Building Connections: Final Report

In 2015, with financial support from the Public Health Agency of Canada’s Supporting the Health of Survivors of Family Violence Investment, Mothercraft launched Building Connections. The Public Health Agency of Canada provided $2,216,873 from October 15, 2015 to March 31, 2021 for this initiative. We would also like to acknowledge the in-kind contributions of our partners in this initiative, including Mothercraft/Breaking the Cycle, Children’s Aid Society of Toronto, Catholic Children’s Aid Society of Toronto, Toronto Public Health, Toronto Western Hospital – Woman’s Own Detox, St. Joseph’s Health Centre, and Hospital for Sick Children and the Ministry of Community Safety and Correctional Services. 

The goal of Building Connections

Was to enhance the capacity of service providers working in the Public Health Agency of Canada’s (PHAC) Community Action Program for Children (CAPC), Canada Prenatal Nutrition Project (CPNP), and Aboriginal Head Start in Urban and Northern Communities (AHSUNC) projects to identify and respond to mothers and young children impacted by interpersonal violence (IPV) and child maltreatment.   

The objectives of Building Connections were:

  1. To build awareness, capacity and confidence among CAPC/CPNP/AHSUNC project staff to respond to IPV using trauma-informed and relational approaches. 
  2. To train and provide consultation to facilitators in the delivery and evaluation of the Connections intervention. 
  3. To deliver the Connections intervention to 400 participants in approximately 30 CAPC/CPNP/ AHSUNC sites across Canada. 
  4. To evaluate the implementation of the intervention, and to translate and disseminate the knowledge developed from the initiative broadly and to a wide range of audiences.

 

The background for Building Connections:

Since 1995, Mothercraft has delivered Breaking the Cycle (BTC), one of Canada’s first prevention and early intervention programs for pregnant and parenting women using substances, and their young children 0 – 6 years.  Funded by the PHAC’s CAPC and CPNP programs, BTC operates through a formal multi-sectoral partnership representing child welfare, addiction treatment, public health, addictions medicine, corrections and probation, obstetrics, mental health, developmental paediatrics, child care, children’s mental health, and infant/child development. Trauma-informed, developmental-relational and attachment-based frameworks guide interventions and approaches. In 2006, BTC developed Connections in response to the needs of mothers and children in the program.   

Connections - a group intervention for mothers and children experiencing violence in relationships:

Connections is a “two-generation”, trauma-informed group intervention that helps mothers reflect on how their experiences of traumatic relationships (i.e., child abuse, relationship violence) have affected: (1) the development of their own sense of self; (2) the relationships they have established over the course of their lives; and (3) the relationships they create with their own children. The intervention addresses the mother’s needs, the child's needs, and their relationship needs.   Providing supports early in the mother-child relationship is critical to interrupting cycles of trauma, and to establishing safe, healthy relationship patterns between mother and child. Designed to be delivered in the context of holistic programs that offer ancillary supports, Connections is a manualized 6-week group intervention available in English and French, and adapted for Indigenous communities.  All three manuals are available on the Mothercraft website. Connections has been delivered at Breaking the Cycle since 2006.  An early evaluation of the intervention confirmed positive outcomes for the mother, the child, and the mother-child relationship.  

Activities and key findings of Building Connections were:

1. Dissemination of resources and training to all 800+ CAPC/CPNP/AHSUNC projects.  

A resource manual and training webinar were designed to increase awareness and knowledge on IPV, trauma-informed/relational approaches, and application of these frameworks.   

  • The Resource Manual Building Connections:  Supporting Community-Based Projects to Address Interpersonal Violence and Child Maltreatment/Créer Des Liens:  soutenier les programmes communautaires pour lutter contre la violence interperssonnelle et la maltraitance des enfants was mailed to 806 CAPC/CPNP/AHSUNC projects in every province and territory.  The English and French resource manuals are available on the Mothercraft website.  
  • The National Training Webinar. Building Connections:  Using Trauma-Informed and Relational Approaches to Help women and Children Experiencing Interpersonal Violence/Créer des liens:  Utiliser des approaches axées sur les traumatismes et sur les relations pour aider les femmes et les enfants qui vivent de la violence interpersonnelle was delivered live to all CAPC/CPNP/AHSUNC projects with almost 300 registrants from projects representing every Canadian province and territory.   The webinar was archived in English and French on the Mothercraft website. 

Key findings:  

  • Over 700 additional resource manuals were requested by projects or their community partners, for a total of 1,520 resource manuals disseminated during the course of the initiative.  
  • Participants reported significant increases in their awareness, capacity, and confidence to identify and respond to IPV-related issues after, compared to before, watching the training webinar. There were also high levels of satisfaction reported. 

CAPC/CPNP/AHSUNC projects who watched the training webinar and indicated an interest in additional training received the Your Starting Point Story Readiness Assessment Tool, which they were invited to complete and submit.  The YSPS tool was used to select a subset of projects who would receive the certified Connections training and implement the intervention in their communities. In collaboration with an Indigenous researcher, the YSPS was modified to incorporate items and language applicable specifically for Indigenous communities (Your Aboriginal Starting Point Story – YASPS). There was an aim to achieve geographic, cultural and linguistic representation among projects selected for certified training and intervention delivery.   All other inclusion criteria being equal, projects that promoted representation along these dimensions were selected. 

2. Connections certified training and community of practice

Connections certified training was delivered to 75 facilitators from 34 projects and communities during 8 training sessions that were held between January 2017 and June 2019.  Three to four projects were trained per session, with two staff from each invited project participating in an intensive 3-1/2 day training at BTC in Toronto.  An Indigenous-specific certified training was held in June 2018 for 8 training delegates from 4 AHSUNC projects.  The training was based on the Indigenous Connections intervention manual and the training curriculum was adapted by an Indigenous partner and co-delivered with Indigenous trainers and a healer.   

Key findings: 

  • Of the 48 YSPSs assessed, 31 CAPC/CPNP projects were accepted and invited to attend the training (one declined due to scheduling) for a total of 30 CAPC/CPNP projects trained. As such, 97% of accepted applicants attended training. 
  • 4 YASPSs were assessed and accepted; those AHSUNC projects attended the training (100%).  

The Connections Community of Practice (CCP) was held weekly from March 2017 – March 2020, and was available to all certified facilitators after they completed the training.  The purpose was to expand and extend training concepts; to promote fidelity of the intervention and evaluation; to facilitate sharing of information, experiences and learning; to maintain and nurture relationships among certified facilitators; and to support the delivery of the intervention.  A virtual resource sharing platform was created to share materials, documents and resources related to Connections among CCP members. 

Key findings: 

  • Certified Facilitators reported very high levels of satisfaction with the CCP, both on a weekly basis and overall. 

For a list of participating CAPC/CPNP/AHSUNC projects and detailed evaluation of the certified training and CCP, see the Evaluation Report. 

3. Delivery of connections intervention

The Connections intervention was delivered in 28 communities across Canada from January 2017 – March 2020.  

Key findings: 

  • 87% of CAPC/CPNP projects whose staff received certified training delivered the Connections intervention.  Five community‐based projects implemented the intervention 5 times during the funding period, two projects implemented the intervention 4 times, six projects implemented the intervention 3 times, six projects implemented the intervention twice, and seven projects implemented the intervention once. The remaining four projects did not deliver the intervention.   
  • Two AHSUNC projects implemented the intervention once and two did not deliver the intervention. The uptake and implementation of the Connections intervention delivery was 50% for AHSUNC projects. 

For a comprehensive description of the screening process for selecting women to participate in the Connections intervention, see the Evaluation Report and related academic paper. 

4. Evaluation and knowledge dissemination. 

Building Connections was evaluated in partnership with CAPC/CPNP/AHSUNC projects in 34 intervention sites.  From 2015 – 2021, learnings were translated locally, nationally, and internationally to a broad range of audiences including service providers, researchers and policy makers.   

Key findings: 

  • A summary of activities including knowledge products, presentations, academic papers and reports is available in the Evaluation Report. 

Project outcomes for Building Connections:

During this initiative a number of processes were developed in order to conduct the evaluation in a manner that is consistent with relational, trauma-informed practices. For a comprehensive description of the frameworks and practices used, see the Evaluation Report and related academic papers. 

1. Outcomes for certified facilitators.  

  • Facilitators described positive changes in their awareness, competency, collaborative practice, and safety considerations in their own work with families facing IPV, as a result of participating in Building Connections.   
  • Facilitators also reported an unexpected impact for CAPC/CPNP/AHSUNC projects at an organizational level related to IPV awareness, competency, and collaborative work within the organization and the larger community 
  • In addition, AHSUNC certified facilitators described feeling respected, and that the Connections training was culturally relevant and safe. 

2. Outcomes for connections participants – CAPC/CPNP. 

  • 383 women participated in the Connections intervention. There were evaluation data available for 310 women and of these, 248 completed the intervention (an intervention completion rate of 80%).  
  • In the outcome measures assessed before and after participation in the group, women endorsed significant changes in all areas including: higher self-esteem, self-efficacy, ability to experience closeness in relationships, ability to depend on others in relationships, knowledge of services in the community, and an understanding of concepts related to IPV. Women also reported lower anxiety in relationships and parenting stress. 
  • Women reported very high ratings of satisfaction for Connections, both on a weekly basis and at the end of the intervention. 
  • A subset of women agreed to be contacted for follow-up evaluation research and in many cases these positive outcome were maintained over time, with specific patterns identified.  
  • Women described the impact that Connections had on their sense of self (e.g., forgiveness, healing, self-care, self-esteem, and empowerment); relationships (making changes to and ending unhealthy relationships); parenting; and, the importance of using supports available to them through their community CAPC/CPNP projects. 

3. Outcomes for connections participants – AHSUNC. 

  • Twelve women enrolled and 5 women completed the Connections intervention in AHSUNC projects and, based on the 3 women who completed evaluation measures before and after the group, all changes were reported in the desired direction.   
  • Indigenous women reported high satisfaction with the usefulness of the information they received, with feeling safe and supported, and that the curriculum was culturally relevant.
  • Women described learning to love themselves, feeling less guilt and shame, making healthier choices in relationships, and becoming more empathic and supportive towards their children.

4. Outcomes related to efficacy.

  • There were very few significant differences in the impact of the initiative based on the location of implementation. Regardless of population centre size, or geographic location, Connections was delivered with consistent success and resulted in high satisfaction from facilitators and women attending CAPC/CPNP/AHSUNC projects across Canada. 

The success of Building Connections was based on five key principles:

  1. Understanding and ensuring the readiness of communities, projects, facilitators, and women to deliver and participate in the Building Connections initiative. 
  2. Highlighting safety through trauma-informed principles embedded in the processes of engagement, selection, training, delivery, and evaluation of Building Connections.
  3. Focussing on relational approaches to develop and maintain partnerships with CAPC/CPNP/ AHSUNC projects and to support the use of relational approaches with families experiencing IPV. 
  4. Emphasizing fidelity by providing the certified training at BTC and maintaining relationships with projects through the weekly CCP.  In this way, efficacy of the Connections intervention and evaluation could be maintained, while respecting the local wisdom developed in CAPC/CPNP/ AHSUNC projects and communities across Canada.  
  5. Recognizing the unique strengths and capacities of CAPC/CPNP/AHSUNC projects to support mothers and children affected by interpersonal violence. 

 

Beyond Building Connections:

The following project deliverables will be self-sustaining and available on the Mothercraft website beyond the completion of this contribution agreement:  

  • The resource manual: Building Connections: Supporting Community-Based Projects to Address Interpersonal Violence and Child Maltreatment  
  • The intervention manual: Connections: A Group Intervention for Mothers and Children Experiencing Violence in Relationships (English, French and adaptation for Aboriginal communities)  
  • Archived training webinar: Building Connections: Using Trauma-Informed and Relational Approaches to Help Women and Children Experiencing Interpersonal Violence  
  • Final technical report: Building Connections to Support Mothers and Children Affected by Interpersonal Violence: The Evaluation Report 
  • Final plain language report: Building Connections for Healthy Relationships:  What We Learned 
  • 5 published research papers  

Additionally, 75 certified facilitators can continue to deliver the Connections intervention, train others to do so, promote trauma-informed and relational approaches within their organizations, and develop partnerships and collaborations to promote capacity to address IPV in communities across Canada. 

Lasting Impact of Building Connections

The Lasting Impact of Building Connections will be its contribution to the literature regarding mothers and young children affected by IPV, and the demonstration of the significant capacity of the Public Health Agency of Canada’s CAPC/CPNP/AHSUNC projects to implement an effective IPV intervention using trauma-informed and relational approaches.