Opening Doors Initiative - Ministry of Health and Long ...health.gov.on.ca/.../reports_publications/opening_doors_report.pdf · The formal survey evaluation of the Opening Doors Counselling

Opening Doors Initiative

Program Evaluation Report for theAIDS Bureau, Community Health Unit

Ministry of Health and Long-Term Care

Project 2006-05-007

Blair Henry, BSc. MTSPrincipal Evaluation

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Acknowledgements Ethical Affairs wishes to acknowledge the following individuals and organizations for their contribution to Opening Doors Counseling Initiative- Evaluation Report 2006. The author is particularly thankful to the support and guidance from the staff at the Ministry of Health and Long-Term Care: AIDS Bureau, who funded and provided leadership on this project. In particular: Joanne Lush, Frank McGee, Ken English, Saoussan Askar, and James Jezioro. Recognition of support and thanks in the identification of relevant stakeholders to participate in the actual survey goes out to all of the Opening Doors Provincial Representatives: Elaine Myers, Janet Dawson, John MacTavish, Kim Dolan, Lori Lucier, Marilyn Weller, Michael Sobota, Michelle Ball, Patrick Hooey, Richard Rainville, Gail Linklater, Peter Richtig, Vicki Kett, Tom Hammond, and Rajendra Maharaj. Access to participants and the level of survey participation would not have been possible without their generous support of time and resources. A special note of thanks is extended to Bruce Schwartzentruber, a Research Consultant, for his help in the development of the survey tools and the collation of the results; Ms. June Galbraith for her transcription of hard copy surveys into the online survey tool, and to Base Two Media for the design of this cover. Please note that the analyses and conclusions in the present report document do not necessarily reflect those of the individuals or organizations mentioned above.

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Executive Summary and Recommendations The formal survey evaluation of the Opening Doors Counselling Initiative (ODCI) was completed in the late fall of 2006; and the findings of this evaluation are presented in the enclosed report. A preliminary draft report was issued in December 2006. However, in follow-up to this report, it was recommended that a meeting of the Opening Doors Regional Representatives be held in Toronto to present and discuss the findings of this study and to assemble a set of recommendations for presentation to the AIDS Bureau for final consideration. This Executive Summary is the presentation of the recommendations and conclusions drawn from the meeting held on March 21, 2007. A Survey Participation # Surveys

Mailed out # Surveys Received

% Participation

Banking Agency

15 9 60

Planning Committee

67 41 61

Conference Participants

564 205 36

The above participation percentiles are considered average (36%) to very good (60%) for this design of survey. However, the overall rate of participation, for both the Banking Agency and the Conference Participants are low, and any interpretation of results should be accorded this consideration. B Regional Initiatives: Overview The following table outlines, in very general terms, the range of ODCI conferences held across the province. This information is based on the statistics collected from 2005/06. As noted variation between regions exist in terms of timing, duration, cost and use of paid conference coordination staff.

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Region # Of

conference attendees

Total Conference Cost ($)

Cost per person

Length of conference (days)

Paid Coordinator

Time

Central East

70 23K 330 2.5 No Oct

North West

80 30 375 2 Yes Oct

North East

60 35.5 590 2 Yes Oct

Eastern

163 40 245 3 No April

Toronto

47 15.3 325 1 Yes Sept

Central West

105 22 210 2 No Nov

South West

75 12.3 164 1.5 No Feb

C Guiding Principles and Values

Original Guiding Principles

Evaluation Findings of Key Values

Bring people together Breaking the isolation Share power and knowledge Building Capacity Affordability Mutual self-help Networking Voice of PHA’s Voice of PHA’s PHA’s and those caring for them are the experts

Throughout the various surveys completed, all stakeholder group identified the following to be the key values of the current Opening Doors Counselling Initiatives: It provided an opportunity for clients, ASO staff, and regional allied health staff to meet- face to face, thereby enabling networking, and capacity building to occur; Further, the conferences broke the isolation between stakeholder groups, which is a constant factor in AIDS and community-based work.

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It is interesting to compare the stated key values with the initial guiding principles that were drafted to guide the various regions in the development of its Opening Doors Counselling Initiatives, and how well aligned the measured values compare with the desired principles. This would indicate that the initial goals envisioned for this initiative still hold in terms of relevancy and value. D Challenges

1. Continuum of Needs Each region experiences unique challenges particular to their own context, and these are identified and shared in the regional evaluation summaries and in the main text of this report. However, it was noted that across the province, a wide variety of co-existing needs have to be addressed; these needs can be understood as elements of a continuum that overlap at certain points, and reflect concurrent but slightly different needs. Examples include geographical areas, such as that which lie between rural and urban areas, and conference content, which can be basic or, at the other end of the continuum, highly advanced. This continuum presents challenges to the organization, and operation, of ODCI Conferences. Finding an “appeal“ for the various stakeholders to continue with the momentum of these conferences was viewed as a “marketing challenge” for each region (i.e., the promotion and communication of a meaningful difference about the ODCI conference). Only through the direct identification of the challenges and the conscious effort to deal with the multiple co-existing needs can successful conferences be ongoing. This is perhaps one area where the lessons of successful regional initiatives in one region can be transferred/shared to other regions.

2. Diversity

First Nations Ethno-cultural French American Sign Language (ASL) Sexual Orientation

Not separate, but distinct, from the challenges presented in Section D, is the issue of managing diversity for the ODCI. French language translation is mandated to be provided in regions where this has been identified as a need. However, diversity as a consideration is not given priority in all regions. In larger urban centres, such as Toronto where approximately 53% of all new immigrants

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settle, the issue of HIV and immigration needs to be a constant part of the ODCI program. However, the diversity issues being faced in rural settings are no less demanding of attention and concern. Some regions are reporting a growing need for other language services and points to the need for monitoring of immigration trends throughout the province. Inclusive of this effort will be the need to reach out to high risk communities and individuals- as identified in epidemiological studies and reports. Similarly- each region needs to look critically at who is not at the table, in terms of conference planning and participation. E Planning Committee The greatest challenge for most of the Regional Planning Committees involved committee recruitment, retention, and inclusive membership composition, to ensure representation from all major stakeholder groups. This challenge has historically been addressed in several ways: where in some regions the leadership of the ODCI is taken on by senior members of the most involved agencies (ASO)- ensuring that the appropriate level of energy and resources are dedicated to this event. The use of ongoing standing committees versus striking up a new committee annually was also identified as a helpful strategy. Open versus closed (invitation only) recruitment techniques were also suggested. To assist in this process the potential alignment with the Community Planning Groups may also be useful. F Counselling Focus Many of the participants who were surveyed believed that the counselling focus for the conference, though important, was too narrow a focus. Participants consistently rated: treatment information, prevention strategies, and harm reduction as being important topics which needed to be addressed by ODCI. G Conference Themes

Major Themes Aboriginal Issues Harm Reduction Grief and Loss Treatment Info Networking Co-infections Addiction Mental Health Substance Use Prevention Health Promotion Isolation Peer Support HIV Testing

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The table above outlines an abridged version of the ODCI themes, provided by the AIDS Bureau through the 14 year history of the conference. When viewed in light of the concerns expressed in Section G (pertaining to the perception that counselling is too narrow a focus) – it would indicate that t he definition of what is understood by the term counselling needs to be expanded and enhanced. Additionally, several regions requested that they have some input into the creation of conference themes and that the timing of when themes are released need to correspond better with the regional planning process. H Conference Administration Four of the seven Banking Agency representatives surveyed indicated that the 4% admin fee, outlined in the Program and Financial Guidelines, was not sufficient recompense for the work entailed in providing conference support Several of the regions use fundraising and sponsorship as a means to offset the cost of running ODCI Conferences, and it was suggested that the Program and Financial Guidelines be updated to incorporate conference sponsorship guidelines for Banking Agencies and Planning Committees to follow. The issue of regional boundaries was looked at as part of this evaluation- however, the survey results were inconclusive. Most of the participant surveyed felt satisfied with the current regional boundaries. However, alignment with the newly formed Community Planning Regions (12 in total for the province) or the new Local Health Integration Networks (LHIN’s – of which there are 14 in the province) could be more appropriate when relating to regional resources. Though politically appropriate, the increased number of regions (from the current 7 to possibly 12 or 14) would result in increased overall cost to the Ministry. The survey also attempted to determine the interest in periodic Provincial conferences (in lieu of, or in conjunction with regional Initiatives). The assessment of this parameter is inconclusive due to a flaw in the survey design- in that the wording of this question may have biased respondents into thinking that the regional conferences might be replaced by a provincial conference. Recommendations Based on the presentation of findings at the March 21, 2007 meeting of the regional representatives, the following listing of recommendations is presented to the AIDS Bureau for consideration:

1) Develop a shared/common evaluation tool for all ODCI conferences, which would incorporate specific questions needed by the individual regions, combined with a set of standard questions and rating scales that would

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facilitate in the sharing of evaluations between regions- specifically in the area of themes and overall conference needs.

2) A new expanded and more inclusive definition of “counselling“ should be developed to guide regions and participants in understanding the mandate and role of the ODCI.

3) The ODCI should develop a policy statement on diversity for use by all regions in the planning of conferences. Each region needs to identify what voices are not being represented, and to outline a diversity action plan that would address this is recommended.

4) It is recommended that the 2005 ODCI Program and Financial Guidelines document be revised in light of the report findings and recommendations.

5) Each region should be encouraged to look at the connection between the mandate of the ODCI and the needs identified in the Community Plan: Where possible a link (formal or informal) could be created to facilitate partnerships and content for future conferences.

6) It is recommended that further review of the 4% Administrative fee cap be undertaken. A detailed assessment of the current Banking Agency administrative needs- outlining justification for an increase in overall funding should be undertaken.

7) The issue of Provincial boundaries in relation to the LHIN’s (14) or the Community Planning Regions (12) remains unsettled and requires further study. The cost and organizational implications for such a change would be significant. It is recommended that flexibility be incorporated within the Program and Financial Guidelines to allow neighbouring regions to collaborate on conferences if required.

8) Consensus exists from the regional representatives on the creation of a province-wide ODCI conference. This should be further investigated and if feasible attempted to determine effectiveness and overall receptivity. Notable, from the evaluations in the regions, was the concern that a single provincial conference would limit access for many people in the province.

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9) It is recommended that within the Program and Financial Guidelines an allowance be made for regions to periodically “opt out“ of conference planning if necessary (i.e. once every 5 years), without threat to future funding.

10) The timing for when the annual themes are issued to the regions needs to be better aligned with regional planning timeframes. Based on the current schedule of events, the issue of theme at or around April 30 should enable all regions to incorporate them into their planning sessions.

11) It was acknowledged that the annual themes provided by the AIDS Bureau should have a significant role in the planning of the regional ODCI conferences. The history of the themes created have been shown to match the needs of the participants and it is was also acknowledged that they can better prepare regions for new or emerging trends not yet realized in a specific region. A recommendation would be that the AIDS Bureau issue two (2) annual themes with the region being able to add an additional theme(s) based on their specific demographic and need.

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Table of Contents Acknowledgements i

Executive Summary ii

1. Introduction 4

2. History of the Opening Doors Initiative 7

3. Regional Operating Structures 10

4. Overall Study Methodology 16

5. Banking Agency Survey 17 a. Methodology b. Findings c. Recommendations

6. Planning Committee Survey 27

a. Methodology b. Findings c. Recommendations

7. Participants Survey 57

a. Methodology b. Findings c. Recommendations

8. Regional Summaries 84

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Tables

Table 1.1 Opening Doors Provincial Advisory Committee 5-6

Table 1.2 Evaluation Timeline 4 Table 2.1 Opening Doors Annual Themes 8-9 Table 3.1 Operating Matrix for Regional 10-15

Conference Table 6.1 ODC Planning Committee Overview 46 Table 7.1 ODC Participants Survey Overview 76 Table 8.1 Regional Survey Summaries 85- 91

Survey Templates

Banking Agency Survey 24-26 Planning Committee Survey 48-56 Participants Survey 78-83

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Appendices (Separate Cover)

Section Contents A1 AIDS Bureau Staff

Completed Survey Collated results from 3 staff members A2 Banking Agency Representatives Completed Survey Collated results from 9 members A3 Planning Committee Representatives Completed Survey Collated results from 41 members A4 Participants Completed Survey Collated results from 205 members

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1. Introduction The Opening Doors Counselling Initiative has been in operation for 15 years without a formal evaluation having been conducted. The AIDS Bureau awarded Ethical Affairs a contract, on May 30, 2006, to conduct a province-wide evaluation of the initiative. A meeting of representatives from the AIDS Bureau, various AIDS service organizations, and regional healthcare workers from the seven regional Opening Doors planning committees, was held on June 22, 2006. A listing of the representatives is presented in Table 1.1. At this kick-off meeting, discussions of the overall scope and proposed timeline of the evaluation were held. The support required from the regional representatives was also outlined, in order to successfully complete this evaluation. The evaluation project was completed on the following timeline:

Table 1.2 Evaluation Timeline

Date Event March 30/06 Contract issued to Ethical Affairs to conduct the

evaluation June 22, 2006 Kick-off meeting in Toronto of all Regional

Representatives July 10 to August 20, 2006

AIDS Bureau Survey in circulation

July 10 to August 18, 2006

Banking Survey in circulation

August 5 to September 2, 2006

Planning Committee Survey in circulation

September 5 to Nov 30, 2006

Participant Survey in circulation

December 15, 2006 Draft Report Completed & Submitted to AIDS Bureau January 2007 Completed Report This report represents the data obtained from the overall evaluation. Separate individual regional reports of findings (Banking Agency, Planning Committee, and Participants Surveys) were issued to each of the Regional Planning Committees- under a separate cover.

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Table 1.1

Opening Doors Provincial Advisory Committee

REGION Contacts Primary Contact Contact Information

Contacts Rajendra Maharaj Lisa Crawley-Beames

Tel: 416-767-3813 [email protected] [email protected]

TORONTO

Banking Agency Contact

Lori Lucier John Gaylord

AIDS Committee of Toronto 399 Church Street Toronto, ON M5B 2J6 Tel: 416 340-2437 [email protected] [email protected]

Contacts Patrick Hooey

Lakeridge Health 300 Gordon St. Whitby ON L1N 5T2 905-668-6831 Ext 3120

CENTRAL EAST


Kim Dolan

Peterborough AIDS Resource Network 159 King Street, Ste. 302 Peterborough, ON K9J 2R8 Tel: 705 749-9110

Contacts

Janet Dawson Heather Robinson

Tel: 905-825-6000 ext. 4546 Halton Region Health Department 5353 Lakeshore Rd, Unit 2 Burlington ON L7L 1C8 Tel: 905-358-3636

CENTRAL WEST


Tom Hammond AIDS Committee of Guelph & Wellington County 58 Dawson Road Guelph, ON N1H 1A8 Tel: 519-763-2255 x 26

mailto:[email protected]�



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Table 1.1 Opening Doors Provincial Advisory Committee

Contacts John MacTavish Michelle Ball

Tel: 613 545-3698 HIV/AIDS Regional Services 844-A Princess St Kingston ON K7L 1G5 Tel: 613-238-5014 ext 235

EAST


Michelle Ball AIDS Committee of Ottawa 251 Bank Street, Ste 700 Ottawa. ON K2P 1X3

Contacts Elaine Myers

Tel: 519-254-6115 HIV Care Program 2085 Tecumseh Rd. Windsor ON N8W 1E3

SOUTH WEST


Marilyn Weller

AIDS Committee of Windsor 1168 Drouillard Road, Suite B Windsor, ON N8Y 2R1 Tel: 519 973-0222

NORTH EAST


Richard Rainville

Access AIDS Network 111 Elm St., Ste 203 Sudbury, ON P3C 1T3 Tel: 705 688-0500

Contacts Michael Sobota Gail Linklater

Tel: 807 345-1516 ext.18 Tel: 807 345-1516 ext. 24

NORTH WEST


Michael Sobota AIDS Thunder Bay P.O. Box 24025 Thunder Bay, ON P7A 4T0

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2. History of the Opening Doors Initiative In 1989 Health Canada sponsored, through the various provincial Ministries of Health, a series of events to examine HIV/AIDS counselling issues, with the intent being to push forward the field of HIV Counselling. In Ontario the AIDS Bureau, Ministry of Health and Long-Term Care, established a steering committee to review how best to approach this issue. Following extensive consultations with the community, the first provincial Opening Doors Counselling Initiative was held in 1990. The goal of this conference was to determine: the major HIV counselling issues, the strengths and weaknesses within the field, and methods through which caregivers, counselors, families, friends and people with HIV could work together to support and care for one another. Following this event, the AIDS Bureau began the practice of sponsoring annual regional initiatives beginning in 1992. Each year seven regions in the province receive funding from the AIDS Bureau to hold a local event(s). These regions are: North East (Sudbury/Sault Ste. Marie/ North Bay); North West (Thunder Bay/Kenora); East (Kingston/Ottawa); Central East (Peterborough/Simcoe); Central West (Hamilton/Kitchener/Guelph); South West (London/Windsor) and Toronto. The Opening Doors Initiative has the following as its main goals- to enhance the overall quality of counselling and to meet the needs of the local community. The AIDS Bureau directive, for the operation of the Opening Doors Counselling Initiative, is presented in Appendix A5 of this report (Opening Doors Counselling Initiatives: Program and Financial Guidelines 2005). The organization of the Opening Doors Counselling Initiative is structured in the following manner:

• The province is divided into 7 regions (as described above) • A Provincial Opening Doors Advisory Committee comprised of key regional

stakeholders who meet under the direction of the AIDS Bureau, to communicate various issues, concerns and suggestions pertaining to the annual conferences.

• Seven regional Conference Planning Committees, each mandated to plan, organize and run a local initiative according to the guidelines provided by the AIDS Bureau.

• Seven regional Banking Agencies each responsible for the administration, and tracking of all expenses and budgets for their respective local initiatives.

Each year the AIDS Bureau provides the regional planning committees with two themes for the planning committee to assist with the planning of the event. These suggestions are based on consultation with community members on the emerging issues within the field of HIV/AIDS Counselling. A listing of the annual themes, dating back to the first Opening Doors Initiative in 1992, is presented in Table 2.1

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Table 2.1

Opening Doors Annual Themes 1992 • Sensitivity towards aboriginal issues

• Working with substance users • Pre/post test counselling

1993 • Health promotion • Grief, multiple loss and bereavement

1994 • Self help and peer support are a source of strength and hold great promise for everyone affected by HIV

• Counsellors have a great opportunity to break down the artificial barrier between professional and non-professional caregivers, to share “power”, knowledge and experience for the benefit of everyone involved

• Counsellors have an important role to play as facilitators, bringing people with common experiences together and helping them build on and share their strengths

1995 • How can we ensure that such events reflect the principles of Opening Doors Counselling Initiatives, i.e. to improve counselling through a consultative process which includes those infected and affected?

• How do we address the need for support, during an event, for those either in recovery or affected by substance use?

• How do we ensure a system of follow up that addresses the feeling of ‘let down’ and isolation that may occur immediately following the event when participants return to their own communities?

1996 • Examining Prevention Strategies in the second decade of HIV/AIDS; Learning from the past to prepare for the future

• Understanding the complexities of dual and multiple diagnoses to enhance provision of service and to assist in the development of resources and referrals

1997 • Our understanding of addictions, treatment and harm reduction strategies is essential to the appropriate delivery of service to the drug using community

• Developing and maintaining peer support programs and volunteer bases are an important component of most services. Such support is uniquely personal and deserves ongoing attention to ensure continued success

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Table 2.1 Opening Doors Annual Themes

1998 • To share HIV counselling issues and provide current treatment

information • To provide the opportunity for caregivers, counsellors, families,

friends and people with HIV to work together, to support, and care for one another

• To understand addictions, treatments, and harm reduction strategies that are essential to the appropriate delivery of service

• To develop and maintain volunteers and peer support programs as an important component of most services

1999 • Knowledge of wide range of harm reduction strategies as applied to both safer sex and safer injection and other drug use is an essential element of counselling

• Review of HIV testing option in ON to clarity what they are, how service is delivered and by whom

• Emphasis on peer support and networking 2000 • Knowledge of the wide range of harm reduction strategies as applied

to both safer sex and safer injection, and other drug use is an essential element of counselling

• A review of the HIV testing options in Ontario to clarify what they are, how service is delivered, and by whom

2001 • Issues related to co-infection re: HIV/AIDS and Hep C • Prenatal testing • Needle exchange programs

2002 • Co-infection • Hepatitis C • HIV and mental health.

2003 • Building community and breaking down barriers 2004 • Enhance understanding of how to identify and respond to depression

in people living with HIV/AIDS • Explore the role of people living with HIV/AIDS in HIV prevention (i.e.

secondary prevention). 2005 • The Opening Doors guidelines

• Future directions.

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3. Regional Operating Structures Though tasked with a similar objective of holding an annual Opening Doors Counselling Initiative, each of the 7 provincial regions are unique in how they organize and structure their conferences. The following tables illustrate the organizational matrix for each region:

Table 3.1 Operating Matrix for Opening Doors Conferences by

Geographical Area

South West Use paid Coordinator for planning of the Opening Doors Initiatives

Yes

Typical Date of the Opening Doors Initiative (Month)

February

Number of participants 75 Registration Fee (General) $50 Registration Fee (PHA) $ 0 (Full waiver of fees) Location of Event Varies (Hotel) AIDS Bureau Funding $16,050 Cost of Event $ 12,322 Fundraising No Duration of the event (days) 1 Evening and 1 full day Region description (please describe- in detail, how your region is defined geographically)

Windsor-Essex, Chatham-Kent, Sarnia-Lambtom, London, Middlesex, Oxford, Huron, and Perth

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Geographical Area

Central West Use paid Coordinator for planning of the Opening Doors Initiatives

No


Nov

Number of participants 100-110 due to facility size and budget Registration Fee (General) $75 Registration Fee (PHA) $10 Location of Event Hotel AIDS Bureau Funding $ 16290.00 Cost of Event $22,005.90 Fundraising yes Duration of the event (days) 2 days Region description (please describe- in detail, how your region is defined geographically)

Peel, Halton, Niagara, Hamilton, Haldimand-Norfolk, Brant County, Wellington-Dufferin Guelph, Kitchener-Waterloo (from central Hamilton, each area can be reached in about 1 hour, geographically small compared to other regions, but have one of the biggest total populations.)

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Geographical Area

Toronto Use paid Coordinator for planning of the Opening Doors Initiatives

Yes


Sept

Number of participants 47 Registration Fee (General) $30.00 Registration Fee (PHA) $ pay what you can. Location of Event Local Hotel AIDS Bureau Funding $16,000. Cost of Event $ 15,300. Fundraising (Yes/No) No Duration of the event (days) 1 day Region description (please describe- in detail, how your region is defined geographically)

GTA, but we do not refuse from outside GTA

Eastern Region Use paid Coordinator for planning of the Opening Doors Initiatives

No

Typical Date of the Opening Doors Initiative

April

Number of participants 163 Registration Fee (General) 75 Registration Fee (PHA) Scholarship available to decrease rate

to $25 Location of Event Resort AIDS Bureau Funding $18k Cost of Event $40 K Fundraising Yes Duration of the event (days) 3 days Region description (please describe- in detail, how your region is defined geographically)

Covers Eastern Ontario from Trenton in the south and North to Chalk River over to the Quebec border.

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Geographical Area

North East Region uses paid Coordinator for planning of the Opening Doors Initiatives

Yes (in prior years) – will be trying to do it within organization this year as opposed to hiring Coordinator.


October – November (in Sault Ste. Marie). This year due to later start will be doing conference in February/March in Timmins.

Number of participants 60 Registration Fee (General) $ 75.00 Registration Fee (PHA) $ usually scholarship. Advisory

Committee will review and probably charge minimum amount as per other regional conferences

Location of Event Hotel AIDS Bureau Funding $ 22,807.00 Cost of Event $ 35,479.29 Fundraising (Yes/No) Yes Duration of the event (days) Traditionally has been two days Region description (please describe- in detail, how your region is defined geographically)

Area covers four districts: Sudbury/Manitoulin; Algoma (geographic area covers over 93,219 square kilometers or approx 8.66% of Ontario); Cochrane (geographic area covers 141,000 square kilometers or approx 13.10% of Ontario); North Bay (geographic area covers 16,000 square kilometers or approx 1.49% of Ontario. Combined kilometers: 250,219 ….. less than 1 person per kilometer…. Geographic area represents 23.25% of Ontario.

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Table 3.1

Operating Matrix for Opening Doors Conferences by Geographical Area

North West Use paid Coordinator for planning of the Opening Doors Initiatives

Yes


October

Number of participants 80 Registration Fee (General) $50 Registration Fee (PHA) (waived upon request) Location of Event Hotel AIDS Bureau Funding $22K Cost of Event $30 K Fundraising Yes Duration of the event (days) 2 Region description (please describe- in detail, how your region is defined geographically)

North West Ontario ODCC draws from the Manitoba Border (to the West), Geraldton/Marathon (to the East), the U.S. Border (South) and several Aboriginal Reserves (fly-in) to the North – these would be several hours by air, North of Thunder Bay). Historically, our ODCC has also accepted participants from Duluth, Minnesota (south of the border, in the U.S.) and from Winnipeg (in Manitoba).

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Table 3.1

Operating Matrix for Opening Doors Conferences by Geographical Area

Central East Use paid Coordinator for planning of the Opening Doors Initiatives

No

Typical Date of the Opening Doors Initiative

October being changed to April in 2007

Number of participants 70 Registration Fee (General) $50 changed to $75 in 2007 Registration Fee (PHA) $0 Location of Event Resort Bayview Wildwood AIDS Bureau Funding $17,000 Cost of Event $23,000 Fundraising Yes Duration of the event (days) 2 ½ days Region description (please describe- in detail, how your region is defined geographically)

The planning region historically consist of three ASO’s catchment areas: Simcoe County, Durham Region and the Haliburton, Kawartha and Pineridge regions

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4. Overall Study Methodology This project was designed to complete a systematic evaluation of the Opening Doors Counselling Initiative. To accomplish this goal, the evaluation focused on obtaining input from the following 3 key stakeholder groups:

Given the different focus for each of the above stakeholders, a total of 3 different evaluation tools (surveys) were created in order to obtain the requisite information to meet the evaluation scope of this project. The surveys were initially developed based on documentation provided by the AIDS Bureau on work previously started on this project. Subsequently, the surveys were reviewed using the following process:

-Vetting by AIDS Bureau -Review and input by Regional Representative

-Review of the participant survey by a select focus group of conference participants

The final surveys were edited for plain English comprehension. A detailed survey methodology is reported in the individual reports sections .

Stakeholder Participants Survey Focus Banking Agency

Staff from the “Banking Agency“ of each provincial region responsible for the financial management of the conferences, and liaison with Ministry and Planning Committees

Input on the organizational and financial efficacy of procedural guidelines issued by the Ministry.

Regional Committee

All members of the regional planning committees, comprised of staff from AIDS Service organizations, staff from Allied Health, community agencies and PHA’s

Input on the use of guidelines for organization of the conference along with conference operation and organizational perspectives

Conference Participants

Target PHA’s, Informal Caregivers, regional ASO’s and Non-ASO staff members who have attended the Opening Doors Initiatives

Input on the actual conferences they’ve attended (meeting needs,relevancy, etc.)

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5. Banking Agencies’ Report Methodology Population Individuals who had served as representatives of one of the seven regional Banking Agencies, formed one of the stakeholder groups identified for evaluation in this study. The regional representatives identified 15 individuals who had served in this capacity for one or more years, and each was sent a survey to provide his or her input to the evaluation. Survey Design As the study’s main goal was to gather important individual perspectives, it was decided to implement a descriptive study, using primarily qualitative data. The survey orientation featured questions posed from an historical perspective, asking respondents to reflect back on past experiences, which in a number of instances, spanned many of the 15 years the Initiative has been in operation. Where possible, ordinal or ranking questions were used to assess respondents’ level of satisfaction or agreement with different aspects of the Opening Doors Initiatives’ operations. All questions were followed by open-ended questions designed to elaborate on and describe the subject of the questions in the respondents’ own words and to provide opportunities for the respondents to contribute much needed descriptive information. Some questions collected information that could only be properly provided through the open-ended format. Some basic ‘demographic’ questions were posed to understand the general characteristics of the respondents so that differences between groups of respondents, if any, might be identified. A series of questions were prepared and refined based on input from a variety of sources:

1. The AIDS Bureau’s ‘Opening Doors Counselling Initiatives Program & Financial Guidelines of 2005’ provide a number of Financial Guidelines and Principles regarding the roles and responsibilities of Banking Agencies. The banking agency is the administrator of funds provided for each region’s annual initiatives. These guidelines and principles statements were used to construct questions which would evaluate and describe their practical usefulness and effectiveness.

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2. Representatives from each region participated in a provincial meeting convened by the AIDS Bureau at which they discussed the need for an evaluation and provided advice about the process and content of the evaluation research. The minutes of the provincial meeting and regional summary reports proved important to the design and development of the surveys.

3. The AIDS Bureau provided goal and objective statements to the researchers

which assisted in defining the focus and scope of the study. In the Banking Agencies survey, financial management was central, rather than the success of the initiatives themselves.

A copy of the final survey is enclosed at the end of this chapter. Data Collection Respondents’ contact information - e-mail addresses - were provided by regional committee members serving as regional resource people to the research team. Respondents were offered three alternatives:

1. The survey was entered onto the Survey Monkey website. E-mail letters of introduction invited respondents to visit the website and respond to the survey on-line. This provided the researchers with automatic tabulation and printing of results as each survey was completed.

2. An MS Word version of the survey was attached to the e-mail message so that

anyone preferring to complete the survey ‘offline’ could do so. The completed survey could then be e-mailed back to the researchers.

3. Hardcopy questionnaires were also available for mailing to anyone without e-mail

or Internet capabilities. A deadline for survey retrieval was provided in the letters of introduction and a number of reminders were sent out at periodic intervals in order to gain the best response rate possible. Limitations Because of the modest size of the population and the study’s goal to gather important individual perspectives, it was decided to implement a descriptive study using primarily qualitative data. As a result, the data collected does not lead to cause and effect conclusions and does not yield data, useful though it might be, that can be seen as statistically reliable or statistically significant in any way.

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Response Rates: Out of a total of 15 requests for participation, nine (60%) completed surveys were received. Seven of the respondents had individually served as the banking agency representative more than four times, while six out of nine reported that their agencies had served as the Banking Agency seven or more times. Table 1: Please indicate which region you are from.

Response Percent

Response Total

Toronto 11.1% 1

South West 22.2% 2

North East 11.1% 1

Eastern 11.1% 1

Central East 11.1% 1

Central West 22.2% 2

North West 11.1% 1

Total Respondents 9

(skipped this question) 0

Compliance with AIDS Bureau Guidelines: A variety of questions focused on the Banking Agencies’ roles and responsibilities, primarily through their membership within their region’s Planning Committee. Notable findings were that:

• 100% of respondents were members of their region’s Planning Committee.

• Overall, respondents were evenly split between “very” or “somewhat satisfied” when asked about the requirements (record-keeping, reporting through financial updates and settlement forms, budget monitoring/maintenance) of their role.

• Four respondents reported that they were “somewhat” or “very dissatisfied” with

the 4% administration fee, as one noted: “…because of the amount of work, it should be increased.” Another commented that the Banking Agencies’ work is “more complex than it was in the early 1990's” suggesting an administrative fee of 8-10%.

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Table 2: The AIDS Bureau has issued a Program and Financial Guidelines document for the operation of the Opening Doors Initiatives. In your role as your region’s Banking Agency representative, indicate what level of satisfaction you have had with:

Very Satisfied

Somewhat Satisfied

Somewhat Dissatisfied

Very Dissatisfied

Response Average *

The record-keeping requirements ofthe role as outlined in the financial

guidelines.50% (4) 50% (4) 0% (0) 0% (0) 1.50

The 4% Administration fee, whichsupports the agency in reporting.

11% (1) 44% (4) 22% (2) 22% (2) 2.56

The Reporting Requirements (regularfinancial updates) to the Planning

Committee.33% (3) 67% (6) 0% (0) 0% (0) 1.67

The Reporting Requirements(Settlement Forms, etc.) to the AIDS

Bureau.50% (4) 50% (4) 0% (0) 0% (0) 1.50

The Budget monitoring/maintenanceprocess.

50% (4) 50% (4) 0% (0) 0% (0) 1.50

Total Respondents 9


* Low average score = high level of satisfaction

General observations: Respondents were asked to comment on what worked well…:

• We are able to process income and expenses for the additional funding through our regular bookkeeping system smoothly; processing of cheque requisitions; deposit payment to the conference site & final billing

• The fact that ACO has waived the 4% administrative fee works very well. The planning committee is very supportive

• Having the banking statements prepared for the planning committee to review/question at monthly meetings.

• Finance committee assists in reviewing budgets regularly, direct link with AIDS Bureau if assistance is required,

…and what did not work well in their banking agency roles:

• Tracking pharma donations requires attention, as does the tracking of registrations & receipt of registration payment. We will be revising these systems.

• Trying to put together a $35,000 to $40,000 conference on a very limited budget.

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• I am able to respond to this question only as one of the committee members. I was on the committee for 2 seasons. I did not have a role different from my colleagues on this committee (other than to receive invoices and forward to our finance department). As far as I can see the only leading role ACT performed is the administration of the funds. What did not work well from this perspective was recruiting new committee members to continue the work.

• We split the admin. fee with another agency which handles the accommodation bookings and some other admin work. The remaining 2% admin. fee likely does not cover the cost of reporting to the planning committee, audit, settlement forms etc. Having said that, it's an important and valuable initiative and we are fortunate to have it.

• Not having a strong working knowledge of budget preparation. • Believe the 4% admin, should be reviewed and increased; working with a budget

that is low and not necessarily representative of today's needs. Building on Success: Respondents were given an opportunity to provide suggestions or recommendations to build on successes and improve the financial management of future Opening Doors Initiatives:

• As we work with 2 other ASO’s, it would be helpful to have a shared master registration & payment format. Monthly reporting on the budget could be changed to regular financial statement reporting.

• The existing protocols from the Funder are not onerous, and serve to help make the handling of the funding transparent and accountable.

• The actual management of finances have worked very well thus far, so in terms of management there is not any changes I would make at this time.

• Develop a customized schedule B for the project. No claw-backs, as the initiative already has to fund-raise to keep afloat.

• To have unspent dollars returned more quickly, so we don't have it sitting in our pot for so long.

• Offering some training on preparing budgets, explaining profit and loss balance sheets to banking agency members who participate in planning committee.

• Financial guidelines are good, review current budget and increase as appropriate.

Discussion of Findings Response Rates: The 60% return rate is statistically very good, when compared to surveys sent to a general population. The response rate could also be perceived as a mild disappointment given the ‘in-group’ nature of the population and what one might think is an intrinsic commitment to, and self-interest in, improving the Opening Doors Counselling Initiatives through participation in this process.

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The findings show that those who did respond are very likely to have been involved for some years; however we cannot make inferences about those who did not respond. Perhaps less commitment can be expected from those members who were banking agency representatives, but are no longer or from those who are new to this responsibility. Another possible speculation is that respondents are asked to respond to frequent surveys and that the response rate may be due to ‘survey fatigue’. Still another speculation may be drawn from the summer implementation of the survey, traditionally a more difficult time to encourage participation. Compliance with AIDS Bureau Guidelines: With the modest exception regarding the 4% administration fee provided to the banking agencies by the AIDS Bureau, the level of satisfaction with the roles and responsibilities outlined for them is generally positive. General observations: The open-ended responses reinforce the satisfaction data:

i) that the functions expected of and implemented by banking agencies are working well, and,

ii) that there is some dissatisfaction with the 4% administration fee paid to the banking agencies, given the quantity of work they are expected to do.

Building on Success: The responses to this question include a few suggestions regarding some technical changes that might be instituted to improve the financial reporting systems. Recommendations and Conclusions The overall observation of the study is that are few major concerns, and that the people who participated in the survey are generally satisfied with the financial guidelines and their usefulness. Given the modest number of respondents, it is difficult to make strong conclusions or recommendations. However the responses do yield some useful information on which we can base the following recommendations. It is recommended that:

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1. The AIDS Bureau collaborate with the provincial Opening Doors Representatives committee to look at different ways to solicit better participation and responses to future evaluation surveys.

This could involve scheduling the survey differently, providing more opportunities for participation in the survey planning stage and more effective communication strategies to promote the value of the survey in improving the Opening Doors Counselling Initiative.

2. The AIDS Bureau conduct consultations with the Banking Agencies to more

accurately define the financial costs of completing the requirements of the role as set out in the AIDS Bureau Guidelines.

While the 4% administration fee prompted the highest level of dissatisfaction (see Table 2) one organization waived the administrative fee so that it could be used for conference programming

3. The following recommendations, relate to financial monitoring:

a. Planning Committees and AIDS Bureau staff initiate discussions with Banking Agency representatives to assess the need for the monthly budget reporting to be changed to regular financial statement reporting (This was also suggested by one respondent.)

b. The AIDS Bureau should develop a customized schedule B for the project. c. The AIDS Bureau clarify end of year financial reporting procedures in both the Opening Doors and Settlement Form Guidelines – to facilitate the timely return of unspent dollars.

d. Planning Committees and AIDS Bureau staff assess and provide training as needed to banking agency members on financial management functions. Some of the specific suggestions made are preparing budgets and explaining profit and loss balance sheets.

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Opening Doors Counselling Initiative

Banking Agencies Survey Introduction

The AIDS Bureau is conducting an evaluation of the Opening Doors Counselling Initiative, which has been operating since 1992. This questionnaire asks Banking Agency representatives about their perspectives and experiences as financial managers of the Conferences. This survey is to help assess the various roles of the Conference stakeholders and to get a sense of the experiences of Banking Agency staff in evaluating the outcomes of the conferences. Please note that this information will be shared with the AIDS Bureau and the Opening Doors Counselling regional planning committees. Your answers will be grouped with all the other answers to help us plan and prepare for the future.

1. Please indicate which region you are from.

Toronto Central East South West Central West North East North West Eastern

2. How many times have you personally served as a representative of the Banking Agency?

None 1-3 4-6 7 plus 3. How many times has your agency served as the Banking Agency?

None 1-3 4-6 7 plus 4. In your region, is a representative of the Banking Agency also a member of the Planning Committee? Yes No 5. The AIDS Bureau has issued a Program and Financial Guidelines document for the operation of the Opening Doors Initiatives. In your role as your region’s Banking Agency representative, indicate what level of satisfaction you have had with:

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5.1 The record-keeping requirements of the role as outlined in the financial guidelines.

Very Satisfied Somewhat Satisfied


Very Dissatisfied

5.2 The 4% Administration fee, which supports the agency in reporting.



Very Dissatisfied

5.3 The Reporting Requirements (regular financial updates) to the Planning Committee.



Very Dissatisfied

5.4 The Reporting Requirements (Settlement Forms, etc.) to the AIDS Bureau.



Very Dissatisfied

5.5 The Budget monitoring/maintenance process.



Very Dissatisfied

3 (15%)

6. Please briefly describe why you were very satisfied or very dissatisfied with any of the Banking Agency role requirements mentioned in Question 5.

7. Please briefly describe what worked well in your role as the Banking Agency for the Opening Doors Initiatives in your region.

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8. Please briefly describe what did not work well in your role as the Banking Agency for the Opening Doors Initiatives in your region. 9. In relation to your role as your region’s Banking Agency representative, what suggestions or recommendations would you make to build on successes and improve the financial management of future Opening Doors Initiatives?

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6. Planning Committees’ Survey Report a. Methodology Population The population for this survey consisted of individuals who have served, or are serving, on the Planning Committees established in each of the seven regions over the past fifteen years. A total of 67 planning committee members were identified to participate in this survey, and each was sent a survey to provide his or her input to the evaluation. Survey Design As the study’s main goal was to gather important individual perspectives, it was decided to implement a descriptive study, using primarily qualitative data. The survey orientation featured questions posed from an historical perspective, asking respondents to reflect back on past experiences, which in a number of instances, spanned many of the 15 years the Initiative has been in operation. Where possible, ordinal or ranking questions were used to assess respondents’ level of satisfaction or agreement with different aspects of the Opening Doors Initiatives’ operations. All questions were followed by open-ended questions designed to elaborate on and describe the subject of the questions in the respondents’ own words and to provide opportunities for the respondents to contribute much needed descriptive information. Some questions collected information that could only be properly provided through the open-ended format. Some basic ‘demographic’ questions were posed to understand the general characteristics of the respondents so that differences between groups of respondents, if any, might be identified. A series of questions were prepared and refined based on input from a variety of sources:

4. The AIDS Bureau’s ‘Opening Doors Counselling Initiatives Program & Financial Guidelines of 2005’ provide a number of guidelines and principles regarding the roles and responsibilities of Planning Committees. These guidelines and principles statements were used to construct questions which would evaluate and describe their practical usefulness and effectiveness.

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1. Representatives from each region participated in a provincial meeting convened by the AIDS Bureau, at which they discussed the need for an evaluation and provided advice about process and content of the evaluation research. The minutes of the provincial meeting and regional summary reports proved valuable to the survey design and development.

2. The AIDS Bureau provided goals and objective statements to the researchers

which assisted in defining the focus and scope of the study. A copy of the Planning Committee evaluation survey is presented at the end of this section. Data Collection Respondents’ contact information (e-mail addresses) were provided by the committee members serving as regional representatives to the research team. Respondents were offered three alternatives:

4. The survey was entered onto the Survey Monkey website. E-mail letters of introduction invited respondents to visit the website and respond to the survey on-line. This provided the researchers with automatic tabulation and printing of results as each survey was completed.

5. An MS Word version of the survey was attached to the e-mail message so that

anyone preferring to complete the survey ‘offline’ could do so. The completed survey could then be e-mailed back to the researchers.


or Internet capabilities. A deadline was provided in the letters of introduction and a number of reminders sent out at periodic intervals in order to gain the best response rate possible. Limitations Because of the modest size of the population and because of the study’s goal to gather important individual perspectives, it was decided to implement a descriptive study using primarily qualitative data with some quantitative information collected through ordinal data. As a result, the data collected does not lead to cause and effect conclusions and does not yield data, useful though it might be, that can be seen as statistically reliable or statistically significant in any way.

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A large amount of detail that has been eloquently provided by the respondents has been summarized, through content analysis, to reflect the general points being made. Specific illustrative quotes are used frequently to amplify the points. Some of the statistics reported for rating questions (measurements of success or satisfaction, for example) included a ‘Response Average’ (RA) which produces a single number for each question that can be easily compared to the RA of any other rating question. The presence of a “Don’t Know’ response option however, in several questions, has the potential to skew the RA, as Don’t Know’s are assigned a number which will change the RA of a question, despite what should be a neutral response – and therefore excluded from the RA calculation. b. Findings Characteristics of Respondents Out of a total of 67 requests for participation, 41 (61%) completed surveys were received. Regional Distribution One quarter of the respondents were from the Central West region while the South West region was the least represented among the regions with only 3 respondents.

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Table 1: Please indicate which region you are from.

Response Percent

Response Total

Toronto 10% 4

South West 7.5% 3

North East 10% 4

Eastern 12.5% 5


Central West 25% 10

North West 17.5% 7

Total Respondents 40

(skipped this question) 1 Membership by Stakeholder Group AIDS Bureau guidelines state that the committees’ “Membership consists of representatives from the HIV/AIDS counselling community, both service providers and recipients of service, and representatives from other key services in the local community…” Those who responded came from each of the stakeholder groups noted in the guidelines (see Table 2). Table 2: Membership by Stakeholder Group

Response Percent Response Total

AIDS Service Organization 58.5% 24

Person with HIV/AIDS 29.3% 12

AIDS-Affected Family

member or Friend 7.3% 3

Health care providers (e.g.

Public health, mental health,addictions) 29.3% 12

Non-health Service

Organization (e.g. housing) 4.9% 2

Other (please specify) 9.8% 4


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Committee Experience The largest number of people (18 or 44%) reported that they had been planning committee members for 1-3 years; 11 of the other respondents had 4-6 years of experience while 10 reported membership for over 7 years. Respondents noted that they had attended the conferences they helped plan in similar numbers. The majority (77%) also reported that their Planning Committees had hosted more than seven conferences since 1992; 18% reported hosting 4-6 conferences. When asked why conferences were not hosted annually, 9 respondents reported a variety of reasons, in general citing competing events and priorities. As one individual noted, “In the '90's, we occasionally coordinated local events targeted to specific regions, in order to increase accessibility to the information. This was done in addition to a PHA only retreat.” Thirty-three respondents did not answer this question or directly stated that they did host annual meetings. Opinions About Opening Doors’ Main Objective The past regional Opening Doors initiatives have been responsible for meeting the objective of “strengthening counselling skills, resources and supports in Ontario”. A series of questions focused on gaining the opinions of planning committee members about that objective. When asked if they believed the conferences had achieved that objective, and whether the objective “remained applicable”:

• more than half (22) answered ‘Very Much’ and another 15 people indicated that the conferences had ‘Somewhat Strengthened’ counselling, for a 90% approval rating.

• 25 indicated the objective remained ‘Very’ applicable and 12 responded “Somewhat” for a total of 90%

A further question asked for open-ended responses to explain why people felt the conference were, or were not, applicable. The following is a summary of 32 responses:

• Several noted that there is staff burnout and “frequent turn-over in the social worker/counsellor field.” Promotions and retirement were also cited as reasons why the annual conferences are needed to inform and support new front line workers.

• Others said it was important to have a “unique forum for PHA's and professionals

to see each other's point of view.” One respondent noted that “networking with those infected is an important strategy to assist in de-stigmatization of the

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disease. It allows people to face their fears and misconceptions about this disease.”

• The field is changing with new treatments, legal issues and strategies; experts

can transmit important information to many, and help professionals to “improve skills”.

• Public health nurses, people from community services and individual counsellors

“may not engage frequently with an HIV+ individual. When they do, they are likely ‘out of practice’, or not up to date on HIV/AIDS counselling info and skills.”

• Conference objectives should include “networking” and “education” especially

since the conferences serve to inform PHA’s and general community health and social service workers about counselling services that are available.

• As one observed: “the provincial movement toward mainstreaming HIV support

must be supported by hands on information about HIV. It remains our task to ensure education of front line workers in mental health, addictions and homelessness - the 'social determinants of health' as another stated.

• People from rural and northern communities have few opportunities to hear about

the latest developments and to meet others with expertise in the field.

• One participant queried the setting of the Opening Doors themes by the AIDS Bureau, as potentially driving what is determined as the relevant current issues in the HIV/AIDS movement. In the event that the Ministry decides that ‘networking’ should not be something that they choose to fund, then the strengthening of resources and supports that occurs through ‘networking’ is not optimized.”

• One respondent stated that “strengthening our communities' capacities is

important, I'm not sure that a regional conference is the best way to approach our desired outcome. Many service providers in other sectors would like to attend but a 2 day commitment in a community 2 hours away isn't possible for most organizations.”

A more direct question further explored opinions about the desired status of the counselling focus of the Opening Doors initiatives. As seen in Table 3, there is a majority interest (60%) among those responsible for organizing the regional Opening Doors conferences in change, and particularly (52.5%) in change determined through local consultation.

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Table 3: Currently the AIDS Bureau guidelines direct the regional Opening Doors initiatives to focus primarily on counselling. Should the focus of the initiatives:

Response Percent

Response Total

Remain the same 35% 14

Be changed after consultation with local committees

52.5% 21

Be changed now,

based on information already available

7.5% 3

Don’t know 5% 2

Total Respondents 40 A follow-up question invited respondents to make specific suggestions about the “focus” or main objectives of the future Opening Doors Initiatives, leading to the following summarized comments:

• Many of the remarks stressed the continuing need for the enhancement of “professionals’ counselling “skills to remain a priority focus while listing a variety of shifts in HIV/AIDS treatment and new ways of thinking – all of which merit additional priorities for the Opening Doors Initiatives to support.

• A large number of people emphasized the need for a shift to a more client-

centered focus “…on peer support and personal development/leadership development of PHA's (“client skills building”)….’counselling’ should be inclusive enough to include the counselling provided by peers.”

• Concerns about the importance of prevention came up repeatedly: “Renewed

focus on such human realities as opportunities, optimism, HOPE, caring, virtue, strength, resourcefulness, resilience, dialogue, encouragement, work ethic, spirituality, and wisdom. Perhaps positive psychology can bring new life to the practice of prevention… Our communities, schools & workplaces should be hotbeds of prevention. “

• Networking priorities such as “Connecting with community and creating

partnerships. “

• Education and outreach initiatives also received many mentions, for example, to convey “emerging issues, updates on treatments.”

• A few respondents expressed opinions about the process by which the Opening

Doors main objective and annual themes are determined, suggesting that there be a “Review (of) the Community Plans for each region in order to determine the

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top three Community Plan Recommendations,” and suggesting “local flexibility to present themes for each conference.”

• And there were several people who are happy the way things are and want them

to “remain the same.” Determination of Opening Doors Annual Conference Themes A further series of questions probed planning committee members about the annual conference themes suggested by the AIDS Bureau. A similar number of people indicated that they were “Always Consulted” (13), “Sometimes Consulted” (11) or “Don’t Know” (15) if they were consulted about the annual themes. Only one person stated that they were “Never Consulted”. Table 4 illustrates the success ratings that respondents assigned to various planning functions that the themes might have had in facilitating their annual conference planning efforts. Between 55% and 67% of respondents attested that the themes positively influenced the success of their efforts, the majority indicating that the themes were “somewhat” successful. The ‘Response Average’ given to each function suggests that “Helping your local planning committee to organize regional initiatives” (2.31) was the greatest beneficiary of the suggested themes, while “Making observable improvements in counselling services and supports” (2.81) benefited the least. Table 4: To what extent have the themes suggested by AIDS Bureau been successful in:

Very Much SomewhatNot Very

Much Not At All Don’t Know

Response Average

Helping your local planning committeeto organize regional initiatives. 23% (9) 44% (17) 21% (8) 5% (2) 8% (3) 2.31 Assisting in attracting relevant

speakers and presentations. 25% (10) 30% (12) 20% (8) 10% (4) 15% (6) 2.60 Engaging service providers and People

with HIV/AIDS in dialogue aboutdifferent aspects of HIV/AIDS

counselling. 25% (10) 40% (16) 20% (8) 5% (2) 10% (4) 2.35

Providing a focal point to generateinterest in attending. 22% (9) 35% (14) 25% (10) 8% (3) 10% (4) 2.48

Making observable improvements in counselling services and supports. 18% (7) 30% (12) 28% (11) 5% (2) 20% (8) 2.80


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A specific question the asked respondents to “describe changes, if any, (they) would like to see in the way the annual themes are determined. “ The following is a summary of the 23 comments.

• Many respondents decried the timing of the themes’ announcements by the AIDS Bureau, typically stating that “the themes are consistently presented to us after our conference is already planned.”

• Themes need to be provincially and locally determined: “if there is a really

emergent issue in a region, there should be flexibility to allow for that to occur”

• The AIDS Bureau does a good job in selecting the themes: “The Bureau is consistently well informed and responsive to emerging trends and hot issues,” although one person felt that they are “very Toronto based.” For example: "struggles facing the African and Caribbean communities", wouldn't work in Northern Ontario.”

• Several suggested specific themes they would like chosen in future: “alternative

remedies,” “how to address sexual issues for first and second generations” of Finish Italian and French Canadian cultures, “Urban/rural issues, challenges caused by living in the North, ie., party phone lines, de-stigmatization of HIV/AIDS, etc., would help.”

Compliance of Planning Committees With Guidelines A series of questions focused on the work that planning committees do in order to assess their perceived effectiveness and gather ideas that built on successes and suggested improvements. Table 5 shows that planning committee members have a generally strong regard for their achievements, especially when it comes to “Ensured the safety and confidentiality of all participants,” as 90% responded ‘Very Much’. At the other end of the scale, 28% responded that they had “Benefited from fundraising or sponsorship initiatives involving corporations.”

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Table 5: In your opinion, to what extent has the planning committee in your region:

Very Much Somewhat

Not Very Much Not At All

Don’t Know

Response Average

Used local speakers/presenters forlocal events, to provide an Ontario

context. 72% (29) 22% (9) 2% (1) 0% (0) 2% (1) 1.38

Complied with required registrations ofService Providers (40%), People Living

with HIV/AIDS (30%), and OtherProfessionals and Persons Affected

(30%).

50% (20) 30% (12) 12% (5) 0% (0) 8% (3) 1.85

Reported these figures to the AIDSBureau in the final report of the

conference. 72% (29) 12% (5) 2% (1) 0% (0) 12% (5) 1.68

Worked within the guidelines providedby the AIDS Bureau to plan a local

initiative. 72% (28) 21% (8) 0% (0) 0% (0) 8% (3) 1.51

Met the Reporting Requirementsguidelines by submitting information

(lists, agenda, budget, minutes,reports, etc.) to the AIDS Bureau.

80% (32) 10% (4) 0% (0) 0% (0) 10% (4) 1.50

Ensured the safety and confidentialityof all participants. 90% (36) 5% (2) 2% (1) 0% (0) 2% (1) 1.20

Gave participants opportunities toexchange information about local

resources and contact persons. 69% (27) 23% (9) 5% (2) 0% (0) 3% (1) 1.44

Benefited from fundraising orsponsorship initiatives involving

corporations. 28% (11) 30% (12) 20% (8) 8% (3) 15% (6) 2.53



A follow-up question invited respondents to elaborate:

• Some respondents commented on the need to have committee representation from the stakeholder groups listed in the guidelines, one pointing out that “the geographic area is large and difficult for travel (as is) attracting the % mix required especially the “30% PHA participation, due to numbers in this region.”

• Several mentioned that speakers are almost exclusively from their home regions

although one challenge cited was the difficulty “to get speakers to please both health care workers and PHA's at the same level.”

• Confidentiality is important, “paramount,” as one put it: “We include the need for

confidentiality in our brochure, make reference to this each day during the plenary session, and use only first names on name tags.”

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• Several people provided some details about their compliance with reporting

functions, for example, noting that “we compile a completed year of all materials which is taken to the 'wrap up meeting.”

• Many reported receiving “additional funding from pharmaceutical companies”

although with mixed results. Banking Agencies Planning committees are required to assign the financial management of their funds to a banking agency, yet remain accountable for the banking agencies’ work. Asked to what extent did their banking agency ‘Submit accounts of Opening Doors expenses on their Settlement Forms,’ 51% responded ‘Always’ while 44% said they ‘Don’t Know’. As for their banking agencies’ capacity to ‘Work effectively with your Planning Committee,’ 46% responded ‘Always’; another 30% indicated that they ‘Don’t Know’. The open-ended follow-up responses reflect a range of experiences from planning committee members reporting that, for example, “Budget and financial matters are transparent and reported to the whole planning committee at each meeting,” while another states “it's my understanding that this is taken care of adequately. “ Planning Committee Representation of People With HIV/AIDS (PHA’s) The large number of detailed remarks about this subject suggests that this AIDS Bureau guideline presents a challenge to some Planning Committees. The reported success rate ranges from “we always have at least one PHA on the planning committee” to “a number of PHA’s are currently represented on the planning committee”. Another stated that the committee “provides seats at the table for PHA's”. Meeting the Opening Doors Goals Planning Committee members were asked about the extent of their agreement with four Opening Doors Initiative goal statements. Table 6 illustrates a positive and moderate assessment of the success of the Opening Doors in accomplishing its major goals.

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Table 6: To what extent are you in agreement that:

Strongly

Agree Somewhat

Agree Somewhat Disagree

Strongly Disagree

Don’t Know

Response Average

The Opening Doors initiatives have madetangible improvements to the province’s

HIV/AIDS counselling services.38% (15) 48% (19) 2% (1) 2% (1) 10%

(4) 2.00


related community services with respect tohow they serve Persons with HIV/AIDs

(People With HIV/AIDS).

48% (19) 35% (14) 5% (2) 5% (2) 8% (3) 1.90


informal supports with respect to how theysupport People With HIV/AIDS.

55% (22) 28% (11) 5% (2) 2% (1) 10% (4) 1.85

Communications among all stakeholders inthe HIV/AIDS ‘community’ have improvedbecause of the Opening Doors initiatives.

55% (22) 32% (13) 5% (2) 2% (1) 5% (2) 1.70



The most emphatic approval rating was given to the Initiative’s success in improving communications among a variety of stakeholders and in improving informal supports for PHA’s. The least definite, although still positive, rating was assigned to the Initiative’s role in improving counselling services. Twenty-one people added explanatory comments, summarized here:

• Many of the comments lauded the value of Opening Doors in connecting many different groups and stakeholders – “an incredible network has been established”, especially referencing the gaps bridged between AIDS-specific organizations (ASO’s) and community organizations such as “the prison system, public health, John Howard, Access Centres and others.”

• Responding to a changing service environment, “especially when you think about

the law, treatment…” the change in treatment focus from “hospice care (to) rehab.”

• “This is the only affordable opportunity that most health care workers have in the

year to look at the changing needs of their HIV client.”

• What has been frustrating for those in smaller communities in our region, is that they see what others in large centers can be involved in, and due to lack of funds etc. for travel, they cannot partake of services or activities on an ongoing basis.

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• Having more people in various agencies aware of HIV and dealing with their own attitudes, values and beliefs about HIV and populations infected has had a huge impact in increasing support and reducing stigma.

Opening Doors Successes An evaluation must collect information about successes, so respondents were given a further opportunity to document their positive observations, many of which were lengthy but eloquent personal statements about the impact of the Opening Doors conferences, summarized below:

• “Opening Doors… is the best, most convenient, affordable, educational, and relevant HIV counselling conference offered regionally each year.”

• The idea that the conferences nurture mutual aid supports for PHA’s; “Creates a

comfortable safe space for people living with HIV/AIDS and opportunity to connect with others living with HIV.”

• “Support from the ministry has made it affordable to a lot of health care workers

who get very little funding for education.”

• “This work is both gratifying and soul destroying as we witness the brutal social inequities this disease has highlighted in our society. Workers need the catharsis and hope that Opening Doors has provided over the years.”

• “Opening Doors puts a human face on the issues.”

• “That people from so many different walks of life come together and share

together for this period of time is absolutely incredible. So much growth happens in each one of us.”

Opening Doors Improvements Respondents were given a further opportunity to document their suggestions for improvement.

• Some people indicated “increased funding, so that either the conference could be expanded in attendee's or duration… hard to attend all the 'vital' sessions that one has an interest in.”

• “We could provide more tools for PHA self empowerment and leadership. We

also need to come up with new strategies to engage professionals.”

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• A few people suggested “one provincial conference would better meet the needs of professional and client skills building”; others wanted a rotation between regional and provincial conferences.

The Future: Structural Issues Respondents were asked to consider statements regarding the format, funding, frequency, location and continuation of future Opening Doors initiatives. Format: There is an openness to making some changes to the format, and a similar level of support for the status quo. Funding: 58% agreed to some extent that funding needed to be increased while 22% answered ‘Don’t Know’. Frequency: There is a spectrum of opinions about making “significant changes” to the frequency of the conferences. Location: There is a great deal of support (74%) for the suggestion that there be “periodic provincial initiatives,” and similar agreement (79%) that regions be given the option of not holding conferences some years if they are “willing and able”. Continuation: A majority (84%) disagreed with the idea that the Opening Doors Initiatives be discontinued in the future with another 8% replying that they ‘Don’t Know’. Almost half the respondents provided commentary about the structural questions, summarized as follows:

• “…remote areas need more funding because of travel, but isn't it just as relevant to provide similar funding to those areas that have huge populations. When you plan a conference in an area with around 2 million people and only can accommodate about 100 people because of funding is seems a bit of an imbalance doesn't it? “

• “If a region is not able to have a planning committee devoted to ensuring a

viable…conference, then I personally question the continued funding of that area… (but) should not disclude (sic) them from future funding if they are able to display an involved and committed committee.”

• With the geographical boundaries of the Community Planning Initiatives around

the province being different than those of Opening Doors, it would seem that the Opening Doors boundaries should change as well.

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• Periodic provincial initiatives could be quite interesting if this does not deny the opportunity of the regions to plan and hold their own annual conference.

• Opening Doors is an initiative that is championed by professionals and PHA’s

alike, so it would be disappointing to see OD end.

• “Discontinuing the program would be a huge error. It has taken years to build a well proven project.” As another said: “why 'fix' something that isn't broken?”

• “The benefits of the conference, in terms of improving professional services to

HIV+ clients, is doubtful. However, the need to continue a reorganized program is without question the correct thing; in light of the current poor state of coordinated services in the community. “

Regional Boundaries A question about boundaries indicated that 44% like the boundaries as they are while 33% would like to see them changed “after consultation with local committees”. Commentary included the following:

• “Central West is a bit too big, Peel Region is so big it really could be on its own, but it isn't for me to decide. “

• “The wider you make the areas, the harder it will be to: 1) maintain a viable

committee committed to regular planning venues. 2) focus on 'regional' issues.”

• To enlarge a region will increase costs in travel, accommodations and meals.

• The problem of mismatched planning boundaries came up: “In our region the planning initiative region and the opening door are different and that has causes some confusion.” Another suggested that boundaries “perhaps should mirror the LHINs ”.

• A few think it isn’t the boundaries but “the naming of the regions is confusing”

and “probably should be renamed”.

c. Discussion of Findings Characteristics of Respondents A response rate of 61% is considered excellent for this type of study. Regional Distribution

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The response distribution, based on regions, is skewed with an unusually large Central East and West response and an unusually low Toronto and South West response, given what we know of the population sizes of these areas. Membership by Stakeholder Group The distribution of respondents by stakeholder group indicates that the groups most likely to respond – AIDS service providers (59%), People with HIV/AIDS, (29%) and Community health service providers (29%) – did so. These are the people with the most at stake in a well-funded, coordinated, collaborative HIV/AIDS ‘system’ and therefore with the greatest motivation to be involved in the planning process and to express their views about the Opening Doors Initiative through the survey. Committee Experience Those who chose to respond to this survey reported a wide range of experience levels and demonstrated a balance among those who have some, more and greater levels of experience as planning committee members. This balance suggests that the results reflect the ideals and traditions, the openness to change and the historical context of both recent and longer term members. Opinions about Opening Doors’ Main Objective Both the closed and open-ended questions regarding the Opening Doors Initiatives mandate – “to strengthen counselling skills, resources and supports” – send a clear message: that, while still an essential mandate, it does not include several other important mandates that for many planning committee members, may deserve a more formal recognition and inclusion: Education about all aspects of the HIV/AIDS treatment and prevention, creating opportunities for networking to foster dialogue among professionals – AIDS and community organizations – and PHA’s, are of equal value to many respondents of this survey. Determination of Opening Doors Annual Conference Themes The annual use of new conference themes serves to broaden the scope of the Opening Doors initiative and does provide an answer to those critical of what they might perceive to be a too-narrow focus on counselling. But many planning committee members referred to an ongoing flaw, in that they are too far along in the annual planning process to easily benefit from the AIDS Bureau’s themes announcement. Table 4 reinforces the moderate influence of the themes on the success of the conferences as the most prevalent responses are “somewhat’ successful. Local flexibility to include different themes or exclude locally irrelevant provincial themes and a broader consultation process are also reasonable suggestions.

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Compliance of Planning Committees with Guidelines Not surprisingly, planning committee members report that they are complying with the guidelines outlining their duties. By comparing the relative strength of their responses to the different duties, it is clear that they are less confident in their abilities to include PHA’s in the planning process and to attract fundraising and corporate sponsorship funds. Fundraising and corporate sponsorship are not part of the guidelines, however, most regions do it out of necessity to ensure the conferences meet both the financial limitations and specific regional needs. Banking Agencies The large number of ‘Don’t Know’ responses, to questions regarding the performance of the banking agencies, along with the comments to the follow-up question, suggest that a significant number of planning committees, or at least a number of their members, do not pay close attention to the work of the banking agencies. On the other hand, approximately half of all respondents were definite and clear about the satisfactory performance of their banking agencies. This would suggest that there are at least two very different planning committee cultures with regard to the financial management of the committee’s affairs. In one culture the banking agency’s work is “transparent” to committee members, where in others, the banking agency’s work is a low priority. Planning Committee Representation of People with HIV/AIDS (PHA’s) There appears to also be notable differences among planning committees when it comes to successfully including PHA’s on planning committees. Is it enough to “have seats available” for PHA’s, or to be satisfied that one PHA is involved? While some PHA’s may well be professional people, there are challenges inherent in efforts to include non-professionals in committee functions. Language, professional jargon, the greater historical awareness of professionals, the failure to credit the expertise of the ‘client’ or ‘patient’, the greater resources of professionals to find the time (from work) and money (e.g. travel, child care) to attend are challenges that come with the territory. One respondent described the formation of a “PHA panel that talks about some issues and things that are of concern to them.” The panel is a safe place for PHA’s to meet and to establish a sense of belonging around the table and can often serve as a training ground to ensure that PHA’s are prepared and are confident of their place on the planning committee as an equal. Planning committees will take the time and effort to enlist, orient and fully include PHA’s in their work when they have a full appreciation of the tremendous benefits accrued from hearing how it is and what it feels like to be on the receiving end of the services we provide.

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Meeting the Opening Doors’ Goals The positive comments of respondents suggest that the Opening Doors Initiative is relevant and providing a variety of benefits that extend beyond the main counselling objective. Planning committee members value ‘HIV/AIDS education’ and ‘networking among stakeholders’ as additional main objectives of the Opening Doors Initiative. They offer a number of concerns that the current mandate is too narrow and express their sense that commitment and funding may be more secure if the mandate accurately reflects the multi-dimensional nature of the conferences they hold. Opening Doors Successes Planning committee members are committed, for the most part, to the Opening Doors Initiative, and feel strongly, often passionately, that the annual conferences provide essential benefits to people who serve and receive HIV/AIDS services and supports. In particular, people from rural and northern regions described the value of the Initiative in combating the professional and personal isolation they experience. Opening Doors Improvements and Future Concerns There was no clear consensus or major thrust put forward by the respondents although there many indicators of changes they think are needed:

• Expand main objectives and mandate • Increase funds to allow more people to participate • More flexibility in themes, announced earlier in the planning cycle • More flexibility in frequency of conferences, different mix of regional and

provincial events • Improve involvement of PHA’s in planning efforts • Consider special allowances for rural and northern regions

Regional Boundaries There are a number of regions where the logic of boundaries – and of the names – is under question, although it also appears that a larger number are happy with the regional boundaries as they are presently constituted. A couple of respondents took note of other planning bodies and the new LHIN’s planning structures and questioned if Opening Doors regional boundaries should be co-terminus with other health jurisdictions.

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Regional Variance Table 7 outlines some of the variations on responses to the overall survey questions. The following conclusions are drawn from the analysis:

• Consistent across all regions is the belief that the Opening Doors Initiative has improved counselling skills within the regions and that for the majority of regions Counselling skills should remain a relevant objective of these conferences.

• With the exception of the Eastern and Central Western regions, a majority

of respondents believe that the focus of future conference should be changed from just counselling.

• No consensus emerged regarding regional decisions about the status of

the current boundaries. The Eastern region wants its boundaries to remain unchanged, and the other regions are uncertain or at best split on this issue.

• Almost all regions agreed that holding a periodic Provincial Opening Doors

initiative might be a good idea. The strongest support for this idea came out of the Toronto, North Eastern, and North Western regions.

• In terms of keeping the Opening Doors Conferences the same or

continuing with significant changes- representative from the Eastern Region wanted no changes to their format, and the North East region wanted to maintain the conferences with significant changes. The Central West region wanted their conference to remain the same without significant changes

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Table 6.1 ODC Planning Committee Survey Overview

* agree includes the strongly and somewhat categories,

and disagree included the somewhat and strongly categories Recommendations and Conclusions

1. Consider the formal addition of ‘HIV/AIDS education’ and ‘networking among stakeholders’ as main objectives of the Opening Doors Initiative.

2. AB and regional representatives should receive full report of all open-ended

responses in order to gain from the important and well-stated opinions and useful ideas.

3. AB should announce themes much earlier to coincide with regional planning

calendars.

Question 25 Regarding ODC * Region # Question 7 Has ODC increased Counselling skills

Question 8 Degree that counselling skills remains relevant

Question 10 Should CounsellingFocus be changed

Stay same Change significantly

Hold provincial conference

Question 27 Regional Boundaries

Toronto

4 75% somewhat agree

75% very much agree

50/50 change

50/50 stay/change

50/50 100% agree

67% don’t know

South West


67% somewhat agree

100% change

100% change

67% agree

67% agree 67% change

North East

4 50% very much agree

50/50 very/ somewhat agree

75% change

75% stay 100% % agree

75% agree 50% change

East


100% very much agree

80% stay same

100% stay 100% disagree

60% agree 100% stay same

Central East


57% somewhat agree

71% change

50/50 stay/change

57% agree

72% agree 50/50 split

Central West


60% very much agree

60% stay same

89% stay 50% disagree

67% agree 67% stay same

North West


71% very much agree

50% change

50/50 undecided 83% agree

57% don’t know

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4. Empower regional planning committees to include locally relevant themes and, when justified, to exclude provincially set themes that are clearly locally irrelevant.

5. Brainstorm strategies on how to attract and retain PHA’s on committees and

what works in making the conferences attractive to PHA’s.

6. Brainstorm strategies on how regional planning committees can benefit from fundraising or sponsorship initiatives involving corporations; find out what works in successful regions.

7. Encourage better interactions among planning committees and their banking

agency representatives.

8. Review apparent disparities in the success and commitment of different regions; assess why these disparities exist. The survey results clearly outline the success of the Eastern Regional conferences- and perhaps a closer review of this regions practices and methodologies could help other regions struggling with this issue.

9. Consider the measures that are needed to better support the unique challenges

facing rural and northern regions in planning and holding annual conferences. Interestingly the planning committee members representing the Northern regions all supported a periodic Provincial Opening Doors Initiative. This could be reviewed with the idea of holding a Northern Regions Conference to discuss the specific challenges of working in a larger rural area.

10. Investigate boundaries established by the LHIN’s and the community planning

regions and consider the adaptation of co-terminus Opening Doors regional boundaries.

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Opening Doors Counselling Initiative

Planning Committee Members’ Survey

Introduction

The AIDS Bureau is conducting an evaluation of the Opening Doors Counselling Initiative, held since 1992. The evaluation will help to assess the various roles of the stakeholders and to get a sense of their experiences in evaluating the outcomes of the initiatives. This questionnaire asks Planning Committee members about their perspectives and experiences as planning and organizing agents of the initiatives. This information is confidential and does not ask for names or other identifying information. Your answers will be grouped with all the other answers to help us plan and prepare for the future.

1. Please indicate which region you are from.

Toronto Central East South West Central West North East North West Eastern

2. Are you a Planning Committee member from any of these categories: (Please check more than one if applicable)

AIDS Service Organization Person with HIV/AIDS AIDS-Affected Family member or Friend Health care providers (e.g. Public health, mental health, addictions)

Non-health Service Organization (e.g. housing)

Other (Please describe) 3. How many years have you been a member of the Opening Doors Planning Committee?

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None 1-3 4-6 7 plus

4. How many Opening Doors initiatives/events has your region’s Planning Committee hosted since 1992?

None 1-3 4-6 7 plus

5. If you did not host a conference/event during some years, please describe the reasons why: (select more than one if applicable) Too much work to organize every year

Difficulty getting Planning Committee members

Competing local events Competing provincial or national events

Funding problems Other (please

describe below)

6. Please indicate how many Opening Doors initiatives you have attended?

None 1-3 4-6 7 plus 7. In your opinion, to what extent have the past regional Opening Doors initiatives strengthened counselling skills, resources and supports in Ontario.

Very Much

Somewhat Strengthened

Not Very Much

Not at all Strengthened

Don’t Know

8. Given current issues in the HIV/AIDS movement, to what extent do you believe that the Opening Doors Initiative’s main objective (“to strengthen counselling skills, resources and supports in Ontario.”) remains applicable.

Very Applicable Somewhat Applicable

Not Very Applicable

Not at all applicable

Don’t Know

9. Please give examples to illustrate your response to Question 8.

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10. Currently the AIDS Bureau guidelines direct the regional Opening Doors initiatives to focus primarily on counselling. Should the focus of the initiatives:

Remain the same Be changed after consultation with local committees Be changed now, based on information already available

Don’t know

11. What would you suggest the Opening Doors Initiatives have as its focus.

12. In the Opening Doors guidelines, issued by the AIDS Bureau, it states that: “Each year the AIDS Bureau, Ministry of Health and Long-Term Care provides two new suggestions to assist with the event planning. These suggestions are based on consultation with community members on the emerging issues in the field of HIV/AIDS.” To what extent has the AIDS Bureau consulted with your Planning Committee about what annual themes will be determined for the Opening Doors regional initiatives?

Always consulted Sometimes Consulted Never consulted Don’t Know

13. To what extent have the themes suggested by AIDS Bureau been successful in:

13.1 Helping your local planning committee to organize regional initiatives.

Very Much Somewhat Not Very Much Not At All Don’t Know

13.2 Assisting in attracting relevant speakers and presentations.


13.3 Engaging service providers and People with HIV/AIDS in dialogue about different aspects of HIV/AIDS counselling.


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13.4 Providing a focal point to generate interest in attending.


13.5 Making observable improvements in counselling services and supports.


14. Please describe changes, if any, you would like to see in the way the annual themes are determined. 15. The AIDS Bureau’s Program and Financial Guidelines of 2005 detail the program and financial requirements of local planning committees. In your opinion, to what extent has the planning committee in your region:

15.1 Used local speakers/presenters for local events, to provide an Ontario context.


15.2 Complied with required registrations of Service Providers (40%), People Living with HIV/AIDS (30%), and Other Professionals and Persons Affected (30%).


15.3 Reported these figures to the AIDS Bureau in the final report of the conference.


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15.4 Worked within the guidelines provided by the AIDS Bureau to plan a local initiative.

Very Much Somewhat Not Very Much

Not At All Don’t Know

15.5 Met the Reporting Requirements guidelines by submitting information (lists, agenda, budget, minutes, reports, etc.) to the AIDS Bureau.


15.6 Ensured the safety and confidentiality of all participants.


15.7 Gave participants opportunities to exchange information about local resources and contact persons.


15.8 Benefited from fundraising or sponsorship initiatives involving corporations.


16. Please give examples to illustrate your responses to Question 15.

17. To what extent did the Banking Agencies (to the best of your knowledge):

17.1 Submit accounts of Opening Doors expenses on their Settlement Forms.

Always Frequently Rarely Never Don’t Know

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17.2 Worked effectively with your Planning Committee.



19. To what extent did your Planning Committee meet its responsibilities by:

19.1 Submitting final reports to the AIDS Bureau in a timely fashion following the conference.


19.2 Submitting a proposed budget to the AIDS Bureau.


19.3 Appropriately engaging People With HIV/AIDS and other concerned community members (family, friends, caregivers) in their planning and implementation.



21. To what extent are you in agreement that: 21.1 The Opening Doors initiatives have made tangible improvements to the province’s HIV/AIDS counselling services.

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Strongly Agree Somewhat Agree

Somewhat Disagree

Strongly Disagree

Don’t Know

21.2 The Opening Doors initiatives have made tangible improvements to the province’s related community services with respect to how they serve Persons with HIV/AIDs (People With HIV/AIDS). Strongly Agree Somewhat


Strongly Disagree

Don’t Know

21.3 The Opening Doors initiatives have made tangible improvements to the province’s informal supports with respect to how they support People With HIV/AIDS. Strongly Agree Somewhat


Strongly Disagree

Don’t Know

21.4 Communications among all stakeholders in the HIV/AIDS ‘community’ have improved because of the Opening Doors initiatives. Strongly Agree Somewhat


Strongly Disagree

Don’t Know


23. Briefly describe any specific successes of the Opening Doors initiatives that have not been

previously documented.

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24. Briefly describe any specific areas for improvement of the Opening Doors initiatives that

have not been previously documented.

25. To what extent do you agree with the following statements. The regional Opening Doors Counselling Initiative should:

25.1 Continue essentially in the same format. Strongly Agree Somewhat


Strongly Disagree

Don’t Know

25.2 Continue with significant changes in format.


Somewhat Disagree

Strongly Disagree

Don’t Know

25.3 Continue with significant changes in funding. Strongly Agree Somewhat


Strongly Disagree

Don’t Know

25.4 Continue with significant changes in frequency.


Somewhat Disagree

Strongly Disagree

Don’t Know

25.5 Hold periodic provincial initiatives. Strongly Agree Somewhat


Strongly Disagree

Don’t Know

25.6 Continue initiatives for regions that are willing and able, not for others. Strongly Agree Somewhat


Strongly Disagree

Don’t Know

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25.7 Not continue initiatives in the future. Strongly Agree Somewhat


Strongly Disagree

Don’t Know

26. Please give details to explain your answers to Question 25. 27. Should the regional boundaries used to organize the initiatives? (Pick one only)

Remain the same

Be changed after consultation with local committees

Be changed now, based on information already available

Don’t Know

28. Please explain your answer to Question 27. 29. Please add any comments, concerns or suggestions about the Planning Committee not covered in the previous questions.

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7. Participants’ Survey Report Methodology Population The population for this survey consisted of participants to the Opening Doors initiatives organized in each of the seven regions over the past thirteen years. A total of 564 individuals were identified, by the regional representatives, as participants who had attended past events. Of this total, 276 were emailed an invitation to visit a Survey Monkey website to complete a survey online; to protect participant’s confidentiality, the regional AIDS service organization mailed out surveys to 288 additional people requesting their participation. Survey Design As the study’s main goal was to gather important individual perspectives, it was decided to implement a descriptive study, using primarily qualitative data. The survey orientation featured questions posed from an historical perspective, asking respondents to reflect back on past experiences, which in a number of instances, spanned many of the 15 years the Initiative has been in operation. Where possible, ordinal or ranking questions were used to assess respondents’ level of satisfaction or agreement with different aspects of the Opening Doors Initiatives’ operations. All questions were followed by open-ended questions designed to elaborate on and describe the subject of the questions in the respondents’ own words and to provide opportunities for the respondents to contribute much needed descriptive information. Some questions collected information that could only be properly provided through the open-ended format. Some basic ‘demographic’ questions were posed to understand the general characteristics of the respondents so that differences between groups of respondents, if any, might be identified. A series of questions were prepared and refined based on input from a variety of sources:

3. The AIDS Bureau’s ‘Opening Doors Counselling Initiatives Program & Financial Guidelines of 2005’ provided a number of guidelines and principles regarding the

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themes, objectives and operations of the annual initiatives. These guidelines and principles statements were used to construct questions which would evaluate and describe their practical usefulness and effectiveness.

4. Representatives from each region and The AIDS Bureau met to identify the need

for an evaluation and to provide advice about process and content of the evaluation research. The minutes and reports produced by the committee were important inputs to the survey design.

5. The AIDS Bureau provided goal and objective statements to the researchers

which assisted in defining the focus and scope of the study. A copy of the Participant’s evaluation survey is presented at the end of this section. Data Collection Respondents’ contact information - e-mail addresses - was provided by regional committee members serving as regional resource people to the research team. Respondents were offered two alternatives:

7. The survey was entered onto the Survey Monkey website. E-mail letters of introduction invited respondents to visit the website and respond to the survey online. This provided the researchers with automatic tabulation and printing of results as each survey was completed.


or Internet capabilities, as well as those who were identified as clients of the ASO and whose identity was protected.

A deadline of Nov 30, 2006 was provided in the letters of introduction and a number of reminders sent out at periodic intervals in order to gain the best response rate possible. Limitations Because of the modest size of the population and because of the study’s goal to gather important individual perspectives, it was decided to implement a descriptive study using primarily qualitative data with some quantitative measurements collected through ordinal data. As a result, the data collected does not lead to cause and effect conclusions and does not yield data, useful though it might be, that can be seen as statistically reliable or statistically significant in any way.

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A large amount of detail that has been eloquently provided by the respondents has been summarized through content analysis to reflect the general points being made. Specific illustrative quotes are used frequently to amplify the points. Some of the statistics reported for rating questions (measurements of success or satisfaction, for example) included a ‘Response Average’ (RA) which produces a single number for each question that can be easily compared to the RA of any other rating question. The presence of a “Don’t Know’ response option however, in several questions, has the potential to skew the RA, as Don’t Know’s are assigned a number which will change the RA of a question, despite what should be a neutral response – and therefore excluded from the RA calculation. Findings Out of a total of 564 requests for participation, 205 (36.3%) completed surveys were received. Regional Distribution The regional distribution of the participant’s survey is presented in Table 1. Almost one quarter of the respondents were from the Eastern region while the North East region was the least represented among the regions with only 10 (4.9%) respondents. When the data provided by Person with HIV/AIDS (PHA’s) was filtered, it was notable that 33% (23) of all PHA’s are from the Eastern Region.

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Table 1: Regional Identification of Participants.

Response Percent

Response Total

Toronto 9.3% 19

South West 13.7% 28

North East 4.9% 10

Eastern 24.4% 50


Central West 17.6% 36

North West 9.8% 20

Not Sure 9.3% 19


(skipped this question) 0 Membership by Stakeholder Group Those who responded came from each of the stakeholder groups noted in the guidelines as reflected in Table 2, in particular from Health Service Organizations (39%), AIDS Service Organizations (37%), and Persons with HIV/AIDS (34%). A large number of the 20 people who responded ‘Other’ to this question, indicated that they were speakers, presenters or conference organizers while a few were from social service (women’s shelter, needle exchange) or community organizations such as aboriginal groups.

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Table 2: Membership by Stakeholder Group Do you attend the annual conferences as a member of any of these categories:

Response Percent

Response Total

Person with HIV/AIDS 34.3% 70

AIDS-Affected Family

member or Friend 9.3% 19

AIDS Service Organization 36.8% 75

Health care providers(e.g. Public health,

mental health,addictions)

38.7% 79

Non-health Service

Organization (e.g. housing) 4.9% 10

Other (please specify) 9.8% 20



Conference Attendance The largest number of people (61%) reported that they had attended from 1-3 conferences while a declining percentage reported that they had attended 4-6 (23%) or more than 7 (15%) conferences. Conference Experiences A series of questions were asked to gather participants’ assessments about the quality of the conferences. Table 3 illustrates the relative levels of agreement with 9 evaluative statements.

http://www.surveymonkey.com/TextBreakdown.asp?SID=2288184&QID=28511818&OptionType=1�

http://www.surveymonkey.com/TextBreakdown.asp?SID=2288184&QID=28511818&OptionType=1�

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Table 3: Thinking back over the year(s) that you have attended the Opening Doors Conferences, to what extent do you agree with the following sentences:

Very Much Somewhat Not Very Much Not At All Response

Average

I decided to attend because of thethemes of the Opening Doors

Conferences. 47% (94) 39% (78) 7% (15) 7% (14) 1.75

I found the workshops helpful. 61% (123) 34% (68) 4% (9) 1% (2) 1.46 I found the speakers provided good

information. 65% (132) 32% (64) 2% (5) 0% (1) 1.38

I found the speakers interesting. 65% (131) 32% (64) 3% (6) 0% (1) 1.39 It was important to meet others

during the Opening Doors Conferences.

74% (150) 19% (38) 6% (13) 0% (1) 1.33

I found the conference facilitiesprovided a comfortable place to meet. 79% (159) 19% (39) 2% (4) 0% (0) 1.23

The conferences were easy to travelto. 71% (143) 24% (49) 3% (7) 1% (2) 1.34

Subsidies were available to make thecost of the conferences affordable. 76% (146) 16% (31) 5% (10) 3% (6) 1.36

I found the Opening DoorsConferences welcoming in language

and attitude to everyone, regardless ofbackground, gender, race or working

status (paid/non-paid).

79% (156) 17% (34) 4% (7) 1% (1) 1.26


(skipped this question) 3 Table 3 suggests a high degree of approval for the various characteristics of the conferences they have attended. Response Averages (lowest RA = highest level of agreement) show that the conference facilities’ comfort (1.23) and the “welcoming” nature of the conferences (1.26) had the highest rate of agreement, while the role of conference themes (1.75), as a determining factor in attendance, received the lowest rating. The follow-up open-ended question was answered by 126 respondents, a sampling provided below:

• Many indicated that information-sharing and education was a key benefit of the conferences for them, for example, to “share updates of programs in our agencies” and “Speakers seem to be well informed with updated info.”

• Others focused on the importance of meeting other people: “The networking

component is fantastic. Meeting and sharing personal/professional life experiences gives me greater insight into this illness.”

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• A number of responses focused on the integration of professionals and non-professionals: “The PHA's during the panel discussion bring a real face to the challenges and the personal stories shared are extremely powerful”, and, “conferences were invaluable in bringing PHA's and professionals together as equals.”

• Some comments were made about facilities: “It is a comfortable environment

and everyone is treated equally,” ”Didn't like the way they paired people into rooms.”

• The way conferences were organized also drew multiple comments such as:

First class operation, everything was done with professionalism and a welcoming atmosphere, “OD relaxed and informative,” and, “more interactive, participatory workshops please.”

• The themes and programming were referenced many times: “would like to see

more offered on actual counselling”, “I find the Medical information and Research information to be extremely helpful”, “Themes have never been very clear. It is generally the speakers and topics they are speaking to that help me decide whether or not to attend”, “the conference was sometimes too conservative when it could be quite innovative”, and, “new ideas were often shut-out depending who was on the planning committee each year.”

• Subsidies received a number of references from grateful participants: “The

subsidies helped a great deal allowing me the opportunity to attend and participate fully over the entire event”, and, “(Subsidies) make it available to me even if my employer is not in a financial position to send me.”

• The high participation rate of respondents, and especially of PHA’s, from the

Eastern Region was matched by a number of compliments about that region’s organizational capabilities with comments such as: “I've been to other area's Opening Doors but none of them even come close to Kingston's in Ganonoque. Why not use Kingston's as the model?” and “The set-up (in Gananocque) is conducive to people from all sectors mingling together, enriching the experience for all parties”, “Eastern Ontario Opening Doors is a very comfortable place to be. The organizers are always there for whatever your needs may be”, and “the Eastern Opening Doors is by far the best organized, attended and delivered.”

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Conference Outcomes Participants were questioned about several desired conference outcomes and asked to rate their level of agreement about the extent to which these outcomes had been achieved. Table 4: Level of Agreement with Desired Outcomes Achieved

To what extent do you agree that:

Strongly

Agree Somewhat


Strongly Disagree

Response Average

The Opening Doors Conferences havemade obvious improvements to the

province’s HIV/AIDS counsellingservices.

43% (86) 47% (94) 9% (18) 1% (1) 1.67


province’s related community services(for example: public health, housing,

mental health, addictions) with respectto how they serve Persons with

HIV/AIDs.

41% (80) 45% (88) 14% (27) 1% (2) 1.75


province’s informal supports (forexample: self-help, volunteer groups)

with respect to how they supportPersons with HIV/AIDs.

45% (88) 49% (95) 5% (9) 1% (2) 1.61

The Opening Doors Conferences haveincluded Persons with HIV/AIDs and

other concerned community members(family, friends, caregivers) in their

planning and running.

74% (146) 22% (43) 3% (5) 2% (3) 1.31

Communications among all concernedpeople in the HIV/AIDS ‘community’

have improved because of theOpening Doors Conferences.

52% (102) 36% (71) 11% (21) 2% (3) 1.62



Response Average scores in Table 4 indicate that people felt most strongly (RA=1.31) that the conferences had been successful in engaging stakeholders who were not professional AIDS Service Organization staff in the planning and running of the conferences. They were the least supportive in their collective agreement (RA=1.75) that gains had been made in improving the services provided by community services such as public health and housing, mental health and addictions. It should be noted that only 15% of respondents disagreed that community service improvements had been made. More detailed information about conferences’ outcomes was collected from 114 open-ended responses, summarized below:

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• Many responses indicated that the Opening Doors Conferences do a good job of

providing information: “Conference provides information on new drugs, counselling methods, and how to be sensitive with clients,” “Education reduces stigma and racism, sexism…” “In some communities, the Opening Doors conferences are the only means of accessing services and information on HIV/AIDS.”

• Improved networking in communities was a common observation: “Local ASO’s

have improved much because of conference”, “helps us get good information about dealing with issues in a rural setting.” “Communication essential between affected, infected and the caregivers.” “Any time you have community coming together on an issue it builds community”

• The involvement of PHA’s was often seen as a positive outcome, but not without

some disagreement: “Opening Doors conference has… not involved people affected and infected by HIV/AIDS, and, “I think that having HIV + people at the conference allows discussion and empathy to widen and deepen amongst all the members.” “Empowerment of PHA's is palpable.” “Have come a long way with support and financial assistance, but more is still needed for PHA's”

• Distinctions between urban and rural: “improvements are more apparent in bigger

communities…in smaller remote areas these improvements are not so obvious.” “Speakers are often using an urban perspective but the info helps inform us.” “I still see a fair amount of isolation, particularly for those who live in rural areas. “

• Conference organization: “Better conference organizing skills and knowledge

transfer needs to occur from areas that have great OD conferences to those that don't...” ; “I point to the marginalization of people who use drugs and work in the sex trade… the emphasis and leadership is still almost exclusively in the hands of gay stakeholders.”

• While there were many interesting and detailed responses, quite a few people

remarked on the difficulty answering the questions: “Can't really say - haven't seen measured outcomes.” “I don't really feel qualified to answer the above questions confidently.”, “I wish there was an 'I don't know' answer for this question”.

Focus of the Conferences Participants were asked about the counselling focus of future conferences. A number of respondents (38%) indicated that the focus should be changed after consultation, while 36% felt the focus on counselling should continue.

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To follow up, respondents were asked what focus, outside of HIV/AIDS counselling, they thought the Opening Doors Conferences should provide. A variety of comments made by 134 people are summarized as follows:

• Many people referenced the need for getting “More medical information”, such as “more specific drug information”; “Diabetes”, “Cross cultural partnering”, “ Meth and Substance Use”; “Hep C”; “review of medication updates”; “more on nutrition and health”.

• Many spoke to the desire to broaden the conferences’ focus: “expand focus of

conferences based on the needs of the communities and as the need changes”; “expanded based on evaluations for each region”; “Counselling is a somewhat narrow perspective, important but certainly should not be the primary focus”; “Each location needs to determine this for themselves.”

• A similar number felt that conferences should keep the same focus: “I find the

mental and emotional counselling to be most important to me “; “Keep up the good work”; “Counselling should remain at the front of the list.”; “they are great the way that they are now”; “If you start adding other concerns it gets watered down and unfocussed.”

• Several emphasized the importance of helping marginalized populations: “…in

hostels”; “Service updates re: marginalized people and immigrants living with and affected by HIV/AIDS”; “OD needs to 'open doors' for the straight HIV men”; “more of a focus on cross-cultural counselling.”; “more focus on refugees/new immigrants and their needs.”

• Education and reducing stigma was mentioned many times: “education for the

public - proactive things people can get involved in to break down the barriers and misinformation”; “incorporate… Health Promotion and Population health models. Counselling and other health promotion activities are important, but so is addressing stigma, discrimination, housing, etc… the event would have to be bigger, but what an opportunity - the community is already engaged.”; “educating the larger community to reduce stigma.”

• Prevention and harm reduction was mentioned many times: “Prevention,

education and Psychosocial Issues”; “Prevention & harm reduction”

• The case was often made for making related community services more responsive: “Addiction workshops”; “Housing, Mental health “; “Crack use and HIV”; “Start looking at other social determinants of health”

• Help PHA’s develop leadership skills: “PHA involvement and leadership in

advocacy”; “Leadership training for PHA's”; “Leadership training for PHA's wanting to get more involved in advocacy, peer training”; “How to empower clients with their care”; “Peer network development”

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• The macro view was mentioned numerous times: “Inter-agency communication

and cooperation, planning”; “Community planning Coordination of services”; “each conference could include a session regarding working together to centralize the issues”; “Focus on resource sharing, and resource availability.”

Conference Changes in Frequency, Format and Funding A series of statements were made regarding future conference changes other than focus. Table 5 illustrates the range of responses when asked about their level of agreement with the statements. Table 5: Agreement with Suggested Conference Changes To what extent do you agree with the following statements. The regional Opening Doors Conferences should:

Strongly

Agree Somewhat


Strongly Disagree

Don’t Know

Response Total

Continue basically in the same way. 37% (74) 39% (78) 13% (26) 7% (14) 4% (7) 199 Continue with major changes in the

way they are run. 12% (23) 25% (49) 25% (49) 22% (44) 16% (31) 196 Continue with major changes in

funding. 21% (42) 27% (53) 10% (19) 9% (18) 33% (64) 196 Continue with major changes in how

often they are held. 17% (33) 21% (40) 21% (41) 27% (53) 14% (28) 195 Be replaced by province-wide

conferences from time to time. 11% (21) 23% (46) 17% (34) 43% (85) 6% (11) 197 Continue Opening Doors Conferencesfor regions that are willing and able,

not for others. 25% (50) 27% (54) 14% (27) 21% (42) 14% (27) 200

Not continue in my region. 2% (4) 2% (4) 6% (12) 83% (161) 7% (13) 194



The results suggest that people want modifications to the Opening Doors formats, but not major changes. Funding changes (assuming those changes were seen as increases) received moderate endorsement with 33% indicating that they “Don’t Know” if funding should be changed. There was little support (34%) for the suggestion that provincial conferences periodically replace regional ones, but stronger agreement (52%) for leaving it up to individual regions to hold, or not hold, annual events. A significant 89% disagreed that their region should not continue to host Opening Doors conferences.

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Respondents provided further details in 113 open-ended responses, summarized below:

• “Don't mess with success”; “Not broke don't fix it...”Change is good but the conferences are very valuable so don't eliminate them

• “More funding could help expand and meet more that once a year, also to do

much better HIV/AIDS community driven workshops”; “these conferences should still be run every year, and should be well funded.”

• “Opening Doors does need to re-examine its focus and change a bit, but that is

true of any program. It is still a viable need for the community”; “Needs new focus and direction”; “Conference well done; new information/formats would keep it relevant.”

• “Although it would be nice to group people province wide, I think the regional

setting is more personal and more beneficial to those who attend.”

• “Have the funding reflect the difficulties of holding conferences in rural regions.”

• “A provincial one is a great idea every second year and then the regional ones could be in the other year or annually.”; “the idea of a provincial open doors every once and a while is wonderful.”; “Don't need provincial because there is OAN.”

• “if a community does not see the benefit to the conference that the money should

be allocated to communities who would use it.”; “Opening Door conferences should take place whether a region is willing and able to do it or not. These conferences primarily belong to people living with HIV.”; “perhaps in Toronto (just as an example) there may not be a need for an Opening Doors compared to my eastern region… spread out with rural and urban areas where the Opening Doors is viewed as a positive event of learning and sharing.”; “Northwestern Ontario faces unique challenges - geography, climate, distances from home to service organizations and other situations. “I know a revamping is necessary- but in regions where this event is a catalyst for better communication and service, why not support that region? In others, a rethink is necessary- like Toronto.”

• “Conference mandates and organizational structures should be

evaluated/reviewed on a regular basis to ensure that funding, content and structure continue to meet the needs of the targeted communities “

• “Kingston to teach their OD skill to others”; “The Eastern Ontario Opening Doors

continues to draw people; it is often hard to get in as the conference fills quickly.”

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• “The size and availability is just right. A province-wide conference might be overwhelming for some and would definitely take away from the closeness and ability to meet people on a one-to-one basis that is so evident in the current Open-Doors conferences.”; “One needs considerable time between conferences to utilize what has been learned. It is hard for some PHA to travel a long distance so I would not recommend replacement by province-wide conferences.”

• “it would be beneficial to have at least two per year”; “every 6 months”

• The region has been a great help to many PHA's and family

Regional Boundaries A further question asked for comments about whether or not regional boundaries should “remain the same or be changed”. Out of 137 responses, 55 (40%) indicated that they wanted the boundaries to remain unchanged. Another 19 (14%) said that they “don’t know” or “don’t know about other regions’ boundaries”. The remaining comments ranged from a few suggestions that boundaries re-align with new planning boundaries, such as LHIN'S to numerous northern concerns about distances that led one person to suggest that “the North East and North West conferences should be joined every alternate year … in 2007 have it in Thunder bay, …and in 2008 have it in Sudbury.” Suggestions for Other Community Events Respondents were asked to suggest any other events they would like in their communities, with the following summarized results:

• “Have speakers go into schools (start with Gr 7) and talk about the issues”

• “Link ODC to housing, homelessness, and poverty issues and other indicators of health”

• “Middle and upper class white folks aren't the ones being hit the hardest by this

virus, yet they are the ones being invited to attend- get into the trenches and the shooting galleries. “

• “more interactive workshops with hands on learning“

• “Retreats, 2-3 day workshop, and getaways”; “more events like Opening Doors

organized in our communities.”; “mini conferences in individual cities/towns.”; “Community forums”

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• “Need an Opening Doors Conference in east Toronto. Currently, people living with HIV in east Toronto are scattered and if one wishes assistance, one has to commute to central Toronto.”

• “Semi annual or quarterly meetings for local ASO's”

• Twenty people said “no” or “not at this time”

What did you like the most about the Opening Doors Conferences? The following comments each represent numerous similar comments made by the 158 people who answered this question:

• “Having PHA's speak and share their stories”; “Contact with other PHA's”; “Interacting with those infected and affected.”

• “Workshops and networking”

• “Speakers and knowledge”; “Education - knowledge learned”; “Range of topics

Expertise of speakers”

• “Integrating of PHA's and professionals”

• “It made me see and think outside of the box.”

• “Relaxed feeling"; "Peer support and opportunity for learning”; “appreciated the way everyone was treated equal and very politely.”; “I liked the immediate sense of camaraderie and purpose. Although all people had varying reasons for attending, it still united us in cause.”

• “New medication information”

• “The food”

What did you like the least about the Opening Doors Conferences? Of the 108 people who responded to this question 24 (22%) said “Really like it all”; “nothing” or a similar comment, other repeated comments are summarized as follows:

• “Time passed too quickly”; “Too short”; “one more day would be a benefit.”

• “Saying goodbye for a year “

• “Challenging behaviours”; “The way some people act out

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• “The intolerance some people demonstrate or verbalize in relation to ‘less acceptable’ behaviours.”

• “Partying”; “Some attendees used the conference only to 'party' which may be

due to the limited opportunities to get away.”

• “Sometimes workshops are too elementary”; “presentation styles/lack of variety in presentation format (power point, lecture)“; “Sessions not well organized”

Other Comments Respondents were given a final opportunity to make comments that had not been solicited through previous questions; the 53 comments are summarized below:

• “Keep up the great work! I feel that its a good way to create awareness and lessen the fears and stigma that goes hand in hand with HIV”

• “I would like to be able to see who the presenters are and what they are going to

talk about before I attend a session”

• “Opening Doors Conference is a great initiative but needs review”

• “Opening doors must continue to exist”; “Opening Doors has been happening for 15 years in this region and it still continues to grow that is all that is needed to be said.”

• “Please keep the subsidy money available so more people can attend the

conference.”

• “work throughout the year to bring the subject and topic of HIV to the community…. all schools, community centres and wider AIDS Advertising on the streets”

• “Concerned you will not be gathering valid information with this survey Need

better demographics (age, gender, involvement on organizing committee)”

• “If you're doing something for PHA'S, leave it up to them to say what they want to learn more about.”

• “the organizing committee's should have at least one front line worker on them”

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Discussion of Findings Regional Distribution The data suggests a high level of engagement of participants from the Eastern Region in the Opening Doors Initiative, and, in particular, a commitment of significant numbers of PHA’s from this region willing to share their views. The Eastern Region is a mixture between an urban (Ottawa) and predominantly small urban/rural, sparsely populated region, making its level of representation in this survey quite notable. Conversely, the heavily populated Toronto region was modestly represented by only 9% of the responding participants. The differences between rural and urban regions and their needs for the outcomes provided by the Opening Doors initiative will be discussed in greater detail. Membership by Stakeholder Group AIDS Bureau guidelines include a number of principles that refer to the value of including all of the HIV/AIDS stakeholders in the Opening Doors initiatives, for example, indicating that one principle is “to break down the artificial barrier between professional and non-professional caregivers, to share “power”, knowledge and experience for the benefit of everyone involved.” The distribution of stakeholders suggests that Opening Doors is achieving the broad participation needed to comply with this principle. However we have no benchmarks to measure the stakeholder groups’ response rates against. For example, have an exceptionally high percentage of health services participants (39%) responded or is their representation in this survey consistent with their participation in Opening Doors conferences? Conference Experiences The findings indicate a generally positive evaluation of the conference formats, although there are some criticisms about each dimension. The establishment of annual conference themes apparently has limited value in attracting participants, who attend for a variety of other reasons such as education, networking and forging links between those who provide, and those who receive, services and supports. The large contingent of Eastern Ontario respondents, many of whom express very positive opinions about the conferences they have attended, contribute greatly to that positive evaluation. Conference Outcomes The respondents were generally positive about all of the described conference outcomes, particularly the successful involvement of PHA’s and other non-professional family members and caregivers – often referred to as “infected and affected”. The open-

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ended responses substantiate the positive outcomes of Opening Doors and provide a lot of feedback about ways of improving outcomes. It is clear from the data that some areas have been more successful in achieving stated outcomes than others and it is oft-stated that rural regions rely more heavily on the annual conference exchanges of people and information than do their urban colleagues. Further analysis of the data may be useful in confirming the impression that there are notable regional discrepancies. There also may be different levels of community engagement that varies according to the commitment and expertise of local planning committees. As one person suggested, “Better conference organizing skills and knowledge transfer needs to occur from areas that have great OD conferences to those that don't...” Focus of the Conferences An equal number of respondents appear to be comfortable with the counselling focus of Opening Doors and with the idea of expanding the focus. A large number of interesting ideas were generated about specific new initiatives or workshop topics or strategies for involving more people. But many of the benefits and described activities of past conferences have already expanded far beyond a counselling focus and there seems in some people’s view, considerable tolerance to a broad interpretation of the Opening Doors mandate. It may be that many feel that Opening Doors is providing an acceptable level of diversity in meeting the interests and needs of participants – as presently constituted. Conference Changes in Frequency, Format and Funding The results suggest that people want modifications to the Opening Doors formats, but not major changes. There is some acceptance of the idea of allowing individual regions to hold conferences less often than annually and a larger number of suggestions that, in other areas, Opening Doors conferences should be held more frequently or perhaps include smaller local community forums, public education thrusts or workshops targeted to specific populations such as aboriginals, recent immigrants, Intravenous Drug Users, students, youth, or the general public. Province-wide conferences are generally supported by participants although this support was usually qualified to point out that costs and travel times are high, especially for non-professionals and non-AIDS-specific organizations. A further qualification was frequently made that provincial conferences should not replace regional ones, although there was some tolerance for the idea that this might happen on occasion. Regional Boundaries

There was not a lot of strong opinion expressed about boundaries, suggesting that the majority of participants give boundary issues little thought, or have limited information

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available to them about their own, or others’ boundaries. Those participants whose work gives them a broader perspective or relevant information about other regions or other planning activities, did have a few suggestions worth investigating further, such as increasing the number of northern regions to reduce travel and planning logistics, amalgamating regions in the more densely populated south, and in looking at other planning jurisdictions (e.g. LINHs) with which Opening Doors might re-align. Suggestions for Other Community Events As noted earlier, a variety of targeted local events and audiences were suggested as possible variants of the Opening Doors Initiative or as separate activities that could be taken on by local community organizations. There were few suggestions about which community organizations might stage these local events if they were not held under the Opening Doors umbrella. What did you like the most about the Opening Doors Conferences? Many of the open-ended responses to this and other questions could be categorized as eloquent tributes to the human dimension of the Opening Doors conferences. While not universal, there was a very substantial amount of content that attested to a sort of spiritual dimension to the conferences that can be traced back to the power of connecting with others who have a different view or experience, in dealing with this deadly disease. The poignancy and passion of many, many responses, not easily replicated in a summary report, deserves a full reading from those with access to the full results of this survey. A full understanding of the good work accomplished by the Opening Doors Initiative cannot be otherwise acquired. What did you like the least about the Opening Doors Conferences? The fact that 97 people had no response to this question, along with the 24 who took pains to state that they had no complaints, in itself suggests a high rate of positive endorsement of Opening Doors by the participants that responded. It was, however, the same ‘human dimension’, the same differences in background, experience and status, that accounted for the major group of ‘least liked’ attributes when people of diverse backgrounds met at Opening Doors conferences. “Challenging behaviours”, such as too much partying, drinking too much, acting out, talking out of turn, and conversely, anger with those who were intolerant of those behaviours, formed the predominant set of complaints. A few additional remarks focused on speakers who were dull or workshops that flopped, or substandard facilities, but these were infrequent.

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Regional Variances Table 7.1 outlines some of the regional variations on responses to key questions in the survey. The following observations can be drawn from a cursory analysis of the data presented.

• In terms of overall level of satisfaction with the Opening Doors Conference, as rated by participants, the Toronto and Central East obtained the lowest rating. The other regions scored very well in this category.

• In terms of the overall impact, the Opening Doors Conferences was

believed to have had on regional delivery of services and supports to PHA’s, with the exception of the Eastern and North West regions, the assessment was very poor.

• With the exception of the Eastern and North West regions, most regions

supported changing the counselling focus of the Opening Doors Conferences. The majority opinion from the North Eastern region was uncertain.

• All regions were unanimous in desiring that the Opening Doors

Conference should continue basically in the same way.

• In terms of favoring the creation of a periodic Provincial Opening Doors conference, Toronto and the South West regions and a min majority support from the North East region was reported. The other regions did not have a majority consensus on this issue.

It should be noted that the above observations are based only on majority indicators in the various questions being looked into- what is not represented is the actual range and diversity of the minority opinions collected by the survey.

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Table 7.1 ODC Participants Survey Overview

Region # Question 4

Overall Rating*

Question 6 Overall Impact**

Question 8 Change the counselling focus

Question 10 ODC to Stay as is

Question 10 Provincial ODC

Toronto

18 3/9 1/5 Yes Yes Yes

South West

28 9/9 1/5 Yes Yes Yes

North East

10 9/9 1/5 Don’t Know Yes Yes (min)

East

50 8/9 5/5 No Yes No

Central East

23 6/9 1/5 Yes Yes No

Central West

36 8/9 1/5 Yes Yes No

North West

20 8/9 5/5 No Yes No

• * Out of 9 categories around how well the conference were run- this column

reports on how many had 51% above in the very much category • ** Out of 5 categories about the impact of OD on the region- this column reports

how many had 51% above in the very much category

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Recommendations and Conclusions

1. Make all open-ended responses available to relevant AIDS Bureau staff. In addition, regional representatives and Planning Committee members to can be provided access to the data from their region to read and gain a fuller understanding of the impact of their work.

2. Given the large number of accolades used to describe the

Gananocque/Kingston/Eastern Region, closer investigation should be undertaken to see if the way conferences are organized here can be exported to other regions.

3. Bring planning committees together to share organizational strategies that will

increase the level of success in meeting the objectives of the Opening Doors initiative across all regions.

4. Consider different approaches in format, frequency and funding for rural and

urban areas where there may be different needs and levels of commitment to annual regional conferences.

5. Investigate the possibility of reconciling Opening Doors boundaries with other

health service planning boundaries to enhance inter-agency collaborations and reduce duplicated efforts to share and act on information.

6. Planning Committees consider preparing and posting Codes of Acceptable

Behaviour for the participants of future conferences.

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Opening Doors Conference

Participants’ Survey Introduction The Ontario Ministry of Health - AIDS Bureau is evaluating the Opening Doors Conferences, held since 1992. This survey asks people who attended these conferences about their opinions and experiences. This information does not ask for names or other identifying information. Your answers will be put together with all the other answers to help us plan and prepare for the future. Please note your confidentiality will be maintained. Please answer as honestly as possible in looking back at your past experiences and in making any suggestions or comments that will help us plan ahead.

If you are replying to this survey through e-mail, please ‘cut and paste’ to replace the check box beside your answer, with an X. Example below:

Yes X No

1. Do you attend the Opening Doors Conferences as a member of any of these groups: (Note you may indicate more than one category)

Person with HIV/AIDS

AIDS-Affected Family member or Friend

AIDS Service Organization

Health care providers (e.g. Public health, mental health, addictions)

Non-health Service Organization (e.g. housing)

Other (Please describe)

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2. Please check off which region you are from.

Toronto Central East South West Central West North East North West Eastern Not Sure

3. Please check off how many Opening Doors Conferences you have attended?

None 1-3 4-6 7 plus 4. Thinking back over the year(s) that you have attended the Opening Doors Conferences, to what extent do you agree with the following sentences:

4.1 I decided to attend because of the themes of the Opening Doors Conferences.

Very Much Somewhat Not Very Much Not At All

4.2 I found the workshops helpful.


4.3 I found the speakers provided good information.


4.4 I found the speakers interesting.


4.5 It was important to meet others during the Opening Doors Conferences.


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4.6 I found the conference facilities provided a comfortable place to meet.


4.7 The conferences were easy to travel to.


4.8 Subsidies were available to make the cost of the conferences affordable.


4.9 I found the Opening Doors Conferences welcoming in language and attitude to everyone, regardless of background, gender, race or working status (paid/non-paid).


5. Please give details to explain your answers to Question 4 as well as any other comments you might have.

6. To what extent do you agree that:

6.1 The Opening Doors Conferences have made obvious improvements to the province’s HIV/AIDS counselling services.

Strongly Agree Somewhat Agree Somewhat Disagree

Strongly Disagree Don’t Know

Strongly Agree Somewhat Agree Somewhat

Disagree Strongly Disagree Don’t Know

6.2 The Opening Doors Conferences have made obvious improvements to the province’s related community services (for example: public health, housing, mental health, addictions) with respect to how they serve Persons with HIV/AIDs.

Strongly Agree Somewhat Agree Somewhat Strongly Disagree Don’t Know

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Disagree

Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree

6.3 The Opening Doors Conferences have made obvious improvements to the province’s informal supports (for example: self-help, volunteer groups) with respect to how they support Persons with HIV/AIDs.


Strongly Disagree Don’t Know

6.4 The Opening Doors Conferences have included Persons with HIV/AIDs and other concerned community members (family, friends, caregivers) in their planning and running.


Strongly Disagree

Don’t Know

6.5 Communications among all concerned people in the HIV/AIDS ‘community’ have improved because of the Opening Doors Conferences.


Strongly Disagree

Don’t Know

7. Please give details to explain your answers to Question 6 as well as any other comments you might have.

8. At this time, the AIDS Bureau guidelines direct the regional Opening Doors conferences to focus mainly on HIV/AIDS counselling. Should the focus of the conferences: (Please check one)

Remain the same Be changed after discussion with local committees

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Be changed now, based on information already available

Don’t know

9. What focus, outside of HIV/AIDS counselling, do you think the Opening Doors Conferences should provide?

10. To what extent do you agree with the following statements. The regional Opening Doors Conferences should:

10.1 Continue basically in the same way. Strongly Agree Somewhat


Strongly Disagree

Don’t Know

10.2 Continue with major changes in the way they are run.


Somewhat Disagree

Strongly Disagree

Don’t Know

10.3 Continue with major changes in funding. Strongly Agree Somewhat


Strongly Disagree

Don’t Know

10.4 Continue with major changes in how often they are held.


Somewhat Disagree

Strongly Disagree

Don’t Know

10.5 Be replaced by province-wide conferences from time to time. Strongly Agree Somewhat


Strongly Disagree

Don’t Know

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10.6 Continue Opening Doors Conferences for regions that are willing and able, not for others. Strongly Agree Somewhat


Strongly Disagree

Don’t Know

10.7 Not continue in my region. Strongly Agree Somewhat


Strongly Disagree

Don’t Know

11. Please give details to explain your answers to Question 10 as well as any other comments you might have. 12. Should the regional boundaries (listed in Question 2) used to organize the Opening Doors Conferences, remain the same or be changed.? Please comment.

13. Do you have other suggestions for events in your community?

14. What did you like the most about the Opening Doors Conferences?

15. What did you like the least about the Opening Doors Conferences?

16. Please add any comments, concerns or suggestions about the Opening Doors Conferences not covered in the previous questions.

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8. Regional Summaries During the preliminary review of the provincial findings, the rich content data available specifically to each of the regional planning committees- (from the various surveys: Banking Agency, Planning Committee and Participants) was noted. At the request of the AIDS Bureau, the individual regional surveys were compiled and mailed to each of the local planning committee members for their review. This would ensure that the valuable regional comments and observations would not be subsumed under the provincial comments- and be made available to the regions. In addition, the consultant compiled a one page summary of all three surveys, by region. This summary is presented in Table 8.1

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Table 8.1 Regional Survey Summaries

Central West Banking Agency Comments 2 responses. Fairly experienced in the role. Feel the Admin Fee isn’t enough as they split this with another agency who looks after another part of the conference organization. Would like to have training on preparing budgets and developing a customized Schedule B. Planning Committee Comments 10 responses. Good mix of roles in the responses. Feel the conference has improved counselling skills in the region and that this should still be a focus of the conferences. Believe that the AIDS Bureau themes don’t have a major impact on the running of Opening Doors. They have a good relationship with Banking Agency. Value of the conferences is in keeping community partners updates, networking is very important, would like to see Education as an objective of the conferences. High staff turn-over means people still need the basics, and the cross pollination between PHA and staff is important. Would like to see emphasis on things like positive psychology, prevention, skills building. Concern that the timing of the themes being announced doesn’t work for this region when it organizes the conference. The AB Guidelines are viewed as very helpful. See the conference as making a difference in bridging various services (ASO and others) in the region. Pricing is good for the conference and promotes access. Needs more funding so more people can attend and more workshops can be held. Funding can only allow 10 people per city to attend. They would like to see the format of the conference changed somewhat (not significantly). Keep regional boundaries to stay the same and the idea of occasional Provincial conference was not very popular. Participants Comments 36 responses. They gave the conferences a good overall rating. Particularly values for bringing PHAs and professionals together and the opportunity for networking. The themes were considered moderately important. Felt the conference really built community. In terms of the conference increasing the regions counselling skills, improving related HIV Community services, and informal supports – the conference received a decent rating. The organizers were to be congratulated for including PHA’s on the planning committee. Thought is might be ok to change the conference focus away from counselling but only with discussion. Topics they wanted to see addressed in conferences: Health promotion, life skills, reducing barriers such as discrimination and stigma, prevention, cross-cultural issues, treatment and AIDS education. No strong interest in a provincial conference, and no interest in changing regional boundaries.

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South West Banking Agency Comments: 2 responses. Feel the AIDS Bureau Guidelines are a useful tool for doing their work. Planning Committee Comments: 7 responses received. Challenges seem to be around trying to get new members to sit on the planning committee, and that it is difficult to organize conference with the amount of work required. In terms of the focus on counselling skills, most see some value in this but generally want to see this changed after consultation. Getting a good balance of attendees to the conference is a challenge (PHA/ASO/Non-ASO/ etc.) Generally ok with the idea of a Provincial Conference periodically. Interested in seeing a change in format of the conferences. Participants Comments: 28 responses received. Overall the comments on the conferences are very positive and supportive. A desire to see a change in the counselling focus of the conference was noted. Participants lukewarm on the Provincial conference idea- due to funding and travel issues. The region seems to have different and distinct centres/communities- suggestion is to look at holding workshops throughout the regional as opposed to only having regional conference. Several mentioned the need for more PHA only events. Positive aspects of the current conference is that it creates a safe environment for people to meet, the networking is seen as very relevant and it helps to break down the isolation that comes from living in a rural area. They want the counselling focus to be more opened- this is a need for sharing of information, getting treatment and health information out to participant. Concern in how to get more stakeholders to attend the conference. Always want to see themes come from the regions. Topics of importance: Mental Health, Prevention, New Treatments, Networking, Addiction, and Harm Reduction.

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Eastern Banking Agency Comments 1 response Guidelines from AB very helpful. The agency has donated its 4% admin fee to enable more money to go into the conference itself. The administrative side of the conference organization is working very well. Planning Committee Comments 5 responses The planning committee seems to be composed of stable and long term members. Feel that the counselling skills is being improved by the conference and that it remains a vital part of the focus. However, counselling needs to be broadly understood. The offer good feedback around the conference themes, they work with them to develop the conference. They work well with the banking agency, and the guidelines are strongly followed. They state that they really use the evaluations to improve on and plan future conferences. Feel OD has a big impact on the community. Want to see it continued without substantive change- but they could use more funds. Don’t see need for major changes, the idea of an occasional provincial conference garnered min support, and the regional boundaries seem adequate. Participants Comments 50 responses Comments came from a very good blends of participants. They acknowledge the following as being reasons why they like coming to the conference: great workshops and speakers, it’s a great opportunity to meet others, it’s a welcoming space and a great facility. Feel that the conference has made a big impact on the community support of PHA’s and that counselling still needs to be the focus. They was a general lack of interest in a provincial conference, in fact they feel what they have is great and are reluctant to see it change significantly. The regional boundaries do not seem to be a concern. They liked the diversity present at the conference and the intermingling of people. Feel the organizers are using a broad focus of topics to attract a diverse group. Participants sense they listen to the evaluations and make the changes needed every year to improve things. The survey generate a very comprehensive and useful list of suggestions for different topics and ideas for future conferences.

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North East Banking Agency Comments 1 response only. Indicated reasonable satisfaction with the AB Guidelines. However, feels the 4% administration fee is not sufficient for the work required. Planning Committee Comments 4 responses received from a good mix of committee representatives. Consensus was that the conference is improving counselling skills, and that it should remain as a focus of the conference. The conference should also be looking at the large issues such as harm reduction and basic education. Themes for the conference are not seen to have a major impact on the actual conference- and that the themes need to come from the regions. Responders felt the AB Guidelines were being followed, however, that in the region getting the prescribed mix of people was often difficult and that getting local speakers is sometimes a challenge. Feel they have a good relation with the banking agency. Feel the conference is having a good overall impact on the region. They would be ok with a provincial conference and also with reviewing the regional boundaries. Participants Comments 10 responses. People felt that the provision of subsidies, the welcoming environment of the conference and the interesting speakers were all draws that made the conference successful. Generally the feeling was that OD’s has not made a major impact on the counselling skills in the region- however its one of the few venues available to support all stakeholders and is considered very important. No consensus on whether or not to keep the counselling service as a main focus of the conference. Issues such a prevention, networking and treatment updates were all viewed as important. Several stated that the conferences needed changing but no clear suggestions on what kind of change was noted. No strong preference about provincial conferences and most felt the regional boundaries should stay the same. Important aspect of the conference was that it enabled people to talk with each other and share support and resources.

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Toronto Banking Agency Comments 1 response This individual indicated dissatisfaction with the 4% admin fee- indicating it was not enough. In terms of the AB Guidelines, only somewhat satisfied with reporting protocols. Planning Committee Comments 4 Responses Stated that they have had problems in holding conferences in the past: too much work to organize, the event competes with other conferences and recruiting committee members is a big concern. See the conference having made a difference in the counselling skills and that this is still relevant today. View the AB guidelines as helpful in organizing the conference, but that the conference themes do have major impact on the organizing of the event. Participants Comments 18 responses One of the big draws for participant is to meet others, The comment was that the content is too basic for long term workers, however, the conference seemed to be geared to PHAs. There were comments stating that the focus of the conference should be towards: harm reduction, working with marginalized groups, Co-infections, prevention, IDU issues, Youth and Women, treatment issues and networking. One suggestion was that counselling was to narrow a construct and that we should be looking at the word “support” that would entail a broader perspective on the issues.

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North West Banking Agency Comments 1 response Generally very satisfied with the AB Guidelines, with the exception of the 4% admin fee, which has not changed since OD has been operating- and given the work involved, an 8-10% fee schedule would be more appropriate. Feel that the AB protocols are good practice for transparency and accountability. Planning Committee Comments 7 people responded Generally perceive the counselling skills in region have improved as a result of OD, and that this remains a relevant focus for this initiative. Given that for the region OD is the only venue for focusing on counselling skills and given the frequent turnover of staff and the reality that many staff are not working with high volume of PHA’s this is a good opportunity for skills building. However, would like to see increase in the OD focus to include: prevention, treatment issues, AIDS 101 for other community partners (Police, Firemen, Paramedics, Teachers…) The themes used for the conference do not seem to have a major impact on the conference success or draw- and the feeling is that they do need to come out of the regions. They feel the AB guidelines are helpful and followed by the planning committee. It is believed the conference makes a difference in the greater community. On the issue of regional boundaries, having a provincial conference, making changes to the conference, etc. no strong message was determined from the survey. One regional concern is the high travel costs to attend OD. A suggestion from one committee planner is to have a provincial speakers list for regional committee to draw on when needed. Participants Comments 20 responses The main reasons cited for attending OD were: to meet others (PHA, and Workers), that the conference were held in a safe and comfortable environment, the provision of subsidies was import, and that good knowledge was imparted through the conference. People felt that OD was making an impact on the larger community in a favourable way. They did want to see a change in the focus from counselling to: Education, Prevention, Treatment, Harm Reduction. Over riding message was to keep the conference the same in format, not great support for a provincial conference- but a strong message that it needs to continue. The regional boundaries seem to generally work. There was a call to link OD to other determinants of health (housing, mental health, etc.) Also that the region needs to focus on the populations that are being hit the hardest by HIV. Critical to the success of OD is being able to hear the voice of the PHA’s and the networking opportunities.

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Central East Banking Agency Comments 1 response. Stated they were somewhat satisfied with the AB Guidelines provided. The issue of working with another ASO brings out the need for a shared master registration and payment system. Also recommended using financial statements created as the form of reporting instead of doing up monthly reporting forms. Planning Committee Comments 7 responses. In terms of counselling skills, feel the conference has somewhat strengthened this capacity in the region and the same rating was given to the idea that it remains relevant. Of all the conference benefits, PHA peer support was considered very important, particularly for a rural area. This coupled with networking opportunities for everyone and a great chance for new staff to learn about key issues were seen as important focuses for the conference. They did not see the themes as having a major impact, again because of the timing of the conference. See themes needing to flow from local realities and from the evaluations of needs done by the conference participants. They have a good working relationship with the Banking agency. Conference attracts mainly ASO staff and PHAs- other community agencies often feel they do not carry a large enough HIV caseload to warrant attending conferences. Conference is key for breaking the isolation felt by PHAs. Most want the conference to remain the same, and no strong push for a provincial conference was noted, likewise the issue of regional boundaries seems inconclusive. Participants Comments 23 responses. The major reasons for attending the conference were- great networking opportunity, it’s a very welcoming event, at a great facility, and people enjoy the speakers and sessions provided. Very well attended by PHA and there is always a waiting list of PHAs wanting to attend. The counselling skills was not seen as an important focus for those contributing to the survey. Would like to see the following focus for future conferences: Prevention, education, new treatments, co-infections, and practical issues (legal, housing and ADSP). No strong preference in terms of making changes to existing conference format or to holding period provincial initiatives. The key component of the success of the existing conference are- location, environment, the safety of the space and the creation of community for attendees.

For addtional information regarding this evaluation contact:

Ethical Affairs788 Markham St

Toronto ON M6G 2M5Phone 416-588-3222Project 2006-05-007 ETHICAL

AFFAIRS

Documents

Opening Doors Initiative - Ministry of Health and Long ...health.gov.on.ca/.../reports_publications/opening_doors_report.pdf · The formal survey evaluation of the Opening Doors Counselling