Building social capital as a pathway to success:community development practices of an earlychildhood intervention program in Canada

HONGXIA SHAN1,2, NAZEEM MUHAJARINE1,3*,KRISTJANA LOPTSON1,4 and BONNIE JEFFERY1,5

1The Saskatchewan Population Health and Evaluation Research Unit, Saskatchewan, Canada,2Department of Educational Studies, University of British Columbia, Vancouver, British Columbia,Canada, 3Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon,Saskatchewan, Canada, 4Department of Political Sciences, University of Alberta, Edmonton, Alberta,Canada and 5Department of Social Work, University of Regina, Regina, Saskatchewan, Canada*Corresponding author. E-mail: nazeem.muhajarine@usask.ca

SUMMARY

In the last three decades, various concepts and strategieshave been developed to address social determinants ofhealth. This paper brings together the different focuses ofhealth promotion, and demonstrates that effective healthintervention programs need to be conducted at multiplelevels and fronts. Specifically, based on the evaluation ofKidsFirst, an early childhood intervention program inSaskatchewan, Canada, this paper presents the programpractices effective in enhancing the social capital andsocial cohesion at the community and institutional levels.The findings fall into three interconnected areas: strength-ening community fabric; building institutional socialcapital and bonding, linking and bridging. KidsFirst hasbrought the community together through conductingbroad and targeted community consultations, and devel-oping partnerships and collaborative relationships in anopen and transparent manner. It has also developed

institutional social capital through hiring locally and en-couraging staff to deepen connections with the communi-ties. Additionally, it has endeavoured to create conditionsthat enable vulnerable families to enhance connectednessamong themselves, link them to services and integratethem to the larger community. The program’s success,however, depends not only on the program’s local prac-tices, but also on the government’s central policy frame-work and commitment. In particular, the program’s focuson children’s healthy development easily resonated withlocal communities. Its endorsement of local and intersec-toral leadership has facilitated mobilizing communityresources and knowledge. Further, its commitment tolocal ownership of the program and structural flexibilityhas also determined the extent to which the programcould fit into the histories of local communities.

Key words: community development; social capital; evaluation research; intervention program

INTRODUCTION

Following the Ottawa Charter for HealthPromotion, various community-based conceptsand strategies have been developed in popula-tion health to address social determinants of

health (e.g. Ziglio et al., 2000; Wise and Signal,2000; Labonte, 2004). Concomitant with thetraditional community concepts, such as com-munity development, community empowermentand community capacity, there have emerged anumber of social concepts including social

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capital, social cohesion and social inclusion/exclusion. If the community-based notions haveshifted the focus of health promotion from indi-viduals to the community environments, thesocial concepts may have been instrumental indirecting attention to the higher orders of polit-ical systems and perhaps give us another reasonto attend to the community (Labonte, 2004).Corresponding to the conceptual expansion, thepast three decades have witnessed the emer-gence of ever more proactive health promotionstrategies, ranging from community capacitybuilding (e.g. Crisp et al., 2000; Laverack, 2003)to building alliances and intersectoral partner-ships (e.g. Gillies, 1998; Jones and Barry, 2011),as well as advocacy (Carlisle, 2000). Specific tothe Aboriginal people, a most vulnerable popu-lation, whose health is disproportionately im-pacted by cultural disruption, institutionalizedracism, colonialism and long-term social marginal-ization (St Denis, 2007; King, 2009), decolonizingapproaches (Mundel and Chapman, 2010) havealso been proposed to promote health in cultural-ly relevant manners. Echoing the expansive inter-ests of health promotion practices, the GlobalHealth Promotion Conference in Nairobi 2009(Lin et al., 2009) also proposed that health promo-tion strategy should address not only individualempowerment, but also community empower-ment, health systems strengthening, intersectoralaction, as well as building institutional and organ-izational capacity for health promotion.

This paper demonstrates that effective healthintervention needs to be conducted at multipleinstitutional and societal levels and fronts.Specifically, it presents a range of effective healthpromotion practices reported in our evaluationof KidsFirst, an early childhood interventionprogram serving vulnerable families in targetedareas in Saskatchewan, Canada. In the study, re-search participants repeatedly emphasized ‘rela-tionship building’ as a fundamental pathway forthe program to evolve and thrive. With this obser-vation, we organize our findings as they arerelated to enhancing social capital building atboth the institutional and community levels. Therest of the paper is divided into five sections. Thefirst section focuses on the conception of socialcapital that informed our data analysis. Thesecond and third sections introduce the KidsFirstprogram and the evaluation methods, respective-ly. The fourth section presents the research find-ings and the last is a discussion of the limitationsand implications of the findings.

SOCIAL CAPITAL AS A DETERMINANTOF HEALTH

Social capital is a notion that has recently beenintroduced to population health (Kawachi andBerkman, 2003; Szreter and Woolcock, 2004). It isa multilevel and multi-component concept gener-ally defined as a relational resource, such aspersonal and community networks, sense ofbelonging, civic engagement, norms of reciprocityand trust, which determines the quality of life, in-cluding our well-being and good health (e.g.Coleman, 1988; Putnam, 2000; Lin, 2001; Szreterand Woolcock, 2004). While the term, socialcapital, became well known through Coleman andPutnam’s work much earlier, our paper is directlyinformed by the writings of Wakefield and Poland(Wakefield and Poland, 2005) and Mignone andO’Neil (Mignone and O’Neil, 2005).

Wakefield and Poland (Wakefield and Poland,2005) have argued that social capital cannot beconceived in isolation from social, economic andpolitical structuring of inequality. They have iden-tified three constructs of social capital. The first,communitarian social capital, which followsPutnam’s tradition, refers to the norms and socialtrust and ties that facilitate cooperation formutual benefits (Putnam, 2000). The second is in-stitutional social capital. Woolcock and Narayan(2000) referred to institutional social capital asthe quality of formal institutions, including their‘internal coherence, credibility competence andexternal accountability to civil society’. Wakefieldand Poland (Wakefield and Poland, 2005) furtheremphasized the importance of ‘scaling up’ indi-vidual social ties program staff possess and usethese for organizational and community develop-ment purposes. The third is Bourdieu’s criticalconstruct (Bourdieu, 1979, 1986), which seessocial capital as resources accrued to the sociallyand economically privileged individuals andgroups. According to Bourdieu, differences inaccess to and control of social capital may explainwhy the same amount of economic and culturalcapital may mean different degrees of profit,powers and influence for different actors.Wakefield and Poland (Wakefield and Poland,2005) thus suggest that community developersconsider the duality (inclusivity and exclusivity)of social capital and consciously engage in trans-formative practices.

Building on Woolcock and Narayan’s work(2000), Mignone and O’Neil (Mignone andO’Neil, 2005) see three dimensions to social

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capital that are particularly relevant to Abori-ginal communities: bridging, bonding andlinkage. The notions of bonding and bridgingoriginated with Putnam (Putnam, 2000), whomaintained that among all of the dimensions ofsocial capital, the distinction between bridgingand bonding is the most important. Bondingrefers to the inward-looking social ties that re-inforce and strengthen group identity and bridg-ing to the outward-looking ties that overcomesocial cleavages. Woolcock and Narayan (2000)further pointed out that any entity, be it organi-zations, communities or state institutions, alonedo not possess all of the resources for change;therefore, it is important for these entities to belinked and synergized. For Aboriginal people,Mignone and O’Neil (Mignone and O’Neil,2005) define bonding as relations within individualAboriginal communities, bridging as the horizon-tal links between Aboriginal communities andother communities, and linkage as the connectionsbetween Aboriginal communities and state institu-tions and private/public corporations.

The above review shows that social capital isa relational resource within and between groupsthat can be cultivated, mobilized and trans-formed for the wellbeing of a community. Aswell, social capital is not solely about sharedvalues and norms; it is also about social andeconomic privileges and entitlements that areoften unevenly distributed. Further, social insti-tutions play an important role in mediating thedistribution and production of social capital.With this understanding of social capital inplace, we now turn to the KidsFirst program.

KidsFirst

KidsFirst is a provincial government initiated,community-based early childhood interventionprogram implemented in nine sites with highcommunity needs in Saskatchewan, Canada.The vision of the program is that vulnerablechildren enjoy a good start in life and benurtured and supported by caring families andcommunities. The aim of the program is toenhance existing services, fill service gaps andsupport front-line staff working with high-risk families (Saskatchewan Education, Health,Intergovernmental and Aboriginal Affairs &Social Services, 2001).

At its inception, each site formed a programmanagement committee with senior-level repre-sentatives from human service sectors such as

the health region, school divisions, social ser-vices and Aboriginal or Metis organizations.For each site, a community accountable partner,usually the health region or the school board,was designated. The program management com-mittee and the community partner then hired aprogram manager to coordinate the develop-ment of the program in each site. Working withthe management committee, program managersconsulted with individuals and organizations toidentify community needs and service gaps.They then formed partnerships with other orga-nizations, particularly service providers, byfunding and supplementing existing services forvulnerable families, such as home visitation,mental health and addictions counselling andearly learning and childcare.

Home visitation is the core component ofKidsFirst. Home visitors support families bymeeting their basic needs, sharing prenatal andparenting knowledge with them and linkingthem to services and to their communities.Most home visitors are hired from the localcommunity, and many are mothers who have atone time faced similar struggles as KidsFirstparents. All home visitors undergo standardprogram training, which is facilitated by theProvincial Early Childhood Development Unit(ECDU) of the Ministry of Education, thegovernment unit overseeing the program.

KidsFirst is a voluntary program for parentswith children from prenatal to age 5. Programparticipants are primarily identified throughin-hospital birth screenings. Some are referredby existing KidsFirst parents or social serviceproviders. Program eligibility is assessed basedon the presence of risk factors, including lowmaternal education level, maternal substanceabuse, mental health issues, low infant birthweight and financial or social instability. Theprogram targets at-risk families of all culturalbackgrounds, including women with Aboriginalheritage. Aboriginal people share with thegeneral population some common determinantsof health, such as income, education, employ-ment, social support and access to health ser-vices. Owing to colonialism and long-termmarginalization, they also face some Aboriginalspecific health factors (Kendall, 2001; St Denis,2007; King, 2009). Among others, the residen-tial school system in Canada, has not only dis-rupted family and community lives, but also ledto the loss of Aboriginal languages, knowledgeand traditions as well as devaluation of

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Aboriginal identities (Kirmayer et al., 2003;Aboriginal Healing Foundation, 2012). As aresult, compared with other populations,Aboriginal families and children may be morelikely to suffer from serious health issues thatare challenging to redress.

RESEARCH METHODS

Mixed methods research was conducted todetermine how the program has met its goalsand objectives (see Muhajarine et al., 2007); thequantitative study was conducted to measurethe short-term impacts KidsFirst has had onparticipating parents and children, while thequalitative study was designed to capture theprogram impacts that could not be captured bynumbers, and identify ways in which theprogram has taken effect. Research questionswere derived from the Evaluation Framework(see Muhajarine et al., 2007), which the researchteam developed collaboratively with theprogram staff and policy makers. Specifically,the qualitative study asked what impacts theprogram has had on parents, children and thecommunities, and what program policies andpractices contributed to the program outcomes(Muhajarine et al., 2010).

For the field research, researchers travelled toall nine sites between May and October 2009 toconduct interviews and focus groups, makeobservations and take field notes. As shown in

Table 1, semi-structured interviews were con-ducted with 28 home visitors, 15 home visitorsupervisors, each of the 9 program managers, 34KidsFirst clients and 1 Aboriginal Elder whoworked with the program. Additionally, 10 stafffocus groups were conducted with home visi-tors, supervisors and supporting staff, 7 withmanagement committees and 2 with a combin-ation of management committee and supportingagencies. A focus group was also conductedwith members of ECDU. Focus groups not onlyenabled us to learn about the program from theperspectives of various stakeholders efficiently,but also allowed us to observe the dynamics ofdifferent groups across sites. All research parti-cipants had been involved in the program for atleast 6 months at the time of the interviews.With the exception of the ECDU focus group,research participants were identified from acontact list provided by program managers.

In the study, research participants were askedto relay their experiences with the program, andpotential areas for program improvement, and toidentify changes in parenting practices and com-munity collaboration that have come about as aresult of the program. A separate interviewguide was used for KidsFirst parents, home visi-tors, home visitor supervisors and program man-agers. A separate focus group guide was used forKidsFirst staff, management committees, sup-porting agencies and ECDU (see Muhajarineet al., 2010). The diversity of our study partici-pants allowed us to capture different experiencesand perspectives as well as to enhance the reli-ability of the research findings.

Interviews and focus group discussions weretape recorded, transcribed verbatim and sentback to the research participants for checking.For data analysis, we adopted a basic interpret-ive qualitative approach, which is descriptiveand inferential in nature, focusing on uncoveringmeaning from research participants’ views(Merriam, 2002). With a basic interpretive quali-tative approach, data were ‘inductively analyzedto identify the recurring patterns or commonthemes that cut across the data’ (Merriam, 2002).ATLAS.ti, a qualitative data analysis tool, wasused for coding and analysis purposes.

Building social capital as a pathway to success:community development practices

In this section, from the lens of social capitalbuilding, we present KidsFirst policies and

Table 1: Interview and focus group participants

Interviews Focus groups

9 Program Managerinterviews

10 staff focus groups (2 in theNorth) consisting of homevisitors, home visitorsupervisors and support staff

31 parent interviews 7 supporting agency focusgroups

1 Aboriginal Elderinterview

7 management committeefocus groups

15 home visitorsupervisor interviews

2 combined supporting agency/management committeefocus groups

28 home visitorinterviews

1 Early ChildhoodDevelopment Unit (ECDU)focus group

Total number ofinterviews: 84

Total number of focus groups:27

Total number ofinterview participants:87

Total number of focus groupparticipants: 155

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practices that the research participants reportedto be effective in improving the life circum-stances of children. These practices are themat-ically summarized including strengthening thecommunity fabric, building institutional socialcapital and bonding, linking and bridging. Wealso highlight the overall program frameworkand policy commitments that are essential tothe success of the program, including the pro-gram’s goals to advance children’s health andwellbeing, intersectoral leadership and theprogram’s commitment to community planningand structural flexibility.

Strengthening the community fabric

By strengthening the community fabric, wemean that KidsFirst has brought the commu-nity together, cultivated communitarian socialcapital and improved institutional and serviceenvironments. In this respect, the program hasbenefited from broad and targeted communityconsultation, and building partnership andcollaborative relationship through transparentcommunications.

Conducting community consultation both broadlyand in a targeted manner. To develop theprogram, KidsFirst has reached out to serviceagencies and other organizational and insti-tutional bodies, as well as individual communitymembers, which, to a certain extent, has servedto bridge cleavages between KidsFirst familiesand other social groups across occupations,organizations and class lines. Through broadoutreach, KidsFirst made the program known tothe public, and raised the awareness of thecommunity with regard to children’s health; ithas also gained support from different organi-zations such as local fire departments, doctor’soffices, pharmaceutical manufacturers andbusiness owners. These organizations pooled theirefforts with KidsFirst by organizing fundraisingevents, donating medications, providing freeservices and spreading health information.

KidsFirst also conducted targeted outreach.For instance, in some sites, it was able to buildon existing interagency work where differentservice agencies had worked together to iden-tify community needs. Reportedly, where theprogram succeeded in building on communitymomentum, it has benefited from the synergy,leadership, knowledge, trust and relationships

that had been cultivated over the years withinthe community.

KidsFirst came to the tables [of the interagencygroup] looking for resources . . . everybody knewwhat the gaps were and . . . It is the process wehave gone through to build trust amongst theagencies, . . . that had brought us to where [theprogram is]. (Management Committee Member)

Targeted outreach also refers to focused com-munity consultation that KidsFirst conducted insome sites around particular issues.

I called together people in the community whowere experts in [specific areas]. . . when we weretalking about mental health, I had mental healthfolks in the community come together and provideus some advice about what kind of model wewanted and [which organization] we might want totake that. And when we did the home visitingpiece we had huge groups, . . . thirty people sittingaround a table talking about what were our chal-lenges and what were our strengths, and whatmight we do. And . . . we had families at thosetables. (Program Manager)

In focused community consultation, differentstakeholders were involved in discussing specificissues and services. This practice has helpedKidsFirst identify community needs and effect-ive service delivery models, and reorient exist-ing services by educating service providersabout the needs of the community. For instance,some agencies were initially critical of KidsFirstparents for not keeping their appointments.When they learned from home visitors and/orfamily members the different factors inhibitingfamilies from accessing services, they started tounderstand that the ways in which they providedservices might be part of the problem. With thisinsight, some organizations changed theirservice delivery methods. In one site, an agencybegan transporting families to and from theirappointments. In some other sites, communityagencies have started providing childcare, foodand transportation during their evening eventsand have since noted an increase in familyattendance in their programs.

Building partnerships and collaborative relati-onships. To bridge gaps in services, KidsFirstforms partnerships and works collaborativelywith service agencies, which may have helpedimprove the quality of institutional and serviceenvironments. One barrier obstructing

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inter-agency collaboration is territorialism (seeAltman et al., 1991). Some study participantssuggested that service organizations maybecome territorial when they are put in aposition to compete for the same pool offunding or when the policies, procedures andmandates of different institutions conflict.

With regard to partnership formation, thestudy shows, when KidsFirst selects its servicepartners in a transparent manner, it reducesconflict and competition among service organi-zations. Below are some effective practicesreported in one particular site:

We picked our partners like an interview process.So they came to the table and we had sort of alittle community panel and they presented whatthey thought they could bring to the program andthe families, and that was how we made our deci-sions. It was very transparent in the community.We had very good agencies say things like ‘. . . Iknow exactly what you’re looking for. You’vebeen transparent about that. We are not a good fitbut those folks that are applying are a good fit’.We didn’t have fallout from the decisions.

(Program Manager)

Of note, while interviewing typically accentu-ates power differences between the interviewerand the interviewees, and necessarily encoura-ges competition, by using the format of acommunity panel, the program created anopportunity for KidsFirst and the communityagencies to mutually assess needs and fits in anopen and transparent manner. As a result, theprogram was able to reach partnerships withselected agencies, without hurting its communitybases or relationship with other stakeholders.

Territorialism is an issue when KidsFirst staffworked together with other agencies and orga-nizations whose institutional mandates con-flicted with those of KidsFirst, as demonstratedin the following example:

[Their services were] butting up against ours andvice versa, and I’ve met with them and said ‘Lookour programs are designed to be in conflict witheach other so this is not a personality issues, it’s apolicy and procedural’ . . . for example we encour-age moms to spend that time after they have ababy to do the bonding and the attachmentwhereas [their] piece is they need to be movingforward . . . back into work or education at threemonths. We are designed to be in conflict.

(Program Manager)

In order to work through mistrust and conflictsdue to institutional differences, KidsFirst in thisparticular site convened community organizationsto discuss issues and to produce common proto-cols. We noted that dialogue and open commu-nications helped draw healthy work boundariesfor different organizations, and foster mutualunderstanding among individual workers, whichenabled them to work across institutionalconstraints.

Building institutional social capital

To integrate the program into local communities,KidsFirst puts great value on staff’s personal tieswith both parents and other organizations withinthe community. Staff’s individual relationshipswith other members in their respective commu-nities constitute a form of institutional socialcapital, an essential element for the success ofthe program.

Scaling up individual ties. Relationship building,according to many research participants, iscrucial to the success of the program. Parentrespondents especially valued their relationshipswith home visitors. Some referred to homevisitors as ‘friends’, and some saw them asfamily members. Some parents indicated emo-tional investment when they decided to let inhome visitors. One parent, for instance, felthurt when she had to change home visitors.

I kinda got shuffled around from three differenthome visitors the first while which was a little diffi-cult ‘cause you start opening up to one person, getused to her and then you gotta start opening upagain with the next person. (Parent)

Home visitors are the program ambassadorswho work directly with vulnerable families. Toengage and retain parents, KidsFirst has made apoint to match families with home visitors withwhom they can connect at a personal level. Ithas also hired home visitors from the local com-munities; many of the home visitors had similarbackgrounds as those of the parents on theprogram. Some sites also intentionally hiredCree speakers and elders to work withAboriginal parents.

While the relationships and connectionshome visitors establish with parents are scaledup into institutional social capital, in theprocess, home visitors may run the risk ofexperiencing burnout. It is not uncommon for

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KidsFirst families to call home visitors andshow up at their homes for help outside of theirworking hours, which was reported to be aproblem for a number of home visitors. As well,given the relational and emotional work homevisitors conduct, and the extremely difficult cir-cumstances they witness, some home visitorshave also had traumatic experiences.

Another aspect of home visitors’ relationalwork is to develop formal and informal socialrelations with other service providers whilelinking families to services. Through establish-ing these relationships, home visitors sometimesare able to make changes in how other serviceproviders deliver services.

It should be noted that it is not only homevisitors, but also KidsFirst staff at all levels whoengage in relationship building within the com-munity. In sites where the program is reportedto be a success, research participants describedgood relationships between KidsFirst and otherservice organizations, and researchers observedrapport and healthy dynamics among theprogram staff who participated in focus groupdiscussions.

Hiring staff locally and community develop-ment. When KidsFirst expands its institutionalsocial capital through hiring staff locally, itdirectly contributes to community development.In particular, it opens up employment andother life opportunities for the hired staff.

Well . . . one of the things that we didn’t expect tohappen . . . was [that] we’ve had a huge impact onour home visitors and their families . . . As they’rebeing trained, they’re learning all kinds of new in-formation. So I think we’re seeing a ripple[effect], which is very good . . . Many of the homevisitors come from the neighbourhoods that we’re[serving],. . . from a community development per-spective, that’s been a really unanticipated goodie.Many of our home visitors who leave the programare leaving to go back to school. We’ve got severalin faculty of education, [and] in faculty of socialwork . . . (Program Manager)

While the program provides personal growthopportunities to its staff, the day-to-day workdoes not come without challenge for the homevisitors, especially those without formal trainingin social services. For instance, some home visi-tors reported difficulty in filling out paper workand entering information on the computerizedinformation management system. Some also

found it a challenge to deal with extremelyhigh-risk families. These findings call for add-itional customized training programs to bettermeet the needs of the staff.

Bonding, linking and bridging

Families play a central role in shaping children’sdevelopment. Parents’ access to services, socialnetworks and opportunities for social and com-munity participation are all key determinants ofhealth (e.g. Lynch, 2000). KidsFirst has pro-vided families with assistance ranging frommeeting their basic needs, to a greater degreeof integration within the community. From theperspective of social capital development, theprogram has played a significant role in creatingbonding relationships among the families,linking them to services and bridging themmore broadly to the community at large. Whilecreating bonding, linking and bridging condi-tions is important for all KidsFirst families, itmay be particularly relevant for the Aboriginalfamilies whose ‘stock’ of social capital has beennegatively affected by social, cultural, and polit-ical marginalization and economic deprivationthroughout history (e.g. Mignone and O’Neil,2005).

Creating bonding opportunities. KidsFirst acrosssites has created opportunities for the familiesto develop relationships and support networkswith other families. One parent said:

KidsFirst also gave us . . . another social networkbecause there were other families in the programthat you went with your children . . . now thesefamilies are people who are friends of ours.

(Parent)

When engaging Aboriginal families, KidsFirsthas also provided culturally relevant programsand services. For instance, in KidsFirst North,which serves a predominantly Aboriginal popu-lation, the program has been working to re-establish the parenting knowledge lost due tothe residential school system. It has organizedcultural activities such as retreats for parentsand families where elders reconnect the youngparents with land- and lake-based activities.During these gatherings, parents learn tradition-al and holistic approaches to family life and par-enting. Great-grandparents who have witnessedthe disruption of language transmission to theirgrandchildren teach Cree and Dene at these

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events and within their extended family homes.In other sites, the program has also made con-scious efforts to integrate culturally specific pro-gramming to make KidsFirst more relevant toclients with Aboriginal backgrounds. One homevisitor reported using Aboriginal prenatal calen-dars when working with Aboriginal women. Insome communities, home visitation services arealso offered in Cree or Dene, which has helpeda number of families overcome language bar-riers, and supported the use of these languagesin the community. Through such activities, theprogram works to encourage cultural continuityfor Aboriginal people, which may strengthentheir cultural identity and sense of community.

Linking families to services. The study revealedthat many KidsFirst parents do not trust stateinstitutions and lack the means, knowledge andconfidence to seek out help on their own.KidsFirst has played a central role in linkingparents with health and other services. It hasprovided referrals and arranged transportationand childcare so that parents can keep theirappointments. Home visitors also accompaniedparents when they accessed services andmodelled ways of self-advocacy vis-a-visinstitutions. This is the type of support thatVygotsky termed as ‘scaffolding’ (Vygotsky,1978), where home visitors support families touse different services and then, when parentsfeel more confident using services on their own,gradually withdraw support.

A parent described the support she receivedthis way:

I [didn’t] trust doctors with me . . . [then] my homevisitor came with me and held my hand through itall. I’m able to go on my own now. (Parent)

While linking families to services brings us backto the reality that KidsFirst, a government-funded project, represents a state apparatusafter all, the ways in which KidsFirst builds lin-kages between the individual and the institu-tional suggests an orientation towardscommunity development. Instead of subjectingfamilies to institutional management, theprogram strives to develop families’ confidenceto independently use, navigate and negotiatewithin the service system.

[The home visitor has helped me stand up formyself ] . . . [I]f I ever had to take my daughter [tothe doctor’s],. . . and I knew there was something

wrong,. . . [If I was told], ‘. . . there’s nothingwrong’, I [would] just stick to [my] guns and makesure things [get] checked out. (Parent)

On the other hand, KidsFirst has also combatedsocial marginalization through advocating forthe families within governmental institutions.The program has influenced the ways in whichother services agencies work with the familiesthrough informing, if not educating, them of thereality of KidsFirst families. In some othercases, the program has directly influenced thepolicies and practices of governmental depart-ments. For instance, housing safety was identi-fied as a concern for families. In response, inone site, KidsFirst brought housing concerns tothe local municipality’s attention. At anothersite, involvement from KidsFirst and other localagencies led to the development of a bylaw toregulate property standards within the local mu-nicipality. Such advocacy work is significant inchallenging the structural exclusion that parentsmay experience.

Bridging families to the community life. Givenlong-term poverty, social isolation and in someinstances, mental health and addiction issues,as well as associated low self-confidence andself-efficacy, many KidsFirst families do notparticipate in community activities and affairs.KidsFirst has contributed to breaking this cycleby enabling their voices, and expanding theirsocial opportunities in the community.

In some sites, it has systematically involvedfamilies in program development, which hasenabled them to participate in the decision-making process within the community.

With the community development work . . . there’s[a] focus . . . on . . . strategizing and thinking abouttapping into the voice of actual communitymembers; of families who’ve been [an] influencefor their children, to be that voice . . . [We use]focus groups, and we use a model calledDevelopmental Assets, which is a positive frame-work for families in communities to look at howchildren are thriving in your community. And it’sstrength-based. (Management Committee Member)

KidsFirst not only involves families in the initialprogram consultation process, but alsoencourages them to be part of the program inmany other capacities. For instance, in one site,some families were invited to sit on hiring com-mittees. In another site, some families were

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involved in streamlining services. In yet anothersite, because the program has been open andwelcoming to families’ voices, some familymembers have reportedly developed a sense ofownership over the program.

They’re phoning . . . to make a suggestion,. . . theyphone with ‘Have you ever thought’ and . . . it’sbecause we’ve provided that kind of welcoming. . .‘It’s your program’ right . . . so ‘What kind ofprogram will work for you?’ We’ve had familieswho’ve actually influenced some of our practice.

(Program Manager)

While what is presented here is from the man-agement perspective, it does suggest that themanagement recognizes the significance ofhaving parents driving the development of theprogram.

While encouraging voices from participatingfamilies in the community, KidsFirst has alsoworked to bridge families to the communitybeyond the program. For instance, through mea-sures such as providing transportation, it hasencouraged and enabled KidsFirst families tojoin family-centred and community-based socialactivities where they had new opportunities tosocialize and connect. Through participating inthese activities, some families were able toexpand their own social networks. Some alsostarted giving back to the community by volun-teering in different programs. A few even tookon leadership roles within their community. Insome cases, KidsFirst has also played an instru-mental role in helping parents return to schooland to the labour market. What needs to beemphasized is that expanding the social capitalat the community level is not a one-way street.Instead, the program in some sites has alsoundertaken community education and culturaltraining to break down racial stereotypes aboutAboriginal populations, and to explore someunderlying causes of poverty and poor healthassociated with these populations.

Program framework and policy commitment

The success of KidsFirst depends not only onthe program’s local practices, but also on theoverall program framework and policy commit-ment. The study showed that the program’sfocus on children’s health, its intersectoral lead-ership framework, and its commitment to localplanning and flexibility constituted structuralconditions for the success of the program.

Community development programs plannedand implemented from above often encounter re-sistance because they may conflict with agendasand interests of the community (Carlisle, 2010).KidsFirst staff across sites reported that it waseasy to find allies within the community becausepartners could easily support the program’s focuson children’s wellbeing. Intersectoral leadershipwas also emphasized as an important successfactor; it facilitated KidsFirst tapping into andmobilizing the expertise and resources from keysectors within the community. In sites wheremanagement staff from different organizationsare involved in KidsFirst’s management commit-tee, reportedly, information and messages fromKidsFirst get communicated efficiently to otherorganizations, and this could lead to relativelyquick feedback, actions and changes. One draw-back of intersectoral leadership, however, assome of the research participants mentioned, isthat it may have added layers of accountabilitythat at times unnecessarily prolonged thedecision-making process for the program.

Policy commitment to local planning andflexibility in program structure also determinesthe extent to which KidsFirst integrates into thehistory and realities of local communities. Manyresearch participants believed that the strengthof the program is that while the governmentsets the major guidelines, it has left open theopportunity for communities to shape theirprogram to suit their local histories and con-texts. As a result, the program has evolved dif-ferently from site to site, which reflects theparticular needs, local resources, history andleadership in different communities.

It needs to be raised that the program frame-work may not always be facilitative of the devel-opment of the program locally. Prior to thelaunching of KidsFirst, collective inter-agencywork had existed in some sites. Reportedly,when the program framework was aligned withthe existing capacity, infrastructure and commu-nity momentum in particular sites, it gained astrong head start in program implementation. Incontrast, where the program mandate contra-dicted what the local community believed to bethe most effective strategies, it had a hard timegathering community support, and the establish-ment of the program was delayed. For example,in one site, the local community was planningto build additional facilities to serve all families.This measure did not fit within the KidsFirstframework, which does not typically allow

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stand-alone projects independent of existing ser-vices. In this case, the local people involved inthe program planning process felt that their pri-orities were not taken into account, and as aresult, lost interest in engaging further withKidsFirst. It took the program a long time toremedy the damage done.

CONCLUSION, LIMITATIONS ANDIMPLICATIONS

Through the lens of social capital building, in thispaper, we presented a set of effective communitydevelopment policies and practices reported bythe research participants in our evaluation ofKidsFirst. The notion of social capital was not inthe original evaluation framework. Yet, in thestudy, ‘relationship building’ was a recurringtheme in the interview data collected. Programstaff believed that relationship building withparents, with community organizations and withcommunity members at large was most challen-ging, and yet it was an essential pathway to thesuccess of the program. While some KidsFirstparticipants joined the program for tangible bene-fits such as food coupons and free transportation,many highly cherished the personal relationshipthey were able to build through the program.Further, although the evaluation focused on theshort-term impacts of KidsFirst, particularly in re-lation to children’s developmental outcomes, wewould suggest that the long-term impact of theprogram is contingent on how the program is ableto enhance social capital at the individual, com-munity and institutional levels.

The findings presented are not without theirlimitations. First, not all the practices illustratedare evident across all nine KidsFirst sites. Weelicited best practices from the research partici-pants, but did not explore if the same practiceswere employed across sites, or if there was con-sensus among research participants regardingthe effectiveness of particular practices.Secondly, given that this paper focuses on theprogram policies and practices, KidsFirst staffwho provided us with detailed descriptions ofthe program have had more of a presence andvoice than the parents. Despite the limitations,this paper has significant implications for healthpromotion programs in other settings. To startwith, echoing WHO’s call for multidimensionalaction, we suggest that effective health promo-tional practices need to be implemented at

different levels and fronts. In the study, effect-ive practices are not only about empowering in-dividual parents in vulnerable families, they arealso about building social cohesion among thecommunity members, building partnerships andintersectoral collaboration at the institutionallevels, advocating for the disempowered, as wellas providing culturally relevant services. Thesehealth promotion strategies are not parallel ordiscrete practices. Rather, they interconnect andcoalesce around building capacity and socialcapital among individuals, institutions andcommunities. We therefore hope to sensitizecommunity developers and researchers to thesignificance of the everyday activity of relation-ship and social capital building.

To enable the vulnerable individuals todevelop social capital, it is important for healthpromotion programs to recognize both theirbasic needs and their needs for social connec-tion and space. Further, when programs helpenlarge the social space for marginalized popu-lations, they embark on a project that is notsolely about social cohesion. Given the unevendistribution of social capital, which often servesto exclude, health promotion programs may alsoneed to tackle fundamental inequalities inpeople’s access to information, resources, ser-vices and community membership. Should theprograms manage to advocate for the margina-lized and engage the larger community in thisproject, they would be working to enhance thesocial capital at the community level, and con-tributing to the common well-being of the com-munity. To build social capital in communitieswhere Aboriginal people are involved, it is alsoimportant for the program to be culturally rele-vant and to explicitly take on a decolonizingapproach. In the case of KidsFirst, consciousefforts have been made to re-engage and recon-nect Aboriginal families with Aboriginal lan-guages and traditions, which may have helpedaffirm the cultural identities of these families.

The study also notes that for a community-based program directed from above, building in-stitutional social capital through scaling up indi-vidual staff’s local connections may beinstrumental for the program’s success andlonger term sustainability in the local commu-nity. Hiring local community members andencouraging all staff to develop relationshipsin the community therefore are of strategicimportance. Management, however, needs torecognize that additional workload and worker

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burnout may result due to the blurring ofprivate and public lives for the staff. Specializedtraining may need to be provided to effectivelysupport staff. Finally, we reiterate that socialcapital is a crucial determinant as well as medi-ator of health that can be addressed throughmulti-pronged health intervention programs.We consider this paper one among many thatare needed to deepen our understanding ofcommunity-based interventions to promotehealth equity through enhancing social capitalat multiple and intersecting levels—individual,institutional and community.

ACKNOWLEDGEMENTS

We acknowledge the insights, as well as the fi-nancial contributions, provided by the EarlyChildhood Development Unit (Gail Russell,Gary Shepherd, Rob Gates, WendyMoellenbeck and Murray Skulmoski) and eachof the nine KidsFirst program sites. We alsothank the KidsFirst program managers, the staffat all sites and all those who participated in theinterviews and focus groups for providing thestories and experiences which formed the sub-stance of this study. This study was developedwith the guidance, support and contributions ofthe many members of the KidsFirst EvaluationTeam. This includes the following KidsFirst inves-tigators: Nazeem Muhajarine (PI, nazeem.muha-jarine@usask.ca for inquiries about the study),Angela Bowen, Jody Glacken, Kathryn Green,Bonnie Jeffery, Thomas McIntosh, DavidRosenbluth, Nazmi Sari as well as the followingresearch staff: Darren Nickel, Taban Leggett,Fleur Macqueen Smith, Hongxia Shan andRobert Nesdole. Additionally, we recognize thework of Julia Hardy, Jillian Lunn, Karen Smith,Hayley Turnbull, Kristjana Loptson, KathleenMcMullin and Taban Taban Leggett in theprocess of data collection for this study.

FUNDING

This project was supported in part byfunding received from the Canadian PopulationHealth Initiative-Canadian Institute for HealthInformation and the Government ofSaskatchewan. All errors and interpretations arethe responsibility of the authors and are notnecessarily the views of the funding agencies.

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