We all need to make sure our elders stay with us as long as possible. The objective of the Coming Full Circle training is to promote a more active and healthy lifestyle with the frail and disabled senior population in Aboriginal communities. NIICHRO's approach emphasizes assisting CHRs and family caregivers in motivating elder Aboriginal people to become more active by encouraging activities that include traditional lifestyles. The elder Aboriginal target group includes those who are frail, disabled, with chronic conditions, confined to wheelchairs or bedridden. The project methodology is as follows:

Conducting a review of programs, literature and resources on the frail and disabled older adults in Aboriginal communities. Preliminary research, discussions with other relevant agencies and our experience have indicated that there is little documentation to draw upon and so have determined that a needs assessment and data gathering from representative communities would be necessary.

Utilizing this data through the literature review, community consultation/needs assessment and guidance from a National Steering Committee composed of relevant agencies and two Aboriginal elders, training materials and a training program would be developed.

Producing a training manual, one 24-minute instructional/motivational video for those who have some infirmity to contend with, and resource materials. All materials will be produced in both English and French. Preliminary data and our experience have indicated that the most critical issue with the older frail Aboriginal persons is "motivation". The video would include interviews with the older frail or disabled Aboriginal persons, woven together to speak on the barriers they faced and how they overcame them.

Producing a 44-page English and French In Touch Magazine on the Coming Full Circle project. This document will be mailed out to the 1,000 Community Health Representatives and 400 other health professionals. The magazine will also be uploaded to NIICHRO's website and linked to appropriate sites.

Conducting a 3.5-day "Train the Trainers" session of 12 CHRs representative of all regions (both French and English) from across Canada to utilize the training manual and materials developed.

Providing a 3-day National Training Session (in English and French) to 275 CHRs from across Canada at the annual general meeting to be held in June 2003. Once again, the training materials developed by NIICHRO will be utilized.

Heidi Kuran, B.A. has been contracted by NIICHRO to complete the Literature Review, Community Consultation and needs assessment, In Touch magazine and training manual.

Charmaine Carvalho, who directed Spirit in Motion, will produce and direct the 24-minute video.

A project like Coming Full Circle needs to have input from key stakeholders who can help guide the direction and the integrity of the training. An effective, experienced Steering Committee was needed to help develop culturally relevant training tools and a training program for Community Health Representatives and other health professionals across Canada. As in the past, NIICHRO sought to work in partnership with the Centre for Activity and Ageing, University of Western Ontario, London and the Active Living Coalition for Older Adults, Toronto. In addition to ALCOA and the Centre for Activity and Ageing, NIICHRO looked for guidance from two Aboriginal elders.

The Steering Committee includes:

Linda Kremer, a physiotherapist and member of the Active Living Coalition for Older Adults.

Linda Kremer is an accomplished health-care professional with experience in management, program development, clinical practice and health promotion. She is experienced in varied and diverse areas of health care and health promotion and has lectured, presented for universities, private sector, and professional organizations and media. Linda has developed training manuals, teaching videotapes, and courses and contributed a chapter for a professional textbook. She has been a consultant to professional, government, and educational committees at the local, provincial, and national levels. Linda has held many positions as a physiotherapist and works specifically in geriatric care; she has worked in health promotion and exercise. Linda is an associate at the Centre for Health Promotion, University of Toronto. She is registered with the College of Physiotherapists of Ontario and is a member of the Canadian Physiotherapy Association as well as the Ontario Physiotherapy Association. Linda is the Ontario representative for the Gerontology Division, Canadian Physiotherapy Association.

Stephanie Luxton, Coordinator of Programs for the Frail and Elderly, University of Western Ontario

Stephanie Luxton is currently the Coordinator of Leadership Training related to Frail Older Adults at the Canadian Centre for Activity and Ageing. She received her Honours Bachelor of Science in Kinesiology from the University of Waterloo in 1994 and a Certificate in Organizational Learning and Development from Fanshawe College in 2001. The program in Organizational Development included practical experience in needs analysis, instructional design, facilitation and evaluation related to adult education. Stephanie has facilitated over 20 courses related to physical activity or rehabilitation of the elderly and has assisted in designing manuals and resource materials. She has experience in rehabilitation and fitness for the frail elderly in clinical, community and residential settings. Her most recent position before returning to the CCAA was in home care doing rehabilitation of the frail elderly under the guidance of a physiotherapist. In her past positions she has worked with clients from very diverse backgrounds and she is sensitive to the diverse needs of individuals.

Annie Evans, Community Health Representative, Inuit from Makkovik, Labrador

Annie has been a CHR for 16 years. She completed her training at the Community College in Goose Bay, Labrador, Mt. St. Vincent's, and Dalhousie in Nova Scotia. Although she is an elder, she continues to work and cannot think of retiring for a while yet. She has five children and ten grandchildren and remains very active in her community. Annie has been involved with NIICHRO since its first Annual General Meeting and Training Session in Calgary in 1986. She has helped NIICHRO on the HIV/AIDS project and now brings her experience to "Coming Full Circle".

Alice Smith, former Community Health Representative from Hagersville, Ontario

Alice Smith has lived in her community of Hagersville all her life. She is married and has three children and three grandchildren. Alice is a graduate of the Native Community Care Program of Mohawk College in Brantford. She has her CHR certification and began work as a CHR in 1977; Alice retired in 1999. As a CHR, Alice was involved in School and Community Health. The school programs she was involved in were: safety (bus, bicycle, home/fire, water), dental health, head lice control, immunization, nutrition education, and eye and hearing tests. She promoted, planned, prepared, and presented Community Prevention Programs and worked with the Environmental Health officers doing building and environmental inspections. Alice administered the CHR program on her reserve - a large, heavily populated reserve. She has attended various training conferences across Canada but her most recent activities involve supporting church organizations that provide financial and material aid to those who need it in Canada.

The first meeting of the National Steering Committee was held in Kahnawake, Quebec on January 14-15, 2002. At that meeting all participants agreed that focus groups should be conducted to get input from the frail and elderly in different communities in Canada. It was decided that an isolated northern community, an urban and a rural community should be consulted to get an effective cross-section of experiences. Linda and Stephanie, both in the field of physiotherapy, offered professional advice on types of safe movement. Annie and Alice, both CHRs, have personal experience of the daily problems that may occur with the Aboriginal frail elderly.

The second Steering Committee Meeting was held on May 18-19, 2002 in Vancouver, British Columbia. In addition to the Steering Committee, a delegation from the SHARE Award committee was also in attendance from the University of Pennsylvania and GlaxoSmithKline. This delegation included Hewitt Ashbridge, Gwen Yeo, and Vince Tookenay. The purpose of their visit was to evaluate the progress of the project and to assess the data collection and measures. It was also a way for the SHARE delegation to get to know the project team and hear about any barriers experienced in the research process. At that meeting, the results of the Literature Review and Community Consultation were discussed in greater detail. The Committee was able to ask questions about the experiences of the research team in the communities. There was a discussion about the development of the Coming Full Circle Training Manual and an outline of the manual was discussed. In addition, the Committee approved the video concept and script developed by Charmaine Carvalho.

Evaluation Process

With guidance from Gwen Yeo, the SHARE Award's evaluation consultant, The Coming Full Circle project will be professionally evaluated to confirm that the goals of the project are measurable and achieved. Karen McCulla, M.Ed., has been contracted to conduct the following:

An assessment of, and advice on the literature review, community needs assessment, and data collection methodology would be provided to the National Steering Committee, NIICHRO and staff persons.

A review of draft training manual, video production, resource materials, and In Touch Magazine by the evaluator to provide analysis and commentary for the final production of these documents.

A "tracking tool" will be developed so that NIICHRO will be able to access data from the Community Health Representatives and other health workers. This will provide information on the trainees when they return to their communities. That is, to what extent did they use the training, was it appropriate, and importantly, what is the reaction/impact on caregiver and the elderly Aboriginal client.

The development and implementation of a questionnaire/interview guide for the 12 trainers at the "Train the Trainers" session on the usefulness of the materials developed. The analysis of the data would be included in the final evaluation report and would provide guidance for the training tools and training before their final printing and production of the training kits.

The development and implementation of a questionnaire/interview guide for the 275 Community Health Representatives participating in the National Training Session. The analysis of the data would be included in the final evaluation report.

Develop and implement an interview guide for the National Steering Committee including a focus on the participation and collaboration of the partners and elders involved in the project.

Most importantly, the evaluator will interview selected elder Aboriginal persons who are frail and disabled with the aim of discovering how the training affected them.