, though the inclusion and scheduling of any activity will depend on the immediate practicalities of the community during the Coordinator’s visit. Various materials are used during education workshops, including those found in the CATIE Ordering Centre and a small number developed by Blood Ties. Resources were used to illustrate teachings on HIV and hepatitis C prevention and transmission. (Please see Other Useful Resources for examples of these resources.) Food and refreshments are provided to all workshop participants at all sessions, which helps to encourage attendance and “break the ice.”  

Activity One: Community suppers and workshops with general population and specific populations

This event, which is most often hosted on the Coordinator’s first night in the community and can be held in a variety of locations such as a community centre or home, includes providing a meal to community members and engaging them in conversation about HIV and hepatitis C. It is open to all and usually attended by a cross-section of the community. This event encourages the general population to come out to meet the Coordinator and to start thinking about HIV and hepatitis C.

This workshop can be designed to attract youth, adults and elders. Often, an Aboriginal person living with HIV and/or hepatitis C will be invited to attend the workshop to tell her or his story. This person’s active presence is very effective in helping the audience connect with the topic.

Activity Two: Workshop with health and social service providers

This activity was done early in the project. Blood Ties brought 15 health and social service providers to Whitehorse for three and a half days of training. The goal of this activity was primarily to assist health and social service providers in increasing their overall comfort with working with community members who have HIV or hepatitis C or who are at risk. Initially, despite their knowledge of HIV and hepatitis C, CHRs lacked comfort with the idea of supporting an HIV-positive person directly, and this workshop increased their comfort level. A secondary goal was to provide CHRs with up-to-date information about hepatitis C.

Activity Three: Casual conversations

When the Coordinator is out and about in the community, she can engage people in one-on-one discussions about HIV, hepatitis C, sexual health and harm reduction to answer questions and provide referrals. She does this by being very proactive in approaching people respectfully. Once she has developed a strong rapport with community members, locals begin to approach her for information and informal conversation.

Activity Four: Movie night

Engaging community members to come together to watch a movie gives the Coordinator another opportunity to build rapport and have discussions. Movies, often focusing on remote rural and First Nations experiences, are chosen to help facilitate discussion on HIV and hepatitis C stigma in the local context. Some of the most popular films that have been presented are: The Long Walk Home, California Syringe Access, Under the Skin and Kecia. Additionally, Blood Ties worked with a filmmaker to have a rural Yukon film produced. HIV YT is frequently presented and well received in rural Yukon communities.

Activity Five: Ongoing support

Besides conducting workshops during each visit, the Coordinator provides referrals and support to health and social service providers, who often do not have training in serving clients living with HIV and/or hepatitis C.